journal article·2024-08-20Open access

A Comparative Study of Deep Learning and Manual Methods for Identifying Anatomical Landmarks through Cephalometry and Cone-Beam Computed Tomography: A Systematic Review and Meta-Analysis

Yoonji Lee, Jeong-Hye Pyeon, Sung-Hoon Han, Na Jin Kim, Won-Jong Park, Jun-Beom Park

Applied Sciences· Volume 14· Issue 16

Abstract

Background: Researchers have noted that the advent of artificial intelligence (AI) heralds a promising era, with potential to significantly enhance diagnostic and predictive abilities in clinical settings. The aim of this meta-analysis is to evaluate the discrepancies in identifying anatomical landmarks between AI and manual approaches. Methods: A comprehensive search strategy was employed, incorporating controlled vocabulary (MeSH) and free-text terms. This search was conducted by two reviewers to identify published systematic reviews. Three major electronic databases, namely, Medline via PubMed, the Cochrane database, and Embase, were searched up to May 2024. Results: Initially, 369 articles were identified. After conducting a comprehensive search and applying strict inclusion criteria, a total of ten studies were deemed eligible for inclusion in the meta-analysis. The results showed that the average difference in detecting anatomical landmarks between artificial intelligence and manual approaches was 0.35, with a 95% confidence interval (CI) ranging from −0.09 to 0.78. Additionally, the overall effect between the two groups was found to be insignificant. Upon further analysis of the subgroup of cephalometric radiographs, it was determined that there were no significant differences between the two groups in terms of detecting anatomical landmarks. Similarly, the subgroup of cone-beam computed tomography (CBCT) revealed no significant differences between the groups. Conclusions: In summary, the study concluded that the use of artificial intelligence is just as effective as the manual approach when it comes to detecting anatomical landmarks, both in general and in specific contexts such as cephalometric radiographs and CBCT evaluations.
Source: crossref · Quality: baseline

Research context

OpenAlex topics: Dental Radiography and Imaging · Medical Imaging and Analysis · Artificial Intelligence in Healthcare and Education

SciVX discovery tags are terminology-based. OpenAlex topics are source-provided classifications.

Affiliations

Orthodontics, Graduate School of Clinical Dental Science, The Catholic University of Korea, Seoul 06591, Republic of Korea

Department of Orthodontics, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea

Medical Library, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea

Department of Oral and Maxillofacial Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea

Department of Periodontics, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea

Dental Implantology, Graduate School of Clinical Dental Science, The Catholic University of Korea, Seoul 06591, Republic of Korea

Department of Medicine, Graduate School, The Catholic University of Korea, Seoul 06591, Republic of Korea

References (100+)

