Effect of 3 different disinfection methods on the image quality of photostimulable phosphor plates.

OBJECTIVE: The aim of this study was to assess the effects of 3 disinfection protocols on the quality of images acquired with a photostimulable phosphor (PSP) plate system. STUDY DESIGN: Thirty DIGORA Optime PSP plates were divided into 3 groups of 10. Group 1 was disinfected with 95% ethanol. Group 2 was disinfected using germicidal disposable wipes. Group 3 was disinfected with 95% ethanol, followed by hydrogen peroxide gas sterilization. Images of a quality assurance phantom were acquired on each plate before disinfection (baseline images). Disinfection and imaging cycles were repeated 45 times for each plate. Changes in image quality were assessed between baseline and final images. Image quality was evaluated for dynamic range, spatial resolution, and contrast perceptibility. The Fisher exact test was used to detect statistically significant differences among the 3 disinfection methods relative to decreases in image quality parameters between the baseline and final radiographs. Additionally, for each group, the Z-test was used to detect statistically significant decreases in image quality parameters between baseline and final images. The significance level was established at P < .05. RESULTS: No statistically significant differences were detected among the disinfection groups or relative to baseline values for any group at a 5% significance level. CONCLUSIONS: Hydrogen peroxide gas may be considered to prevent cross-contamination while preserving image quality. Regular quality assurance testing is recommended to maintain image quality over time.

Computed vs. film-based radiographs' contour artifacts influence diagnosis of secondary caries.

To test local grey-scale changes on dental bitewing radiographs near filling margins for image acquisition. Forty approximal preparations in caries-free amalgam filled teeth and bitewing radiographs were acquired under standardized conditions applying four techniques. Film-based analog radiographs were digitized using flat-bed scanner (FDR). Phosphor-plate computed radiographs (PCR) were directly acquired by scanning VistaScan imaging plates. Image quality was tested using Preset Filter (PF) or manually applied IntraOral Fine Filter (IF) to enhance digital images. Local changes from digital imaging processing were assessed by comparing the margin-near (MN) and margin-far (MF) zone by a multivariate repeated measurements analysis. All images were acquired with 8-bit depth (256 shades). Dentine was displayed in 79 shades for FDR and 54 shades for PCR. PF or IF locally modify bitewing radiographs by darkening marginal dentine by 8 or 29 shades, respectively. The sharpest display of the margin (shades per pixel) from dentine to filling was found for IF (26.2), followed by FDR (23.2), PF (15.3) and PCR (8.3). Computed radiography with phosphor plates generate more homogeneous images compared to flatbed-digitized film-based radiographs. The filling margin was sharpest represented with the IF filter at the detriment of an artificial darkening of the dentine near the margin of the filling. Contour artifacts by filters have the potential to confound diagnosis of secondary caries. Algorithms and filters for sensor data processing, causing local changes above 2% of the dynamic range by non-continuous mathematical functions, should only be applied with caution, manually when diagnosing and reversibly.

Experimental assessment of a phosphor model for estimating the relative extrinsic efficiency in radioluminescent detectors.

Optimising phosphor screens in dose detectors or imaging sensor designs is a cumbersome and time- consuming work normally involving specialised measuring equipment and advanced modelling. It is known that crucial optical parameters of the same phosphor may vary within a wide range of values. The aim of this work was to experimentally assess a simple previously published model where the case specific optical parameters (scattering and absorption) are instead represented by a fixed, single parameter, the light extinction factor, ξ. The term extrinsic efficiency, N, of a phosphor is also introduced, differing from the common denotation "absolute efficiency", after noting that unknown factors (such as temperature dependence) can have an influence during efficiency estimations and hence difficult to claim absoluteness. N is expressed as the ratio of light energy emitted per unit area at the phosphor surface to incident x-ray energy fluence. By focusing on ratios and relative changes in this study, readily available instruments in a Medical Physics Department (i.e. a photometer) could be used. The varying relative extrinsic efficiency for an extended range of particle sizes (7.5 and 25 µm) and layer thicknesses (220 to 830 µm) were calculated in the model from the input parameters: the mean particle size of the phosphor, the layer thickness, the light extinction factor and the calculated energy imparted to the layer. In-house manufactured screens (Gd2O2S:Tb) were used for better control of design parameters. The model provided good qualitative agreement to experiment with quantitative deviations in relative extrinsic efficiency within approximately 2%.

