{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T17:36:47Z","timestamp":1790617007838,"version":"4.1.0"},"reference-count":32,"publisher":"The Angle Orthodontist (EH Angle Education & Research Foundation)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec id=\"st1\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate the accuracy and reliability of a fully automated landmark identification (ALI) system as a tool for automatic landmark location compared with human judges.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"st2\">\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>A total of 100 cone-beam computed tomography (CBCT) images were collected. After the calibration procedure, two human judges identified 53 landmarks in the x, y, and z coordinate planes on CBCTs using Checkpoint Software (Stratovan Corporation, Davis, Calif). The ground truth was created by averaging landmark coordinates identified by two human judges for each landmark. To evaluate the accuracy of ALI, the mean absolute error (mm) at the x, y, and z coordinates and mean error distance (mm) between the human landmark identification and the ALI were determined, and a successful detection rate was calculated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"st3\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Overall, the ALI system was as successful at landmarking as the human judges. The ALI's mean absolute error for all coordinates was 1.57 mm on average. Across all three coordinate planes, 94% of the landmarks had a mean absolute error of less than 3 mm. The mean error distance for all 53 landmarks was 3.19 \u00b1 2.6 mm. When applied to 53 landmarks on 100 CBCTs, the ALI system showed a 75% success rate in detecting landmarks within a 4-mm error distance range.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"st4\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Overall, ALI showed clinically acceptable mean error distances except for a few landmarks. The ALI was more precise than humans when identifying landmarks on the same image at different times. This study demonstrates the promise of ALI in aiding orthodontists with landmark identifications on CBCTs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2319\/122121-928.1","type":"journal-article","created":{"date-parts":[[2022,6,2]],"date-time":"2022-06-02T12:28:56Z","timestamp":1654172936000},"page":"642-654","source":"Crossref","is-referenced-by-count":21,"title":["Automated landmark identification on cone-beam computed tomography: Accuracy and reliability"],"prefix":"10.2319","volume":"92","author":[{"given":"Ali","family":"Ghowsi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Hatcher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heeyeon","family":"Suh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Wile","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wesley","family":"Castro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Krueger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joorok","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heesoo","family":"Oh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1164","reference":[{"key":"i1945-7103-92-5-642-b01","series-title":"J Am Dent Assoc","first-page":"7S","article-title":"Practical applications of cone-beam computed tomography in orthodontics","volume":"141","author":"Mah","year":"2010","unstructured":"Mah\n              JK,\n            \n            \n              Huang\n              JC,\n            \n            \n              Choo\n              H.\n            \n          \n          Practical applications of cone-beam computed tomography in orthodontics.\n\t\t\t\t\tJ Am Dent Assoc.\n\t\t\t\t\t2010;141:\n\t\t\t\t\t7S\u201313S."},{"key":"i1945-7103-92-5-642-b02","article-title":"Fully automatic system for accurate localisation and analysis of cephalometric landmarks in lateral cephalograms. Sci Rep.","author":"Lindner","year":"2016","unstructured":"Lindner\n              C,\n            \n            \n              Wang\n              CW,\n            \n            \n              Huang\n              CT,\n            \n            et al.\n          \n          Fully automatic system for accurate localisation and analysis of cephalometric landmarks in lateral cephalograms. Sci Rep.\n          2016:\n\t\t\t\t\t6;33581."},{"key":"i1945-7103-92-5-642-b03","series-title":"Eur J Orthod","first-page":"38","article-title":"Precision of identifying cephalometric landmarks with cone beam computed tomography in vivo","volume":"35","author":"Hassan","year":"2013","unstructured":"Hassan\n              B,\n            \n            \n              Nijkamp\n              P,\n            \n            \n              Verheij\n              H,\n            \n            et al.