Objective: This study aimed to evaluate agreement among three methods for cervical vertebral maturation (CVM) assessment, comprising direct viewing, tracing only, and tracing with digitized points.
Material and Method: Two examiners received training and tests of reliability with each CVM method before evaluation of
agreement among methods. The subjects were 96 female-cleft lateral cephalometric radiographs (films of eight subjects for
each age ranged from seven to 18 years). The examiners interpreted CVM stages of the subjects with four-week interval
between uses of each method.
Results: The range of weighted kappa values for paired comparisons among the three methods were: 0.96-0.98 for direct viewing and tracing only comparison; 0.93-0.94 for direct viewing and tracing with digitized points comparison; and 0.96-
0.97 for tracing only and tracing with digitized points comparison. The intraclass correlation coefficient (ICC) value among the three methods was 0.95. These results indicated very good agreement among methods.
Conclusion: Use of direct viewing is suitable for CVM assessment without spending more time for tracing. However, the three methods might be used interchangeably.

Keywords: Agreement, Cervical vertebral maturation, Tracing, Direct viewing