READERS' FORUM
Letters to the editor*
Evaluating airway volume with CBCT
W ith interest, we read the Techno Bytes article on
analyzing airway volume by using cone-beam
computed tomography (CBCT) in the May 2012 issue
of the AJO-DO.1 The authors used the data from
CBCT scans to obtain resin-negative prototypes of the
airway. The resin prototypes were scanned again in
CBCT, and the airway volumes of the prototypes were
measured with Dolphin software with different threshold
values. These Dolphin measurements were then com-
pared with the physical volumes of the prototypes to lo-
cate the most appropriate threshold value to use in the
Dolphin software for airway volume measurement.
However, we have the following concerns about this
study.
1. The prepared negative prototypes were expected to
mimic the soft tissues surrounding the airway. To
enhance the contrast to the air, resin materials
were used to print the negative prototypes. How-
ever, resin materials have a much higher density
than the soft tissues; this might lead to a higher
threshold value setting in the software. Conse-
quently, the threshold value suitable for resin proto-
type measurements might not be comfortably
applied directly to the measurement of the in-vivo
2.
CBCT scan.
The authors’ choice of the 8 threshold values in the
Dolphin software was made by referring to previous
research. However, unlike conventional computed
tomography, the tube voltage varies widely among
different CBCT devices. Therefore, the computed
tomography values of the same tissue can have sig-
nificant deviations when scanned by different CBCT
machines.2 In addition, voxel size and artifacts
might also affect the accuracy of the CBCT im-
ages.3,4 Thus, the threshold values chosen in the
Dolphin software might have little comparability
when it comes to different CBCT machines and
different scan parameters.
We recommend that the authors use a wax
material for the prototype to simulate the in-vitro
conditions, because wax has a similar density to the
soft tissues.
*The viewpoints expressed are solely those of the author(s) and do not reflect
those of the editor(s), publisher(s), or Association.
284
Niansong Ye
Jingtao Li
Wenli Lai
Chengdu, China
Am J Orthod Dentofacial Orthop 2012;142:284
0889-5406/$36.00
Copyright Ó 2012 by the American Association of Orthodontists.
http://dx.doi.org/10.1016/j.ajodo.2012.07.002
REFERENCES
1. Alves M Jr, Baratieri C, Mattos CT, Brunetto D, Fontes RC,
Santos JRL, Ruellas AC. Is the airway volume being correctly
analyzed? Am J Orthod Dentofacial Orthop 2012;141:657-61.
2. Ma X, Zhang Z. Clinical application of oral & maxillofacial cone
beam computed tomography. Beijing, China: People's Medical Pub-
lishing House; 2011.
3. Damstra J, Fourie Z, Huddleston Slater JJ, Ren Y. Accuracy of linear
measurements from cone-beam computed tomography-derived
surface models of different voxel sizes. Am J Orthod Dentofacial Or-
thop 2010;137:16.e1-6.
4. Baumgaertel S, Palomo JM, Palomo L, Hans MG. Reliability and ac-
curacy of cone-beam computed tomography dental measurements.
Am J Orthod Dentofacial Orthop 2009;136:19-28.
Authors' response
W e appreciate the interest of Drs Ye, Li, and Lai in the
controversial topic of airway volume assessment
with CBCT. Below are our responses to their questions.
The aim of our study was the comparison between
the scanned and actual volumes from the prototype air-
way. The choice of a negative prototype to create an air-
way model was because the Dolphin software only
allows the volume measurement of empty areas. We
did not expect to mimic the soft tissues surrounding
the airway.
We did not intend to establish a protocol for airway
assessment but to determine the most accurate thresh-
old for airway volume calculation with specific experi-
mental conditions. So, it was not our objective to
extend our results to the measurement of in-vivo
CBCT scans but to raise the question of the great differ-
ence that can arise from volume calculations with differ-
ent thresholds. Unfortunately, it is not possible to do this
research in humans.
The description of the scan protocol (milliamperes,
kilovolts) used by CBCT machines is important in studies
that evaluate airway volume. Several studies have evalu-
ated airway volumes with different CBCT machines.1-12