\n          \n          Precision of identifying cephalometric landmarks with cone beam computed tomography in vivo.\n\t\t\t\t\tEur J Orthod.\n\t\t\t\t\t2013;35:\n\t\t\t\t\t38\u201344."},{"key":"i1945-7103-92-5-642-b04","series-title":"IEEE Trans Biomed Eng","first-page":"1615","article-title":"Automated 2-D cephalometric analysis on X-ray images by a model-based approach","volume":"53","author":"Yue","year":"2006","unstructured":"Yue\n              W,\n            \n            \n              Yin\n              D,\n            \n            \n              Li\n              C,\n            \n            \n              Wang\n              G,\n            \n            \n              Xu\n              T.\n            \n          \n          Automated 2-D cephalometric analysis on X-ray images by a model-based approach.\n\t\t\t\t\tIEEE Trans Biomed Eng.\n\t\t\t\t\t2006;53:\n\t\t\t\t\t1615\u20131623."},{"key":"i1945-7103-92-5-642-b05","series-title":"Am J Orthod Dentofacial Orthop","first-page":"140","article-title":"Hybrid approach for automatic cephalometric landmark annotation on cone-beam computed tomography volumes","volume":"154","author":"Mont\u00fafar","year":"2018","unstructured":"Mont\u00fafar\n              J,\n            \n            \n              Romero\n              M,\n            \n            \n              Scougall-Vilchis\n              RJ.\n            \n          \n          Hybrid approach for automatic cephalometric landmark annotation on cone-beam computed tomography volumes.\n\t\t\t\t\tAm J Orthod Dentofacial Orthop.\n\t\t\t\t\t2018;154:\n\t\t\t\t\t140\u2013150."},{"key":"i1945-7103-92-5-642-b06","series-title":"BMC Med Imaging","first-page":"32","article-title":"The accuracy of a designed software for automated localization of craniofacial landmarks on CBCT images","volume":"14","author":"Shahidi","year":"2014","unstructured":"Shahidi\n              S,\n            \n            \n              Bahrampour\n              E,\n            \n            \n              Soltanimehr\n              E,\n            \n            et al.\n          \n          The accuracy of a designed software for automated localization of craniofacial landmarks on CBCT images.\n\t\t\t\t\tBMC Med Imaging.\n\t\t\t\t\t2014;14:\n\t\t\t\t\t32."},{"key":"i1945-7103-92-5-642-b07","series-title":"Int J Comput Assist Radiol Surg","first-page":"1737","article-title":"A knowledge-based algorithm for automatic detection of cephalometric landmarks on CBCT images","volume":"10","author":"Gupta","year":"2015","unstructured":"Gupta\n              A,\n            \n            \n              Kharbanda\n              OP,\n            \n            \n              Sardana\n              V,\n            \n            et al.\n          \n          A knowledge-based algorithm for automatic detection of cephalometric landmarks on CBCT images.\n\t\t\t\t\tInt J Comput Assist Radiol Surg.\n\t\t\t\t\t2015;10:\n\t\t\t\t\t1737\u20131752."},{"key":"i1945-7103-92-5-642-b08","series-title":"Am J Orthod Dentofacial Orthop","first-page":"170","article-title":"Machine learning and orthodontics, current trends and the future opportunities: a scoping review","volume":"160","author":"Mohammad-Rahimi","year":"2021","unstructured":"Mohammad-Rahimi\n              H,\n            \n            \n              Nadimi\n              M,\n            \n            \n              Rohban\n              MH,\n            \n            \n              Shamsoddin\n    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.\n\t\t\t\t\t2020;90:\n\t\t\t\t\t69\u201376."},{"key":"i1945-7103-92-5-642-b10","series-title":"Angle Orthod","first-page":"823","article-title":"How much deep learning is enough for automatic identification to be reliable? A cephalometric example","volume":"90","author":"Moon","year":"2020","unstructured":"Moon\n              JH,\n            \n            \n              Hwang\n              HW,\n            \n            \n              Yu\n              YS,\n            \n            \n              Kim\n              MG,\n            \n            \n              Donatelli\n              RE,\n            \n            \n              Lee\n              SJ.\n            \n          \n          How much deep learning is enough for automatic identification to be reliable? A cephalometric example.\n\t\t\t\t\tAngle Orthod.\n\t\t\t\t\t2020;90:\n\t\t\t\t\t823\u2013830."