The reliability of head film measurements. 3. Tracing superimposition.

The superimposition of tracings from lateral skull x-ray films taken at different timepoints is an important method for assessing developmental and treatment changes through time. The usefulness of the data derived is, however, limited by the fact that the physical act of superimposing tracings is performed with some error. The magnitudes of error for superimpositions on different "planes" have not been amenable to quantitation by previously available methods. Using newly developed computer-aided techniques, we have been able to quantitate both the primary errors of tracing superimposition and the associated secondary landmark displacements for four conventionally employed anatomic reference "planes". For each reference "plane," twenty-five independent film pairs were examined independently by each of four judges. Therefore, 100 acts of tracing superimposition were available for each reference "plane." Output data are presented which appear to support the conclusion that measurement errors in tracing superimposition are a consequential factor affecting the confidence which should be placed in head film comparisons, particularly with regard to individual cases. Some consequences of this conclusion with respect to growth prediction and to the evaluation of treatment effects are considered.