Dose reduction in mammography by using imaging plate technology: A retrospective analysis.

PURPOSE: Conventional mammography is a decisive tool in detecting breast cancer. Continuous efforts are undertaken in order to further improve the image quality as well as to reduce the applied doses. The purpose of our study was to compare diagnostic image quality of dose reduced computed mammography with a new needle-based detector system to full dose powder imaging plates. METHODS: We retrospectively compared 360 randomly chosen mammographies performed on a GE Senographe DMR running the Agfa DX-M needle-based imaging plate system (NIP) with their preliminary examinations which were acquired at standard dose with the same GE mammography device and an Agfa CR85-X powdered storage phosphor imaging plate system (PIP). NIP-based mammographies were about 29.8 % dose-reduced. The preliminary examinations had to be performed not earlier than 2 years before the recent investigations. Exclusion criteria were changes in ACR level and appearance of the scored targets and not optimally positioned and exposed mammographies. The images were blinded and read separately twice by 2 mammography experts according to a 3-point score on diagnostic image quality and the visualization of parenchyma, cysts, fibroadenomas, physiologic lymph nodes, solitary microcalcifications and macrocalcifications. RESULTS: Dose reduced NIPs showed a significantly better visualization of parenchyma at ACR II/III and solitary microcalcifications at ACR I-III mammographies (p < 0.001) whereas the difference in scoring macrocalcifications, cysts, fibroadenomas and physiologic lymph nodes was not significant. The reading showed an excellent intra- (r = 0.97/0.94) and interobserver agreement (r = 0.92). CONCLUSION: With computed mammography using the needle-based detector system a significant dose reduction is possible without loss of diagnostic image quality.

Analysis of the deterioration of photostimulable phosphor plates.

OBJECTIVES: To assess, objectively to determine the deterioration of the photostimulable phosphor plates (PSPs) after several acquisitions. METHODS: Two new PSPs without preliminary use were exposed with an intraoral X-ray unit, and the EXPRESS® (Instrumentarium Imaging, Tuusula, Finland) unit was used for scanning of the PSPs. A 12-stepwedge aluminum scale were used superimposed with the PSPs during the X-rays exposures to perform the objective analyses. Objective analysis was carried out by mean gray values using the Image J software through a region of interest (ROI) of 0.1 × 0.1 mm, and the data were analyzed statistically using ANOVA. RESULTS: For each, the Express® PSP a total of 1800 images were acquired during 60 days. The objective analysis showed loss of the mean gray values between the initial and final images. Besides, the percentage of mean gray values' loss was between 0.7%, for the thickest step, and 8.4%, for the lowest thickness step. CONCLUSION: After many X-ray exposures of the Express® PSP a singular deterioration in the mean gray values could be observed.

Thermodynamics, cooperativity and stability of the tetracycline repressor (TetR) upon tetracycline binding.

Allosteric regulation of the Tet repressor (TetR) homodimer relies on tetracycline binding that abolishes the affinity for the DNA operator. Previously, interpretation of circular dichroism data called for unfolding of the α-helical DNA-binding domains in absence of binding to DNA or tetracycline. Our small angle X-ray scattering of TetR(D) in solution contradicts this unfolding as a physiological process. Instead, in the core domain crystal structures analyses show increased immobilisation of helix α9 and two C-terminal turns of helix α8 upon tetracycline binding. Tetracycline complexes of TetR(D) and four single-site alanine variants were characterised by isothermal titration calorimetry, fluorescence titration, X-ray crystal structures, and melting curves. Five crystal structures confirm that Thr103 is a key residue for the allosteric events of induction, with the T103A variant lacking induction by any tetracycline. The T103A variant shows anti-cooperative inducer binding, and a melting curve of the tetracycline complex different to TetR(D) and other variants. For the N82A variant inducer binding is clearly anti-cooperative but triggers the induced conformation.

The effects of physical photostimulable phosphor plate artifacts on the radiologic interpretation of periapical inflammatory disease.