Show source-provided references
1. Kim, Y.H., Kim, I., Kim, Y.J., Kim, M., Cho, J.H., Hong, M., Kang, K.H., Lim, S.H., Kim, S.J., and Kim, N. (2023). The prediction of sagittal chin point relapse following two-jaw surgery using machine learning. Sci. Rep., 13.10.1038/s41598-023-44207-2 ↗
2. Revolutionizing scholarly publishing by integrating artificial intelligence into editorial and peer review processes10.5051/jpis.245402edi01 ↗
3. A New Era of Dental Care: Harnessing Artificial Intelligence for Better Diagnosis and Treatment
4. Revilla-León, M., Gómez-Polo, M., Sailer, I., Kois, J.C., and Rokhshad, R. (2024). An overview of artificial intelligence based applications for assisting digital data acquisition and implant planning procedures. J. Esthet. Restor. Dent.10.1111/jerd.13249 ↗
5. Deep learning for temporomandibular joint arthropathies: A systematic review and meta-analysis10.1111/joor.13701 ↗
6. Liu, J., Zhang, C., and Shan, Z. (2023). Application of Artificial Intelligence in Orthodontics: Current State and Future Perspectives. Healthcare, 11.10.3390/healthcare11202760 ↗
7. Kazimierczak, N., Kazimierczak, W., Serafin, Z., Nowicki, P., Nożewski, J., and Janiszewska-Olszowska, J. (2024). AI in Orthodontics: Revolutionizing Diagnostics and Treatment Planning-A Comprehensive Review. J. Clin. Med., 13.10.3390/jcm13020344 ↗
8. Zhu, J., Chen, Z., Zhao, J., Yu, Y., Li, X., Shi, K., Zhang, F., Yu, F., Shi, K., and Sun, Z. (2023). Artificial intelligence in the diagnosis of dental diseases on panoramic radiographs: A preliminary study. BMC Oral Health, 23.10.1186/s12903-023-03027-6 ↗
9. The Integration of Artificial Intelligence into Clinical Practice10.3390/applbiosci3010002 ↗
10. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews10.1186/s13643-021-01626-4 ↗
11. QUADAS-2: A revised tool for the quality assessment of diagnostic accuracy studies10.7326/0003-4819-155-8-201110180-00009 ↗
12. Shahidi, S., Bahrampour, E., Soltanimehr, E., Zamani, A., Oshagh, M., Moattari, M., and Mehdizadeh, A. (2014). The accuracy of a designed software for automated localization of craniofacial landmarks on CBCT images. BMC Med. Imaging, 14.10.1186/1471-2342-14-32 ↗
13. Automatic Analysis of Lateral Cephalograms Based on Multiresolution Decision Tree Regression Voting10.1155/2018/1797502 ↗
14. Automated identification of cephalometric landmarks: Part 2-Might it be better than human?10.2319/022019-129.1 ↗
15. Frontal cephalometric landmarking: Humans vs artificial neural networks
16. Accuracy of automated identification of lateral cephalometric landmarks using cascade convolutional neural networks on lateral cephalograms from nationwide multi-centres10.1111/ocr.12493 ↗
17. Evaluation of a multi-stage convolutional neural network-based fully automated landmark identification system using cone-beam computed tomographysynthesized posteroanterior cephalometric images10.4041/kjod.2021.51.2.77 ↗
18. Accuracy of auto-identification of the posteroanterior cephalometric landmarks using cascade convolution neural network algorithm and cephalometric images of different quality from nationwide multiple centers10.1016/j.ajodo.2021.11.011 ↗
19. Le, V.N.T., Kang, J., Oh, I.S., Kim, J.G., Yang, Y.M., and Lee, D.W. (2022). Effectiveness of Human-Artificial Intelligence Collaboration in Cephalometric Landmark Detection. J. Pers. Med., 12.10.3390/jpm12030387 ↗
20. Evaluation of an artificial intelligence-based algorithm for automated localization of craniofacial landmarks10.1007/s00784-023-04978-4 ↗
21. Accuracy of posteroanterior cephalogram landmarks and measurements identification using a cascaded convolutional neural network algorithm: A multicenter study10.4041/kjod23.075 ↗
22. Accuracy of automated 3D cephalometric landmarks by deep learning algorithms: Systematic review and meta-analysis10.1007/s11547-023-01629-2 ↗
23. Smart Smile: Revolutionizing Dentistry With Artificial Intelligence
24. The performance of artificial intelligence models in generating responses to general orthodontic questions: ChatGPT vs Google Bard10.1016/j.ajodo.2024.01.012 ↗
