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Nenoff L, Amstutz F, Murr M, Archibald-Heeren B, Fusella M, Hussein M, Lechner W, Zhang Y, Sharp G, Vasquez Osorio E. Review and recommendations on deformable image registration uncertainties for radiotherapy applications. Phys Med Biol 2023; 68:24TR01. [PMID: 37972540 PMCID: PMC10725576 DOI: 10.1088/1361-6560/ad0d8a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 10/30/2023] [Accepted: 11/15/2023] [Indexed: 11/19/2023]
Abstract
Deformable image registration (DIR) is a versatile tool used in many applications in radiotherapy (RT). DIR algorithms have been implemented in many commercial treatment planning systems providing accessible and easy-to-use solutions. However, the geometric uncertainty of DIR can be large and difficult to quantify, resulting in barriers to clinical practice. Currently, there is no agreement in the RT community on how to quantify these uncertainties and determine thresholds that distinguish a good DIR result from a poor one. This review summarises the current literature on sources of DIR uncertainties and their impact on RT applications. Recommendations are provided on how to handle these uncertainties for patient-specific use, commissioning, and research. Recommendations are also provided for developers and vendors to help users to understand DIR uncertainties and make the application of DIR in RT safer and more reliable.
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Affiliation(s)
- Lena Nenoff
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- OncoRay—National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden—Rossendorf, Dresden Germany
- Helmholtz-Zentrum Dresden—Rossendorf, Institute of Radiooncology—OncoRay, Dresden, Germany
| | - Florian Amstutz
- Department of Physics, ETH Zurich, Switzerland
- Center for Proton Therapy, Paul Scherrer Institute, Villigen PSI, Switzerland
- Division of Medical Radiation Physics and Department of Radiation Oncology, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Martina Murr
- Section for Biomedical Physics, Department of Radiation Oncology, University of Tübingen, Germany
| | | | - Marco Fusella
- Department of Radiation Oncology, Abano Terme Hospital, Italy
| | - Mohammad Hussein
- Metrology for Medical Physics, National Physical Laboratory, Teddington, United Kingdom
| | - Wolfgang Lechner
- Department of Radiation Oncology, Medical University of Vienna, Austria
| | - Ye Zhang
- Center for Proton Therapy, Paul Scherrer Institute, Villigen PSI, Switzerland
| | - Greg Sharp
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Eliana Vasquez Osorio
- Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom
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Mangal U, Lee SM, Lee S, Cha JY, Lee KJ, Yu HS, Jung H, Choi SH. Reorientation methodology for reproducible head posture in serial cone beam computed tomography images. Sci Rep 2023; 13:3220. [PMID: 36828940 PMCID: PMC9958024 DOI: 10.1038/s41598-023-30430-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/22/2023] [Indexed: 02/26/2023] Open
Abstract
Low dose and accessibility have increased the application of cone beam computed tomography (CBCT). Often serial images are captured for patients to diagnose and plan treatment in the craniofacial region. However, CBCT images are highly variable and lack harmonious reproduction, especially in the head's orientation. Though user-defined orientation methods have been suggested, the reproducibility remains controversial. Here, we propose a landmark-free reorientation methodology based on principal component analysis (PCA) for harmonious orientation of serially captured CBCTs. We analyzed three serial CBCT scans collected for 29 individuals who underwent orthognathic surgery. We first defined a region of interest with the proposed protocol by combining 2D rendering and 3D convex hull method, and identified an intermediary arrangement point. PCA identified the y-axis (anterioposterior) followed by the secondary x-axis (transverse). Finally, by defining the perpendicular z-axis, a new global orientation was assigned. The goodness of alignment (Hausdorff distance) showed a marked improvement (> 50%). Furthermore, we clustered cases based on clinical asymmetry and validated that the protocol was unaffected by the severity of the skeletal deformity. Therefore, it could be suggested that integrating the proposed algorithm as the preliminary step in CBCT evaluation will address a fundamental step towards harmonizing the craniofacial imaging records.
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Affiliation(s)
- Utkarsh Mangal
- grid.15444.300000 0004 0470 5454Department of Orthodontics, Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, 03722 Korea
| | | | - Seeyoon Lee
- grid.15444.300000 0004 0470 5454Department of Orthodontics, Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, 03722 Korea
| | - Jung-Yul Cha
- grid.15444.300000 0004 0470 5454Department of Orthodontics, Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, 03722 Korea
| | - Kee-Joon Lee
- grid.15444.300000 0004 0470 5454Department of Orthodontics, Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, 03722 Korea
| | - Hyung-Seog Yu
- grid.15444.300000 0004 0470 5454Department of Orthodontics, Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, 03722 Korea
| | | | - Sung-Hwan Choi
- Department of Orthodontics, Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, 03722, Korea.
