Critical value in surgical pathology: evaluating the current status in a multicenter study.

BACKGROUND: The concept of critical value is not evident in surgical pathology, and there is no established protocol for determining, reporting, and documenting these results. MATERIALS AND METHODS: A questionnaire was designed regarding critical value in surgical pathology, and all pathologists and some clinicians from five laboratories were asked to participate through an invitation link. The most important items were selected, and all pathologists were instructed to follow a standard operating procedure to deal with critical results for a year. RESULTS: A total of 43 pathologists and 44 non-pathologists participated in the study. Some critical or unexpected items were selected. Most participants agreed that the optimal time to announce critical reports is within 24 h of establishing the final diagnosis, and a phone call was the most dependable communication option. In addition, the most qualified recipients were the attending physicians. Therefore, a written policy was implemented for a year. One hundred seventy-seven critical or unexpected cases (0.5%) were detected. Mucormycosis and cytomegalovirus (CMV) were the most frequent critical cases. CONCLUSION: There are no set criteria for critical items or the reporting process in surgical pathology. It is possible to establish more uniform norms for reporting these cases by boosting pertinent research efforts and recruiting more pathologists and physicians. Additionally, it is advised that each medical facility compile its own unique critical or unexpected diagnosis list.

Termination of Repeat Testing in Chemical Laboratories Based on Practice Guidelines: Examining the Effect of Rule-Based Repeat Testing in a Transplantation Center.

BACKGROUND: Although the automation of instruments has reduced the variability of results and errors of analysis, in some laboratories, repeating a test to confirm its accuracy is still performed for critical and noncritical results. However, the importance of repeat testing is not well established yet, and there are no clear criteria for repeating a test. MATERIALS AND METHODS: In this cross-sectional study, all repeated tests for 26 biochemical analytes (i.e., albumin, alkaline phosphatase (ALP), alanine aminotransferase (ALT), amylase, aspartate aminotransferase (AST), bilirubin total (BT), bilirubin direct (BD), blood urea nitrogen (BUN), calcium, chloride (Cl), cholesterol total (CholT), creatine kinase (CK), creatinine (Cr), glucose, gamma-glutamyl transferase (GGT), high-density lipoprotein-cholesterol (HDL-c), iron, lactate dehydrogenase (LDH), LDL-c, lipase, magnesium (Mg), phosphorus (Ph), protein total (ProtT), total iron binding capacity (TIBC), triglyceride (TG), and uric acid) were assessed in both critical and noncritical ranges over two consecutive months (routine subjective test repeats in the first month and rule-based repeats in the second month). To determine the usefulness of test repeats, differences between the initial and verified results were compared with the allowable bias, and repeat testing was considered necessary if it exceeded the allowable bias range. All causes of repeat testing, including linearity flags, delta checks, clinically significant values, and critical values, were also documented. All data, including the cause of repeats, initial and verified results, time, and costs in the two consecutive months, were transferred to Microsoft Excel for analysis. For comparison of data between the months, Student's t-test was used. RESULTS: A total of 7714 repeat tests were performed over two consecutive months. Although a significant decline (38%) was found in repeated tests in the second month (P < 0.001), there was no significant change in the percentage of unnecessary repeats (77% in the first month and 74% in the second month). In both consecutive months, AST and ALT were the most commonly repeated tests, and delta check was the most common cause of repeat testing. Mg, ALP, AST, and lipase showed the highest rates of necessary repeats, respectively (the least stable tests), while albumin, LDL, and CholT tests showed the highest rates of unnecessary repeats, respectively (the most stable tests). The total cost and delay in turnaround time (TAT) due to repeated testing decreased by 32% and 36%, respectively. CONCLUSION: Although repeat testing has been shown to be unnecessary in most cases, having a strict policy for repeat testing appears to be more valuable than avoiding it completely. Each laboratory is advised to establish its own protocol for repeat testing based on its own practice.

Comparison of Cone-Beam Computed Tomography and Intraoral Radiography in Detection of Recurrent Caries under Composite Restorations.

