Automated 3D cephalometry: A lightweight V-net for landmark localization on CBCT

Cephalometric analysis is a widely adopted procedure for clinical decision support in orthodontics. It involves manual identification of predefined anatomical landmarks on three-dimensional cone beam CT scans, followed by the computation of linear and angular measurements. To reduce processing time and operator dependency, this study aimed to develop a light-weight deep learning (DL) model capable of automatically localizing 16 anatomically defined landmarks. To ensure model robustness and generalizability, the model was trained on a dataset of 350 manually annotated CBCT scans acquired from various imaging systems, covering a wide range of patient ages and skeletal classifications. The trained model is a V-net, optimized for practical use in clinical workflows. The model achieved a mean localization error of 1.95 ± 1.06 mm, which falls within the clinically acceptable threshold of 2 mm. Moreover, the predicted landmarks were used to calculate cephalometric measurements and compare with manually derived values. The resulting errors was -0.15 ± 0.95° for angular measurements and 0.20 ± 0.28 mm for linear ones, with Bland-Altman analysis demonstrating strong agreement and acceptable variability. These results suggest that automated measurements can reliably replace manual ones. Given the clinical relevance of cephalometric parameters - particularly the ANB angle, which is critical for skeletal classification and orthodontic treatment planning - this model represents a promising clinical decision support tool. Additionally, its low computational complexity enables fast prediction, with mean inference time lower than 32 s per scan, promoting its integration into routine clinical settings due to both technical feasibility and robustness across heterogeneous datasets.