Accuracy of three-dimensional measurements obtained from cone beam computed tomography surface-rendered images for cephalometric analysis: influence of patient scanning position

The aims of this study were to assess the accuracy of linear measurements on three-dimensional (3D) surface-rendered images generated from cone beam computed tomography (CBCT) in comparison with two-dimensional (2D) slices and 2D lateral and postero-anterior (PA) cephalometric projections, and to investigate the influence of patient head position in the scanner on measurement accuracy. Eight dry human skulls were scanned twice using NewTom 3G CBCT in an ideal and a rotated position and the resulting datasets were used to create 3D surface-rendered images, 2D tomographic slices, and 2D lateral and PA projections. Ten linear distances were defined for cephalometric measurements. The physical and radiographic measurements were repeated twice by three independent observers and were compared using repeated measures analysis of variance (P = 0.05). The radiographic measurements were also compared between the ideal and the rotated scan positions. The radiographic measurements of the 3D images were closer to the physical measurements than the 2D slices and 2D projection images. No statistically significant difference was found between the ideal and the rotated scan measurements for the 3D images and the 2D tomographic slices. A statistically significant difference (P < 0.001) was observed between the ideal and rotated scan positions for the 2D projection images. The findings indicate that measurements based on 3D CBCT surface images are accurate and that small variations in the patient's head position do not influence measurement accuracy