The cephalographic projection

Part II. Principles of image distortion in cephalography

J AHLQVlST, S ELiASSON and U WELANDER

From the Department of Oral Radiology, Umea University, and the Department of Oral Radiology, Karolinska
institutet, Stockholm, Sweden.

KEY WORDS: Cephalography; reaioqrepnlce projection technique

The principle effects of image distortion in cepha/ography are presented. The effects of misalignment between
the ray source, the cepha/ostat, and the film are considered as well as ma/positioning of the object.

In cephalometry, angles, distances, and rela-
tions between defined anatomical landmarks
are established. However, cephalometric mea-
surements are performed in a two-dimensional
image of a three-dimensional object placed in
the radiographic system. Also when alignment
of the radiographic equipment, and positioning
of the patient are ideal, projection errors may
arise affecting cephalometric measurements.
In a methodological study Slagsvold & Peder-
sen (5) found significant differences between
measurements of the gonial angle in skulls and
lateral radiographs of the same individual. Ber-
gersen (2) studied magnification and distortion
in cephalometric radiographs and found devia-
tions from true values in linear measurements
when the landmarks were situated outside the
sagittal plane. van Aken (1) demonstrated that
projectional errors are usually small but may be
significant for landmarks positioned outside the
sagittal plane in cases having asymmetrical
skulls. There are few analyses of the principles
underlying image distortion in cephalography.
The cephalographic system consists of three
main components: the ray source, the cephalo-
stat, and the film. The distances between these
components are strictly defined. In the ideal
case, a true orthogonal projection is created.
The ray source is aligned with a positioning de-
vice in the cephalostat, usually ear-plugs, and
the film is held perpendicular to the central ray.
Mathematically, the elements of interior orienta-
tion of the projection, Le.the center of projection
and the divergence of the beam, are easily de-
fined. Any deviation from true orthogonality
complicates calculations. Solutions to problems
that may arise are available, however, in photo-
grammetric literature (6). The photogrammetric
approach was used by Hollender (4) to deter-
mine the elements of interior orientation in ra-
diography. Generalized analyses of geometric
image characteristics based on a knowledge of
the elements of interior orientation and object
properties seem to be lacking.
In an earlier article (3) the basic mathematics
for calculating the projected cephalographic im-
age were presented (See Appendix). These ex-
pressions make it possible to calculate the im-
age for any position of the object and/or any
alignment between the components of the ra-
diographic system. The purpose of the present
work was to present the sources of distortion
and their main effects on the cephalographic im-
age.

Dentomaxillofac. Radiol. 12:101-108, 1983 101

METHOD
The expressions for coordinate transformation
presented in Part I of this series of articles (3)
were used for calculating the projected image of
different model objects onto a two-dimensional
film plane. All calculations were performed using
YIP
a Hewlett-Packard 98458 computer. The pro- Y
Yo
grams were written in such a way as to indepen- a
dently allow:
• rotation of the cephalostat/object around its
three axes;
• rotation of the film plane around its two axes;
• translation in any direction of the cephalostatl
object;
• different focus to cephalostatlobject and fo-
cus to film distances. YIP
b
Translation of the ray source in a plane per-
pendicular to the central ray is analogous to the Fig. 2. A plane limited by four line segments. OP1.
corresponding translation of the cephalostatl OP3 . OP2. OP3. was placed in the coordinate system
object. When the film plane is tilted, translation of the cephalostat, and its projection onto the film
plane studied.
perpendicular to the central ray of the beam is
analogous to changing the focus to film distance a. The object plane coinciding with the y-z-plane of
the cephalostat.
(3). b. The object plane rotated around the z-axis.
All calculations were performed using a focus
to object distance of 1400 mm and a focus to film
distance of 1550 mm. • a cube which in one dimension was divided
The following model objects were studied: into equally spaced planes;
• a rectangular plane subdivided into squares • a sphere which in one dimension was divided
of equal size; into equally spaced planes.

