In vitro comparison of four different dental X-ray films and direct digital radiography for proximal caries detection.

This study investigated the efficiency of different speeds of conventional intraoral films and a direct digital system for proximal caries detection. In this study, 48 extracted human posterior permanent teeth were used. Conventional bitewing radiographs and direct digital radiographs were obtained from the teeth. Three observers independently assessed 96 proximal surfaces, each observer had 10 years of experience. The presence or absence of caries was scored according to a five-point scale. True caries depth was determined by histological examination. The diagnostic accuracy of each radiographic system was assessed by means of a receiver operating characteristic (ROC) curve analysis. The mean of areas under the ROC curve (Az) was analyzed by pairwise comparison of ROC curve. The interobserver agreement was evaluated by using ANOVA analysis. The statistical analysis of Az scores exhibited no significant difference for the five imaging modalities (p > 0.05). There was no statistically significant difference between interobserver agreements (p > 0.05). The results of this study showed that the diagnostic performance of E- and F-speed films and direct digital radiography are similar for proximal caries detection.

A laboratory evaluation of Ektaspeed Plus dental X-ray film.

OBJECTIVES: The aim of this study was to make a laboratory evaluation of the image quality of a new dental X-ray film, Ektaspeed Plus, compared with Ektaspeed and Ultraspeed films. METHODS: Films of each emulsion type underwent a range of exposures at both 50 kVp and 70 kVp, and characteristic curves were constructed to give a comparison of fog, speed and contrast. Line pair and contrast detail test objects were used to assess the resolution of radiographs and the ability of the two film types to reproduce minor differences in subject contrast. The sensitivity of the emulsions to safelighting for a range of times was also tested. RESULTS: Ektaspeed Plus had the same speed, a slightly higher base plus fog density but a higher contrast (50 and 70 kVp) than Ektaspeed. The speed of Ektaspeed Plus was higher and the contrast similar to that of Ultraspeed film. Limiting resolutions of the three films were the same. There was a slightly better imaging of one contrast detail phantom with Ektaspeed Plus compared to Ektaspeed at 70 kVp only. All three emulsions were insensitive to recommended safelighting conditions. CONCLUSION: The improved image contrast of Ektaspeed Plus may be more acceptable to dentists than Ektaspeed and lead to a greater acceptance of E-speed film, contributing to dose reduction.

A perceptibility curve comparison of Ultra-speed and Ektaspeed Plus films.

OBJECTIVE: The purpose of this study was to evaluate the subjectively assessed contrast difference between Kodak's Ultra-speed and Ektaspeed Plus dental radiography films (Eastman Kodak, Rochester, N.Y.) through the use of perceptibility curves. DESIGN: Four series of 22 radiographs were exposed at 70 and 90 kVp with each film type by means of a Gendex 1000 dental radiography unit (Gendex Corp., Milwaukee, Wis.) for times ranging from 0.05 to 5 seconds at 10 ma. The test object consisted of a 7-mm-thick rectangular aluminum block with 10 circular depth cuts, each 2 mm in diameter, which created wells varying in depth from 50 to 500 microns. The corresponding films were processed concurrently (for 4.5 minutes) in total darkness with fresh Kodak Readymatic solutions (Eastman Kodak) held at a constant temperature of 28 degrees C. The resulting radiographs were viewed in a predetermined random order under ideal conditions by 10 dentists. The evaluators recorded the maximum number of perceptible images on each film. A pair of perceptibility curves were generated at 70 and 90 kVp by plotting the log relative exposure versus the mean number of perceptible images. RESULTS: There was no statistical difference between the two film types with respect to the mean number of perceptible images, as analyzed by Wilcoxon's signed rank test (p = 0.22; p = 0.44). CONCLUSIONS: There is no subjectively assessed contrast difference between Kodak s Ultra-speed and Ektaspeed Plus films at 70 and 90 kVp.

Effects of focal spot size on caries diagnosis with D and E speed images.

