Quality of film-based and digital panoramic radiography

OBJECTIVES: To compare the image quality of panoramic radiographs obtained with storage phosphor plate and screen-film systems. METHODS: Panoramic radiographs were taken in 60 patients both with film and with a storage phosphor plate system (30 with DenOptix (Dentsply/Gendex) and 30 with Digora PCT). The images were obtained with either the Cranex Tome or the Scanora multimodal X-ray unit. The screen-film combination was Lanex medium/Curix Ortho HT-G. The digital images were displayed as 8-bit images with a 300 dpi resolution on a 19" monitor and the film images were placed on a light box adjacent to the screen. Ten observers evaluated diagnostic image quality by means of visual grading analysis of different anatomical structures. The structures were scored as being visualized much better (5), better (4), equal (3), worse (2) or much worse (1) in the digital images than in the film images. The mean number of patients receiving the different scores was calculated. Statistical methods used were Wilcoxon sign rank test and Mann-Whitney test. RESULTS: On average, visualization was equal in 19 of the 30 patients imaged using Digora PCT; in 10 it was worse. The corresponding values for DenOptix were 20 and 9. The difference between the film-based and the digital images was small but statistically significant (P<0.0001). The difference between the two image plate systems was not statistically significant (P>/=0.17). CONCLUSIONS: It was concluded that digital panoramic radiographs are equivalent to film-based images for most purposes.