Martin, KimKimMartinKatsaros, ChristosChristosKatsarosBrylka, RobertRobertBrylkaSchwanecke, UlrichUlrichSchwaneckeSchulze, RalfRalfSchulze0000-0002-7880-00462025-03-312025-03-312025-03-17https://boris-portal.unibe.ch/handle/20.500.12422/207733Background The aim of this study was to investigate the effect of defined head-motion during x-ray exposure on the identification accuracy of typical cephalometric reference points which form the basis of treatment planning.Methods By means of a dry adult human skull and a precise motion simulation system digital Cephs are acquired while certain predefined movement patterns (shift, tilt and nodding with a motion amplitude from 5 - 50 mm) of the skull were executed. They represent the movements of children and adolescents, the main group for cephalometric radiographs.The scanning time was 9.4 s per Ceph. 10 typical landmark points of cephalometric analysis were identified by 20 observers on each Ceph twice. Using a non-motion image (Ceph0) as reference, displacement was computed as vectors relative to this image. Commonly used angles and vertical and horizontal distances were calculated.Results Both inter-rater as well as intra-rater-reproducibility were perfect. There was very little change in the vertical distance N-Me, in contrast to the horizontal distance S-N which showed a large variation. So patient motion parallel to the scanning direction of the fan-beam-detector unit, heavily influence distances parallel to this direction. The ANB angle and the Maxillo-Mandibular Plane Angle (ANS-PNS to Me-Go) only varied by about 1-2°, but large enough to greatly influence a treatment plan.Conclusions The study observed a severe influence on reference point location of motion patterns parallel to the scanning direction and also on clinically relevant distances parallel to the scanning direction. Therefore, we recommend to use a horizontal scanning direction, to minimise scanning time to a minimum, or to prefer a one-shot technique if possible. Future advancements in this field may include the integration of artificial intelligence or algorithms for the purpose of motion correction.enCephalometric analysisDiagnostic imagingDigital cephalometric radiographyHead movementScanning technique600 - Technology::610 - Medicine & healtharticle10.48620/868434009800410.1186/s13005-025-00491-z