Noise in subtraction images made from pairs of bitewing radiographs: a comparison between two subtraction programs

Reduction of scratch or dirt artifacts on intraoral radiographs using dual imaging plates in image processing

OBJECTIVES

Artifacts including scratches and dirt artifacts on the digital intraoral radiographs finally contribute to making inaccurate diagnoses. The aim of this study was to reduce the incidence of artifacts using dual imaging plates (DIPs) in imaging processing.

METHODS

Conventional X-rays were taken of a porcine mandible embedded in acrylic resin using a DIP which consists of a front IP (FIP) and a back IP (BIP) with some scratches and dirt. The two images of the FIP and BIP were then synthesized and averaged to obtain a conventional DIP image. The following image processing method was used to make a DIP with artifact reduction (DIP+AR) image. A subtraction image of the FIP and BIP was constructed and the standard deviation (SD) was calculated. If the pixel value was over 3SD on the subtraction images, the pixel value of the DIP was swapped with the value on the opposite side of the non-artifact pixel. The conventional and DIP+AR images were also subjectively evaluated.

RESULTS

Image processing to create a DIP+AR image was able to reduce the number of artifacts. Medians of number of artifacts evaluated were 2.00 [interquartile range (IQR), 2.50] in DIP images and 0.67 (IQR, 1.29) in DIP+AR images, indicating a significant reduction of number of artifacts in DIP+AR images.

CONCLUSIONS

DIP+AR image processing can reduce the incidence of artifacts caused by scratches and dirt, and could extend the lifespan of the IP and contribute accurate diagnosis in oral radiology.

Reproducibility and diagnostic value of a new wedge-guided bitewing image receptor-holding device

OBJECTIVE

To assess the reproducibility of a wedge-guided bitewing image receptor-holding device (IRHD-WG) compared to a commercially available bitewing image receptor-holding device (IRHD-XCP).

METHODS AND MATERIALS

Ten operators randomly acquired bitewing radiographs of four posterior regions (Premolar, Molar 1, Molar 2, Molar 3) distributed in two dry bone skulls and mandibles using 2 IRHDs (IRHD-WG and IRHD-XCP). The radiographs corresponding to the same region and IRHD but acquired by different operators were paired for reproducibility comparison. A total of 360 pairs of radiographs were randomized for analysis. Objective analysis consisted of extracting the pixel values from each radiograph and comparing the values between each pair by intraclass correlation coefficient. For subjective analysis, the IRHDs images were digitally removed. Five oral radiologists blinded for the study conditions classified the radiograph pairs according to their similarity and diagnostic value. The answers' relative frequencies were compared by the chi-square test (α = 0.05).

RESULTS

The IRHD-WG presented a higher reproducibility (Mean = 0.850; SD = 0.144) than the IRHD-XCP (Mean = 0.615; SD = 0.287) in the objective analysis. Radiographs acquired with the IRHD-WG were more similar than those acquired with the IRHD-XCP (p < 0.001). The diagnostic value of bitewing radiographs acquired with the IRHD-WG was considered superior to those acquired with the IRHD-XCP (p < 0.001).

CONCLUSION

For the objective and subjective analyses of reproducibility, the IRHD-WG performed better than the commercial IRHD-XCP.

Assessment of three methods of geometric image reconstruction for digital subtraction radiography

OBJECTIVES

To evaluate three methods of geometric image reconstruction for digital subtraction radiography (DSR).

METHODS

Digital periapical radiographs were acquired of 24 teeth with the X-ray tube at 6 different geometric configurations of vertical (V) and horizontal (H) angles: V0°H0°, V0°H10°, V10°H0°, V10°H10°, V20°H0° and V20°H10°. All 144 images were registered in pairs (Group V0°H0° + 1 of the 6 groups) 3 times by using the Emago(®) (Oral Diagnostic Systems, Amsterdam, Netherlands) with manual selection and Regeemy with manual and automatic selections. After geometric reconstruction on the two software applications under different modes of selection, all images were subtracted and the standard deviation of grey values was obtained as a measure of image noise. All measurements were repeated after 15 days to evaluate the method error. Values of image noise were statistically analyzed by one-way ANOVA for differences between methods and between projection angles, followed by Tukey's test at a level of significance of 5%.

RESULTS

Significant differences were found between most of the projection angles for the three reconstruction methods. Image subtraction after manual selection-based reconstruction on Regeemy presented the lowest values of image noise, except on group V0°H0°. The groups V10°H0° and V20°H0° were not significantly different between the manual selection-based reconstruction in Regeemy and automatic selection-based reconstruction in Regeemy methods.

CONCLUSIONS

The Regeemy software on manual mode revealed better quality of geometric image reconstruction for DSR than the Regeemy on automatic mode and the Emago on manual mode, when the radiographic images were obtained at V and H angles used in the present investigation.

Analysis of the reproducibility of the gray values and noise of a direct digital radiography system

The aim of this study was to evaluate the reproducibility of the gray values and noise of a direct digital radiography system (Visualix eHD) for various exposure times and analyzed regions. To obtain radiographic images in a standardized manner, the digital sensor of the system and a stepwedge were positioned in a phantom at a focus-film distance of 30 cm in a dental device at 70 kV, 7 mA and 2.2 mm filtration. Ten consecutive repetitions of X-ray imaging were performed at each exposure time (0.05, 0.07, 0.09 and 0.13 s). Gray values were analyzed using ImageJ software in five regions of interest (ROIs): alveolar bone (AB), soft tissue (ST) and three steps of the stepwedge (S1, S2 and S3). The results showed that both the variability of the gray values and the noise were statistically greater (p < 0.05) in the most radiolucent region (ST). Only the noise was affected by the exposure time. In conclusion, the reproducibility of the gray values and the noise of the Visualix eHD system can vary in specific areas with different radiolucency.

