A semi-automatic approach for longitudinal 3D upper airway analysis using voxel based registration

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OBJECTIVES: To propose and validate a reliable semi-automatic approach for three-dimensional (3D) analysis of the upper airway (UA) based on voxel-based registration (VBR). METHODS: Post-operative cone beam computed tomography (CBCT) scans of 10 orthognathic surgery patients were superimposed to the pre-operative CBCT scans by VBR using the anterior cranial base as reference. Anatomic landmarks were used to automatically cut the UA and calculate volumes and cross-sectional areas (CSA). The 3D analysis was performed by two observers twice, at an interval of two weeks. Intraclass correlations and Bland-Altman plots were used to quantify the measurement error and reliability of the method. The relative Dahlberg error was calculated and compared with a similar method based on landmark re-identification and manual measurements. RESULTS: Intraclass correlation coefficient (ICC) showed excellent intra- and inter-observer reliability (ICC ≥ 0.995). Bland-Altman plots showed good observer agreement, low bias and no systematic errors. The relative Dahlberg error ranged between 0.51 and 4.30% for volume and 0.24 and 2.90% for CSA. This was lower when compared with a similar, manual method. Voxel-based registration introduced 0.05-1.44% method error. CONCLUSIONS: The proposed method was shown to have excellent reliability and high observer agreement. The method is feasible for longitudinal clinical trials on large cohorts due to being semi-automatic.

Original languageEnglish
Article number20210253
JournalDentomaxillofacial Radiology
Issue number3
Number of pages11
Publication statusPublished - 1. Mar 2022


  • Cone-beam computed tomography
  • Orthognathic surgery
  • Pharynx
  • Respiratory system
  • Three-dimensional imaging
  • Reproducibility of Results
  • Imaging, Three-Dimensional/methods
  • Humans
  • Facial Bones
  • Cephalometry/methods
  • Cone-Beam Computed Tomography/methods
  • Anatomic Landmarks


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