[show abstract][hide abstract] ABSTRACT: Cone beam computed tomography (CBCT) images of ideally positioned and systematically mispositioned dry skulls were measured using two-dimensional and three-dimensional software measurement techniques. Image measurements were compared with caliper measurements of the skulls.
Cone beam computed tomography volumes of 28 skulls in ideal, shifted, and rotated positions were assessed by measuring distances between anatomic points and reference wires by using panoramic reconstructions (two-dimensional) and direct measurements from axial slices (three-dimensional). Differences between caliper measurements on skulls and software measurements in images were assessed with paired t tests and analysis of variance (ANOVA).
Accuracy of measurement was not significantly affected by alterations in skull position or measurement of right or left sides. For easily visualized orthodontic wires, measurement accuracy was expressed by average errors less than 1.2% for two-dimensional measurement techniques and less than 0.6% for three-dimensional measurement techniques. Anatomic measurements were significantly more variable regardless of measurement technique.
Both two-dimensional and three-dimensional techniques provide acceptably accurate measurement of mandibular anatomy. Cone beam computed tomography measurement was not significantly influenced by variation in skull orientation during image acquisition.
[show abstract][hide abstract] ABSTRACT: Measurements of ideally positioned and systematically mis-positioned skulls were used to evaluate errors in linear measurements and symmetry ratios made with panoramic X-ray images.
Digital panoramic images of 30 skulls placed in ideal, shifted and rotated positions, were assessed by measuring distances between anatomic points and fiducial references. Differences between photographic measurements (control) and radiographic measurements were compared. Horizontal measurements included a 20 mm wire and the distance from gonion to mental foramen (G-MF). Vertical distances measured included a 40 mm wire, condyle to sigmoid notch length, and condyle to gonion (posterior mandibular height or PMH). A relative symmetry ratio comparing the difference between right and left PMH was also calculated. Distances measured in panoramic images were corrected using the left vertical wire distance or the panoramic unit's stated magnification factor (1.25x).
Greatest differences were noted for horizontal measurements and shifted skull positions. Use of an arbitrary magnification correction was consistently less accurate than use of an internal calibration and resulted in general underestimation of actual dimensions. Measures of PMH varied significantly from expected values for each of the three skull positions (P<0.005). Panoramic accuracy for detecting asymmetry was 67% for ideal, 70% for rotated, and 47% for shifted skull positions when an internal reference was used.
Panoramic radiographs should be used with caution in making absolute measurements or relative comparisons. Even when internal fiducial calibration for image distortion of anatomy is used, measurements such as those assessing posterior mandibular facial symmetry may be unreliable.