OBJECTIVE: To evaluate how physical photostimulable phosphor (PSP) plate artifacts, such as those created by scratches, phosphor degradation, and surface peeling, affect the radiologic interpretation of periapical inflammatory disease. STUDY DESIGN: A novel technique was developed to digitally superimpose 25 real PSP artifact masks over 100 clinical complementary metal oxide semiconductor (CMOS) periapical images with known radiologic interpretations. These images were presented to 25 general dentists, who were asked to state their radiologic interpretations, their confidence in their interpretations, and their opinions on whether the plates should be discarded. Statistical analyses were conducted by using random intercept mixed models for repeated measures and χ2 tests of the pooled data. RESULTS: No statistically significant adverse effect on interpretation was seen, even at severe artifact levels. There was a statistically significant decrease in the clinicians' confidence and an increase in discard proportions when interpreting images with severe PSP plate artifacts (P < .05). CONCLUSIONS: Although diagnostic efficacy was unaffected, clinicians' confidence decreased and proportionally more clinicians opted to discard sensors when interpreting images with severe artifacts. Future studies on the effects of artifacts on the efficacy of diagnosis of other dental diseases are recommended. Ultimately, these results can guide recommendations for PSP plate quality assurance.

Higher order assembling of the mycobacterial polar growth factor DivIVA/Wag31.

DivIVA or Wag31, which is an essential pole organizing protein in mycobacteria, can self-assemble at the negatively curved side of the membrane at the growing pole to form a higher order structural scaffold for maintaining cellular morphology and localizing various target proteins for cell-wall biogenesis. The structural organization of polar scaffold formed by polymerization of coiled-coil rich Wag31, which is implicated in the anti-tubercular activities of amino-pyrimidine sulfonamides, remains to be determined. A single-site phosphorylation in Wag31 regulates peptidoglycan biosynthesis in mycobacteria. We report biophysical characterizations of filaments formed by mycobacterial Wag31 using circular dichroism, atomic force microscopy and small angle solution X-ray scattering. Atomic force microscopic images of the wild-type, a phospho-mimetic (T73E) and a phospho-ablative (T73A) form of Wag31 show mostly linear filament formation with occasional curving, kinking and apparent branching. Solution X-ray scattering data indicates that the phospho-mimetic forms of the Wag31 polymers are on average more compact than their phospho-ablative counterparts, which is likely due to the extent of bending/branching. Observed structural features in this first view of Wag31 filaments suggest a basis for higher order Wag31 scaffold formation at the pole.

Distortion and magnification of four digital cephalometric units.

OBJECTIVES: To assess the validity of using the calibration ruler for correcting magnification of linear measurements and to explore and compare the vertical and horizontal magnification of four digital cephalometric units. METHODS: An acrylic box was imaged at seven sagittal positions using four digital cephalometric units: Orthopantomograph OC100, Orthopantomograph OC200, Sirona Orthophos CD, and Sirona Orthophos DS. The true linear lengths of the phantom, corrected, and uncorrected linear lengths on the images were measured and compared. The validity of measurements using the calibration ruler was assessed. The magnification values and distortion indices were calculated and compared among the four cephalometric units. RESULTS: For linear measurements on the mid-sagittal plane and averaged linear measurements on bilateral symmetric sagittal planes, the bias 1.96 STD of the calibration ruler ranged from 1% to 2% for the four cephalometric testing units. For linear measurements on the single lateral sagittal plane, the bias 1.96 STD ranged from 3% to 6%. The vertical scanning charge-coupled device cephalometric unit produced the greatest distortion, ranging from 1.029 to 0.964. CONCLUSION: The metal millimeter calibration ruler is an accurate reference for linear measurement magnification correction. Because of unpredictability and machine specificity, the magnification and distortion of a cephalometric unit should be calibrated for the estimation of cephalometric measurement error.

Comparison of testing of collimator and beam alignment, focal spot size with slit camera, and tube current consistency using computed radiography and conventional screen-film systems.

Conversion to a filmless technique of physical performance testing is becoming a topic of much interest to researchers. We assessed the use of a computed radiography (CR) system with postprocessing software as an alternative tool for performing the three physical performance tests of an x-ray tube. Collimator and beam alignment, focal spot size, and milliampere second (mAs) linearity, were performed using a CR system. Results were then compared with those obtained from a conventional screen-film (SF) system. The distances of collimator misalignment measured by the SF system were decreased while peak tube voltage (kVp) was increased (mAs was fixed), whereas those measured by CR were independent of exposure level. The degrees of beam collimator misalignment measured by the CR system were not different from those measured by the SF system. The differences in focal spot dimensions measured by SF and CR systems were less than 4% for large and small focal spot size in both width and length. The mAs linearity evaluated by the SF system agreed with those evaluated by the dose measurement at 50 kVp and 4 mAs, as well as 55 kVp and 3.2 mAs, while the mAs linearity test using the CR system agreed with those using the dose measurement method for all exposure levels. In summary, a CR system could be utilized to assess the three physical performance tests of a single x-ray tube, but required more time than an SF system. Medical physicists with image processing skills were needed to perform the analyses.

