Accuracy of digital and analogue cephalometric measurements assessed with the sandwich technique

Introduction: The purpose of the study was to evaluate the accuracy of cephalometric measurements obtained with digital tracing software compared with equivalent hand-traced measurements. In the sandwich technique, a storage phosphor plate and a conventional radiographic film are placed in the same cassette and exposed simultaneously. The method eliminates positioning errors and potential differences associated with multiple radiographic exposures that affected previous studies. It was used to ensure the equivalence of the digital images to the hard copy radiographs. Cephalometric measurements instead of landmarks were the focus of this investigation in order to acquire data with direct clinical applications. Methods: The sample consisted of digital and analog radiographic images from 47 patients after orthodontic treatment. Nine cephalometric landmarks were identified and 13 measurements calculated by 1 operator, both manually and with digital tracing software. Measurement error was assessed for each method by duplicating measurements of 25 randomly selected radiographs and by using Pearson's correlation coefficient. A paired t test was used to detect differences between the manual and digital methods. Results: An overall greater variability in the digital cephalometric measurements was found. Differences between the 2 methods for SNA, ANB, S-Go:N-Me, U1/L1, L1-GoGn, and N-ANS:ANS-Me were statistically significant (P < .05). However, only the U1/L1 and S-Go:N-Me measurements showed differences greater than 2 SE (P < .0001). Conclusions: The 2 tracing methods provide similar clinical results; therefore, efficient digital cephalometric software can be reliably chosen as a routine diagnostic tool. The user-friendly sandwich technique was effective as an option for interoffice communications.