The model objects were centered analogous

to a real object in order to study the distortion in
that portion of the image where most cephalo-
metric landmarks are found (Fig. 1).
The image distortion was studied, partly by
means of diagrams where distances and angles
were plotted as functions of rotation and/or
translation of the different components of the
system, partly using tabulated values, and partly
using computer drawn representations, or
Yo images, of the model objects.

ANALYSIS OF IMAGE DISTORTION

Geometrically and mathematically the ortho-
Fig. 1. The model objects were positioned where most gonal projection that is applied in cephalogra-
cephalometric landmarks are found. phy creates a perspective image. Rotation of the

102
:I: f- The projection of a line segment coinciding
--l f0-
with the z-axis will remain unchanged during ro-
H
u, I.S E tation around this axis. The projection of a verti-
f0-
W cal line segment not coinciding with the rotati-
I 1.4 onal axis, the z-axis, varies during rotation due
I- E
1.2
f0-
to changing values of the x-coordinate, i.e.
z r-
...................... changing object depth, resulting in decreased
o La ...................... or increased magnification. The magnification

o
I

Z
13.8
will be affected by the degree of rotation and by
the distance between the line segment and the
W a.s rotational axis (Fig. 3).
--l
• 13.4 Y YIP
--l
W I
~
-813 -sa -413 -213 a 213 413 sa 813
ANGLE, degrees
Fig. 3. The projected length of a vertical line segment
in a plane rotating around the z-axis of the cephalo-
stat is dependent on the angle of rotation. The pro- a
jected length is alsoaffected by the distancebetween
the rotational axis and the line segment. Vertical line
segmentsplaced 50 mm (solid line)and 100mm(dot- :I:
ter line) from the rotational axis. --l I.S
H
u,
1.4
W
I 1.2
I-
film plane results in deviations from the true per-
Z 1. a I---------;:;o-i-"""i:"-------j
spective and distorts the image registered on o
the film. Knowledge of these basic facts facili- I 13.8
tates the understanding of the geometrical cha- I-
racteristics of the cephalographic image. 19 a.s
Z
W
--l 0.4
Rotation of the model object plane
The distortion effects to be expected when a ~ 13.2
plane is made to rotate around the z-axis of the W
cephalostat (Fig. 2) may be studied by calculat- ~

ing the projections of horizontal and vertical dis-
tances, line segments, onto the film plane.
Consider two horizontal and two vertical line
segments in a plane placed in the cephalostat in
such a way that two line segments coincide with
the y- and z-axis, respectively, and two line seg-
ments are parallel to these axes (Fig. 2a). When
the plane is rotated around the z-axis of the ce-
phalostat (Fig. 2b) the new coordinates for the
endpoints of the line segments in the cephalo-
graphic system, and their projections onto the
film plane, may be calculated using coordinate
transformation (3).
-80 -S0 -40 -20 0 213 40 S0 80
b
ANGLE, degrees
Fig. 4. Horizontal line segmentsrotating around the z-
axis with one endpoint at the origin of the coordinate
system of the cephalostat.
a. The maximum projected length is found when the
line segment is perpendicular to the ray passing
through its endpoint. When the length of the line
segmentincreases, this occurs at successively in-
creasing rotation angles.
b. The projected length of a rotating horizontal line
segment with one endpoint at the origin of the
coordinate system of the cephalostat is depen-
dent on the angle of roation and the length of the
line segment. (Solid line: line segment 50 mm;
dotted line: line segment 100 mm).