Annual measurement of the x-ray unit focal spot size has been recommended by the American Academy of Oral and Maxillofacial radiology as part of the dental radiographic quality control program. This study compares the effects of focal spot size on caries diagnosis. Three x-ray units with small, medium, and large focal spot sizes were used to produce bite-wing images on extracted teeth mounted in acrylic bases. Randomized films were scored for lesion presence and depth by two general dentists. Weighted kappa statistics were used to evaluate the agreement of reviewer caries diagnosis by film speed and focal spot size. Comparisons of caries cells with small versus medium and small versus large focal spot size produced weighted kappa statistics = 0.72 and 0.70, respectively. Differences in caries calls were greater because of film speed rather than focal spot size. The results of this study suggest that the clinical significance of varied focal spot size is negligible. The value of annual measurement of focal spot size is questionable, and its recommendation should be revisited.

In vitro carious lesion detection on D-, E-, and F-speed radiographic films.

OBJECTIVES: To compare the accuracy in detection of interproximal natural carious lesions in vitro between Ultraspeed (D), Ektaspeed Plus (E), and Insight (F) radiographic films. STUDY DESIGN: Ten observers indicated on a 5-point scale their confidence in detecting an interproximal lesion in 240 surfaces (120 extracted teeth) with noncavitated carious lesions. Truth was assessed microscopically from hemisections. The areas (Az) beneath receiver operating characteristic (ROC) curves were pairwise compared and used for a 2-way analysis of variance. RESULTS: Az values were significantly correlated with observers (P=.002; Eta=0.671) and film type (P=.003; Eta=0.412). E differed significantly (mean Az: 0.624) from both D (mean Az: 0.591; P=.028) and F (mean Az: 0.594; P=.037), although the 95% confidence intervals clearly overlapped. CONCLUSION: The superior performance of Ektaspeed failed to prove clinical relevance.

Sensitometric properties of Agfa Dentus OrthoLux, Agfa Dentus ST8G, and Kodak Ektavision panoramic radiographic film.

OBJECTIVES: The purpose of this study was to compare the sensitometric properties of and visualization of anatomical structures with Agfa OrthoLux green-sensitive panoramic radiographic film, Agfa ST8G green sensitive panoramic radiographic film, and Kodak Ektavision green-sensitive panoramic radiographic film used in combination with an Agfa Ortho Regular 400 imaging screen, Kodak Ektavision imaging screen, and Kodak Lanex Regular imaging screen. METHODS: The density response and resolution of panoramic radiographic film/intensifying screen combinations was evaluated by means of Hunter and Driffield curves, modulation transfer functions, and noise-equivalent number of quanta. Image clarity of selected anatomical structures was rated independently by 6 oral and maxillofacial radiologists. RESULTS: The ISO speed for the Agfa OrthoLux panoramic radiographic film combinations was the fastest, and the ISO speed for the Kodak Ektavision green-sensitive panoramic radiographic film combinations was the slowest. The average gradient for the Agfa ST8G systems was relatively steep in comparison with those for the other film/screen combinations. The modulation transfer functions for the Kodak Ektavision film were higher than those for the other films, irrespective of the screen combination used, and those for Agfa OrthoLux film were slightly higher than those for Agfa ST8G film. The noise-equivalent number of quanta for the Agfa ST8G film/screen combinations was lower than those for the other film/screen combinations. The noise-equivalent number of quanta for the Kodak Ektavision film/screen combinations was well within the high-frequency range, whereas Agfa OrthoLux combined with either the Kodak Ektavision imaging screen or the Kodak Lanex Regular imaging screen produced a noise-equivalent number of quanta similar to those of the Kodak Ektavision film/screen combinations in the low-frequency range. Agfa OrthoLux was perceived to provide clearer images of the selected anatomical details than Agfa ST8G, and the Agfa OrthoLux/Agfa Ortho Regular 400 combination was not significantly different from the Kodak Ektavision/Kodak Lanex Regular combination in terms of perceived image quality. CONCLUSION: Agfa OrthoLux is an improvement over Agfa ST8G in film speed, spatial resolution, granularity, and perceived diagnostic image quality. The Agfa OrthoLux/Agfa Ortho Regular 400 combination did not exceed the Kodak Ektavision film/Kodak Ektavision imaging screen combination in resolution, granularity, or perceived image quality.

In vitro comparison of Kodak Ultra-speed, Ektaspeed, and Ektaspeed Plus, and Agfa M2 Comfort dental x-ray films for the detection of caries.

