Automatic 3-dimensional cephalometric landmarking based on active shape models in related projections

Introduction: This article presents a novel technique for automatic cephalometric landmark localization on 3-dimensional (3D) cone-beam computed tomography (CBCT) volumes by using an active shape model to search for landmarks in related projections. Methods: Twenty-four random CBCT scans from a public data set were imported and processed into Matlab (MathWorks, Natick, Mass). Orthogonal coronal and sagittal projections (digitally reconstructed radiographs) were created, and 2 trained active shape models were used to locate cephalometric landmarks on each. Finally, by relating projections, 18 tridimensional landmarks were located on CBCT volume representations. Results: From our 3D gold standard, a 3.64-mm mean error in localization of cephalometric landmarks was achieved with this method, with the highest localization errors in the porion and sella regions because of the low volume definition. Conclusions: The proposed algorithm for automatic 3D landmarking on CBCT volumes seems to be useful for 3D cephalometric analysis. This study shows that a fast 2-dimensional landmark search can be useful for 3D localization, which could save computational time compared with a full-volume analysis. Also, this research confirms that by using CBCT for cephalometry, there are no distortion projections, and full structure information of a virtual patient is manageable in a personal computer.