Scanning resolution and the detection of approximal caries.

OBJECTIVE: To determine a proper scanning resolution for digitizing bitewing radiographs in the detection of approximal caries. METHODS: Fifty-two premolars and 48 molars were mounted in blocks and imaged on conventional film (Ektaspeed Plus, Eastman-Kodak, Rochester, NY USA) simulating a bitewing projection. The 15 bitewing radiographs were then scanned with a flatbed scanner at three resolutions 150, 300 and 600 d.p.i. The digitized images were displayed in random order on a high-resolution cathode ray tube monitor. Ten observers assessed the caries status of 200 approximal surfaces. They scored lesion presence on a 5-point confidence scale and depth on a 3-point scale. The observer's scores were compared with the results from a histological examination. Data were analysed using analysis of variance, by calculating signed observer error, absolute observer error and observer confidence. RESULTS: Lesion depth had a significant effect on confidence of lesion recognition. The main effect of resolution and the interaction between resolution and lesion depth were significant. Pair-wise comparison showed a significant difference between resolutions in case of sound surfaces and surfaces with dentinal lesions for absolute error. The confidence increased as the resolution increased but no significant difference was found between 300 and 600 d.p.i. The best score for depth estimation was obtained at the 300 d.p.i. scanning resolution. CONCLUSIONS: When bitewing radiographs are scanned with a flatbed scanner, a resolution of 300 d.p.i. seems the best choice. At this resolution the digital file size is manageable without significant loss of the information necessary for caries diagnosis.     

Influence of film fog on radiographic caries diagnosis

Increasing film speed may potentially jeopardize diagnostic quality because of a more rapid build up of fog and an ensuing decrease in image contrast. A standardized amount of fog was simulated by pre-exposing E-speed dental films before use to obtain images of extracted teeth with and without approximal caries. Three experiments were performed. In the first, no effort was made to compensate for the increased density caused by fog. In the other two, density was kept constant by reducing exposure and developing time respectively. Nine dentists recorded the presence and absence of caries using a rating scale to indicate diagnostic confidence. As a measure of diagnostic accuracy, the area under the binormal ROC curve was used and the values averaged across observers. The results showed that fog, up to a level of base plus fog of 0.6 optical density units, had no influence on the diagnostic accuracy in the absence of any compensation. When exposure was lowered to compensate for the increased density, significantly lower diagnostic accuracy was found. On the other hand, when developing time was decreased, no significant difference was found. Observers ranked radiographs with higher levels of fog as being of lower quality. However, no significant correlation was found between subjective ranking of image quality and diagnostic accuracy obtained from the same radiographs. It is concluded that relatively high levels of fog do not exert a negative influence on approximal caries diagnosis and no attempt should therefore be made to compensate for the increased density.     

The effect of developer age on the detection of approximal caries using three dental films.

OBJECTIVES: To compare the diagnostic accuracy for the detection of approximal caries of three dental X-ray films using fresh and aged processing chemicals. METHODS: Fifty-six extracted unrestored premolars were radiographed under standardized conditions using the new Dentus M2 (Agfa-Gevaert, Mortsel, Belgium), Ektaspeed Plus and Ultra-speed (Kodak Eastman Co, Rochester, USA) dental films. The films were processed manually using Agfa chemicals (Heraeus Kulzer, Dormagen, Germany). The procedure was repeated once a week until the complete exhaustion of the chemicals (6 weeks). Three independent observers assessed 210 radiographs using the following rating scale: 0 = sound, 1 = enamel lesion; 2 = lesion reaching the ADJ; 3 = dentinal lesion. True caries depth was determined by histological examination (14 sound surfaces, 11 enamel lesions, eight lesions reaching the ADJ and 23 dentinal lesions). True caries depth was subtracted from the values given by the observers and an analysis of variance was performed. The null hypothesis was rejected when P < 0.05. RESULTS: No significant differences were found in the diagnostic accuracy between the three films when using chemicals of up to 3 weeks old (P = 0.056). After the third week, Ultra-speed was significantly better than the other two films (P = 0.012). On average caries depth was underestimated. CONCLUSION: A similar level of diagnostic accuracy for approximal caries is achieved when using the three films. Dentus M2 and Ektaspeed Plus are at present the fastest available films and they should therefore be recommended for clinical practice. Agfa chemicals should be renewed every 3 weeks. Fifty per cent reduction in average gradient is indicative of renewing processing chemicals.     

