Reliability of Upper Airway Assessment Using Cone Beam Computed Tomography

Background Since the late 1990s, CBCT has revolutionized dental imaging, offering 3D visualization with lower radiation than conventional CT. It is used in dentistry, for assessing the upper pharyngeal airway in OSA patients. Despite advancements in semi-automated analysis, reliable CBCT measurements remain challenging due to examiner-dependent factors like image orientation & threshold sensitivity. Objective: To evaluate the accuracy of CBCT measurements of the upper airway's volumetric and cross-sectional areas, focusing on inter- and intra-examiner consistency. Methods and Materials: Six examiners with varying experience analyzed CBCT images of 10 patients, performing airway orientation, slice selection, threshold adjustment, and measurements of A-P, A-W, A-L, and total airway space. After four weeks, measurements were repeated to assess reliability. Results: The study found excellent reliability in A-P, A-W, A-L, and total airway measurements within the group across weeks 1 and 4. A-P comparisons between groups showed no significant differences, with consistent reliability for A-W, A-L, and total airway measurements across all investigators. Conclusions: Despite advancements in 3D analysis, reliable skull & palate alignment methods are crucial. Future research should improve these techniques for accurate airway evaluation.