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Souza-Nunes LAD, Verner FS, Rosado LDPL, Aquino SND, Carvalho ACP, Junqueira RB. Periapical and Endodontic Status Scale for Endodontically Treated Teeth and Their Association with Maxillary Sinus Abnormalities: A Cone-beam Computed Tomographic Study. J Endod 2019; 45:1479-1488. [PMID: 31630784 DOI: 10.1016/j.joen.2019.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 08/26/2019] [Accepted: 09/05/2019] [Indexed: 12/29/2022]
Abstract
INTRODUCTION This retrospective cross-sectional study investigated the applicability of the periapical and endodontic status scale (PESS) to determine the association of endodontically treated teeth with maxillary sinus (MS) abnormalities through cone-beam computed tomographic imaging. METHODS A total of 631 endodontically treated teeth were analyzed. MS abnormalities were classified as mucosal thickening, sinus polyp, antral pseudocyst, nonspecific opacification, periostitis, and antral calcification. The PESS was used to evaluate the quality of endodontic treatment as well as periapical tissue conditions. The data were analyzed by chi-square tests (P < .05). RESULTS MS abnormalities were detected in 70.52% of the sample, with a greater prevalence of mucosal thickening (38.19%), whereas periapical lesions were observed in 55.94% of the cases. Treated root canals with unsatisfactory filling, homogeneity, and coronal sealing had an odds Ratio (OR) of 2.21, 2.88, and 2.99, respectively (P < .001). Periapical lesions larger than 5 mm (OR = 314.95), in more than 1 root (OR = 3.72), involving the furcation region (OR = 5.21), in contact with important structures (OR = 7.37), and with cortical bone destruction (OR = 4.09) were significantly related to the presence of MS abnormalities (P < .001). An OR of 99,668 was observed in periostitis lesions greater than 5 mm (P < .001). CONCLUSIONS The PESS proved to be an important tool for the analysis of endodontic and periapical conditions and was applicable to determine potential associations with MS abnormalities.
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Affiliation(s)
| | - Francielle Silvestre Verner
- Department of Dentistry, Division of Oral Radiology, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil
| | - Lucas de Paula Lopes Rosado
- Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Sibele Nascimento de Aquino
- Department of Dentistry, Division of Oral Pathology, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil
| | | | - Rafael Binato Junqueira
- Department of Dentistry, Division of Endodontics, Federal University of Juiz de Fora, Governador Valadares, Minas Gerais, Brazil
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Case-control study of mandibular canal branching and tooth-related inflammatory lesions. Oral Radiol 2018; 34:229-236. [PMID: 30484033 DOI: 10.1007/s11282-017-0305-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 09/28/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Morphological variations of mandibular canals increase the risk of neurovascular damage and bleeding during surgical procedures by decreasing the predictability of the inferior alveolar neurovascular bundle location. To improve the predictability with such variations, the present study aimed to verify the possibility of a relationship between mandibular canal branches (MCBs) and tooth-related inflammatory lesions, using trough cone-beam computed tomography (CBCT) examinations. METHODS The sample comprised 150 age and sex-matched examinations (50 cases and 100 controls) from two databases. The CBCT examinations were grouped by the presence of MCBs starting in the mandibular body regions as the outcome variable. Tooth-related inflammatory lesions and measurements of gray levels in the posterior region of the alveolar ridge were assessed in both groups. A multiple logistic regression analysis was applied to verify the relationships between MCBs and independent variables (p < 0.05). RESULTS Occurrence of tooth-related inflammatory lesions increased the risk of MCBs in the mandibular body regions (p < 0.001; OR 11.640; 95% CI 4.327-31.311). High-contrast images had a weaker association with MCBs (p = 0.002; OR 1.002; 95% CI 1.002-1.003). The most frequent tooth-related inflammatory lesions in both groups were endodontic (34 lesions; 45.94% of the total lesions). Most of the tooth-related inflammatory lesions related to MCBs were endodontic (20 cases) and combined endodontic and periodontal inflammation (20 cases). CONCLUSIONS An association was observed between MCBs in the mandibular body regions and tooth-related inflammatory lesions. Inflammatory lesions of endodontic origin are most often associated with MCBs.
