Optimising for the Unknown: Domain Alignment for Cephalometric Landmark Detection

Manual cephalometric landmark annotation is important for craniofacial assessment but is labor-intensive and difficult to scale. We introduce CephViT, a Vision Transformer-based model for automated 2D lateral cephalometric landmark localization, and evaluate its use in downstream skeletal malocclusion classification. CephViT was trained and benchmarked on a public lateral cephalogram dataset, achieving a mean radial error of 1.28 +/- 1.42 mm and a successful detection rate of 92.0% at 3.0 mm. Because the private evaluation cohort consisted of 3D CBCT scans, lateral cephalogram-like digitally reconstructed radiographs (DRRs) were generated from each volume and used as 2D inputs to the landmark localization model. Landmark coordinates were normalized into a common coordinate frame, and skeletal malocclusion classification was performed using landmarks shared between the reference and DRR-based pipelines. Classification performance using DRR-localized landmarks was comparable to that obtained using manually annotated reference landmarks, with accuracies of 70.0% and 68.3%, respectively. These results support the feasibility of automated cephalometric analysis on CBCT-derived DRRs for skeletal malocclusion assessment.

Although advancements in face landmark detection (FLD) methods continue to push performance boundaries, they overlook two major functional limitations: (1) different network parameters need to be trained independently for each $N$-point'' benchmark dataset, and (2) a model trained on an $N$-point'' dataset reliably outputs only the $N$ landmarks. In our work, we first conceptualize Face Part-Anchored Landmark Positions (FPALPs), wherein each landmark is treated as a progression value between zero (start) and one (end) along a face part's contour. Every landmark can be expressed in the FPALP format, irrespective of its source dataset, hence unlocking the ability to unify all $N$-point'' datasets into a single dataset. Secondly, we represent each landmark with an FPALP-based query, refine it progressively with a cross-modality decoder, and predict its coordinates based on the final representation. Our approach, called Unified Dynamic FLD, embodies these two design choices and streamlines the landmark detection pipeline by enabling (1) a single model to learn on any number of $N$-point'' datasets, and (2) yield any number of specific landmark predictions by loading the designated landmark queries at runtime. Extensive experiments on multiple benchmark datasets show that our method delivers these benefits while remaining competitive with, and in several cases outperforming existing state-of-the-art methods.

Anatomical landmark detection is a fundamental task in medical image analysis supporting a wide range of diagnostic and interventional workflows. Although recent methods have achieved sub-millimetric localisation, accuracy alone is not sufficient for clinical deployment, requiring reliability and robustness in prediction. Despite its clinical relevance, the impact of representation learning in this context is still underexplored. In this work, we introduce CDPM-align, a multi-scale guidance-aligned conditional diffusion pre-training for anatomical landmark detection. Our experimental setup focuses on a few images and a few annotation regimes. Specifically, we employ three popular heterogeneous small-scale benchmark datasets for representation learning via conditional generative pre-training. Furthermore, we consider low-annotation scenarios for the downstream task of landmark detection, with 10 and 25 annotated images, reflecting realistic trade-offs between clinical effort and resource constraints for annotations. Our results confirm that generative pre-training enables the model to learn a robust representation. This improves both accuracy and uncertainty on the downstream tasks, advancing towards safe and efficient clinical deployment.