The aim of this study was to compare the diagnostic accuracy of two new dental x-ray films, Kodak Ektaspeed Plus (Plus) and Agfa M2 Comfort (M2), respectively, with the current Kodak Ultra-speed (Ultra) and Ektaspeed (Ekta) films for the detection of caries. A total of 103 occlusal and 224 proximal surfaces were examined independently by three observers. A histologic examination performed after the teeth were sectioned served as the validation method for lesion depth. Receiver operating characteristic curve areas were calculated to express the diagnostic accuracy. In the occlusal surfaces the receiver operating characteristic curve areas ranged from 0.764 (in Ultra films) to 0.800 (in Ekta films). In the proximal surfaces the receiver operating characteristic curve areas ranged from 0.550 (in Ultra films) to 0.696 (in Plus films). No statistically significant differences were found between the different film types.

Storage-phosphor computed radiography versus film radiography in the detection of pathologic periradicular bone loss in cadavers.

OBJECTIVES: The purpose of this study was to compare D-speed film, E-speed film, and the Soredex Digora system with respect to the detection of periradicular pathosis. STUDY DESIGN: Radiographic images of 100 cadaver jaws were made with E-speed film, D-speed film, and the Soredex Digora. Each set of 100 images was interpreted by four observers, with 30 days separating each of three viewing sessions from the next. The presence or absence of pathologic (inflammatory) periradicular bone resorption was determined by histologic examination of the samples. The observer performance was compared with the true histologic findings and evaluated with receiver operating characteristic and corrected receiver operating characteristic analysis. RESULTS: No statistically significant differences were found in diagnostic performance among the three radiographic techniques. In addition, no imaging technique was a good indicator of pathosis as determined by histologic analysis. CONCLUSION: Under the conditions of this study, it was determined that D-speed film, E-speed film, and the Soredex Digora were equivalent diagnostic imaging modalities with regard to the detection of pathologic periradicular bone resorption. No technique predictably indicated inflammatory resorption.

Reliability of digital radiography of interproximal dental caries.

PURPOSE: To compare the effects of different image processing modes (filters) on the reproducibility and validity of the assessment of interproximal carious lesions viewed in digitized radiographic images. MATERIALS AND METHODS: Variables studied were film type, exposure time, and tissue scatter radiation. Images were assessed in relation to film type, exposure time and tissue scatter. Standardized radiographs of 50 extracted teeth were obtained and 44 areas of interproximal caries were detected. Six radiographs were obtained of each tooth and digitized using FRIACOM software. Four were made using D-type film with and without soft tissue scatter equivalent at normal exposure time (0.32 seconds) and underexposed (0.16 seconds). Two were made using E-type film with TSE normal (0.16 seconds) and underexposed (0.08 seconds). On each of the 300 radiographs, the central depth (CD) of each carious lesion was measured at 18x magnification both on the unchanged radiographic image and after use of two different filters. All measurements were repeated after 1 week to estimate reproducibility. RESULTS: Histometric CD assessments provided a gold standard for comparison with the radiographic measurements (validity). Whereas reproducibility was not influenced by one of the filters, filter "structure" improved the overall validity of CD measurements. In this study, digital manipulations of radiographic images resulted in statistically significant improvement of the validity of CD measurements.

Tissue radiation dosages using the RVG-S with and without niobium filtration.

Tissue doses for a modified Rando head- and-neck phantom were measured for imaging with speed group E film with standardized aluminium filtration and the RVG-S both with and without added niobium filtration. Cylindrical holes drilled into the phantom's tissue-equivalent material permitted the placement of a small ionization chamber into anatomically correct sites representing the thyroid, parotid, submandibular and sublingual glands. To establish the necessary cone positions, angulations and time settings for each exposure, diagnostically acceptable images of six teeth, representative of different intraoral regions, were made for a DXXTR mannequin. Entrance and exit points were marked and transferred to the phantom to allow reproducible repeat exposures. The RVG-S provided reductions in average skin entrance dose of 31 per cent to 39 per cent with standard aluminium filtration and 51 per cent to 60 per cent with the addition of niobium filtration to attenuate the beam. While dose reductions relative to E-speed film usage were found for deep tissue sites, these were site and projection specific. The cumulative reduction from use of the RVG-S without niobium filtration was 32 per cent. It was 42 per cent with additional niobium filtration. It should be noted, however, that adding niobium filtration resulted in increased dosages to the deeper soft tissues such as the thyroid gland.