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Keil H, Beisemann N, Schnetzke M, Vetter SY, Swartman B, Grützner PA, Franke J. Intraoperative assessment of reduction and implant placement in acetabular fractures-limitations of 3D-imaging compared to computed tomography. J Orthop Surg Res 2018; 13:78. [PMID: 29636062 PMCID: PMC5894195 DOI: 10.1186/s13018-018-0780-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 03/23/2018] [Indexed: 01/24/2023] Open
Abstract
Background In acetabular fractures, the assessment of reduction and implant placement has limitations in conventional 2D intraoperative imaging. 3D imaging offers the opportunity to acquire CT-like images and thus to improve the results. However, clinical experience shows that even 3D imaging has limitations, especially regarding artifacts when implants are placed. The purpose of this study was to assess the difference between intraoperative 3D imaging and postoperative CT regarding reduction and implant placement. Methods Twenty consecutive cases of acetabular fractures were selected with a complete set of intraoperative 3D imaging and postoperative CT data. The largest detectable step and the largest detectable gap were measured in all three standard planes. These values were compared between the 3D data sets and CT data sets. Additionally, possible correlations between the possible confounders age and BMI and the difference between 3D and CT values were tested. Results The mean difference of largest visible step between the 3D imaging and CT scan was 2.0 ± 1.8 mm (0.0–5.8, p = 0.02) in the axial, 1.3 ± 1.4 mm (0.0–3.7, p = 0.15) in the sagittal and 1.9 ± 2.4 mm (0.0–7.4, p = 0.22) in the coronal views. The mean difference of largest visible gap between the 3D imaging and CT scan was 3.1 ± 3.6 mm (0.0–14.1, p = 0.03) in the axial, 4.6 ± 2.7 mm (1.2–8.7, p = 0.001) in the sagittal and 3.5 ± 4.0 mm (0.0–15.4, p = 0.06) in the coronal views. A positive correlation between the age and the difference in gap measurements in the sagittal view was shown (rho = 0.556, p = 0.011). Conclusions Intraoperative 3D imaging is a valuable adjunct in assessing reduction and implant placement in acetabular fractures but has limitations due to artifacts caused by implant material. This can lead to missed malreduction and impairment of clinical outcome, so postoperative CT should be considered in these cases.
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Affiliation(s)
- Holger Keil
- Clinic for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at the University of Heidelberg, MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Nils Beisemann
- Clinic for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at the University of Heidelberg, MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Marc Schnetzke
- Clinic for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at the University of Heidelberg, MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Sven Yves Vetter
- Clinic for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at the University of Heidelberg, MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Benedict Swartman
- Clinic for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at the University of Heidelberg, MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Paul Alfred Grützner
- Clinic for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at the University of Heidelberg, MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Jochen Franke
- Clinic for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at the University of Heidelberg, MINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic Surgery, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany.
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Ristow O, Rückschloß T, Berger M, Grötz T, Kargus S, Krisam J, Seeberger R, Engel M, Hoffmann J, Freudlsperger C. Short- and long-term changes of the pharyngeal airway after surgical mandibular advancement in Class II patients—a three-dimensional retrospective study. J Craniomaxillofac Surg 2018; 46:56-62. [DOI: 10.1016/j.jcms.2017.10.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 10/03/2017] [Accepted: 10/30/2017] [Indexed: 11/28/2022] Open
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Nascimento MDCC, Boscolo SMDA, Haiter-Neto F, Santos ECD, Lambrichts I, Pauwels R, Jacobs R. Influence of basis images and skull position on evaluation of cortical bone thickness in cone beam computed tomography. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 123:707-713. [PMID: 28396071 DOI: 10.1016/j.oooo.2017.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 01/27/2017] [Accepted: 01/30/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to assess the influence of the number of basis images and the orientation of the skull on the evaluation of cortical alveolar bone in cone beam computed tomography (CBCT). STUDY DESIGN Eleven skulls with a total of 59 anterior teeth were selected. CBCT images were acquired by using 4 protocols, by varying the rotation of the tube-detector arm and the orientation of the skull (protocol 1: 360°/0°; protocol 2: 180°/0°; protocol 3: 180°/90°; protocol 4: 180°/180°). Observers evaluated cortical bone as absent, thin, or thick. Direct observation of the skulls was used as the gold standard. Intra- and interobserver agreement, as well as agreement of scoring between the 3 bone thickness classifications, were calculated by using the κ statistic. The Wilcoxon signed-rank test was used to compare the 4 protocols. RESULTS For lingual cortical bone, protocol 1 showed no statistical difference from the gold standard. Higher reliability was found in protocol 3 for absent (κ = 0.80) and thin (κ = 0.47) cortices, whereas for thick cortical bone, protocol 2 was more consistent (κ = 0.60). In buccal cortical bone, protocol 1 obtained the highest agreement for absent cortices (κ = 0.61), whereas protocol 4 was better for thin cortical plates (κ = 0.38) and protocol 2 for thick cortical plates (κ = 0.40). CONCLUSIONS No consistent effect of the number of basis images or head orientation for visual detection of alveolar bone was detected, except for lingual cortical bone, for which full rotation scanning showed improved visualization.