Secondary caries is the most common cause of dental restoration failures. This study aimed to compare the diagnostic accuracy of conventional and digital intraoral radiography and cone beam computed tomography (CBCT) for detection of recurrent caries around composite restorations. mesio-occluso-distal (MOD) cavities were prepared using bur on 45 extracted sound human molar teeth. The teeth were divided into 3 groups. In the control group, cavities were restored with composite resin after etching and bonding (n=15). In Group 2, 500-µm thick wax was placed over the buccal, lingual and gingival walls and the cavities were restored with composite resin. Group 3 specimens were subjected to pH cycling and artificial caries were created on the buccal, lingual and gingival walls. The cavities were restored with composite. Conventional and digital photo-stimulable phosphor (PSP; Optime) radiographs and two CBCTs images (NewTom 3G and Cranex 3D) were obtained from them. Presence or absence of caries in the cavity walls was assessed on these images. Data were analyzed using Kappa statistic. The diagnostic accuracy of CBCT was significantly higher than that of digital and conventional intraoral radiography (p<0.05). The accuracy was 0.83, 0.78, 0.55 and 0.49 for CBCT Cranex 3D, CBCT NewTom 3G, conventional and digital intraoral radiography, respectively. CBCT has a higher diagnostic accuracy than digital and conventional intraoral radiography for detection of secondary caries around composite restorations.

Comparison of Cone-Beam Computed Tomography and Intraoral Radiography in Detection of Recurrent Caries under Composite Restorations

Abstract Secondary caries is the most common cause of dental restoration failures. This study aimed to compare the diagnostic accuracy of conventional and digital intraoral radiography and cone beam computed tomography (CBCT) for detection of recurrent caries around composite restorations. mesio-occluso-distal (MOD) cavities were prepared using bur on 45 extracted sound human molar teeth. The teeth were divided into 3 groups. In the control group, cavities were restored with composite resin after etching and bonding (n=15). In Group 2, 500-μm thick wax was placed over the buccal, lingual and gingival walls and the cavities were restored with composite resin. Group 3 specimens were subjected to pH cycling and artificial caries were created on the buccal, lingual and gingival walls. The cavities were restored with composite. Conventional and digital photo-stimulable phosphor (PSP; Optime) radiographs and two CBCTs images (NewTom 3G and Cranex 3D) were obtained from them. Presence or absence of caries in the cavity walls was assessed on these images. Data were analyzed using Kappa statistic. The diagnostic accuracy of CBCT was significantly higher than that of digital and conventional intraoral radiography (p<0.05). The accuracy was 0.83, 0.78, 0.55 and 0.49 for CBCT Cranex 3D, CBCT NewTom 3G, conventional and digital intraoral radiography, respectively. CBCT has a higher diagnostic accuracy than digital and conventional intraoral radiography for detection of secondary caries around composite restorations.

Resumo A causa mais comum de falha das cáries dentais são as cáries secundárias. Este estudo objetivou comparar a acurácia diagnóstica da radiografia intraoral digital e convencional com a tomografia computadorizada de feixe cônico (TCFC) para a detecção de cáries recorrentes em torno restaurações com compósitos. Cavidades mésio-oclusais-distais (MOD) foram produzidas com broca em 45 molares hígidos humanos extraídos. Os dentes foram dividdos em 3 grupos. No grupo controle, as cavidades foram restauradas com compósito após condicionamento e colagem (n=15). No Grupo 2, foi aplicada uma camada de cera de 500 µm de espessura sobre as paredes bucais, linguais e gengivais; as cavidades foram então restauradas com resina composta. No Grupos 3, as amostras foram submetidas a ciclagem de pH e criação artificial de cáries sobre as paredes bucais, linguais e gengivais; as cavidades foram então restauradas com resina composta. Radiografias convencional e digital com fósforo foto-estimulável (PSP, Optima) e duas imagens em TCFC (NewTom 3G e Granex 3D) foram obtidas de cada amostra. A presença ou não de cáries foi avaliada nestas imagens. Os dados foram analisados por estatística Kappa. A acurácia diagnóstica da TCFC foi significantemente (p<0,05) maior que na radiografia intraoral convencional e digital. A acurácia foi de 0,83, 0,78, 0,55 e 0,49, respectivamente para TCFC Cranex 3D, TCFC NewTom 3G, a radiografia intraoral convencional e digital. A TCFC tem maior acurácia diagnóstica que a radiografia intraoral convencional e digital para detecção de cáries secundárias em torno de restaurações com compósito.

