Quality of individually calibrated customary printers for assessment of typical dental diagnoses on glossy paper prints: a multicenter pilot study

Printed radiographs--is what you see what you get?

Digital dental radiography allows for exchange of images between primary and secondary care. However, it is common practice for radiographs to be printed out and attached to referrals.This study investigates the loss of diagnostic information of printed radiographs compared to the on-screen digital image.The best quality was achieved with images printed onto radiographic film or onto photographic paper with an inkjet printer. Laser and inkjet printer output onto 80 gsm office paper resulted in a loss of diagnostic information. Wherever possible, radiographs should be transmitted digitally between clinicians to maintain image integrity.

CLINICAL RELEVANCE

This paper illustrates the potential pitfalls of printing radiographs to be sent with referrals.

Quantitative pixel grey measurement of the "high-risk" sign, darkening of third molar roots: a pilot study

OBJECTIVES

Our aim was to examine the panoramic darkening of the root, which is a "high-risk" sign, using quantitative measurements of pixel grey values to determine different aetiological backgrounds, namely inferior alveolar nerve (IAN) exposure with or without groove formation of the third molar roots or thinning/fenestration of the lingual cortex (LCTF).

METHODS

38 impacted third molars that had been surgically removed and had darkened roots on panoramic radiographs were included in this retrospective case-control study. 15 IAN exposure cases were selected for the case group, and 23 cases with proven lingual cortical thinning or fenestration were chosen for the control group. The mean pixel grey values of selected areas in the dark band (D) and control areas within the same roots (R) were determined with the ImageTool (University of Texas Health Science Center, San Antonio, TX) software. The differences in pixel values (R-D) of the IAN and LCTF groups were analysed using the Mann-Whitney U-test and Pearson's χ(2) test.

RESULTS

The medians of the R-D pixel values were 45.7 in the IAN group and 34.3 in the LCTF group, whereas the interquartile ranges were 12.0 (IAN) and 18.3 (LCTF) (p < 0.001). The R-D critical value at which the outcomes differed significantly was 38. If the differences in pixel grey values (R-D) were higher than 38, the chance of IAN exposure was approximately 32 times higher than the chance of LCTF (χ(2) test, p < 0.001; odds ratio, 32.0; 95% confidence interval, 3.5-293.1).

CONCLUSIONS

The pre-operative prediction of IAN exposure or lingual cortical thinning in cases with "darkening" is possible based on pixel grey measurements of digital panoramic radiographs.

Ink-jet printout of radiographs on transparent film and glossy paper versus monitor display: an ROC analysis

The aim of this study was to compare the depiction ability of small grayscale contrasts in ink-jet printouts of digital radiographs on different print media with CRT monitor. A CCD-based digital cephalometric image of a stepless aluminum wedge containing 50 bur holes of different depth was cut into 100 isometric images. Each image was printed on glossy paper and on transparent film by means of a high-resolution desktop inkjet printer at specific settings. The printed images were viewed under standardized conditions, and the perceptibility of the bur holes was evaluated and compared to the perceptibility on a 17-in CRT monitor. Thirty observers stated their blinded decision on a five-point confidence scale. Areas (Az) under receiver operating characteristics curves were calculated and compared using the pair wise sign tests. Overall agreement was estimated using Cohen's kappa device and observer bias using McNemar's test. Glossy paper prints and monitor display revealed significantly higher (P < 0.001) average Az values (0.83) compared to prints on transparent film (0.79), which was caused by higher sensitivity. Specificity was similar for all modalities. The sensitivity was dependent on the mean gray scale values for the transparent film.

Work flow with digital intraoral radiography: a systematic review

OBJECTIVE

This systematic review evaluates the six most frequently emphasized advantages of working with digital radiography: less working time, lower radiation dose to the patient, fewer retakes and errors, wider dynamic range, easier access to patient information and easier image storage and communication. Moreover, some clinical aspects and possible disadvantages of digital imaging that were not foreseen at the beginning of the digital era, such as patient discomfort, damage to the receptor, degradation of the image, cross-contamination and viewing conditions, were assessed.

MATERIAL AND METHODS

The literature search used the PubMed database with no limits and was performed during June to August 2009. Search strategies are described in the text for each of the mentioned tasks. A hand search of task-specific journals supplemented the search strategies.

RESULTS

Time seems to be saved when switching from film to digital imaging in dental practice, a dose reduction may not be obtained, retakes and errors may be increased, the dynamic range may be wider with photostimulable storage phosphor (PSP) plates but not with sensors, the effect on patient information has not been well studied and storage and communication create new challenges with regard to handling large files and image compression. In addition, patient discomfort seems to be pronounced with sensors compared with PSP plates and film, the PSP plate may be scratched in clinical use and a two-layer barrier seems to be needed to prevent contamination of the receptor. The type of monitor may not be of major concern if the image is viewed in a room with subdued light.

CONCLUSIONS

Not all of the predicted advantages with digital compared to film-based radiography hold true in daily clinical work. Of particular interest is the relationship between number of images, retakes and the dose given to the patient.

Diagnostic yield of ink-jet prints from digital radiographs for the assessment of approximal carious lesions: ROC-analysis

AIMS

To investigate the diagnostic quality of different quality, individually calibrated ink-jet printers for the very challenging dental radiographic task of approximal carious lesion detection.

MATERIALS AND METHODS

A test-pattern evaluating resolution, contrast and homogeneity of the ink-jet prints was developed. 50 standardized dental radiographs each showing two neighbouring teeth in natural contact were printed on glossy paper with calibrated, randomly selected ink-jet printers (Canon S520 and iP4500, Epson Stylus Photo R2400). Printing size equalled the viewing size on a 17″ cathode-ray-tube monitor daily quality-tested according to German regulations. The true caries status was determined from serial sectioning and microscopic evaluation. 16 experienced observers evaluated the radiographs on a five-point confidence scale on all prints plus the viewing monitor with respect to the visibility of a carious lesion. A non-parametric Receiver-Operating Characteristics (ROC-) analysis was performed explicitly designed for the evaluation of readings stemming from identical samples but different modality. Significant differences are expressed by a critical ratio z exceeding ±2. Diagnostic accuracy was determined by the area (Az) underneath the ROC-curves.

RESULTS

Average Az-values ranged between 0.62 (S520 and R2400) and 0.64 (monitor, iP4500), with no significant difference between modalities (P=0.172). Neither significant (range mean z: -0.40 (S520) and -0.11 (iP4500)) nor clinically relevant differences were found between printers and viewing monitor.

CONCLUSIONS

Our results for a challenging task in dental radiography indicate that calibrated, off-the-shelf ink-jet printers are able to reproduce (dental) radiographs at quality levels sufficient for radiographic diagnosis in a typical dental working environment.