Fraudulent management of digital endodontic images

Digital image fraudulence: A curse to forensic odontology

In today's era of forensic investigations, hard copies of forensic data have been replaced by digital records. However, wide availability of image processing software makes digital image manipulation an easy and low-cost way to distort or conceal facts. This review article aims to understand fraudulence in the digital records in forensic odontology and the various ways to detect as well as prevent it to an appreciable extent. Types of image fraudulence, ways to detect this fraudulence, and measures to prevent it to an appreciable extent have been discussed. Knowledge about digital image fraudulence, detection, and prevention is the desperate need of the hour in today's technology-driven forensic investigations. This review article attempts to focus on this pestering issue and aid the evolving technologies driven by great needs for valid forensic technique trying to claw out their way through the malignant fraudulence rooted in today's evolving digitization.

The effect of two enhancement tools on the assessment of the relationship between third molars and the inferior alveolar canal

OBJECTIVE

This study aims to assess the relationship between the inferior alveolar canal (IAC) and inferior third molars using digital panoramic images (DPI) with and without enhancement and compare the panoramic signs with cone beam computed tomography (CBCT) findings.

METHODS

The DPIs and CBCT of 50 patients were analyzed. The DPIs were copied and enhanced using edge enhancement and an invert tool and then analyzed by two observers using the scores: darkening of the root; deflection of the root; narrowing of the root; superimposition of the root; bifurcation of the root over the IAC; diversion of the IAC; interruption of the cortex of the IAC, and no radiographic findings noted. Kappa and exact binominal tests were used to analyze the correlation between DPIs and CBCT images. The intimate relationship scores were evaluated using a t-test and Mann-Whitney test.

RESULTS

The original DPIs, and the edge enhanced and invert tool images produced kappa coefficients of 0.528, 0.528 and 0.551, respectively. There was no difference among the methods evaluated in this study (p = 0.981).

CONCLUSION

Similar agreement was observed between DPIs with and without enhancement. However, panoramic radiography is not the ideal method to analyze the relationship between lower third molars and the IAC.

Digital radiography in the dental practice: an update

The implementation of digital imaging in dental practice should be considered. The vast number of advantages of digital imaging include time saving and image manipulation. Dose reduction is a big attraction but in practical terms this might not be fully taken advantage of, as a number of studies suggest. Challenges of images storage, back-up and exchange should be taken into account. Careful planning and integration with practice software should lead to a smooth transition. Remember, computer systems sometimes fail and contingency plans should be in place to avoid disruption to the workflow of the practice.

Digital images are data: and should be treated as such

The scientific community has become very concerned about inappropriate image manipulation. In journals that check figures after acceptance, 20-25% of the papers contained at least one figure that did not comply with the journal's instructions to authors. The scientific press continues to report a small, but steady stream of cases of fraudulent image manipulation. Inappropriate image manipulation taints the scientific record, damages trust within science, and degrades science's reputation with the general public. Scientists can learn from historians and photojournalists, who have provided a number of examples of attempts to alter or misrepresent the historical record. Scientists must remember that digital images are numerically sampled data that represent the state of a specific sample when examined with a specific instrument. These data should be carefully managed. Changes made to the original data need to be tracked like the protocols used for other experimental procedures. To avoid pitfalls, unexpected artifacts, and unintentional misrepresentation of the image data, a number of image processing guidelines are offered.

Monitoring of healing by ultrasound with color power doppler after root canal treatment of maxillary anterior teeth with periapical lesions

Aims:

To assess the reliability of ultrasound imaging coupled with Color Power Doppler for monitoring the healing after nonsurgical endodontic therapy.

Materials and Methods:

Ten asymptomatic maxillary anterior teeth with approximately similar-sized periapical radiolucent lesions of average dimension 1.3 – 1.9 cm, as observed on an intraoral periapical radiograph, and confirmed by ultrasound was selected for the study. After confirming the diagnosis all the teeth were subjected to nonsurgical endodontic treatment. Postoperative healing was monitored using postoperative subjective feedback, a radiograph, and an ultrasound with a color power doppler, at intervals of six weeks, three months, and six months.

Results:

Eight among the ten cases studied showed signs of healing, with an ultrasound, as early as six weeks postoperatively, but the radiographs showed a noticeable change only at the end of three months. At the end of the follow-up period of three months and six months, the findings in terms of change in the lesion size were the same with both the radiograph and ultrasound. Ultrasonography was able to predict the healing very consistently at all recall periods from six weeks onward providing vital information such as changes in vascularity and bone formation as compared to radiographs.

Conclusions:

Ultrasound with Color Power Doppler is an efficient tool for monitoring bone healing as compared to the conventionally employed radiographic method.