DENTAL INTRAORAL EXPOSURES IN PORTUGAL: FROM 1990 TO 2018.

Data from dental intraoral radiography quality controls was gathered from 1201 units (22% of the licensed X-ray units existing in Portugal), using film and digital image systems, between 2016 and 2018. The median incident air KERMA for standard superior molar tooth was evaluated in 0.9 mGy with the value of 1.3 mGy as the upper quartile. Comparisons with a 1990 published survey from dental exposures in Portugal were made. A 85% reduction for incident air KERMA per exposure was observed (6.0 mGy for the 1990 survey), which can be attributed to technical advances in the X-ray image receptors, as well as the implementation of legal requirements for technical acceptability of radiological units. It was also observed an increase of X-ray exams, which is related to an increase of dental practitioners, available radiological equipment and the level of dental healthcare.

Optimal beam quality for chest flat panel detector system: realistic phantom study.

OBJECTIVE: To investigate optimal beam quality for chest flat panel detector (FPD) system by semi-quantitatively assessment using a realistic lung phantom. MATERIALS AND METHODS: Chest FPD radiographs were obtained on a realistic lung phantom with simulated lung opacities using various X-ray tube voltage levels (90-140 kV) with/without copper filter. Entrance skin dose was set to maintain identical for all images (0.1 mGy). Three chest radiologists unaware of the exposure settings independently evaluated the image quality of each simulated opacity and normal structure using a 5-point scale (+ 2: clearly superior to the standard; + 1: slightly superior to the standard; 0: equal to the standard; - 1: slightly inferior to the standard; - 2: clearly inferior to the standard). The traditional FPD image obtained at a tube voltage of 120 kV was used as the standard. The scores of image quality were statistically compared using the Wilcoxon rank test with Bonferroni correction. RESULTS: FPD images using 90-kV shot with copper filter were superior to the traditional 120-kV shot without filter with respect to the visibility of vertebra, pulmonary vessels, and nodules overlapping diaphragm and heart (p < 0.05). There was no significant difference with respect to the visibility of all other simulated lung opacities (lung nodules except for overlying diaphragm/heart and honeycomb opacity) between each tube voltage level with/without copper filter and the traditional 120-kV shot without filter. CONCLUSION: Image quality of FPD images using 90 kV with copper filtration is superior to that using standard tube voltage when dose is identical. KEY POINTS: • FPD image quality using 90 kV with filter is superior to that using traditional beam. • Ninety-kilovolt shot with copper filter may be suitable for chest FPD image. • Clinical study dealing with chest FPD beam optimization would be warranted.

A pilot study of the effects of a vacuum sealing barrier method for photostimulable phosphor plates regarding plate damage and prevention of microbiologic cross-contamination.

OBJECTIVE: The aim of this study was to evaluate the effectiveness of a new sealing method for preventing cross-contamination of photostimulable phosphor (PSP) plates. STUDY DESIGN: Twelve new PSP plates were divided into 3 groups (PSP-a, PSP-b, and PSP- c) and placed in 3 different barriers (2 different brands of envelopes and a vacuum sealing method). All plates were exposed to X-rays with an aluminum step wedge, and the images were evaluated for the presence of any artifacts. After radiography, the PSP plates were removed from the barriers. The barriers and the PSP plates were disinfected and culture performed to assess any microorganism burden. Subsequently, the PSP plates were coated again with all barriers. The barriers were then contaminated and microbiologic specimens were collected. Subsequently, the barriers were wiped with alcohol. The PSP plates were removed, and microbiologic specimens were obtained. RESULTS: No artifacts were recorded on the radiographic images on the sensors in any group. Microorganisms were detected on the PSP plates placed in envelopes. No colonization of microorganisms was detected on the vacuum sealed PSP plates. CONCLUSIONS: The new vacuum-sealing method may be useful in preventing cross-contamination of PSP plates during radiographic procedures.