},{"key":"i1945-7103-92-5-642-b11","series-title":"Int J Oral Maxillofac Surg","first-page":"1367","article-title":"Accuracy and reliability of automatic three-dimensional cephalometric landmarking","volume":"49","author":"Dot","year":"2020","unstructured":"Dot\n              G,\n            \n            \n              Rafflenbeul\n              F,\n            \n            \n              Arbotto\n              M,\n            \n            \n              Gajny\n              L,\n            \n            \n              Rouch\n              P,\n            \n            \n              Schouman\n              T.\n            \n          \n          Accuracy and reliability of automatic three-dimensional cephalometric landmarking.\n\t\t\t\t\tInt J Oral Maxillofac Surg.\n\t\t\t\t\t2020;49:\n\t\t\t\t\t1367\u20131378."},{"key":"i1945-7103-92-5-642-b12","series-title":"Clin Oral Investig","first-page":"4299","article-title":"Deep learning for cephalometric landmark detection: systematic review and meta-analysis","volume":"25","author":"Schwendicke","year":"2021","unstructured":"Schwendicke\n              F,\n            \n            \n              Chaurasia\n              A,\n            \n            \n              Arsiwala\n              L,\n            \n            et al.\n          \n          Deep learning for cephalometric landmark detection: systematic review and meta-analysis.\n\t\t\t\t\tClin Oral Investig.\n\t\t\t\t\t2021;25:\n\t\t\t\t\t4299\u20134309."},{"key":"i1945-7103-92-5-642-b13","series-title":"Am J Orthod Dentofacial Orthop","first-page":"315","article-title":"How to report reliability in orthodontic research: part 2","volume":"144","author":"Donatelli","year":"2013","unstructured":"Donatelli\n              RE,\n            \n            \n              Lee\n              SJ.\n            \n          \n          How to report reliability in orthodontic research: part 2.\n\t\t\t\t\tAm J Orthod Dentofacial Orthop.\n\t\t\t\t\t2013;144:\n\t\t\t\t\t315\u2013318."},{"key":"i1945-7103-92-5-642-b14","series-title":"J Appl Oral Sci","first-page":"56","article-title":"Comparison between 3D volumetric rendering and multiplanar slices on the reliability of linear measurements on CBCT images: an in vitro study","volume":"23","author":"Fernandes","year":"2015","unstructured":"Fernandes\n              TM,\n            \n            \n              Adamczyk\n              J,\n            \n            \n              Poleti\n              ML,\n            \n            \n              Henriques\n              JF,\n            \n            \n              Friedland\n              B,\n            \n            \n              Garib\n              DG.\n            \n          \n          Comparison between 3D volumetric rendering and multiplanar slices on the reliability of linear measurements on CBCT images: an in vitro study.\n\t\t\t\t\tJ Appl Oral Sci.\n\t\t\t\t\t2015;23:\n\t\t\t\t\t56\u201363."},{"key":"i1945-7103-92-5-642-b15","series-title":"Angle Orthod","first-page":"758","article-title":"Reliability of 3D dental and skeletal landmarks on CBCT images","volume":"89","author":"Park","year":"2008","unstructured":"Park\n              J,\n            \n            \n              Baumrind\n              S,\n            \n            \n              Curry\n              S,\n            \n            \n              Carlson\n              SK,\n            \n            \n              Boyd\n              RL,\n            \n            \n              Oh\n              H.\n            \n          \n          Reliability of 3D dental and skeletal landmarks on CBCT images.\n\t\t\t\t\tAngle Orthod.\n\t\t\t\t\t2008;89:\n\t\t\t\t\t758\u2013767."},{"key":"i1945-7103-92-5-642-b16","series-title":"Am J Orthod","first-page":"111","article-title":"The reliability of head film measurements: 1. Landmark identification","volume":"60","author":"Baumrind","year":"1971","unstructured":"Baumrind\n              S,\n            \n            \n              Frantz\n              RC.\n            \n          \n          The reliability of head film measurements: 1. Landmark identification.\n\t\t\t\t\tAm J Orthod.\n\t\t\t\t\t1971;60:\n\t\t\t\t\t111\u2013127."},{"key":"i1945-7103-92-5-642-b01","series-title":"J Am Dent Assoc","first-page":"7S","article-title":"Practical applications of cone-beam computed tomography in orthodontics","volume":"141","author":"Mah","year":"2010","unstructured":"Mah\n              JK,\n            \n            \n              Huang\n              JC,\n            \n            \n              Choo\n              H.\n            \n          \n          Practical applications of cone-beam computed tomography in orthodontics.\n\t\t\t\t\tJ Am Dent Assoc.\n\t\t\t\t\t2010;141:\n\t\t\t\t\t7S\u201313S."