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Affiliation(s)
| | | | - Francisco Haiter-Neto
- Department of Oral Diagnosis, Piracicaba Dental School, State University of Campinas, Piracicaba, São Paulo, Brazil
| | | | - Ivo Lambrichts
- Biomedical Research Institute, Laboratory of Morphology, Hasselt, Belgium
| | - Ruben Pauwels
- OMFS IMPATH research group, Department of Imaging & Pathology, University Leuven and Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Radiology, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand
| | - Reinhilde Jacobs
- OMFS IMPATH research group, Department of Imaging & Pathology, University Leuven and Oral & Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
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Slagter KW, Raghoebar GM, Bakker NA, Vissink A, Meijer HJA. Buccal bone thickness at dental implants in the aesthetic zone: A 1-year follow-up cone beam computed tomography study. J Craniomaxillofac Surg 2016; 45:13-19. [PMID: 27939041 DOI: 10.1016/j.jcms.2016.11.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 09/26/2016] [Accepted: 11/08/2016] [Indexed: 11/28/2022] Open
Abstract
Sufficient buccal bone thickness (BBT) is important for an optimal aesthetic outcome of implant treatment in the aesthetic zone. The aim of the study was to assess BBT at dental implants placed in the aesthetic zone (incisor, canine or first premolar in the maxilla) (immediate or delayed, with or without immediate provisionalization) with cone beam computed tomography (CBCT) as a function of time. Eighty patients were divided into 4 groups according to size of the buccal bony defect (<5 or ≥5 mm) after removal of the tooth, and timing of implant placement and provisionalization. CBCTs were made 1 month and 1 year after placement of the implant crown. BBT varied from 0.79 mm to 2.12 mm at 1 month and from 0.71 mm to 2.04 mm at 1 year. Change of BBT between 1 month and 1 year was negligible. This study concluded that BBT at dental implants in the aesthetic zone appears to be stable for immediate and delayed placed implants after placement of the definitive crown, independent of the size of buccal bone defect prior to implant insertion and timing of provisionalization.
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Affiliation(s)
- Kirsten W Slagter
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. F.K.L. Spijkervet), University of Groningen, University Medical Center Groningen, P.O. Box 30.001, NL-9700 RB Groningen, The Netherlands.
| | - Gerry M Raghoebar
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. F.K.L. Spijkervet), University of Groningen, University Medical Center Groningen, P.O. Box 30.001, NL-9700 RB Groningen, The Netherlands
| | - Nicolaas A Bakker
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, NL-9700 RB Groningen, The Netherlands
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. F.K.L. Spijkervet), University of Groningen, University Medical Center Groningen, P.O. Box 30.001, NL-9700 RB Groningen, The Netherlands
| | - Henny J A Meijer
- Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. F.K.L. Spijkervet), University of Groningen, University Medical Center Groningen, P.O. Box 30.001, NL-9700 RB Groningen, The Netherlands; Department of Fixed and Removable Prosthodontics, University of Groningen, University Medical Center Groningen, A. Deusinglaan 1, 9713AV Groningen, The Netherlands
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de Souza LA, Souza Picorelli Assis NM, Ribeiro RA, Pires Carvalho AC, Devito KL. Assessment of mandibular posterior regional landmarks using cone-beam computed tomography in dental implant surgery. Ann Anat 2016; 205:53-9. [PMID: 26851559 DOI: 10.1016/j.aanat.2016.01.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 10/25/2015] [Accepted: 01/15/2016] [Indexed: 01/13/2023]
Abstract
The aim of this study has been to evaluate and correlate the anatomical features of the posterior mandibular region (submandibular fossa depth, bone height and thickness, and mandibular canal corticalization) to improve accident prevention and allow safe planning in implantology. Four parasagittal sections of cone-beam computed tomography (CBCT) from 100 patients were bilaterally analyzed. Linear measurements of the submandibular fossa depth, bone height and thickness were performed. The submandibular fossa was also classified into non-influential undercuts and influential undercuts for implant placement. Mandibular canal corticalization was also evaluated and classified according to the visualization. Data on patient age and gender were also collected. Forty-one scans (41%) were from male patients, and 59 (59%) were from female patients. Patient age ranged between 18 and 84 years, with an average age of 51.37 years. The submandibular fossa depth and implant bone thickness had a significant effect on the variability of the sample (46.1% and 22.3%, respectively). The submandibular fossa depth was quite variable, and the highest values were observed in the posterior regions. In 18.27% of the cases, the presence of the fossa directly influenced implant placement, considering a bone height of 10mm (standard implant). A significant correlation was observed between fossa depth and bone thickness. Thus, greater attention should be paid to thick ridges; although thick ridges are favorable, they may be associated with deeper submandibular fossae. The mandibular canal was the most influential anatomical structure in the premolar region due to the reduced bone height in this region and the greater difficulty in viewing the canal, and the submandibular fossa was the most influential structure in the molar region due to lower bone height leading up to the fossa and the greater fossa depth in this region. Therefore, CBCT is an important tool for assessing the mandibular region and planning for safe implant installation in the posterior mandible. Furthermore, comprehensive evaluation of the characteristics of this region is necessary, as the variables - submandibular fossa depth, bone height and thickness, and mandibular canal corticalization - are related and must be considered together when planning.
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Affiliation(s)
| | | | - Rosangela Almeida Ribeiro
- Department of Social and Pediatric Dentistry, School of Dentistry, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil.
| | | | - Karina Lopes Devito
- Department of Dental Clinic, School of Dentistry, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil.