A carbon CT system: how to obtain accurate stopping power ratio using a Bragg peak reduction technique.

In this study, we investigate the performance of the Gunma University Heavy Ion Medical Center's ion computed tomography (CT) system, which measures the residual range of a carbon-ion beam using a fluoroscopy screen, a charge-coupled-device camera, and a moving wedge absorber and collects CT reconstruction images from each projection angle. Each 2D image was obtained by changing the polymethyl methacrylate (PMMA) thickness, such that all images for one projection could be expressed as the depth distribution in PMMA. The residual range as a function of PMMA depth was related to the range in water through a calibration factor, which was determined by comparing the PMMA-equivalent thickness measured by the ion CT system to the water-equivalent thickness measured by a water column. Aluminium, graphite, PMMA, and five biological phantoms were placed in a sample holder, and the residual range for each was quantified simultaneously. A novel method of CT reconstruction to correct for the angular deflection of incident carbon ions in the heterogeneous region utilising the Bragg peak reduction (BPR) is also introduced in this paper, and its performance is compared with other methods present in the literature such as the decomposition and differential methods. Stopping power ratio values derived with the BPR method from carbon-ion CT images matched closely with the true water-equivalent length values obtained from the validation slab experiment.

Clinical utility of ultra-low-dose pre-test exposure to avoid unnecessary patient exposure due to positioning errors: a simulation study.

The use of digital radiographic systems has decreased the frequency of image retakes due to over/underexposure in general radiography. However, image retakes owing to patient positioning errors are likely to increase because of the convenience of a real-time image check on a console table. The purpose of the present study is to propose a novel radiographic examination procedure with an ultra-low-dose pre-test exposure that may be utilized to check patient positioning prior to taking an actual image, thereby reducing unnecessary patient exposure owing to image retakes. In this study, examination data from 714 knee joint radiographs, both submitted and retaken images, were included. Twelve radiological technologists (RTs) took all images. The actual total exposure dose for each patient was compared with simulated total doses utilized in the proposed procedure. The simulation assumed that each examination was completed following pre-test exposure. Therefore, this method did not involve retaking images although at least one pre-test exposure had been applied to all patients. Pre-test exposures at four dose levels corresponding to 25, 10, 5, and 2% of the actual exposure dose were evaluated to determine whether each dose level could be used to check patient positioning. The results indicated that when the pre-test exposure dose rate was 10% or lower, the total exposure dose reduction equaled or exceeded 8% for all patients. The use of the proposed procedure reduced the total exposure dose for all patients when compared to the exposure dose calculated from records.

Interval breast cancer characteristics before, during and after the transition from screen-film to full-field digital screening mammography.

BACKGROUND: To determine the proportion of "true" interval cancers and tumor characteristics of interval breast cancers prior to, during and after the transition from screen-film mammography screening (SFM) to full-field digital mammography screening (FFDM). METHODS: We included all women with interval cancers detected between January 2006 and January 2014. Breast imaging reports, biopsy results and breast surgery reports of all women recalled at screening mammography and of all women with interval breast cancers were collected. Two experienced screening radiologists reviewed the diagnostic mammograms, on which the interval cancers were diagnosed, as well as the prior screening mammograms and determined whether or not the interval cancer had been missed on the most recent screening mammogram. If not missed, the cancer was considered an occult ("true") interval cancer. RESULTS: A total of 442 interval cancers had been diagnosed, of which 144 at SFM with a prior SFM (SFM-SFM), 159 at FFDM with a prior SFM (FFDM-SFM) and 139 at FFDM with a prior FFDM (FFDM-FFDM). The transition from SFM to FFDM screening resulted in the diagnosis of more occult ("true") interval cancers at FFDM-SFM than at SFM-SFM (65.4% (104/159) versus 49.3% (71/144), P < 0.01), but this increase was no longer statistically significant in women who had been screened digitally for the second time (57.6% (80/139) at FFDM-FFDM versus 49.3% (71/144) at SFM-SFM). Tumor characteristics were comparable for the three interval cancer cohorts, except of a lower porportion (75.7 and 78.0% versus 67.2% af FFDM-FFDM, P < 0.05) of invasive ductal cancers at FFDM with prior FFDM. CONCLUSIONS: An increase in the proportion of occult interval cancers is observed during the transition from SFM to FFDM screening mammography. However, this increase seems temporary and is no longer detectable after the second round of digital screening. Tumor characteristics and type of surgery are comparable for interval cancers detected prior to, during and after the transition from SFM to FFDM screening mammography, except of a lower proportion of invasive ductal cancers after the transition.