},{"key":"i1945-7103-92-5-642-b02","article-title":"Fully automatic system for accurate localisation and analysis of cephalometric landmarks in lateral cephalograms. Sci Rep.","author":"Lindner","year":"2016","unstructured":"Lindner\n              C,\n            \n            \n              Wang\n              CW,\n            \n            \n              Huang\n              CT,\n            \n            et al.\n          \n          Fully automatic system for accurate localisation and analysis of cephalometric landmarks in lateral cephalograms. Sci Rep.\n          2016:\n\t\t\t\t\t6;33581."},{"key":"i1945-7103-92-5-642-b03","series-title":"Eur J Orthod","first-page":"38","article-title":"Precision of identifying cephalometric landmarks with cone beam computed tomography in vivo","volume":"35","author":"Hassan","year":"2013","unstructured":"Hassan\n              B,\n            \n            \n              Nijkamp\n              P,\n            \n            \n              Verheij\n              H,\n            \n            et al.\n          \n          Precision of identifying cephalometric landmarks with cone beam computed tomography in vivo.\n\t\t\t\t\tEur J Orthod.\n\t\t\t\t\t2013;35:\n\t\t\t\t\t38\u201344."},{"key":"i1945-7103-92-5-642-b04","series-title":"IEEE Trans Biomed Eng","first-page":"1615","article-title":"Automated 2-D cephalometric analysis on X-ray images by a model-based approach","volume":"53","author":"Yue","year":"2006","unstructured":"Yue\n              W,\n            \n            \n              Yin\n              D,\n            \n            \n              Li\n              C,\n            \n            \n              Wang\n              G,\n            \n            \n              Xu\n              T.\n            \n          \n          Automated 2-D cephalometric analysis on X-ray images by a model-based approach.\n\t\t\t\t\tIEEE Trans Biomed Eng.\n\t\t\t\t\t2006;53:\n\t\t\t\t\t1615\u20131623."},{"key":"i1945-7103-92-5-642-b05","series-title":"Am J Orthod Dentofacial Orthop","first-page":"140","article-title":"Hybrid approach for automatic cephalometric landmark annotation on cone-beam computed tomography volumes","volume":"154","author":"Mont\u00fafar","year":"2018","unstructured":"Mont\u00fafar\n              J,\n            \n            \n              Romero\n              M,\n            \n            \n              Scougall-Vilchis\n              RJ.\n            \n          \n          Hybrid approach for automatic cephalometric landmark annotation on 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CBCT images","volume":"10","author":"Gupta","year":"2015","unstructured":"Gupta\n              A,\n            \n            \n              Kharbanda\n              OP,\n            \n            \n              Sardana\n              V,\n            \n            et al.\n          \n          A knowledge-based algorithm for automatic detection of cephalometric landmarks on CBCT images.\n\t\t\t\t\tInt J Comput Assist Radiol Surg.\n\t\t\t\t\t2015;10:\n\t\t\t\t\t1737\u20131752."},{"key":"i1945-7103-92-5-642-b08","series-title":"Am J Orthod Dentofacial Orthop","first-page":"170","article-title":"Machine learning and orthodontics, current trends and the future opportunities: a scoping review","volume":"160","author":"Mohammad-Rahimi","year":"2021","unstructured":"Mohammad-Rahimi\n              H,\n            \n            \n              Nadimi\n              M,\n            \n            \n              Rohban\n              MH,\n            \n            \n              Shamsoddin\n              E,\n            \n            \n              Lee\n              VY,\n            \n            \n              Motamedian\n              SR.\n            \n          \n          Machine learning and orthodontics, current trends and the future opportunities: a scoping review.\n\t\t\t\t\tAm J Orthod Dentofacial Orthop.\n\t\t\t\t\t2021;160:\n\t\t\t\t\t170\u2013192."},{"key":"i1945-7103-92-5-642-b09","series-title":"Angle Orthod","first-page":"69","article-title":"Automated identification of cephalometric landmarks: part 2\u2014might it be better than human?","volume":"90","author":"Hwang","year":"2020","unstructured":"Hwang\n              HW,\n            \n            \n              Park\n              JH,\n            \n            \n              Moon\n              JH,\n            \n            et al.\n          \n          Automated identification of cephalometric landmarks: part 2\u2014might it be better than human?\n          \n            Angle Orthod\n          .\n\t\t\t\t\t2020;90:\n\t\t\t\t\t69\u201376."