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Abella F, Morales K, Garrido I, Pascual J, Duran-Sindreu F, Roig M. Endodontic applications of cone beam computed tomography: case series and literature review. GIORNALE ITALIANO DI ENDODONZIA 2015. [DOI: 10.1016/j.gien.2015.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Laher AE, Wells M, Motara F, Kramer E, Moolla M, Mahomed Z. Finding the mental foramen. Surg Radiol Anat 2015; 38:469-76. [DOI: 10.1007/s00276-015-1565-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 10/02/2015] [Indexed: 11/29/2022]
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Slagter KW, Raghoebar GM, Vissink A, Meijer HJA. Inter- and intraobserver reproducibility of buccal bone measurements at dental implants with cone beam computed tomography in the esthetic region. Int J Implant Dent 2015; 1:8. [PMID: 27747630 PMCID: PMC5005615 DOI: 10.1186/s40729-015-0007-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Accepted: 02/19/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sufficient buccal bone is important for optimal esthetic results of implant treatment in the anterior region. It can be measured with cone beam computed tomography (CBCT), but background scattering and problems with standardization of the measurements are encountered. The aim was to develop a method for reliable, reproducible measurements on CBCTs. METHODS Using a new method, buccal bone thickness was measured on ten CBCTs at six positions along the implant axis. Inter- and intraobserver reproducibility was assessed by repeated measurements by two examiners. RESULTS Mean buccal bone thickness measured by observers 1 and 2 was 2.42 mm (sd: 0.50) and 2.41 mm (sd: 0.47), respectively. Interobserver intraclass correlation coefficient was 0.96 (95% CI 0.93 to 0.98). The mean buccal bone thickness of the first measurement and the second measurement of observer 1 was 2.42 mm (sd: 0.50) and 2.53 mm (sd: 0.49), respectively, with an intraobserver intraclass correlation coefficient of 0.93 (95% CI 0.88 to 0.96). The mean buccal bone thickness of the first measurement and the second measurement of observer 2 was 2.41 mm (sd: 0.47) and 2.52 mm (sd: 0.47), respectively, with an intraobserver intraclass correlation coefficient of 0.96 (95% CI 0.93 to 0.97). CONCLUSIONS Applying the methods used in this study, CBCTs are suitable for reliable and reproducible measurements of buccal bone thickness at implants.
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Affiliation(s)
- Kirsten W Slagter
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700RB, Groningen, The Netherlands
| | - Gerry M Raghoebar
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700RB, Groningen, The Netherlands
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700RB, Groningen, The Netherlands
| | - Henny J A Meijer
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700RB, Groningen, The Netherlands. .,Department of Fixed and Removable Prosthodontics, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700RB, Groningen, The Netherlands.
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Kim MS, Kim BY, Choi HY, Choi YJ, Oh SH, Kang JH, Lee SR, Kang JH, Kim GT, Choi YS, Hwang EH. Intravenous contrast media application using cone-beam computed tomography in a rabbit model. Imaging Sci Dent 2015; 45:31-9. [PMID: 25793181 PMCID: PMC4362989 DOI: 10.5624/isd.2015.45.1.31] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Revised: 06/02/2014] [Accepted: 06/09/2014] [Indexed: 01/27/2023] Open
Abstract
Purpose This study was performed to evaluate the feasibility of visualizing soft tissue lesions and vascular structures using contrast-enhanced cone-beam computed tomography (CE-CBCT) after the intravenous administration of a contrast medium in an animal model. Materials and Methods CBCT was performed on six rabbits after a contrast medium was administered using an injection dose of 2 mL/kg body weight and an injection rate of 1 mL/s via the ear vein or femoral vein under general anesthesia. Artificial soft tissue lesions were created through the transplantation of autologous fatty tissue into the salivary gland. Volume rendering reconstruction, maximum intensity projection, and multiplanar reconstruction images were reconstructed and evaluated in order to visualize soft tissue contrast and vascular structures. Results The contrast enhancement of soft tissue was possible using all contrast medium injection parameters. An adequate contrast medium injection parameter for facilitating effective CE-CBCT was a 5-mL injection before exposure combined with a continuous 5-mL injection during scanning. Artificial soft tissue lesions were successfully created in the animals. The CE-CBCT images demonstrated adequate opacification of the soft tissues and vascular structures. Conclusion Despite limited soft tissue resolution, the opacification of vascular structures was observed and artificial soft tissue lesions were visualized with sufficient contrast to the surrounding structures. The vascular structures and soft tissue lesions appeared well delineated in the CE-CBCT images, which was probably due to the superior spatial resolution of CE-CBCT compared to other techniques, such as multislice computed tomography.