103

z
YIP
Y
Fig. 5. Projection of a horizontalline segmentwith one
endpoint at the rotational axis but not coinciding with
the x-y-plane will be affected by divergence of the
beam causing deflection in the image.
The image of a vertical line segment coincid-
ing with the z-axis of the cephalostat and pro-
jected on to the zj-axis of the film will not change
during rotation of the film plane around its zf-
axis. A vertical line segment not coincing with
the z-axis of the cephalostat and the zj-axis of
the film will be registered with varying magnifica-
tion when the film is rotated (Figs 6a and b).
The projected lenght of a horizontal line seg-
ment coinciding with the y-axis of the cephatos-
tat has a minimum value when the film plane is
perpendicular to the ray passing through the
endpoint of the line segment (Figs 7a and b). A

When a horizontal line segment with one end-

point at the origin of the coordinate system of
the cephalostat rotates around the z-axis (Figs
2b and 4a), the image is the projected length of
the perpendicular distance between the end-
point and the central ray. The maximum project-
ed length is found when the line segment is per-
pendicular to the ray of the beam that intercepts
YIP
the endpoint of the line segment. When the a
length of the line segment increases this situa-
tion occurs at successively increasing rotation
angles (Figs 4a and b). The projection of a hori- 1:
zontalline segment with one endpoint on the z-
..J
H
u, 1.6
~
~
axis but not at the origin of the coordinate sys-
tem will, in addition, be influenced by a varying W
:c 1.4
magnification resulting in a deflection of the pro- ~
jected line segment in the image (Fig. 5). De- 1.2
z
pending on the direction of rotation, the line seg-
ment will either be deflected away from the Yf-
axis of the film or toward this axis.
Rotation of the object around the y-axis of the
o
:c
o
Z
I.B

B.B
--
cephalostat causes identical distortion effects. W B.6
..J
However, the effects in the horizontal dimension
• B.4
occur in the vertical dimension and vice versa.
Rotation around the x-axis only of the cepha-
lostat has no effect on image distortion.
..J
W
Q::
~ I I I I

-BS -60 -40 -20 0 20 40 60 B0

Rotation of the film plane
Consider an object plane coinciding with the y-
z-plane of the cephalostat (Fig. 6a). Line seg-
ments are placed on the plane as described
above. When the film is rotated around its axes
new coordinates for the projection of object
points onto the film plane may be calculated us-
ing previously presented expressions (3).
b ANGLE. degrees
Fig. 6.Distortioneffects resultingfroma rotationofthe
film plane was studied by using four line segments
placed in the coordinate system of the cephalostat.
a. The film rotated around its xj-axls.
b. The projected length of vertical line segments po-
sitioned in the y-z-plane; 50 mm (solid line) and
100 mm (dotted line) from the z-axisthe film rotat-
ing around its zj-axis, Maximum and minimum pro-
jected lengths are limited by the size of the film.

104
 Yf~YfP Rotation of the film around its Yt-axis causes
\
Y \
\
identical effects in the image but the effects are
\
\
interchanged between the horizontal and verti-
cal dimensions, respectively.

Translation of the model object plane

Translation of an object plane positioned paral-
lel to the film plane along the x-axis of the ce-
a phalostat causes variations in the magnification
of the projected image. Translation along the y-
and z-axes only causes changes in the position
of the projected image on the film.
L u