25. Artificial intelligence for ultrasound scanning in regional anaesthesia: A scoping review of the evidence from multiple disciplines10.1016/j.bja.2024.01.036 ↗
26. An automatic cephalometric landmark detection method based on heatmap regression and Monte Carlo dropout
27. Reliability of 3D dental and skeletal landmarks on CBCT images10.2319/082018-612.1 ↗
28. Three-dimensional cephalometric analysis in orthodontics: A systematic review10.1111/ocr.12034 ↗
29. Explainable Artificial Intelligence (XAI): What we know and what is left to attain Trustworthy Artificial Intelligence10.1016/j.inffus.2023.101805 ↗
30. Kelly, C.J., Karthikesalingam, A., Suleyman, M., Corrado, G., and King, D. (2019). Key challenges for delivering clinical impact with artificial intelligence. BMC Med., 17.10.1186/s12916-019-1426-2 ↗
31. The problem of assessing landmark error in geometric morphometrics: Theory, methods, and modifications10.1002/ajpa.20616 ↗
32. Methodologic Guide for Evaluating Clinical Performance and Effect of Artificial Intelligence Technology for Medical Diagnosis and Prediction10.1148/radiol.2017171920 ↗
33. The validation of orthodontic artificial intelligence systems that perform orthodontic diagnoses and treatment planning10.1093/ejo/cjab083 ↗
34. Evaluation and Comparison of Anatomical Landmark Detection Methods for Cephalometric X-Ray Images: A Grand Challenge10.1109/TMI.2015.2412951 ↗
35. Bermejo, E., Taniguchi, K., Ogawa, Y., Martos, R., Valsecchi, A., Mesejo, P., Ibáñez, O., and Imaizumi, K. (2021). Automatic landmark annotation in 3D surface scans of skulls: Methodological proposal and reliability study. Comput. Methods Programs Biomed., 210.10.1016/j.cmpb.2021.106380 ↗
36. Jeong, S.H., Yun, J.P., Yeom, H.G., Kim, H.K., and Kim, B.C. (2021). Deep-Learning-Based Detection of Cranio-Spinal Differences between Skeletal Classification Using Cephalometric Radiography. Diagnostics, 11.10.3390/diagnostics11040591 ↗
37. Kim, M., Kim, S., Kim, M., Bae, H.J., Park, J.W., and Kim, N. (2021). Realistic high-resolution lateral cephalometric radiography generated by progressive growing generative adversarial network and quality evaluations. Sci. Rep., 11.10.1038/s41598-021-91965-y ↗
38. Kim, Y.H., Park, J.B., Chang, M.S., Ryu, J.J., Lim, W.H., and Jung, S.K. (2021). Influence of the depth of the convolutional neural networks on an artificial intelligence model for diagnosis of orthognathic surgery. J. Pers. Med., 11.10.3390/jpm11050356 ↗
39. Deformable registration of lateral cephalogram and cone-beam computed tomography image10.1002/mp.15214 ↗
40. Comparison between a human judge and automatic landmark identification on digital models10.1016/j.ajodo.2021.08.020 ↗
41. Artificial intelligence in dentomaxillofacial radiology10.4329/wjr.v14.i3.55 ↗
42. Localization of Craniomaxillofacial Landmarks on CBCT Images Using 3D Mask R-CNN and Local Dependency Learning10.1109/TMI.2022.3174513 ↗
43. Li, S., Gong, Q., Li, H., Chen, S., Liu, Y., Ruan, G., Zhu, L., Liu, L., and Chen, H. (2022). Automatic location scheme of anatomical landmarks in 3D head MRI based on the scale attention hourglass network. Comput. Methods Programs Biomed., 214.10.1016/j.cmpb.2021.106564 ↗
44. Anthropometric Landmarking for Diagnosis of Cranial Deformities: Validation of an Automatic Approach and Comparison with Intra- and Interobserver Variability10.1007/s10439-022-02981-6 ↗
45. Evaluation of automated detection of head position on lateral cephalometric radiographs based on deep learning techniques10.1016/j.aanat.2023.152114 ↗
46. Automated detection of cephalometric landmarks using deep neural patchworks10.1259/dmfr.20230059 ↗
47. Skeletal facial asymmetry: Reliability of manual and artificial intelligence-driven analysis10.1093/dmfr/twad006 ↗
48. Deep Learning-Based Regression and Classification for Automatic Landmark Localization in Medical Images10.1109/TMI.2020.3009002 ↗
49. Accuracy of computerized automatic identification of cephalometric landmarks by a designed software10.1259/dmfr.20110187 ↗
50. A knowledge-based algorithm for automatic detection of cephalometric landmarks on CBCT images10.1007/s11548-015-1173-6 ↗