Influence of Head Orientation in Linear Measurement for Implant Planning in Cone Beam Computed Tomography.

AIM: Use of dental implants in edentulous patients has become a common treatment modality. Treatment of such implants requires radiographic evaluation, and in most cases several different imaging techniques are necessary in order to evaluate the height, width and the structure of bone at implant site. The aim of this study was to evaluate the influence of head orientation in linear measurement for implant planning in cone beam computed tomography (CBCT). MATERIALS AND METHODS: In the present in vitro study, 11 human dry mandibles were used. The width and height of bone at the central, canine and molar teeth areas were measured on the left and right sides by using digital calipers (as gold standard) and on CBCT images with Reaxis option and no Reaxis. Data were analyzed with Statistical package for the social sciences (SPSS) 18, using pair t-test, Tukey test and intraclass correlation (ICC). RESULTS: Data were collected by evaluation of 11 skulls and 66 samples on the whole. There were no significant differences in bone width in any area in both Reaxis and no Reaxis option (p > 0.05). There were significant differences in bone height in the central (p = 0.005) and molar teeth areas (p = 0.010). The results did not show any significant differences between the observers (p = 0.329). CONCLUSION: Using the Reaxis option does not affect the measurement of bone width, while use of this option can make a significant difference for height measurements.

Detection of root perforations using conventional and digital intraoral radiography, multidetector computed tomography and cone beam computed tomography.

OBJECTIVES: This study aimed to compare the accuracy of conventional intraoral (CI) radiography, photostimulable phosphor (PSP) radiography, cone beam computed tomography (CBCT) and multidetector computed tomography (MDCT) for detection of strip and root perforations in endodontically treated teeth. MATERIALS AND METHODS: Mesial and distal roots of 72 recently extracted molar were endodontically prepared. Perforations were created in 0.2, 0.3, or 0.4 mm diameter around the furcation of 48 roots (strip perforation) and at the external surface of 48 roots (root perforation); 48 roots were not perforated (control group). After root obturation, intraoral radiography, CBCT and MDCT were taken. Discontinuity in the root structure was interpreted as perforation. Two observers examined the images. Data were analyzed using Stata software and Chi-square test. RESULTS: The sensitivity and specificity of CI, PSP, CBCT and MDCT in detection of strip perforations were 81.25% and 93.75%, 85.42% and 91.67%, 97.92% and 85.42%, and 72.92% and 87.50%, respectively. For diagnosis of root perforation, the sensitivity and specificity were 87.50% and 93.75%, 89.58% and 91.67%, 97.92% and 85.42%, and 81.25% and 87.50%, respectively. For detection of strip perforation, the difference between CBCT and all other methods including CI, PSP and MDCT was significant (p < 0.05). For detection of root perforation, only the difference between CBCT and MDCT was significant, and for all the other methods no statistically significant difference was observed. CONCLUSIONS: If it is not possible to diagnose the root perforations by periapical radiographs, CBCT is the best radiographic technique while MDCT is not recommended.

In vitro comparison of the effect of different slice thicknesses on the accuracy of linear measurements on cone beam computed tomography images in implant sites.