...J When the model plane is rotated 90 around

~ 2.2 the z-axis of the cephalostat its orientation coin-
cides with the x-z-plane, The plane will be pro-
W a.a jected onto the film as a line. Starting from this
I
t- 1.B position translation along the y-axis results in an
'z oblique projection of the plane. Due to varying
o 1.S magnification within the plane at different object
I depths, it will appear in the image as a trapezoid.
t- 1.4
t!J
Translation of the film plane
~ 1.2
Translation of the film plane along the x-axis of
...J
1.et------""';::O'.............-------1 the cephalostat causes variations in the magnifi-
...J
cation factor whereas translation parallel to the
w e. B y- and z-axes only affects the position of the pro-
D:: L-1......- ' -.........L--I.......L.-'-..L....IL.....L....L.....L....L...I.........L...I
-89 -69 -49 -29 9 29 49 sa Be jected image on the film.
b
ANGLE, degrees
Translation of the focal spot
Fig. 7.
a. A horizontal line segment coinciding with the y- Translation of the focal spot is analogous to
axis hasits minimum projected lengthon a rotated translation of the object or the film plane.
film when the film is perpendicular to the ray pas-
sing through the endpoint of the line segment.
b. The relative projected length of a horizontal line Combinations of rotation and translation
segment coinciding with the y-axis of the cepha- An unlimited number of combinations of rotation
lostat. The film is rotated around its z--axls. The and/or translation of the object, including all
projectedlengthof two line segments, 50 mm (so-
lid line) and 100 mm (dotted line). The maximum possible positions of its landmarks, as well as
projected length is limited by the size of the film. rotation and/or translation of the different com-
ponents of the cephalographic system may
occur. For practical reasons, it is not possible to
systematically describe all possible combina-
horizontal line segment not coinciding with the tions. Image distortion arising from these combi-
y-axis of the cephalostat will be obliquely pro- nations is the summation of the separate distor-
jected onto the film due to divergence of the tion effects described above. It will be noted that
beam. Depending on the direction of rotation in some cases the effects will be added empha-
around the zj-axis of the film, the projected line sizing image distortion (Fig. 8a), in other cases
will be deflected either away from the Yt-axis or the effects may counteract so that image distor-
towards this axis. This effect is similar to the si- tion due to missalignment of one component in
tuation when the cephalostat/object is rotated the cephalographic system will be compensat-
(c.f. Fig. 5). ed by another (Fig. 8b).