A retrospective study of digital subtraction technique to detect sclerotic changes in alveolar bone on intraoral radiographs of bisphosphonate-treated patients

OBJECTIVES

Several reports have suggested that sclerotic changes in cancellous bone of the jaw and thickening of the lamina dura are characteristic radiographic changes of an early silent stage of bisphosphonate (BP)-related osteonecrosis of the jaw. No quantitative evaluation has been reported to support this hypothesis. Emago(®) software (Oral Diagnostic Systems, Amsterdam, Netherlands) can perform digital subtraction on intraoral radiographs even if they were obtained by non-standardized radiography, provided the dimensional error is within a certain limit. The purpose of this study was to evaluate whether sclerotic changes of alveolar bone or thickening of lamina dura in patients using BP can be detected using the subtraction function of Emago.

METHODS

The authors selected 46 pairs of intraoral radiographs of the mandibular molar area in dental patients. All radiographs were obtained at intervals of 6 months or more. Among the 46 pairs, 7 pairs were from patients who were being treated with BP (study subjects), and 39 pairs were from patients who had not been using BP (controls). All pairs of radiographs underwent digital subtraction by Emago. The number of pixels of the sclerotic areas was counted and compared between subjects and controls.

RESULTS

The sclerotic changes were significantly distinguishable in two of the seven subjects (28.6%) using BP.

CONCLUSIONS

Digital subtraction function of Emago was able to detect sclerotic changes in alveolar bone. Therefore, it is suggested that the subtraction function of Emago is a useful tool for quantitatively detecting sclerotic changes that are observed at an early, silent stage of BP-related osteonecrosis of the jaw.

MULTI RESOLUTION BASED IMAGE REGISTRATION TECHNIQUE FOR MATCHING DENTAL X-RAYS

This paper presents a new technique to assess the bone formation after periapical dental surgery. The proposed technique consists of two main stages: image registration and spectral subtraction stages. Image registration is used to avoid projection errors produced due to nonstandardization of X-ray scanners. Wavelet coefficients are used instead of grey values for registering the images. Coarse to fine strategy with four levels of resolutions is used to speed up the process. The second stage is the spectral subtraction stage. It is used to yield the difference image between pre- and post-operative images which represents the bone gain or bone loss with light and dark areas, respectively. Algorithm has been applied on a number of pre- and post-surgery intra oral periapical (IOP) dental X-ray images. Mean and root mean square error (RMSE) are computed to assess the quality of registration technique. The technique presented here is compared with grey level based method; results show that proposed technique outperforms conventional grey level method based on dyadic sampling.

Noise in subtraction images made from pairs of intraoral radiographs: a comparison between four methods of geometric alignment

OBJECTIVES

To compare noise levels in subtraction images produced by four methods of geometric alignment.

METHODS

50 pairs of intraoral radiographs (Digora Optime; Soredex, Tuusula, Finland) were used in this study. Two programs were used to correct geometric differences: ToothVis 1.4 (TV) and DentalStudio 2.0 (DS). Three reference points were manually positioned in both programs (methods 1 and 2); four (method 3) and ten (method 4) reference points were positioned within TV in each of the 50 pairs of images. The standard deviation (SD) of the histogram defining the distribution of grey shades in the subtraction image was used as the statistical parameter for evaluation of homogeneity, i.e. the noise in the subtracted images.

RESULTS

The mean and median shade of grey values were lower for images after geometric correction in TV (126.6\126.8, 126.9\126.8 and 126.1\126.7, for three- four- and ten-point alignment, respectively) than those performed with the positioning module of DS (128.7\127.5) (P<0.05). For the SD, the mean values were significantly lower with TV (4.6, 4.0 and 3.3 for three-, four- and ten-point alignment, respectively) than with DS (6.8). The range of SD values was the largest for four-point alignment with TV (0.7-15.4), smaller for three-point alignment with DS (1.5-15.4) and three-point alignment with TV (0.5-13), and the smallest with ten-point alignment in TV (0.5-8.7).

CONCLUSIONS

The SD of the grey-shade histogram showed that subtraction images produced with ToothVis 1.4 software were statistically less noisy than images produced with Dental Studio 2.0 software. There is a relationship between the number of reference points chosen and the noise in the subtraction images.

Clinical efficacy of a new software developed for dental digital subtraction radiography

OBJECTIVES

The aim of this study was to test and compare the efficacy of software developed recently for digital subtraction radiography (DSR) in vivo.

METHODS

An algorithm performing both manual and automated image reconstructions and contrast correction was developed for the manipulation of radiographic images. Pre- and post-operative radiographic images of ten patients were obtained and the automated subtraction analyses were performed using four different softwares (new software, Emago, Photoshop 8.0 and Paintshop Pro 9). Ten experienced dental specialists evaluated the clinical efficacy of each program and scored the softwares by using visual analogue scales (VAS). The results were statistically analysed and alpha was set as 0.05.

RESULTS

The newly developed algorithm received higher scores than the others (new software =67.89, Emago = 64.26, Paintshop Pro 9 = 33.41 and Photoshop 8.0 = 27.24, respectively). The clinical efficacies of the new software and Emago were not significantly different (P = 0.720); likewise, Photoshop 8.0 and Paintshop Pro 9 performed comparably (P = 0.295).

CONCLUSIONS

Considering this study, the new software and Emago would be suggested for DSR in dental practice.