Comparison of digital systems and conventional dental film for the detection of approximal enamel caries

Objectives

The aims of this study were (1) to compare the accuracy of the detection of approximal enamel caries lesions using three intraoral storage phosphor plate digital systems and one conventional film-based radiographic system; and (2) to determine whether there is a correlation between the histological and radiographic measurements of enamel caries.

Methods

160 approximal surfaces were radiographed under standardized conditions using three storage phosphor stimulable systems (DenOptix and Digora FMX with white and blue plates), and one film system (Insight film). 17 observers scored the images for the presence and depth of caries using a 4-point scale. The presence of caries was validated histologically (gold standard). Two-way analysis of variance was used to test the differences in sensitivity, specificity and overall accuracy (TP + TN). The data from the radiographic and histological measurements were statistically analysed by Spearman’s rank correlation coefficient.

Results

Two-way analysis of variance and the post hoc t-test demonstrated that Digora (white plate) had higher specificity and overall accuracy values than DenOptix (P = 0.021); there was no statistically significant difference among the other imaging modalities (P > 0.05). There was no significant correlation between the histological depth measurements and the radiographic measurements from Digora (blue plate) (P = 0.43), Digora (white plate) (P = 0.15), DenOptix (P = 0.17) and Insight film (P = 0.06).

Conclusions

The results suggest that (1) the performance of the three storage phosphor image plate systems was similar to that of the Insight film for detection of approximal enamel caries, and (2) the increase in histological depth of enamel caries was not significantly correlated with radiographic measurements.     

Radiographic detection of approximal caries: a comparison of dental films and digital imaging systems

OBJECTIVES: To compare the diagnostic accuracy for the detection of approximal caries of two dental X-ray films, two CCD-based digital systems and two storage phosphor (SP) digital systems. METHODS: Fifty-six surfaces in 56 extracted unrestored premolars were radiographed under standardised conditions using two E-speed dental film, Ektaspeed Plus (Eastman Kodak Co, Rochester, NY, USA) and Dentus M2 Comfort (Agfa-Gevaert, Mortsel, Belgium), two CCD systems, Sidexis (Sirona, Bensheim, Germany) and Visualix (Gendex, Milan, Italy) and two SP systems, Digora (Soredex, Helsinki, Finland) and DenOptix (Gendex, Milano, Italy). The images were assessed by eight observers (four radiologists and four general practitioners). True caries depth was determined by histological examination. True caries depth was subtracted from the values given by the observers and an analysis of variance was performed. The null hypothesis was rejected when P < 0.05. RESULTS: No significant differences were found in diagnostic accuracy with the two dental films and the Sidexis and Digora systems. The depth of the lesion significantly affected observer performance. Caries depth was underestimated. Radiologists performed significantly better than general practitioners whatever the recording system. CONCLUSION: The diagnostic accuracy of digital systems is comparable with that of dental films. The ability of dentists to recognise caries correctly is the main factor contributing to variation in radiographic diagnosis and not the imaging modality.     

The effect of the number of iterative restorations on tuned aperture computed tomography for approximal caries detection

OBJECTIVES: To determine whether the number of iterative restorations performed on TACT images affects observers' ability to detect dental caries. METHODS: Eight TACT basis images of 40 extracted human posterior teeth were acquired using a CCD sensor. TACT slices of each tooth were generated and subsequently submitted to 1, 2 or 3 iterative restorations. Stacks of images from the three experimental conditions were presented to six observers in a balanced order, on a high-resolution 21' color monitor. Observers scored the presence or absence of approximal caries using a 5-point confidence scale. Observers' assessments were compared with the results of histological examination. Receiver operating characteristic (ROC) curves were generated and possible significant differences between observers and between modalities tested by ANOVA. The level of significance was set at alpha=0.05. Interobserver reliability was calculated as intraclass correlation. RESULTS: Mean areas under the ROC curves (A(z)) for the three experimental conditions were 0.791 (one iterative restoration), 0.81 (two iterative restorations), and 0.778 (three iterative restorations). ANOVA did not demonstrate any significant difference between modalities (P=0.25) but did so between observers (P=0.031). Interobserver reliability was similar for all experimental conditions tested. CONCLUSIONS: Varying the number of iterative restorations from one to three does not affect observers' ability to detect approximal caries with TACT slices.     

