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Background  Cephalometric analysis and measurements of skull parameters using X-Ray images plays an important role in predicating and monitoring orthodontic treatment. Manual analysis and measurements of cephalometric is considered tedious, time consuming, and subjected to human errors. Several cephalometric systems have been developed to automate the cephalometric procedure; however, no clear insights have been reported about reliability, performance, and usability of those systems. This study utilizes some techniques to evaluate reliability, performance, and usability metric using SUS methods of the developed cephalometric system which has not been reported in previous studies.    Methods  In this study a novel system named Ceph-X is developed to computerize the manual tasks of orthodontics during cephalometric measurements. Ceph-X is developed by using image processing techniques with three main models: enhancements X-ray image model, locating landmark model, and computation model. Ceph-X was then evaluated by using X-ray images of 30 subjects (male and female) obtained from University of Malaya hospital. Three orthodontics specialists were involved in the evaluation of accuracy to avoid intra examiner error, and performance for Ceph-X, and 20 orthodontics specialists were involved in the evaluation of the usability, and user satisfaction for Ceph-X by using the SUS approach.    Results  Statistical analysis for the comparison between the manual and automatic cephalometric approaches showed that Ceph-X achieved a great accuracy approximately 96.6%, with an acceptable errors variation approximately less than 0.5 mm, and 1°. Results showed that Ceph-X increased the specialist performance, and minimized the processing time to obtain cephalometric measurements of human skull. Furthermore, SUS analysis approach showed that Ceph-X has an excellent usability user’s feedback.    Conclusions  The Ceph-X has proved its reliability, performance, and usability to be used by orthodontists for the analysis, diagnosis, and treatment of cephalometric.

Ceph-X: development and evaluation of 2D cephalometric system