BACKGROUND AND AIMS: Use of dental implants in edentulous patients has become a common treatment modality. Treatment of such implants requires radiographic evaluation, and in most cases, several different imaging techniques are necessary to evaluate the height, width, and structure of the bone at the implant site. In the current study, an attempt was made to evaluate the accuracy of measurements on cone beam computed tomography (CBCT) images with different slice thicknesses so that accurate data can be collected for proper clinical applications. MATERIALS AND METHODS: In the present in vitro study, 11 human dry mandibles were used. The width and height of bone at the central, canine, and molar teeth areas were measured on the left and right sides by using digital calipers (as gold standard) and on CBCT images with 0.5-, 1-, 2-, 3-, 5-, and 10-mm slice thicknesses. Data were analyzed with SPSS 16, using paired t-test, Tukey test, and inter class correlation. RESULTS: Data were collected by evaluation of 11 skulls and 63 samples on the whole. There were no significant differences in bone width in any area (P > 0.05). There were significant differences in bone height in the central and molar teeth areas (P = 0.02). The measurements were not significant only at 4-mm slice thickness option and 5-mm slice thickness option for height compared with the gold standard (P = 0.513 and 0.173, respectively). The results did not show any significant differences between the observers (P = 0.329). CONCLUSION: The highest measurement accuracy of CBCT software program was observed at 4-mm slices for bone width and 5-mm slice thickness for bone height.

Evaluation of the accuracy of linear measurements on lateral cephalograms obtained from cone-beam computed tomography scans with digital lateral cephalometric radiography: an in vitro study.

OBJECTIVES: A cephalometric analysis especially designed for the patient who requires maxillofacial surgery was developed to use landmarks and measurements that can be altered by common surgical procedures. Identification of landmarks in cephalometry is very important and useful for orthognathic surgery. The aim of this study was to evaluate the accuracy of linear measurement based on digital lateral cephalograms (DLC) and on lateral cephalograms obtained from cone-beam computed tomography (CBCT) scans. MATERIALS AND METHODS: The linear distances between anatomic landmarks on 6 dry human skulls were measured by 2 observers using digital calipers for sella-nasion (S-N), menton-nasion (M-N), anterior nasal spine-nasion (ANS-N), anterior nasal spine-posterior nasal spine (ANS-PNS), and pogonion-gonion (Pog-Go). Then, images were obtained by using DLCs and in lateral cephalograms obtained from CBCT scans. The measurement errors were calculated for each modality, compared with each other, and analyzed via SPSS software version 18. RESULTS: For all lines (S-N, M-N, ANS-N, Pog-Go, and ANS-PNS), CBCT-derived values did not differ from actual dry skull dimensions (gold standard) (P > 0.05). In DLC, for S-N, M-N, ANS-N, and Pog-Go lines, measurements were significantly higher than actual measurements (P ≤ 0.05), but ANS-PNS values did not differ from actual measurements (P > 0.05). CONCLUSIONS: The results showed that the values obtained in CBCT imaging compared with calculated values of the digital lateral cephalometry much closer to the actual distance are more accurate indicators of this type of imaging and that CBCT permits oral surgeons to visualize the position and surgical anatomy of the tooth as it will be seen in the operating theater and allows orthodontists to plan directional traction.

Prevalence of dental anomalies among 7- to 35-year-old people in Hamadan, Iran in 2012-2013 as observed using panoramic radiographs.

PURPOSE: This study was performed to evaluate the prevalence of all types and subtypes of dental anomalies among 7- to 35-year-old patients by using panoramic radiographs. MATERIALS AND METHODS: This cross-sectional study was conducted on 1649 people in Hamadan City, in 2012-2013. The prevalence of four types and 12 subtypes of dental anomalies was evaluated by two observers separately by using panoramic radiography. Dental anomalies were divided into four types: (a) shape (including fusion, taurodontism, and dens invagination); (b) number (including hypodontia, oligodontia, and hyperdontia); (c) structure (including amelogenesis imperfecta, dentinogenesis imperfecta, and dentin dysplasia); and (d) position (including displacement, impaction, and dilacerations). RESULTS: The reliability between the two observers was 79.56% according to the Kappa statistics. The prevalence of dental anomalies diagnosed by panoramic radiographs was 29%. Anomalies of position and number were the most common types of abnormalities, and anomalies of shape and structure were the least in both genders. Anomalies of impaction (44.76%), dilacerations (21.11%), hypodontia (15.88%), taurodontism (9.29%), and hyperdontia (6.76%) were the most common subtypes of dental anomalies. The anomalies of shape and number were more common in the age groups of 7-12 years and 13-15 years, respectively, while the anomalies of structure and position were more common among the other age groups. CONCLUSION: Anomalies of tooth position were the most common type of dental anomalies, and structure anomalies were the least in this Iranian population. The frequency and type of dental anomalies vary within and between populations, confirming the role of racial factors in the prevalence of dental anomalies.