The use of radiation dose-reduction techniques in the practices of dental faculty members.

X-ray exposure to dental patients has been significantly reduced by the introduction of speed group E intraoral film, rectangular beam limitation, long position indicating devices (PIDs), and rare-earth intensifying screens for extraoral radiography. Research indicates that many dentists do not use these techniques. However, schools of dentistry have implemented them to varying degrees for many years, so this investigation was conducted to determine the extent to which dental school faculty members use these materials and techniques in their own practices. Comparisons were made between full- and part-time instructors, those in practice for fifteen years or less and those in practice for more than fifteen years, and those with postgraduate education versus those with no formal education beyond dental school. The significance of differences was measured with chi-square analysis. The results indicate that dentists with faculty appointments utilize dose-reducing techniques to degrees that are comparable to or greater than reported usage by non-dental faculty practitioners. Faculty dentists in practice fifteen years or less are more likely than their older colleagues to use E-speed film (p = 0.001), whereas those in practice more than fifteen years are more likely to use longer PIDs (p = 0.049). Greater acceptance of these practices by faculty may lead to reinforcement of their use in the clinical education of dental students.

Comparison of sensitometric and diagnostic performance of two films.

The sensitometric properties of Kodak Ektaspeed Plus and Flow E-speed film as well as their diagnostic efficacy for detecting proximal surface caries were compared. Flow and Kodak E-speed films were exposed and processed according to American National Standards Institute and American Dental Association (ADA) specifications, and film speed, contrast, and density of base plus fog were measured. Additionally, 80 premolar and molar teeth were imaged and their proximal surfaces scored by 12 dentists for the presence of caries. The actual depth of the caries was determined by microscopic examination of the teeth after sectioning. Kodak Ektaspeed Plus and Flow E-speed films, although labeled E-speed by the manufacturers, are both slow F-speed films. They have comparable base plus fog densities and comparable contrast curves. Dentists detected carious lesions equally well using both film types. The sensitivity, specificity, accuracy, and receiver operating characteristic area for detecting enamel and dentinal caries were not significantly different between the two films. Kodak Ektaspeed Plus and Flow E-speed films both meet or exceed the ADA performance specifications in terms of sensitometric properties. Both offer equal diagnostic utility for detecting caries.

[Roentgenological materials on the Russian market]. / Rentgenograficheskie materialy na Rossiikom rynke.

The paper outlines the qualitative parameters of radiographic medical films and methods of their evaluation by Russian and foreign experts. A classification of their films is presented. The Russian methods and equipment for film examination do not satisfy the objective testing of up-to-date radiographic materials.

Using GafChromic film to estimate the effective dose from dental cone beam CT and panoramic radiography.

OBJECTIVES: To demonstrate the feasibility of GafChromic(®) XR-QA2 (ISP Corp., Wayne, NJ) as a dosemeter when performing measurements of the effective dose from three cone beam CT (CBCT) units and to compare the doses from examinations of three common dental clinical situations. A second aim was to compare the radiation doses for three digital panoramic units with the doses for the CBCT units. METHODS: The CBCT units used were Veraviewepocs 3De(®) (J Morita MFG Corp., Kyoto, Japan), ProMax(®) 3D (Planmeca, Helsinki, Finland) and NewTom VGi(®) (Quantitative Radiology, Verona, Italy). GafChromic XR-QA2 films were placed between the selected layers of the head and neck of a tissue-equivalent human skull (RANDO(®) phantom; The Phantom Laboratory, Salem, NY). The exposure parameters were set using the automatic exposure control function of the units. Depending on the availability, medium and smaller field of view (FOV) scanning modes were used. The effective dose was estimated using the 2007 International Commission on Radiological Protection formalism. RESULTS: The lowest effective dose of a CBCT unit was observed for ProMax 3D, FOV 4 × 5 cm (10 µSv), the highest for NewTom VGi, FOV 8 × 8 cm-high resolution (129 µSv). The range of effective doses for digital panoramic machines measured was 8-14 µSv. CONCLUSIONS: This study demonstrates the feasibility of using radiochromic films for dental CBCT and panoramic dosimetry.