Influence of different developing solutions and developing times on radiographic caries diagnosis

One hundred extracted premolars were radiographed under standardized conditions with D- and E-speed films. The films were developed with conventional and rapid processors using varying developing times. The influence of different developers and developing times on the diagnostic accuracy of radiographic caries diagnosis was evaluated with the aid of ROC technique. Rapid processing using the developing time recommended by the manufacturer led to a lower density and contrast compared with the conventional developer. Underdeveloped films using the rapid processors resulted in an unacceptable low level of diagnostic accuracy, but otherwise it was the same for all developers, developing times and both types of film.     

In vitro comparison of conventional film and direct digital imaging in the detection of approximal caries

OBJECTIVES: To compare the diagnostic accuracy of conventional film, unenhanced direct digital and inversion grayscale direct digital imaging in the detection of approximal caries. METHODS: 150 approximal surfaces of extracted permanent molars and premolars were selected for the study on the basis of varying lesion depth. The teeth were radiographed using Ektaspeed Plus film; digital images were made with a Schick CMOS-APS sensor. 7 examiners evaluated 58 randomized images of each modality. Histological sectioning of the teeth was used to verify the presence and extent of decay. RESULTS: No significant difference was found between the diagnostic accuracies of the three imaging modalities (P=0.226). Analysis of the diagnostic accuracy of the three modalities on lesion depth showed no statistically significant interaction; however, the main effect of the lesion depth was significant (P<0.001, eta(2)=0.936). CONCLUSIONS: The overall diagnostic accuracy of the three modalities in the detection of approximal carious lesions was comparable. All three modalities performed poorly in the detection of enamel lesions.     

The influence of amalgam fillings on the detection of approximal caries by cone beam CT: in vitro study

Objectives:

The aim of this CBCT investigation on the detection of caries was to assess the influence of artefacts produced by the presence of amalgam fillings located in the vicinity.

Methods:

102 non-cavitated pre-molar and molar teeth were placed in blocks of silicone with approximal contacts consisting of 3 sound or carious teeth and 1 mesial–occlusal–distal amalgam-filled tooth in-between. Radiographs of all the teeth were recorded using the CBCT system (NewTom™ 3G; QR Srl, Verona, Italy; field of view, 9 inches). Data from the CBCT unit were reconstructed and sectioned in the mesiodistal tooth plane. Images were evaluated twice by two observers, using a five-step confidence scale. After the CBCT examination, the teeth were individually sectioned in the mesiodistal direction with a diamond saw. Using a light microscope at ×40 magnification, the true morphological status of all approximal surfaces was established.

Results:

Sensitivity of the CBCT for the detection of caries on surfaces located proximally and distally to an amalgam filing ranged from 0.27 to 0.30 for enamel and from 0.47 to 0.56 for dentin. Specificity values for enamel proximal and distal lesions were 0.48 and 0.53, respectively, for enamel and 0.33 to 0.38, respectively, for proximal and distal dentin cases. Intra-observer reliability was 0.84, and interobserver reliability was 0.49.

Conclusions:

Owing to its low specificity, scans from a CBCT examination should not be used to determine the presence of demineralization of the tooth surface when amalgam fillings are present in the region of interest.     

Evaluation of two imaging techniques: near-infrared transillumination and dental radiographs for the detection of early approximal enamel caries

Objectives

The aim of this paper was to evaluate a transillumination (TI) system using near-infrared (NIR) light and bitewing radiographs for the detection of early approximal enamel caries lesions.

Methods

Mesiodistal sections of teeth (n = 14) were cut with various thicknesses from 1.5 mm to 4.75 mm. Both sides of each section were included, 17 approximal surfaces with natural enamel caries and 11 surfaces considered intact. The approximal surfaces were illuminated by NIR light and X-ray. Captured images were analysed by two calibrated specialists in radiology, and re-analysed after 6 months using stereomicroscope images as a gold standard.

