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. 2024 Jan 11;53(1):52-59.
doi: 10.1093/dmfr/twad006.

Skeletal facial asymmetry: reliability of manual and artificial intelligence-driven analysis

Natalia Kazimierczak  1 , Wojciech Kazimierczak  1   2 , Zbigniew Serafin  2 , Paweł Nowicki  1 , Tomasz Jankowski  3 , Agnieszka Jankowska  3 , Joanna Janiszewska-Olszowska  4
Affiliations

Skeletal facial asymmetry: reliability of manual and artificial intelligence-driven analysis

Natalia Kazimierczak et al. Dentomaxillofac Radiol. .

Abstract

Objectives: To compare artificial intelligence (AI)-driven web-based platform and manual measurements for analysing facial asymmetry in craniofacial CT examinations.

Methods: The study included 95 craniofacial CT scans from patients aged 18-30 years. The degree of asymmetry was measured based on AI platform-predefined anatomical landmarks: sella (S), condylion (Co), anterior nasal spine (ANS), and menton (Me). The concordance between the results of automatic asymmetry reports and manual linear 3D measurements was calculated. The asymmetry rate (AR) indicator was determined for both automatic and manual measurements, and the concordance between them was calculated. The repeatability of manual measurements in 20 randomly selected subjects was assessed. The concordance of measurements of quantitative variables was assessed with interclass correlation coefficient (ICC) according to the Shrout and Fleiss classification.

Results: Erroneous AI tracings were found in 16.8% of cases, reducing the analysed cases to 79. The agreement between automatic and manual asymmetry measurements was very low (ICC < 0.3). A lack of agreement between AI and manual AR analysis (ICC type 3 = 0) was found. The repeatability of manual measurements and AR calculations showed excellent correlation (ICC type 2 > 0.947).

Conclusions: The results indicate that the rate of tracing errors and lack of agreement with manual AR analysis make it impossible to use the tested AI platform to assess the degree of facial asymmetry.

Keywords: AI; automated diagnosis; craniofacial computed tomography; facial asymmetry; orthodontics.

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Conflict of interest statement

None.

Figures

Figure 1.
Figure 1.
Results of automatic cephalometric tracing in sample patient (A), landmarks used in asymmetry analysis (B).
Figure 2.
Figure 2.
Sample of correct tracing (A) and typical case of erroneous tracing and asymmetry report (B).
See this image and copyright information in PMC

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