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Affiliation(s)
- Min-Sung Kim
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Bok-Yeol Kim
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Hwa-Young Choi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Yoon-Joo Choi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Song-Hee Oh
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Ju-Hee Kang
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Sae-Rom Lee
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Ju-Han Kang
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Gyu-Tae Kim
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Yong-Suk Choi
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Kyung Hee University, Seoul, Korea
| | - Eui-Hwan Hwang
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Kyung Hee University, Seoul, Korea
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Venskutonis T, Plotino G, Tocci L, Gambarini G, Maminskas J, Juodzbalys G. Periapical and endodontic status scale based on periapical bone lesions and endodontic treatment quality evaluation using cone-beam computed tomography. J Endod 2014; 41:190-6. [PMID: 25498834 DOI: 10.1016/j.joen.2014.10.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Revised: 10/03/2014] [Accepted: 10/18/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The purpose of this study was to present a new periapical and endodontic status scale (PESS) that is based on the complex periapical index (COPI), which was designed for the identification and classification of periapical bone lesions in cases of apical periodontitis, and the endodontically treated tooth index, which was designed for endodontic treatment quality evaluation by means of cone-beam computed tomographic (CBCT) analysis. METHODS Periapical and endodontic status parameters were selected from the already known indexes and scientific literature for radiologic evaluation. Radiographic images (CBCT imaging, digital orthopantomography [DOR], and digital periapical radiography) from 55 patients were analyzed. All parameters were evaluated on CBCT, DOR, and digital periapical radiographic images by 2 external observers. The statistical analysis was performed with software SPSS version 19.0 (SPSS Inc, Chicago, IL). Chi-square tests were used to compare frequencies of qualitative variables. The level of significance was set at P ≤ .05. RESULTS Overall intraobserver and interobserver agreements were very good and good, respectively. CBCT analysis found more lesions and lesions of bigger dimension (P < .001). CBCT imaging was also superior in locating lesions in the apical part on the side compared with DOR and in the diagnosis of cortical bone destruction compared with both methods (P < .001). Through CBCT analysis, more root canals and more canals associated with lesions were found. The most informative and reproducible periapical and endodontic status parameters were selected, and a new PESS was proposed. CONCLUSIONS The classification proposed in the present study seems to be reproducible and objective and adds helpful information with respect to the existing indexes. Future studies need to be conducted to validate PESS.
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Affiliation(s)
- Tadas Venskutonis
- Department of Dental and Oral Diseases, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Gianluca Plotino
- Department of Endodontics, Sapienza University of Rome, Rome, Italy
| | - Luigi Tocci
- Department of Endodontics, Sapienza University of Rome, Rome, Italy
| | | | - Julius Maminskas
- Department of Prosthodontics, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Gintaras Juodzbalys
- Department of Maxillofacial Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Venskutonis T, Plotino G, Juodzbalys G, Mickevičienė L. The importance of cone-beam computed tomography in the management of endodontic problems: a review of the literature. J Endod 2014; 40:1895-901. [PMID: 25287321 DOI: 10.1016/j.joen.2014.05.009] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 04/16/2014] [Accepted: 05/12/2014] [Indexed: 01/26/2023]
Abstract
INTRODUCTION To obtain essential information in clinical endodontics, cone-beam computed tomographic (CBCT) imaging can be used in all phases of treatment including diagnosis, treatment planning, during the treatment phase, and through post-treatment assessment and follow-up. The purpose of this article was to review the use of CBCT imaging in the diagnosis, treatment planning, and assessing the outcome of endodontic complications. METHODS Literature was selected through a search of PubMed electronic databases for the following keywords: tooth root injuries, tooth root radiography, tooth root perforation, tomography, cone-beam computed tomography, endodontic complications, tooth root internal/external resorption, root fractures, and broken instruments. The research was restricted to articles published in English. One hundred twelve articles met the inclusion criteria and were included in this review. RESULTS Currently, intraoral radiography is the imaging technique of choice for the management of endodontic disease, but CBCT imaging appears to have a superior validity and reliability in the management of endodontic diagnosis and complications. CONCLUSIONS Endodontic cases should be judged individually, and CBCT imaging should be considered in situations in which information from conventional imaging systems may not yield an adequate amount of information to allow the appropriate management of endodontic problems. CBCT imaging has the potential to become the first choice for endodontic treatment planning and outcome assessment, especially when new scanners with lower radiation doses will be available.
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Affiliation(s)
- Tadas Venskutonis
- Department of Dental and Oral Diseases, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Gianluca Plotino
- Department of Endodontics, 'Sapienza' University of Rome, Rome, Italy.
| | - Gintaras Juodzbalys
- Department of Maxillofacial Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Lina Mickevičienė
- Department of Dental and Oral Diseases, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Abstract
OBJECTIVES Doses induced by individual dental examinations are low. However, dental radiography accounts for nearly one third of the total number of radiological examinations in the European Union. Therefore, special attention is needed with regard to radiation protection. In order to lower patient doses, the staff performing dental examinations must have competence in imaging as well as in radiation protection issues. This paper presents a systematic review about the core competencies needed by the healthcare staff in performing digital dental radiological imaging quality assurance. MATERIALS AND METHODS The following databases were searched: Pubmed, Cinahl, Pro Quest and IEEXplore digital library. Also volumes of some dental imaging journals and doctoral theses of the Finnish universities educating dentists were searched. The search was performed using both MeSH terms and keywords using the option 'search all text'. The original keywords were: dental imaging, digital, x-ray, panoramic, quality, assurance, competence, competency, skills, knowledge, radiographer, radiologist technician, dentist, oral hygienist, radiation protection and their Finnish synonyms. RESULTS Core competencies needed by the healthcare staff performing digital dental radiological imaging quality assurance described in the selected studies were: management of dental imaging equipment, competence in image quality and factors associated with it, dose optimization and quality assurance. CONCLUSIONS In the future there will be higher doses in dental imaging due to increasing use of CBCT and digital imaging. The staff performing dental imaging must have competence in dental imaging quality assurance issues found in this review. They also have to practice ethical radiation safety culture in clinical practice.