Results

The interexaminer reliability (Kappa test statistic) for the NIR TI technique showed moderate agreement on first (0.55) and second (0.48) evaluation, and low agreement for bitewing radiographs on first (0.26) and second (0.32) evaluation. In terms of accuracy, the sensitivity for the NIR TI system was 0.88 and the specificity was 0.72. For the bitewing radiographs the sensitivity ranged from 0.35 to 0.53 and the specificity ranged from 0.50 to 0.72.

Conclusion

In the same samples and conditions tested, NIR TI images showed reliability and the enamel caries surfaces were better identified than on dental radiographs.     

Effect of ambient light and monitor brightness and contrast settings on the detection of approximal caries in digital radiographs: an in vitro study

OBJECTIVES: The aim of this study was to investigate how brightness and contrast settings of the display monitor and ambient light level (illuminance) in the viewing room affect the clinician's ability to diagnose carious lesions in digital radiographs. METHODS: Standardized radiographs were taken of 100 extracted teeth. Seven observers evaluated the images for approximal carious lesions twice, once under 50 lux and once under 1000 lux room illumination. Monitor brightness and contrast were varied +/-50% and +/-6%, respectively, to mimic the normal limits of monitor adjustment by an inexperienced user and one optimal setting. This was done by adjusting radiograph brightness and contrast by +/-25%. Thus, five radiographs of each tooth were evaluated. Receiver operating characteristic (ROC) analyses were performed. Histological examinations of the teeth served as the criterion standard. A paired t-test was used to evaluate whether differences in the areas under the ROC curves were significant and kappa was used to evaluate intraobserver agreement. RESULTS: When a monitor with optimal brightness and contrast settings was used to detect approximal carious lesions, ambient light levels less than 50 lux were significantly better than levels above 1000 lux (dentin and enamel lesions, P < 0.01; dentin lesions, P < 0.02). Increasing the contrast setting of the monitor by 6% did not change these results; 50 lux was still significantly better than 1000 lux (enamel lesions, P < 0.01; dentin and enamel lesions, P < 0.02) for evaluating radiographs. Intraobserver agreement differed from fair to good. CONCLUSIONS: Reducing ambient light to less than 50 lux significantly increased the accuracy of diagnosing approximal carious lesions on a monitor with an optimal brightness setting and an optimal or slightly higher than optimal contrast setting.     

Accuracy of radiographic caries diagnosis using different X-ray generators

Dental X-ray machines utilizing five different combinations of X-ray generators and tube voltages (Philips Oralix 65 kV, Siemens Heliodent EC 60 kV, Siemens Heliodent 70 kV, Soredex Minray DC 60 kV and Soredex Minray DC 70 kV) were compared with respect to the accuracy of radiographic diagnosis of proximal caries. Nine observers diagnosed proximal caries in radiographs of extracted premolars. The findings of the observers were compared to the actual presence or absence of caries. The ROC-curve technique was used to evaluate differences in diagnostic accuracy between the X-ray machines. The results showed small differences in diagnostic accuracy between the different X-ray generators but they proved to be statistically non-significant.     

Fractal-feature distance analysis of radiographic image

RATIONALE AND OBJECTIVES: We have conducted a fractal analysis of low-dose digital chest phantom radiographs and evaluated the relationship between the fractal-feature distance and the tube current-exposure time product. MATERIALS AND METHODS: Chest phantom radiographs were obtained at various mAs values (0.5-4.0 mAs) and 140 kVp with a computed radiography system, and the reference images were acquired at 13 mAs. The lung field images were converted to binary images after processing them using the rolling-ball technique; a fractal analysis was conducted using the box-counting method for these binary images. The fractal-feature distances between the low-dose and reference images were calculated using the fractal dimension and the complexity. RESULTS: For all binary images of lung fields, the relationship between the length of the square boxes and the number of boxes needed to cover the positive pixels of the binary image was linear on a log-log scale (r > or = 0.99). For mAs > or = 3.0, the fractal-feature distances were almost constant, whereas for mAs < or = 2.5, they increased depending on the reduction in mAs values. CONCLUSION: We have shown that a binary image of the lung field obtained from a chest phantom radiograph can be analyzed by the box-counting method and that its fractal-feature distance grows as the radiation dose declines.     

