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This paper describes an evaluation of the application of active shape models to cephalometric landmarking. Permissible deformations of a template were established from a training set of hand-annotated images and the resulting model was used to fit to unseen images. An evaluation of this technique in comparison to the accuracy achieved by previous methods is presented. Sixty-three randomly selected cephalograms were tested using a drop-one-out method. On average, 13 per cent of 16 landmarks were within 1 mm, 35 per cent within 2 mm, and 74 per cent within 5 mm. It was concluded that the current implementation does not give sufficient accuracy for completely automated landmarking, but could be used as a time-saving tool to provide a first-estimate location of the landmarks. The method is also of interest because it provides a framework for a range of future improvements.

Original publication




Journal article


European journal of orthodontics

Publication Date





499 - 508


Eastman Dental Institute, UCL, London, UK.


Humans, Image Interpretation, Computer-Assisted, Cephalometry, Random Allocation, Reproducibility of Results, Dental Models, Algorithms, Models, Anatomic, Adolescent, Adult, Child