Prevalence and Severity of Image-Stitching Artifacts in Charge-Coupled Device–based Cephalograms of Orthodontic Patients

Objectives. The aim of this study was to assess the prevalence and severity of image-stitching artifacts in charge-coupled device (CCD)-based cephalograms and their relationship to patient age. Study Design. Cephalograms from 200 patients, acquired by using 2 Promax 2-D units (100 images using Dimax-3 [D-3] and 100 using Dimax-4 [D-4] sensors) were examined. Three observers assessed the presence and severity of image-stitching artifacts for stitching line visibility in 3 categories (none or almost invisible, thin, and thin with vertical stripes or thick) and misalignment between the anatomic structure display in 4 categories (none, <1 mm, 1-3 mm, and >3 mm). Severe artifacts were defined as a stitching line that was thin with vertical stripes or thick, and misalignment >= 1 mm. Patients were grouped by age: <= 13, 14-20, and >20 years old. Observer agreement was assessed by using Kappa statistics. Artifact prevalence and severity were calculated for both sensor types. The effect of age on the presence of severe artifacts was assessed. Results. Stitching lines were observed in 86.7% of D-3 images and 3.3% of D-4 images. Young age had a significant effect on the presence of severe artifacts in D-3 images. Conclusions. Sensor type and patient age have substantial effects on the prevalence and severity of image-stitching artifacts in CCD-based cephalograms.