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Affiliation(s)
- Eija Metsälä
- Degree Programme of Radiography and Radiotherapy, Helsinki Metropolia University of Applied Sciences , Helsinki , Finland
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Neugebauer J, Stachulla G, Ritter L, Dreiseidler T, Mischkowski RA, Keeve E, Zöller JE. Computer-aided manufacturing technologies for guided implant placement. Expert Rev Med Devices 2014; 7:113-29. [DOI: 10.1586/erd.09.61] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Influence of voxel size on the diagnostic ability of cone-beam computed tomography to evaluate simulated root perforations. Oral Radiol 2013. [DOI: 10.1007/s11282-013-0125-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Pauwels R, Beinsberger J, Stamatakis H, Tsiklakis K, Walker A, Bosmans H, Bogaerts R, Jacobs R, Horner K. Comparison of spatial and contrast resolution for cone-beam computed tomography scanners. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 114:127-35. [DOI: 10.1016/j.oooo.2012.01.020] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 01/03/2012] [Accepted: 01/18/2012] [Indexed: 11/24/2022]
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Panmekiate S, Apinhasmit W, Petersson A. Effect of electric potential and current on mandibular linear measurements in cone beam CT. Dentomaxillofac Radiol 2012; 41:578-82. [PMID: 22499132 DOI: 10.1259/dmfr/51664704] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The purpose of this study was to compare mandibular linear distances measured from cone beam CT (CBCT) images produced by different radiographic parameter settings (peak kilovoltage and milliampere value). METHODS 20 cadaver hemimandibles with edentulous ridges posterior to the mental foramen were embedded in clear resin blocks and scanned by a CBCT machine (CB MercuRay(TM); Hitachi Medico Technology Corp., Chiba-ken, Japan). The radiographic parameters comprised four peak kilovoltage settings (60 kVp, 80 kVp, 100 kVp and 120 kVp) and two milliampere settings (10 mA and 15 mA). A 102.4 mm field of view was chosen. Each hemimandible was scanned 8 times with 8 different parameter combinations resulting in 160 CBCT data sets. On the cross-sectional images, six linear distances were measured. To assess the intraobserver variation, the 160 data sets were remeasured after 2 weeks. The measurement precision was calculated using Dahlberg's formula. With the same peak kilovoltage, the measurements yielded by different milliampere values were compared using the paired t-test. With the same milliampere value, the measurements yielded by different peak kilovoltage were compared using analysis of variance. A significant difference was considered when p < 0.05. RESULTS Measurement precision varied from 0.03 mm to 0.28 mm. No significant differences in the distances were found among the different radiographic parameter combinations. CONCLUSIONS Based upon the specific machine in the present study, low peak kilovoltage and milliampere value might be used for linear measurements in the posterior mandible.
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Affiliation(s)
- S Panmekiate
- Department of Radiology, Chulalongkorn University, Pathumwan, Bangkok, Thailand.
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Kamburoğlu K, Kolsuz E, Kurt H, Kiliç C, Özen T, Paksoy CS. Accuracy of CBCT measurements of a human skull. J Digit Imaging 2012; 24:787-93. [PMID: 20857166 DOI: 10.1007/s10278-010-9339-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The purpose of this study is to assess the accuracy and reproducibility of cone-beam computed tomography (CBCT) measurements of a human dry skull by comparing them to direct digital caliper measurements. Heated gutta-percha was used to mark 13 specific distances on a human skull, and the distances were directly measured using a digital caliper and on CBCT images obtained with Iluma (3M Imtec, OK, USA) and 3D Accuitomo 170 (3D Accuitomo; J Morita Mfg. Corp., Kyoto, Japan) CBCT imaging systems. Iluma images were obtained at 120 kVp and 3.8 mA and reconstructed using voxel sizes of 0.2 and 0.3 mm(3). Accuitomo images were obtained at 60 kVp and 2 mA and a voxel size of 0.250 mm(3). In addition, 3-D reconstructions were produced from images obtained from both systems. All measurements were made independently by three trained observers and were repeated after an interval of 1 week. Agreement between observers and image type was assessed by calculating Pearson correlation coefficients, with a level of significance set at p < 0.05. Pearson correlation coefficients between readings ranged from 0.995 to 1 for all image types. Correlations among observers were also very high, ranging from 0.992 to 1 for the first reading and from 0.992 to 1 for the second reading for the different image types. All CBCT image measurements were identical and highly correlated with digital caliper measurements. Accuracy of measurements of various distances on a human skull obtained from different CBCT units and image types is comparable to that of digital caliper measurements.