},{"key":"i1945-7103-92-5-642-b10","series-title":"Angle Orthod","first-page":"823","article-title":"How much deep learning is enough for automatic identification to be reliable? A cephalometric example","volume":"90","author":"Moon","year":"2020","unstructured":"Moon\n              JH,\n            \n            \n              Hwang\n              HW,\n            \n            \n              Yu\n              YS,\n            \n            \n              Kim\n              MG,\n            \n            \n              Donatelli\n              RE,\n            \n            \n              Lee\n              SJ.\n            \n          \n          How much deep learning is enough for automatic identification to be reliable? A cephalometric example.\n\t\t\t\t\tAngle Orthod.\n\t\t\t\t\t2020;90:\n\t\t\t\t\t823\u2013830."},{"key":"i1945-7103-92-5-642-b11","series-title":"Int J Oral Maxillofac Surg","first-page":"1367","article-title":"Accuracy and reliability of automatic three-dimensional cephalometric landmarking","volume":"49","author":"Dot","year":"2020","unstructured":"Dot\n              G,\n            \n            \n              Rafflenbeul\n              F,\n            \n            \n              Arbotto\n              M,\n            \n            \n              Gajny\n              L,\n            \n            \n              Rouch\n              P,\n            \n            \n              Schouman\n              T.\n            \n          \n          Accuracy and reliability of automatic three-dimensional cephalometric landmarking.\n\t\t\t\t\tInt J Oral Maxillofac Surg.\n\t\t\t\t\t2020;49:\n\t\t\t\t\t1367\u20131378."},{"key":"i1945-7103-92-5-642-b12","series-title":"Clin Oral Investig","first-page":"4299","article-title":"Deep learning for cephalometric landmark detection: systematic review and meta-analysis","volume":"25","author":"Schwendicke","year":"2021","unstructured":"Schwendicke\n              F,\n            \n            \n              Chaurasia\n              A,\n            \n            \n              Arsiwala\n              L,\n            \n            et al.\n          \n          Deep learning for cephalometric landmark detection: systematic review and meta-analysis.\n\t\t\t\t\tClin Oral Investig.\n\t\t\t\t\t2021;25:\n\t\t\t\t\t4299\u20134309."},{"key":"i1945-7103-92-5-642-b13","series-title":"Am J Orthod Dentofacial Orthop","first-page":"315","article-title":"How to report reliability in orthodontic research: part 2","volume":"144","author":"Donatelli","year":"2013","unstructured":"Donatelli\n              RE,\n            \n            \n              Lee\n              SJ.\n            \n          \n          How to report reliability in orthodontic research: part 2.\n\t\t\t\t\tAm J Orthod Dentofacial Orthop.\n\t\t\t\t\t2013;144:\n\t\t\t\t\t315\u2013318."},{"key":"i1945-7103-92-5-642-b14","series-title":"J Appl Oral Sci","first-page":"56","article-title":"Comparison between 3D volumetric rendering and multiplanar slices on the reliability of linear measurements on CBCT images: an in vitro study","volume":"23","author":"Fernandes","year":"2015","unstructured":"Fernandes\n              TM,\n            \n            \n              Adamczyk\n              J,\n            \n            \n              Poleti\n              ML,\n            \n            \n              Henriques\n              JF,\n            \n            \n              Friedland\n              B,\n            \n            \n              Garib\n              DG.\n            \n          \n          Comparison between 3D volumetric rendering and multiplanar slices on the reliability of linear measurements on CBCT images: an in vitro study.\n\t\t\t\t\tJ Appl Oral Sci.\n\t\t\t\t\t2015;23:\n\t\t\t\t\t56\u201363."},{"key":"i1945-7103-92-5-642-b15","series-title":"Angle Orthod","first-page":"758","article-title":"Reliability of 3D dental and skeletal landmarks on CBCT images","volume":"89","author":"Park","year":"2008","unstructured":"Park\n              J,\n            \n            \n              Baumrind\n              S,\n            \n            \n              Curry\n              S,\n            \n            \n              Carlson\n              SK,\n            \n            \n              Boyd\n              RL,\n            \n            \n              Oh\n              H.\n            \n          \n          Reliability of 3D dental and skeletal landmarks on CBCT images.\n\t\t\t\t\tAngle Orthod.\n\t\t\t\t\t2008;89:\n\t\t\t\t\t758\u2013767."},{"key":"i1945-7103-92-5-642-b16","series-title":"Am J Orthod","first-page":"111","article-title":"The reliability of head film measurements: 1. Landmark identification","volume":"60","author":"Baumrind","year":"1971","unstructured":"Baumrind\n              S,\n            \n            \n              Frantz\n              RC.\n            \n          \n          The reliability of head film measurements: 1. 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