105

I Zo
I I
I YO
I
I
a
I I
- Fig. 9. Orientation in the cephalostat of a cubic object
b
Fig. 8. Distortion effects due to a combination of rota-
tion around the coordinate axes of the cephalostat
and rotation of the film plane. Dashed lines indicate
the plane free of distortion.
a. Rotation around the axes of the cephalostat: x-
axis: 0°, y-axis: _5°, and z-axis: 5°. Rotation around
the film axes: Yt-axis: _5° and zj-axls: 5°. In this
case summation of the distortion effects empha-
sizes the distortion.
b. Rotation around the axes of the cephalostat: x-
axis: 0°, y-axis: _5°, and z-axis: _5°. Rotation
around the film axes: Yt-axis: _5° and zj-axis: 5°. In
this case summation of the distortion effects eli-
minate oneanother.
106
Z
Y
divided into parallel planes.
Rotation and translation of a cube
A cube may be seen as a series of parallel
planes. Consider a cube positioned in the ce-
phalographic system analogous to a series of
the above model object planes (Fig.9). When the
cube is projected onto the film, different magnifi-
cation factors are vaud at different object
depths. The outer contour will be determined by
the size of the plane positioned closest to the
cephalostat, the plane passing through the ori-
gin of the coordinate system will be projected
onto the film with the distortion effects that re-
sult from rotation. Regarding all the other
planes. projectional errors arise as a combina-
tion of rotational and translatory effects. The
complete image of the cube is thus composed of
the sum of the superimposed images of the
planes (Fig. 10).
Regarding rotation around the y-axis, corre-
sponding distortion effects will arise. Rotation
around the x-axis causes rotation of the image
on the film.
Rotation of the film plane
Rotation of the film plane, distorts the image of
the cube in a way that is analogous to the pre-
viously mentioned effects valid for planes.
 Z +5 o -5
Fig. 10. Calculated images of the cubic object. All
combinations of ±So and 0° rotation around the y- and
z-axes are shown.
Rotation and translation of a sphere
Like the cube, the sphere may be seen as a se-
ries of planes, equally spaced in depth. These
planes will have different sizes (Fig. 11). Consid-
er a sphere placed in the cephalographic sys-
tem analogous to the above cube. The series of
planes inside the sphere are perpendicular to
the x-axis. The sphere will be projected onto the
film with the different magnifications of the dif-
z
Zo
Y
Yo
Fig. 11. Orientation in the cephalostat of a spherical
model object divided into parallel planes.
Z +5 o -5
Fig. 12. Calculated images of the spherical model ob-
ject. All combinations of ±So and 0° rotation around
the y- and z-axes are shown.
ferent planes. The outer contour will be deter-
mined by the projection of those rays which are
tangent to the surface of the sphere.
When the sphere is rotated or translated the
planes will be projected with the same distortion
effects as for rectangular object planes. The
projected outer contour of the sphere will be-
come ovoid during rotation or translation but a
marked translation of the center of the sphere is
necessary to make this change in shape per-
ceptible (Fig. 12).
Fig. 13. The image of a spherical object will become
ovoid when the film plane is rotated. However, a
marked rotation of the film plane is necessary to make
this change in shape perceptible. Rotation around the
z-axis is 30°.
107
Rotation of the film plane
When the film is rotated around its Zt- and/or Yt-
axes, the image of the sphere will gradually be-
come ovoid (Fig. 13).
DISCUSSION
In diagnostic radiology knowledge of image dis-
tortion is important for correct interpretation of
image information. The present work deals with
cephalographic projection technique. The prin-
ciple geometric properties presented here are
generally valid for all conventional radiographic
systems where a fixed focal spot and a fixed film
are employed in radiographying non-moving ob-
jects. In spite of the fact that this radiographic
technique is well established, an analysis of the
present kind seems to be lacking. One reason
may be that the basic principles of orthogonal
projection are geometrically and mathematically
trivial and well known. When the possibility of
varying the relations between the different com-
ponents of the system is introduced, however,
heavy mathematical expressions must be em-
ployed in calculating image characteristics. The
number of parameters involved in each solution
is great. Thus, in cephalography the following
variables must be considered:
• translation of the focal spot in space;
• translation of the cephalostat in space;
• translation of the object in space;
• translation of the film in space;
• rotation of the cephalostat around its three
axes;
• rotation of the object around its three axes;
• rotation of the film plane around its two axes;
• focus to object and focus to film distances.
This list includes 22 variables. In fact, the num-
ber of variables is so great that a systematic ana-
lysis of the influence of all of them, including all
possible combinations, is for practical reasons
impossible. A theoretical analysis of the basic
side-effects is still valuable, however.
In cephalometry, angles and distances be-
tween anatomical landmarks are registered. The
values that are obtained provide information
that is when used to determine the choice of
treatment and in evaluating its outcome. Cepha-
lometric data are also used in studies of deve-
108
lopment. Cephalometric measurements are ex-
pected to be precise and accurate. Consequent-
ly, minor image distortion effects may be signi-
ficant. In subsequent articles in this series the
magnitude of these errors will be analysed.
REFERENCES
1. van Aken, J.: Geometrical errors in lateral skull x-
ray projections. Ned Tijdschr Tandheilkd 70:80,
1963.
2. Bergersen, E.: Enlargement and distortion in ce-
phalometric radiography. Compensation tables
for linear measurements. Angle Orthod 50:3,
1980.
3. Eliasson, S., Welander, U. and Ahlqvist, J.: The ce-
phalographic projection. Part I: General concide-
rations. Dentomaxillofac Radiol 11:117, 1982.
4. Hollender, L.: Determining the elements of the in-
terior orientation in roentgenokgraphy. Acta Ra-
diol Suppl. 230, 1964.
5. Slagsvold, O. and Pedersen, K.: Gonial angle dis-
tortion in lateral head films: A methodologic study.
Am J Orthod 71 :554, 1971.
6. Slama, Ch.C. (ed.): Manual of photogrammetry.
Am Soc Photogram, Falls Church, Va. 1980.
APPENDIX
The expressions presented in Part I of this series were
derived and used according to international mathe-
matical standards.
To avoid a direction of the y-axis of the coordinate
system not commonly applied by the dental profes-
sion, the y-axis was given the opposite direction in the
illustrations.
Regrettably, the expressions for rotation around the
y-axes of the ceonatostat/obiect and the film were not
changed accordingly. However, the expressions are
valid when the directions of the y-axes are changed,
or when the angle of rotation around the y-axes, 41 and
c, change signs.
z z
x
Address:
Dr. Jan Ahlqvist
Dept. of Oral Radiology
University of Urnea
S-901 87 UmealSweden