51. Accuracy of 3D cephalometric measurements based on an automatic knowledge-based landmark detection algorithm10.1007/s11548-015-1334-7 ↗
52. Lindner, C., Wang, C.W., Huang, C.T., Li, C.H., Chang, S.W., and Cootes, T.F. (2016). Fully Automatic System for Accurate Localisation and Analysis of Cephalometric Landmarks in Lateral Cephalograms. Sci. Rep., 6.10.1038/srep33581 ↗
53. Mosleh, M.A., Baba, M.S., Malek, S., and Almaktari, R.A. (2016). Ceph-X: Development and evaluation of 2D cephalometric system. BMC Bioinform., 17.10.1186/s12859-016-1370-5 ↗
54. Automatic Craniomaxillofacial Landmark Digitization via Segmentation-Guided Partially-Joint Regression Forest Model and Multiscale Statistical Features10.1109/TBME.2015.2503421 ↗
55. Fully automated quantitative cephalometry using convolutional neural networks10.1117/1.JMI.4.1.014501 ↗
56. Computer-aided cephalometric landmark annotation for CBCT data10.1007/s11548-016-1453-9 ↗
57. A new methodology for automatic detection of reference points in 3D cephalometry: A pilot study10.1016/j.ortho.2018.03.013 ↗
58. Automatic 3-dimensional cephalometric landmarking based on active shape models in related projections10.1016/j.ajodo.2017.06.028 ↗
59. Hybrid approach for automatic cephalometric landmark annotation on cone-beam computed tomography volumes10.1016/j.ajodo.2017.08.028 ↗
60. Automatic localization of three-dimensional cephalometric landmarks on CBCT images by extracting symmetry features of the skull10.1259/dmfr.20170054 ↗
61. Automatic Three-Dimensional Cephalometric Annotation System Using Three-Dimensional Convolutional Neural Networks
62. Lee, S.M., Kim, H.P., Jeon, K., Lee, S.H., and Seo, J.K. (2019). Automatic 3D cephalometric annotation system using shadowed 2D image-based machine learning. Phys. Med. Biol., 64.10.1088/1361-6560/ab00c9 ↗
63. Personal Computer-Based Cephalometric Landmark Detection With Deep Learning, Using Cephalograms on the Internet10.1097/SCS.0000000000004901 ↗
64. Automated identification of cephalometric landmarks: Part 1-Comparisons between the latest deep-learning methods YOLOV3 and SSD10.2319/022019-127.1 ↗
65. Kim, H., Shim, E., Park, J., Kim, Y.J., Lee, U., and Kim, Y. (2020). Web-based fully automated cephalometric analysis by deep learning. Comput. Methods Programs Biomed., 194.10.1016/j.cmpb.2020.105513 ↗
66. Artificial intelligence in orthodontics: Evaluation of a fully automated cephalometric analysis using a customized convolutional neural network10.1007/s00056-019-00203-8 ↗
67. Lee, J.H., Yu, H.J., Kim, M.J., Kim, J.W., and Choi, J. (2020). Automated cephalometric landmark detection with confidence regions using Bayesian convolutional neural networks. BMC Oral Health, 20.10.1186/s12903-020-01256-7 ↗
68. Wirtz, A., Lam, J., and Wesarg, S. (2020). Automated cephalometric landmark localization using a coupled shape model. Biomed. Tech., 65.10.1515/cdbme-2020-3015 ↗
69. Yun, H.S., Jang, T.J., Lee, S.M., Lee, S.H., and Seo, J.K. (2020). Learning-based local-to-global landmark annotation for automatic 3D cephalometry. Phys. Med. Biol., 65.10.1088/1361-6560/ab7a71 ↗
70. Assessment of automatic cephalometric landmark identification using artificial intelligence10.1111/ocr.12542 ↗
71. Cephalogram synthesis and landmark detection in dental cone-beam CT systems10.1016/j.media.2021.102028 ↗
72. Evaluation of automated cephalometric analysis based on the latest deep learning method10.2319/021220-100.1 ↗
73. Comparison of cephalometric measurements between conventional and automatic cephalometric analysis using convolutional neural network10.1186/s40510-021-00358-4 ↗
74. Kang, S.H., Jeon, K., Kang, S.H., and Lee, S.H. (2021). 3D cephalometric landmark detection by multiple stage deep reinforcement learning. Sci. Rep., 11.10.1038/s41598-021-97116-7 ↗
75. A fully deep learning model for the automatic identification of cephalometric landmarks10.5624/isd.20210077 ↗
76. Deep Anatomical Context Feature Learning for Cephalometric Landmark Detection10.1109/JBHI.2020.3002582 ↗
77. Clinical applicability of automated cephalometric landmark identification: Part I-Patient-related identification errors10.1111/ocr.12501 ↗