Position of impacted mandibular third molar in different skeletal facial types: First radiographic evaluation in a group of Iranian patients.

PURPOSE: This study was performed to evaluate the position of impacted mandibular third molars in different skeletal facial types among a group of Iranian patients. MATERIALS AND METHODS: A total of 400 mandibular third molars in 200 subjects with different types of facial growth were radiographically investigated for their positions according to their types of facial growth on the basis of the ß angle. The subjects were divided into three groups (class I, II, and III) according to ANB angle, representing the anteroposterior relationship of the maxilla to the mandible. Meanwhile, the subjects were also divided into three groups (long, normal, and short face) according to the angle between the stella-nasion and mandibular plane (SNGoGn angle). ANOVA was used for statistical analysis. RESULTS: The mean ß angle showed no significant difference among class I, II, and III malocclusions (df=2, F=0.669, p=0.513). The same results were also found in short, normal, and long faces (df=1.842, F=2, p=0.160). The mesioangular position was the most frequent one in almost all of the facial growth patterns. Distoangular and horizontal positions of impaction were not found in the subjects with class III and normal faces. In the long facial growth pattern, the frequency of vertical and distoangular positions were not different. CONCLUSION: In almost all of the skeletal facial types, the mesioangular impaction of the mandibular third molar was the most prevalent position, followed by the horizontal position. In addition, ß angle showed no significant difference in different types of facial growth.

Assessment of dental implant site dimensions in cone beam computed tomography systems / Avaliação das dimensões da área de implante dentário com sistemas de tomografia computadorizada de feixe cônico

Objective: The aim was to investigate the accuracy of linear measurements of the mandibular ridge recorded using two CBCT systems. Material and Methods: Eleven human dry skull were used in which mandibles were chosen to measure width and height in 6 sites. Before scanning, the points were marked using barium sulfate radiopaque contrast media. Mandible imaging was done using two systems: Newtom3G and Cranex3D. Alveolar ridge dimensions were recorded by two observers under uniform condition using special software for each system. The measurement errors and inter-examiner reliability were calculated for each modality and compared with each other and analyzed via SPSS software version 18. The level of significance was set at P < 0.05. Results: The overall mean was 0.08 mm for Cranex system and 0.5 for Newtom system. The mean of two systems had no statistically significant difference in comparison with each other or with the gold standard. The statistical analysis showed high inter-observer reliability (P < 0.05). Conclusion: CBCT is highly accurate and reproducible in linear measurements in the different areas of the maxillofacial region.

Objetivo: O objetivo deste estudo foi investigar a acurácia de medidas lineares do rebordo mandibular utilizando dois sistemas de TCFC. Material e Métodos: Onze crânios secos humanos foram utilizadas e seis regiões das mandíbulas foram escolhidos para mensuração da largura e da altura. Antes da digitalização, os pontos foram marcados com contraste radiopaco de sulfato de bário. Imagens da mandíbula foram realizadas usando dois sistemas: Newtom3G e Cranex3D . As dimensões rebordo alveolar foram determinadas por dois observadores em condições uniformes utilizando software específico para cada sistema. Os erros de medição e confiabilidade interexaminadores foram calculados para cada modalidade, utilizando o software SPSS versão 18, e comparados entre si. O nível de significância adotado foi p < 0,05. Resultados: A média geral para o sistema Cranexfoi de 0,08 mm e 0,5 para o sistema de Newton. As médias dos dois sistemas não apresentaram diferença estatisticamente significativa em comparação entre si ou com o padrão-ouro. A análise estatística mostrou alta confiabilidade interexaminador (p < 0,05). Conclusão: TCFC é altamente precisa e reprodutível em medidas lineares nas diferentes áreas da região maxilofacial.