Avoiding twisted pixels: ethical guidelines for the appropriate use and manipulation of scientific digital images

Digital imaging has provided scientists with new opportunities to acquire and manipulate data using techniques that were difficult or impossible to employ in the past. Because digital images are easier to manipulate than film images, new problems have emerged. One growing concern in the scientific community is that digital images are not being handled with sufficient care. The problem is twofold: (1) the very small, yet troubling, number of intentional falsifications that have been identified, and (2) the more common unintentional, inappropriate manipulation of images for publication. Journals and professional societies have begun to address the issue with specific digital imaging guidelines. Unfortunately, the guidelines provided often do not come with instructions to explain their importance. Thus they deal with what should or should not be done, but not the associated 'why' that is required for understanding the rules. This article proposes 12 guidelines for scientific digital image manipulation and discusses the technical reasons behind these guidelines. These guidelines can be incorporated into lab meetings and graduate student training in order to provoke discussion and begin to bring an end to the culture of "data beautification".

Fraudulent retouching of digital radiographic images--a potential risk

AIM

To determine whether radiologists can recognize images retouched to include sham lesions.

MATERIALS AND METHODS

Ten representative key images were selected of aortic dissection, hepatocellular carcinoma, renal cell carcinoma, colon cancer, liver metastasis, hepatic cyst, gallbladder stones, splenic artery aneurysm, adrenal adenoma, and stomach cancer from abdominal computed tomography (CT) imaging performed in 2008. Five of the key images were replaced with retouched images using image-editing software. The time to complete retouching was recorded for each image. Radiologists were requested to make a diagnosis for the 10 images, and were then asked to identify possible retouched images. The time taken to reach a decision in each case was recorded. Thirty radiologists (13 residents and 17 attending radiologists) participated as reviewers.

RESULTS

The time to complete retouching was 15.2±3.15 min. None of the reviewers recognized that some images were retouched during diagnosis. The rate of correct diagnosis was 90% (range 71.7-100%). After reviewers were informed of possible image retouching, the detection rate of retouched images was 50% (40-58.3%). This rate was statistically the same as random choice (p=0.876). There was no significant difference between residents and attending radiologists in the detection rate of retouched images (p=0.786). The time to diagnosis and the time to detection of the retouched images were 15 (14-17) and 6 (5-7) min, respectively.

CONCLUSION

Digital images can be easily retouched, and radiologists have difficulty in identifying retouched images. Radiologists should be aware of the potential fraudulent use of retouched images.

Impact of digital image manipulation in cytology

CONTEXT

Digital images have become an important component of cytology practice. They are used in telecytology, automated screening, educational material, and Web sites and have potential for use in proficiency testing. However, there has been no formal evaluation to date to determine if digital image manipulation (intentional or unintentional) can affect their interpretation.

OBJECTIVE

To investigate whether alteration of digital cytology images affects diagnosis.

DESIGN

Acquired digital images of ThinPrep Papanicolaou test slides were manipulated (rotated 90 degrees and brightness, contrast, red-green-blue color, and luminosity adjusted) using Photoshop. A test composed of these altered images, along with their original (unaltered) image and exact duplicates was given to 22 cytologists (13 cytotechnologists, 8 cytopathologists, and 1 fellow). All images were rated as negative, atypical (atypical squamous cells of undetermined significance), low-grade squamous intraepithelial lesion, high-grade squamous intraepithelial lesion, or positive for cancer. Weighted kappa and heterogeneity chi(2) statistics were used to measure levels of agreement and assess concordance between groups.

RESULTS

The level of agreement for identical duplicate images was excellent (kappa = 0.81), compared with the poor agreement for manipulated image pairs (kappa = 0.21), a statistically significant difference (P < .001). For all altered image types agreement was poor. There was no significant difference between cytotechnologists and cytopathologists in level of agreement (P = .56).

CONCLUSIONS

Manipulation of a Papanicolaou test digital image, irrespective of the specific category of cytologic material photographed, significantly affects its interpretation by both cytotechnologists and cytopathologists. This suggests that care needs to be taken when digital cytology images are used, to specifically ensure that their alteration does not affect diagnosis.

Security of patient and study data associated with DICOM images when transferred using compact disc media

The transmission of patient and imaging data between imaging centers and other interested individuals is increasingly achieved by means of compact disc digital media (CD). These CDs typically contain, in addition to the patient images, a DICOM reader and information about the origin of the data. While equipment manufacturers attach disclaimers to these discs and specify the intended use of such media, they are often the only practical means of transmitting data for small medical, dental, or veterinary medical centers. Images transmitted by these means are used for clinical diagnosis. This has lead to a heavy reliance on the integrity of the data. This report describes attempts to alter significant patient and study data on CD media and their outcome. The results show that data files are extremely vulnerable to alteration, and alterations are not detectable without detailed analysis of file structure. No alterations to the DICOM readers were required to achieve this; changes were applied only to the data files. CDs with altered data can be readily prepared, and from the point of view of individuals viewing the images, function identically to the original manufacturer's CD. Such media should be considered unsafe where there is a potential for financial or other gain to be had from altering the data, and the copy cannot be cross-checked with the original data.