计算机X线摄影图像的静止滤线栅伪影分析

目的通过分析计算机X线摄影（CR）系统的采样频率和栅密度频率，提出尽可能有效避免滤线栅伪影出现的抑制方法。方法实际测试不同栅密度的滤线栅与不同规格的成像板（IP）匹配使用，得到不同效果的图像；模拟2种信号频率（即2种栅密度的滤线栅），采用3种采样频率[6、8、10图像空间分辨率（pixels／mm）]，得到不同的模拟图像效果。结果通过对比分析模拟图和实际图像，发现在采样频率正好等于信号频率的2倍时，可以得到正确的信号频率，图像清晰，无混淆现象。栅密度〈4LP／mm时，可较好地与14in×14in、10in×12in（1in=2．54cm）IP匹配使用。结论CR系统与普通IP匹配使用合适的采样频率和栅密度频率，可以有效避免滤线栅伪影出现。     

Comparison of standard and task-specific enhancement of Digora storage phosphor images for approximal caries diagnosis

OBJECTIVES: To compare approximal caries detection on Digora storage phosphor images pre-enhanced with the automatic "caries-specific Oslo enhancement procedure" ("Oslo-enhanced" method) and storage phosphor images individually enhanced by observers particularly experienced in digital imaging using standard brightness and contrast functions of the Digora system ("Digora-enhanced" method). METHODS: Seven staff members from four oral radiology departments rated 240 approximal surfaces for caries with regard to lesion depth in the inner and outer half of the enamel and dentine, using a 5-point confidence scale. The observations were validated histologically. A receiver operating characteristic (ROC) analysis and an analysis of variance with three dependent variables (observer confidence, observer signed error and observer absolute error) were performed. RESULTS: The most evident difference between the methods as elucidated by the ROC analysis was the highly significant smaller interobserver and intraobserver variance with the Oslo-enhanced method for all but one observer. The methods were not different with regard to average diagnostic accuracy (A(z) values) as tested with paired t-tests, and there was no correlation between A(z) across methods. The method and lesion main effects, as well as the lesion by method interaction effect, were multivariately significant (P<0.001) in favour of the Oslo-enhanced method. On a univariate level, the method main effect was not significant for the absolute observer error (P=0.330). All other univariate effects were significant (P<0.001). CONCLUSIONS: The accuracy of approximal caries detection with Digora storage phosphor images pre-enhanced and images individually enhanced was similar, but interobserver and intraobserver variability improved with the Oslo-enhanced method. Since image manipulation is not performed with the Oslo-enhanced method, the increased speed of the diagnostic procedure combined with the improved observer variability would probably be even more pronounced for the general dental practitioner.     

Detection accuracy of in vitro approximal caries by cone beam computed tomography images

Aims

To evaluate the diagnostic accuracy of approximal carious lesions among five CBCT systems and to assess the effect of detector types employed by different CBCT systems on the accuracy of approximal caries diagnosis.

Materials and methods

Thirty-nine extracted non-cavitated human permanent teeth were employed in the study. Seven observers evaluated 78 approximal surfaces of the teeth with respect to caries by the images from the following five CBCT systems: (1) NewTom 9000; (2) Accuitomo 3DX; (3) Kodak 9000 3D; (4) ProMax 3D; and (5) DCT PRO, respectively. The lesions were validated by histological examination. The area under receiver operating characteristic (ROC) curve (A_z) was used to evaluate the diagnostic accuracy.

Results

Microscopy of approximal surfaces found 47.4% sound, 39.8% enamel and 12.8% dentin lesions. The differences of A_z values among the five CBCT systems were not statistically significant (p = 0.348). No significant difference was found between the two detector types of CBCT systems (p = 0.47).

Conclusions

The five CBCT systems employed in the study showed no significant difference in the in vitro approximal caries detection. Neither the detector nor the FOV employed by the CBCT systems has an impact on the detection accuracy of approximal caries.     

Influence of radiographic contrast media on phagocytosis

To evaluate the influence of radiographic contrast media (CM) on human polymorphonuclear leucocytes (PML), the ability of these cells to ingest latex particles after in vitro exposure to five different radiographic contrast media was investigated. All CM inhibited the phagocytic properties of PML. The inhibition was dose dependent. The inhibitory effect was partly due to hyperosmolality but CM specific inhibition was also evident.