Influence of type of radiograph and levels of experience and training on reproducibility of the cervical vertebral maturation method

Anfal Khajah; Aditya Tadinada; Veerasathpurush Allareddy; Chia-Ling Kuo; Ravindra Nanda; Flavio Uribe

doi:10.1016/j.ajodo.2019.03.025

Influence of type of radiograph and levels of experience and training on reproducibility of the cervical vertebral maturation method

Am J Orthod Dentofacial Orthop. 2020 Feb;157(2):228-239. doi: 10.1016/j.ajodo.2019.03.025.

Authors

Anfal Khajah¹, Aditya Tadinada², Veerasathpurush Allareddy³, Chia-Ling Kuo⁴, Ravindra Nanda⁵, Flavio Uribe⁶

Affiliations

¹ Formerly, Division of Orthodontics, Department of Craniofacial Sciences, University of Connecticut School of Dental Medicine, Farmington, Conn; currently, Government hospital, Bneid Al-Gar Dental Specialty Center, Kuwait City, Kuwait.
² Division of Oral and Maxillofacial Radiology, Department of Oral Health and Diagnostic Sciences, University of Connecticut School of Dental Medicine, Farmington, Conn.
³ Department of Orthodontics, College of Dentistry, University of Illinois at Chicago, Chicago, Illinois.
⁴ Connecticut Institute for Clinical and Translational Science, Department of Community Medicine, Institute for System Genomics, University of Connecticut, Farmington, Conn.
⁵ Division of Orthodontics, Department of Craniofacial Sciences, University of Connecticut School of Dental Medicine, Farmington, Conn.
⁶ Division of Orthodontics, Department of Craniofacial Sciences, University of Connecticut School of Dental Medicine, Farmington, Conn. Electronic address: Furibe@uchc.edu.

PMID: 32005475
DOI: 10.1016/j.ajodo.2019.03.025

Abstract

Introduction: The objective of this study was to assess the reproducibility of cervical vertebral maturation (CVM) method based on the type of radiographic image and the level of experience and level of training of the evaluator.

Methods: Ten evaluators (5 orthodontic residents and 5 faculty members) were randomly divided into 2 groups: trained and untrained. All participants evaluated 80 radiographic images previously acquired in 4 different formats: (1) 2-dimensional (2D) digital (2D-digital), (2) 2D digitized hard copy from the Iowa Facial Growth Study (American Association of Orthodontists Foundation Craniofacial Growth Legacy Collection), (3) 2D digital reconstructed from a 3-dimensional (3D) radiograph (2D-from 3D), and (4) 3D cone-beam computerized tomographic (3D-CBCT) images. Agreement among evaluators on the morphology of the cervical vertebrae (CV) and the CVM stage of each radiographic image was assessed using Randolph's kappa statistic and Kendall's W coefficient of concordance.

Results: Interobserver agreement on the determination of a curvature on the inferior border of the CV was substantial to perfect, whereas agreement on shape was fair to moderate. Overall, the level training in all image types, except 3D-CBCTs, but not the level of experience affected the agreement for shape and curvature of the CVs. Interobserver agreement on CVM staging for all combined images was substantial at 0.72. Faculty had a higher level of agreement than residents except for 2D-digital and 3D-CBCT images, whereas trained evaluators had an overall higher level of agreement than untrained evaluators except for 3D-CBCT images.

Conclusions: Interobserver agreement in determining CVM stage was substantial for all images evaluated; experience and training resulted in higher level of agreement for some image types. The 3D-CBCT images did not provide increased interobserver agreement over current 2D-digital lateral cephalograms in determining CVM staging or shape of the CV. The highest agreement in CVM staging was obtained on 2D-digital lateral cephalograms with training.

Publication types

Randomized Controlled Trial

MeSH terms

Cephalometry*
Cervical Vertebrae* / diagnostic imaging
Clinical Competence
Cone-Beam Computed Tomography*
Humans
Imaging, Three-Dimensional
Iowa
Observer Variation
Orthodontics / education*
Reproducibility of Results