Is it true that the radiation dose to which patients are exposed has decreased with modern radiographic films?

OBJECTIVES: To determine whether the radiation dose administered to patients has decreased with new radiographic films and digital imaging systems. METHODS: A total of 10 171 official reports on radiological practice in dental surgeries (covering the years 1996-2003) from 16 Spanish autonomous regions were studied, analysing the type of film used, the exposure times and the radiation doses administered in each dental clinic for four different teeth: upper molar, lower molar, upper incisor and lower incisor. RESULTS: The Agfa Dentus M2 radiographic film needed the longest exposure times for all of the teeth (0.6 s, 0.5 s, 0.4 s and 0.4 s, respectively) followed in decreasing order by Ultraspeed, Insight, Ektaspeed and the digital systems, the decrease with respect to the first reaching as much as 60%. Regarding the dose administered, Agfa Dentus M2 used the highest dose (3.1 mGy) followed by Ultraspeed (2.7 mGy), Insight (2.2 mGy), Ektaspeed (2.2 mGy) and, finally, the digital systems (1.1 mGy). Statistical analysis showed significant differences between the doses administered for the digital systems with respect to the radiographic films (P < 0.001) and with respect to manual or automatic processing (P < 0.001). However, there were no significant differences in dose between the different types of films themselves, or between the radiographic developing processes themselves (manual and automatic). CONCLUSION: Not even the use of the most sensitive of modern films has brought about a reduction of the dose administered to patients in Spain. Only digital systems, it seems, will bring about reduction in this dose.

Digital enhancement of radiographs for assessment of interproximal dental caries.

OBJECTIVES: Evaluation of a particular digital caries image-enhancing mode (filter) for its effect on the validity of measurements of caries lesion depth. METHODS: Standardized radiographs of 44 extracted teeth exhibiting interproximal caries lesions were obtained. Six radiographs were obtained of each tooth and digitized. Four radiographs were made using D-speed film with and without soft tissue scattering equivalent (STSE) at normal exposure time (0.32 s) and underexposed (0.16 s). Two were made using E-speed film with STSE normally (0.16 s) and underexposed (0.08 s). On each of the 264 radiographs, 4 independent examiners measured the central depth (CD) of 1 carious lesion per tooth both on the unchanged radiographic image and after use of the filter. Histometric CD assessments provided a gold standard for comparison with the radiographic measurements (validity). Repeated measures ANOVA was calculated for validity in relation to examiner, lesion type, filter, film type, exposure time and STSE. RESULTS: The lesion type was identified to statistically significantly influence the validity of CD measurements. Examiner in combination with defect type (P<0.001), filter (P = 0.017), exposure (P = 0.027) and film type (P = 0.044) had an additional albeit small effect. CONCLUSIONS: The lesion type significantly influenced the validity of CD measurements: enamel lesions were less underestimated than dentin lesions.

Survey of dental radiological practice in Turkey.

OBJECTIVES: The aim of this study was to determine the dentist's knowledge about dose reduction techniques, radiographic equipment and quality of dental radiographic service in general dental practice in Turkey. METHODS: The survey was performed on 636 dentists who attended the 11th International Congress organized by the Turkish Dental Association. Information on the demographic characteristics of the dentists, radiographic equipment, techniques and processing they used and radiation protection was obtained with a 32 point questionnaire. RESULTS: The respondents' knowledge concerning the technical details of their equipment was limited, with 512 (86.9%) not knowing the kilovoltage peak (kVp) of their machine. Only 34 (5.5%) respondents reported having rectangular collimators. The dentists had little knowledge about the speed of film they used. D-speed film was the most preferred one with 21.6%. Fifty-eight (10.2%) dentists used E-speed film and the F-speed film was used only by 13 (2.3%) dentists. The most preferred technique (62%) for periapical radiography was the bisecting angle technique. Four hundred and eighty five (82.5%) of the dentists reported that they took the radiographs by themselves. CONCLUSIONS: In the present study, the results indicate that for minimizing any unnecessary radiation, attempts should be made to improve dentists' knowledge about radiation dose reduction techniques.