78. Wang, L., Ma, L., Li, Y., Niu, K., and He, Z. (2021). A DCNN system based on an iterative method for automatic landmark detection in cephalometric X-ray images. Biomed. Signal Process. Control, 68.10.1016/j.bspc.2021.102757 ↗
79. Cascaded convolutional networks for automatic cephalometric landmark detection10.1016/j.media.2020.101904 ↗
80. Ahn, J., Nguyen, T.P., Kim, Y.J., Kim, T., and Yoon, J. (2022). Automated analysis of three-dimensional CBCT images taken in natural head position that combines facial profile processing and multiple deep-learning models. Comput. Methods Programs Biomed., 226.10.1016/j.cmpb.2022.107123 ↗
81. Cephalometric Variables Prediction from Lateral Photographs Between Different Skeletal Patterns Using Regression Artificial Neural Networks10.5152/TurkJOrthod.2022.21087 ↗
82. Comparison between cephalometric measurements using digital manual and web-based artificial intelligence cephalometric tracing software10.1590/2177-6709.27.4.e222112.oar ↗
83. Automatic 3-Dimensional Cephalometric Landmarking via Deep Learning10.1177/00220345221112333 ↗
84. Jiang, F., Guo, Y., Zhou, Y., Yang, C., Xing, K., Zhou, J., Lin, Y., Cheng, F., and Li, J. (2022). Automated calibration system for length measurement of lateral cephalometry based on deep learning. Phys. Med. Biol., 67.10.1088/1361-6560/ac9880 ↗
85. Mahto, R.K., Kafle, D., Giri, A., Luintel, S., and Karki, A. (2022). Evaluation of fully automated cephalometric measurements obtained from web-based artificial intelligence driven platform. BMC Oral Health, 22.10.1186/s12903-022-02170-w ↗
86. Comparison of AudaxCeph®’s fully automated cephalometric tracing technology to a semi-automated approach by human examiners10.1016/j.ortho.2022.100691 ↗
87. Tsolakis, I.A., Tsolakis, A.I., Elshebiny, T., Matthaios, S., and Palomo, J.M. (2022). Comparing a Fully Automated Cephalometric Tracing Method to a Manual Tracing Method for Orthodontic Diagnosis. J. Clin. Med., 11.10.3390/jcm11226854 ↗
88. Performance of a Convolutional Neural Network- Based Artificial Intelligence Algorithm for Automatic Cephalometric Landmark Detection
89. Automatic localization of cephalometric landmarks based on convolutional neural network10.1016/j.ajodo.2021.09.012 ↗
90. Yun, H.S., Hyun, C.M., Baek, S.H., Lee, S.H., and Seo, J.K. (2022). A semi-supervised learning approach for automated 3D cephalometric landmark identification using computed tomography. PLoS ONE, 17.10.1371/journal.pone.0275114 ↗
91. Bao, H., Zhang, K., Yu, C., Li, H., Cao, D., Shu, H., Liu, L., and Yan, B. (2023). Evaluating the accuracy of automated cephalometric analysis based on artificial intelligence. BMC Oral Health, 23.10.1186/s12903-023-02881-8 ↗
92. Automatic analysis of lateral cephalograms based on high-resolution net10.1016/j.ajodo.2022.02.020 ↗
93. Deep-Learning-Based Group Point-Wise Spatial Mapping of Structure to Function in Glaucoma
94. Evaluation of the accuracy of fully automatic cephalometric analysis software with artificial intelligence algorithm10.1111/ocr.12633 ↗
95. Automatic landmark identification in cone-beam computed tomography10.1111/ocr.12642 ↗
96. Automated Cephalometric Landmark Detection Using Deep Reinforcement Learning10.1097/SCS.0000000000009685 ↗
97. Human examination and artificial intelligence in cephalometric landmark detection-is AI ready to take over?10.1259/dmfr.20220362 ↗
98. Artificial intelligence system for automated landmark localization and analysis of cephalometry10.1259/dmfr.20220081 ↗
99. Kunz, F., Stellzig-Eisenhauer, A., Widmaier, L.M., Zeman, F., and Boldt, J. (2023). Assessment of the quality of different commercial providers using artificial intelligence for automated cephalometric analysis compared to human orthodontic experts. J. Orofac. Orthop.10.1007/s00056-023-00491-1 ↗
100. Lee, H., Cho, J.M., Ryu, S., Ryu, S., Chang, E., Jung, Y.S., and Kim, J.Y. (2023). Automatic identification of posteroanterior cephalometric landmarks using a novel deep learning algorithm: A comparative study with human experts. Sci. Rep., 13.10.1038/s41598-023-42870-z ↗