Reliability of three-dimensional measurements of the upper airway on cone beam computed tomography images.

OBJECTIVES The aim of this study was (1) to assess intra- and interobserver reliability of the localization of anatomic landmarks of the upper airway on cone beam computed tomography (CBCT) images; and (2) to assess intra- and interobserver reliability of the three-dimensional measurements of the upper airway based on these landmarks. STUDY DESIGN Fifteen NewTom 5G (QR systems, Verona, Italy) CBCT data sets were randomly selected from the archives of the Department of Oral Radiology, Academic Centre for Dentistry (ACTA) at University of Amsterdam and VU University, Amsterdam, The Netherlands. Three observers localized six anatomic landmarks that are relevant for upper airway analysis twice, with a 10-day interval, using 3Diagnosys software (v5.3.1, 3diemme, Cantu, Italy). Subsequently, the observers performed upper airway volume measurement based on those landmarks twice as well, again with a 10-day interval, using Amira software (v4.1, Visage Imaging Inc., Carlsbad, CA). The upper airway measurements also included the minimum cross-sectional area (CSAmin), location of the CSAmin, and anteroposterior and lateral dimensions of the CSAmin. RESULTS Both intraobserver reliability and interobserver reliability were excellent for the localization of the anatomic landmarks of the upper airway (intraclass correlation coefficients = 0.97-1.00) as well as for the three-dimensional upper airway measurements (intraclass correlation coefficients = 0.78-1.00). CONCLUSIONS The methodology of landmark localization and upper airway measurements, as used in this study, showed an excellent reliability and can thus be recommended for upper airway analysis on CBCT images.

[1]  L. Kaban,et al.  Three-dimensional computed tomographic analysis of airway anatomy in patients with obstructive sleep apnea. , 2010, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[2]  Maarten J Koudstaal,et al.  Measuring upper airway volume: accuracy and reliability of Dolphin 3D software compared to manual segmentation in craniosynostosis patients. , 2014, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[3]  Caroline Wilkinson,et al.  Reproducibility of Facial Soft Tissue Thickness Measurements Using Cone‐Beam CT Images According to the Measurement Methods , 2015, Journal of forensic sciences.

[4]  M. Almeida,et al.  Reliability of a method to conduct upper airway analysis in cone-beam computed tomography. , 2013, Brazilian oral research.

[5]  Antônio Carlos de Oliveira Ruellas,et al.  Reliability of upper airway linear, area, and volumetric measurements in cone-beam computed tomography. , 2014, American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics.

[6]  Bassam Hassan,et al.  Precision of identifying cephalometric landmarks with cone beam computed tomography in vivo. , 2013, European journal of orthodontics.

[7]  G. Swennen,et al.  Cone-beam computerized tomography (CBCT) imaging of the oral and maxillofacial region: a systematic review of the literature. , 2009, International journal of oral and maxillofacial surgery.

[8]  Brandon Burke,et al.  Observer reliability of three-dimensional cephalometric landmark identification on cone-beam computerized tomography. , 2009, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[9]  Reyes Enciso,et al.  Imaging software accuracy for 3-dimensional analysis of the upper airway. , 2012, American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics.

[10]  D. Torigian,et al.  Understanding the anatomic basis for obstructive sleep apnea syndrome in adolescents. , 2015, American journal of respiratory and critical care medicine.

[11]  Alessandro Sarti,et al.  Facial soft tissue esthetic predictions: validation in craniomaxillofacial surgery with cone beam computed tomography data. , 2010, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[12]  G. Clark,et al.  Correlation between retroglossal airway size and body mass index in OSA and non-OSA patients using cone beam CT imaging , 2008, Sleep and Breathing.

[13]  A. Motta,et al.  Reliability and reproducibility of three-dimensional cephalometric landmarks using CBCT: a systematic review , 2015, Journal of applied oral science : revista FOB.

[14]  A Ruprecht,et al.  Comparison of observer reliability of three-dimensional cephalometric landmark identification on subject images from Galileos and i-CAT cone beam CT. , 2013, Dento maxillo facial radiology.

[15]  G. Swennen,et al.  Cone-beam computerized tomography imaging and analysis of the upper airway: a systematic review of the literature. , 2011, International journal of oral and maxillofacial surgery.

[16]  S. Walter,et al.  Sample size and optimal designs for reliability studies. , 1998, Statistics in medicine.

[17]  G. Clark,et al.  Soft palate length and upper airway relationship in OSA and non-OSA subjects , 2010, Sleep and Breathing.

[18]  Kate Sutherland,et al.  Craniofacial Morphology in Obstructive Sleep Apnea , 2010 .

[19]  Ahmed Ghoneima,et al.  Accuracy and reliability of cone-beam computed tomography for airway volume analysis. , 2013, European journal of orthodontics.

[20]  Manuel O Lagravère,et al.  Intraexaminer and interexaminer reliabilities of landmark identification on digitized lateral cephalograms and formatted 3-dimensional cone-beam computerized tomography images. , 2010, American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics.

[21]  G. Clark,et al.  Comparison of cone-beam CT parameters and sleep questionnaires in sleep apnea patients and control subjects. , 2010, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[22]  David C Hatcher,et al.  Consistency and precision of landmark identification in three-dimensional cone beam computed tomography scans. , 2012, European journal of orthodontics.