Effect of threshold configuration on accuracy in upper airway analysis using cone-beam computed tomography

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Saba Fahham
Supak Ngamsom
Suchaya Pornprasertsuk-Damrongsri


Objective: To determine the optimal threshold of Romexis software for the airway volume and minimum cross-sectional area (MCA) analysis using image J as a gold standard.

Materials and Methods: A total of ten CBCT images were collected. The airway volume and MCA of each patient were analyzed using the automatic airway segmentation function in the CBCT DICOM viewer (Romexis). Airway volume and MCA measurements were conducted on each CBCT sagittal view with fifteen different threshold values from the Romexis software, ranging from 300 to 1000. Duplicate DICOM files, in axial view, were imported into ImageJ for concurrent airway volume and MCA analysis as the gold standard. The airway volume and MCA measured from Romexis and ImageJ were compared using a t-test with Bonferroni correctio, and statistical significance was set at p<0.003.

Results: Concerning airway volume, thresholds of 600 to 850, as well as 1000, exhibited results that were not significantly distinct from those obtained through ImageJ. Regarding MCA, employing thresholds from 400 to 850 within Romexis Viewer showed no variance from ImageJ. Notably, within the threshold range of 600 to 850, there were no statistically significant differences observed in both airway volume and MCA analyses, in comparison to ImageJ.

Conclusion: This study demonstrates that the utilization of Planmeca Romexis Viewer within the threshold range of 600 to 850 yields airway volume and MCA measurements that exhibit no statistically significant variance in comparison to measurements obtained through ImageJ. This outcome holds implications for diagnosing upper airway obstructions and post-orthodontic surgical monitoring.


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Fahham S, Ngamsom S, Pornprasertsuk-Damrongsri S. Effect of threshold configuration on accuracy in upper airway analysis using cone-beam computed tomography. M Dent J [Internet]. 2023 Oct. 24 [cited 2023 Dec. 10];43(suppl):S37-S46. Available from: https://he02.tci-thaijo.org/index.php/mdentjournal/article/view/264744
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