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Affiliation(s)
- Kivanç Kamburoğlu
- Faculty of Dentistry, Department of Oral Diagnosis and Radiology, Ankara University, Ankara, Turkey,
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Chang ZC, Hu FC, Lai E, Yao CC, Chen MH, Chen YJ. Landmark identification errors on cone-beam computed tomography-derived cephalograms and conventional digital cephalograms. Am J Orthod Dentofacial Orthop 2012; 140:e289-97. [PMID: 22133963 DOI: 10.1016/j.ajodo.2011.06.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 06/01/2011] [Accepted: 06/01/2011] [Indexed: 01/13/2023]
Abstract
INTRODUCTION In this study, we investigated the landmark identification errors on cone-beam computed tomography (CBCT)-derived cephalograms and conventional digital cephalograms. METHODS Twenty patients who had both a CBCT-derived cephalogram and a conventional digital cephalogram were recruited. Twenty commonly used lateral cephalometric landmarks and 2 fiducial points were identified on each cephalogram by 11 observers at 2 time points. The mean positions of the landmarks identified by all observers were used as the best estimate to calculate the landmark identification errors. In addition to univariate analysis, regression analysis of landmark identification errors was conducted for identifying the predicting variables of the observed landmark identification errors. To properly handle the multilayer correlations among the clustered observations, a marginal multiple linear regression model was fitted to our correlated data by using the well-known generalized estimating equations method. In addition to image modality, many variables potentially affecting landmark identification errors were considered, including location and characteristics of the landmark, seniority of the observer, and patient information (sex, age, metallic dental restorations, and facial asymmetry). RESULTS Image modality was not the significant variable in the final generalized estimating equations model. The regression coefficient estimates of the significant landmarks for the overall identification error ranged from -0.99 (Or) to 1.42 mm (Ba). The difficulty of identifying landmarks on structural images with multiple overlapping--eg, Or, U1R, L1R, Po, Ba, UMo, and LMo--increased the identification error by 1.17 mm. In the CBCT modality, the identification errors significantly decreased at Ba (-0.76 mm). CONCLUSIONS The overall landmark identification errors on CBCT-derived cephalograms were comparable to those on conventional digital cephalograms, and Ba was more reliable on CBCT-derived cephalograms.
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Affiliation(s)
- Zwei-Chieng Chang
- Department of Dentistry, National Taiwan University Hospital, Taipei, Taiwan
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Dreiseidler T, Alarabi N, Ritter L, Rothamel D, Scheer M, Zöller JE, Mischkowski RA. A comparison of multislice computerized tomography, cone-beam computerized tomography, and single photon emission computerized tomography for the assessment of bone invasion by oral malignancies. ACTA ACUST UNITED AC 2011; 112:367-74. [DOI: 10.1016/j.tripleo.2011.04.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Revised: 03/28/2011] [Accepted: 04/05/2011] [Indexed: 11/16/2022]
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Fienitz T, Schwarz F, Ritter L, Dreiseidler T, Becker J, Rothamel D. Accuracy of cone beam computed tomography in assessing peri-implant bone defect regeneration: a histologically controlled study in dogs. Clin Oral Implants Res 2011; 23:882-7. [DOI: 10.1111/j.1600-0501.2011.02232.x] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Kamburoglu K, Murat S, Kolsuz E, Kurt H, Yüksel S, Paksoy C. Comparative assessment of subjective image quality of cross-sectional cone-beam computed tomography scans. J Oral Sci 2011; 53:501-8. [DOI: 10.2334/josnusd.53.501] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Salivary calculus diagnosis with 3-dimensional cone-beam computed tomography. ACTA ACUST UNITED AC 2010; 110:94-100. [PMID: 20610300 DOI: 10.1016/j.tripleo.2010.03.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Revised: 02/28/2010] [Accepted: 03/09/2010] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate cone-beam CT (CBCT) diagnoses of sialoliths in the major salivary glands. STUDY DESIGN Twenty-nine CBCT images containing salivary calculi were retrospectively evaluated for image quality and artifact influence. Additionally, the reproducibility of calculus measurement and the differences between CBCT measurements and ultrasonography (US) and histomorphometry (HM) measurements were determined. Diagnostic sensitivity and specificity calculations were based on the observations of 3 masked clinicians, who reviewed a total of 58 CBCT volumes. RESULTS Salivary calculi were sufficiently visualized in all patients. Metal artifacts were detected in images of 7 patients, and movement artifacts in 2. CBCT calculi measurements were highly reproducible, with mean differences of less than 350 microm. Mean CBCT measurements of calculi diameters differed from mean US measurements by approximately 500 microm and differed from mean HM measurements by approximately 1 mm. For calculus diagnoses, the mean sensitivity and specificity were both 98.85%. CONCLUSION Although poor image qualities and artifacts can reduce diagnostic information, salivary calculi can be evaluated adequately with CBCT. CBCT measurements of calculi are highly reproducible and differ little from measurements made with US and HM. Diagnostic sensitivity and specificity levels with CBCT are as high as or higher than those obtained with other diagnostic methods. Because of its high diagnostic-information-to-radiation-dose ratio, CBCT is the preferable imaging modality for salivary calculus diagnosis.
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