The effect of image enhancements and dual observers on proximal caries detection.

OBJECTIVES: The aim of this study was to determine if the use of certain image enhancements and dual observers had an effect on the detection of caries, dentin extension, and cavitation. STUDY DESIGN: Seven observers viewed unenhanced and enhanced images taken on photostimulable phosphor plates (PSP) and Schick 33 sensors and were asked to determine whether proximal caries lesions, dentin extension, and cavitation were present. Pairs of observers also evaluated the unenhanced PSP images and recorded their confidence. Micro-computed tomography was used as the gold standard. RESULTS: For caries lesion detection, PSP outperformed Schick sensors, although the differences are most likely not clinically significant. Observers (single and dual) and filters had no effect on any of the diagnostic tasks. Schick sensors and unfiltered images were more specific for dentin extension. CONCLUSIONS: Caries detection was statistically greater with the PSP plate, but both detectors allowed for high accuracy. Expensive software or time-consuming consultations did not improve outcomes.

Clinical Implementation of a Model-Based In Vivo Dose Verification System for Stereotactic Body Radiation Therapy-Volumetric Modulated Arc Therapy Treatments Using the Electronic Portal Imaging Device.

PURPOSE: To report findings from an in vivo dosimetry program implemented for all stereotactic body radiation therapy patients over a 31-month period and discuss the value and challenges of utilizing in vivo electronic portal imaging device (EPID) dosimetry clinically. METHODS AND MATERIALS: From December 2013 to July 2016, 117 stereotactic body radiation therapy-volumetric modulated arc therapy patients (100 lung, 15 spine, and 2 liver) underwent 602 EPID-based in vivo dose verification events. A developed model-based dose reconstruction algorithm calculates the 3-dimensional dose distribution to the patient by back-projecting the primary fluence measured by the EPID during treatment. The EPID frame-averaging was optimized in June 2015. For each treatment, a 3%/3-mm γ comparison between our EPID-derived dose and the Eclipse AcurosXB-predicted dose to the planning target volume (PTV) and the ≥20% isodose volume were performed. Alert levels were defined as γ pass rates <85% (lung and liver) and <80% (spine). Investigations were carried out for all fractions exceeding the alert level and were classified as follows: EPID-related, algorithmic, patient setup, anatomic change, or unknown/unidentified errors. RESULTS: The percentages of fractions exceeding the alert levels were 22.6% for lung before frame-average optimization and 8.0% for lung, 20.0% for spine, and 10.0% for liver after frame-average optimization. Overall, mean (± standard deviation) planning target volume γ pass rates were 90.7% ± 9.2%, 87.0% ± 9.3%, and 91.2% ± 3.4% for the lung, spine, and liver patients, respectively. CONCLUSIONS: Results from the clinical implementation of our model-based in vivo dose verification method using on-treatment EPID images is reported. The method is demonstrated to be valuable for routine clinical use for verifying delivered dose as well as for detecting errors.

Perception versus reality-findings from a phosphor plate quality assurance study.

OBJECTIVE: The aim of the study was to evaluate the image quality of a photostimulable phosphor (PSP) plate system to determine if image degradation has occurred after a number of clinical uses. STUDY DESIGN: Twenty DIGORA Optime PSP plates (Soredex Orion Corp., Helsinki, Finland) were imaged throughout clinical use. Image quality was assessed by using spatial and contrast resolution through the use of the dental radiographic phantom designed for the Nationwide Evaluation of X-Ray Trends surveys of 1993 and 1999. Spatial resolution was summarized in line pairs per millimeter. The paired t test was used to analyze the contrast wells. The contrast-to-noise ratio (CNR) was calculated to determine the signal-to-noise ratio as another measure of contrast. Descriptive statistics were used to summarize the CNR ratios. RESULTS: Spatial resolution decreased after 48 clinical uses. No significant differences were found for the pairwise comparisons of the contrast wells. No CNR varied by more than two-tenths' value difference. CONCLUSIONS: Digora Optime PSP plates displayed unaffected image quality up to 48 clinical uses. Additional studies are needed to confirm these results and to establish guidelines for appropriate replacement intervals for PSP plates.