Revisiting dynamic range and image enhancement ability of contemporary digital radiographic systems

Objectives: To assess the dynamic range and enhancement ability of radiographs acquired with contemporary digital systems. Methods: Five repeated periapical radiographs of human mandibles with an aluminium step-wedge were acquired using two sensor-based and three phosphor plate-based (PSP plate-based) systems and an X-ray unit at ten exposure times 0.020, 0.032, 0.063, 0.080, 0.100, 0.200, 0.320, 0.400, 0.500, and 0.630 s. All images had their brightness and contrast enhanced by two experienced oral and maxillofacial radiologists in consensus and were exported as both the original and enhanced file formats. Mean grey values were obtained from the aluminium steps and tabulated with their corresponding thicknesses for each exposure time, digital radiographic system, and file format. Images with saturated steps were excluded and the mean grey values from the remaining images were averaged to assess image brightness and the angular coefficient of the linear trendlines was generated from the relationship between mean grey values and their corresponding aluminium thicknesses to assess image contrast. Brightness and contrast values were compared using two-way ANOVA with post-hoc Tukey (α = 0.05). Results: PSP plate-based digital radiographic systems had a broader dynamic range. Longer exposure times produced original images with lower brightness and variable contrast (p < 0.05). Subjective enhancement significantly increased or reduced brightness and/or contrast in some systems (p < 0.05). Conclusions: Contemporary digital radiographic systems present different dynamic ranges and exposure-related brightness and contrast. Image enhancement may be a valuable tool at slightly suboptimal exposure times.

Benefits of using a photostimulable phosphor plate protective device

Objectives: To develop and test a protective device (PD) to increase the resistance of photostimulable storage phosphor (PSP) plate to compressive load, and assess the resulting image quality. Methods: Two prototypes, polyvinylchloride sheets of 0.3 mm and 0.7 mm each, were developed for PSP plate size 2. The resistance to compressive load was tested using eight new PSPs divided into four test groups: (1) PSP, (2) PSP and paperboard protector, (3) PSP and 0.3 mm PD, and (4) PSP and 0.7 mm PD. The resulting images were analyzed by three oral radiologists, based on the consensus for image artifacts. Additionally, the objective image quality test was performed with four new PSPs, using an 8-step wedge aluminum scale. The mean gray values and standard deviation were measured in a total of 240 images, and the data were analyzed using analysis of variance with Bonferroni post-hoc test. Results: Artifacts were seen in the PSP control group starting at 40 n, and at 150 n, 175 n and 300 n in 0.3 mm PD, paperboard protector and 0.7 mm PD, respectively. Although there was no statistical difference among groups, there were differences between exposure times (0.06–0.25 s, 0.06–0.40 s, and 0.10–0.40 s). Scanning resolution of 20 lp/mm showed higher mean gray value than 25 and 40 lp/mm (p < 0.05) Conclusion: The developed PDs improved the PSP resistance to compressive forces, with low interference on the pixel gray values, regardless of exposure time and spatial resolution. Nevertheless, the 0.7 mm PD could withstand the maximum compressive load.

Investigating the Effect of Different Metal Sheets on Reducing Radiation Behind Intraoral Digital Phosphor Plates During Intraoral Radiography using Gray Value

Purpose: To assess the efficacy of metal sheets with different thicknesses on reducing the radiation behind the photostimulable phosphor plate (PSP) during intraoral periapical examinations. Materials and Methods: In this study, a phantom head was used to investigate the effect of using metal sheets of aluminum, stainless steel, and copper with three thicknesses of 0.5, 0.75 and 1mm on reducing the radiation behind PSP. Images were acquired at 66 kVp 8 mA, and 0.16 s using the long-cone paralleling technique. The images were saved and exported to DICOM format without any post-processing. Then, they were transferred to an image processing software (Mimics, Materialize, Leuven, Belgium), and their mean gray values (MGV) were determined. The acquired data were statically analyzed for accessing the significant difference in groups means using ANOVA, and the means of groups were compared using Tukey’s test procedure. Results: The MGV of the second PSP differed significantly from those PSPs slotted with various metals (p<0.001). The MGV for lead and stainless steel at 0.5 mm thickness was insignificant (p = 0.852), but differed significantly from other metals. The MGV for PSPs with 0.75 mm stainless steel and 1 mm copper slots were varied significantly from those of all other PSP and metals. The 1 mm copper group was significantly different from all other groups (p<0.001). Conclusion: Using the mean gray value of the PSP, the use of various metal sheets of different thicknesses could effectively reduce the radiation behind the PSPs during periapical radiographs.

In vitro comparison of two photostimulable phosphor plate systems for early detection of occlusal dentin caries with and without a sharpening filter

Background. Dental caries is the most important reason for tooth loss. Clinical examination is the most commonly used technique for occlusal caries diagnosis. The diagnostic power of digital systems is a matter of controversy in this field. The present study aimed to determine the diagnostic accuracy of two photostimulable phosphor plate (PSP) systems for early occlusal dentin caries in vitro. Methods. Sixty-nine extracted molar and premolar teeth were used in this study. The teeth were mounted in triple blocks, and standard radiographs were taken by the Digora and Acteon digital radiographic systems. The original and filter 1-enhanced radiographs were evaluated by two experienced observers twice at an interval of two weeks, and dentin caries was recorded in Tables prepared for the study. The teeth were then sectioned in a buccolingual direction and evaluated under a stereomicroscope. The observers’ reports were compared with microscopic findings as the gold standard. SPSS 23 was used to calculate the kappa coefficient, sensitivity, specificity, and area under the ROC curve (AUC). Statistical significance was set at P<0.05. Results. The internal and the external agreements in both imaging systems were good to excellent. The means of sensitivity, specificity, and AUC in the Acteon system were 34.1, 92.9, and 0.674, with 30.8, 94.8, and 0.659, respectively, in the Digora system. Conclusion. The accuracy of early occlusal caries diagnosis was poor on both systems, and no significant difference was observed between the two systems at a 95% confidence interval. Although the AUC was slightly higher in the original images, there was no significant difference between them; however, due to their high specificity, they can prevent unnecessary treatments in the clinic.

A RADIOLOGIA ODONTOLÓGICA DIGITAL NO ESQUADRÃO DE SAÚDE DE FLORIANÓPOLIS: RELATO DE CASO

O presente artigo relata como foi implementada a Radiologia Digital na Seção de Odontologia do Esquadrão de Saúde de Florianópolis (ES-FL). O objetivo foi a necessidade de modernização dos equipamentos de radiodiagnóstico odontológico existentes, tornando-os digitais. Para tanto, foram analisadas as opções de sistemas digitais existentes e as vantagens dos sistemas CMOS (Complementary Metal Oxide Semiconductor) e PSP (Photostimulable Phosphor Plate), considerando-se, além de seus aspectos técnicos, também os aspectos de biossegurança, de sustentabilidade e jurídicos. Após análise dos dados e comparação dos preços encontrados por intermédio de processo licitatório, optou-se pelo sistema PSP, que apresentava maior vantajosidade. Constatou-se que a implantação da Radiologia Digital no ES-FL trouxe inúmeras vantagens aos pacientes e profissionais da instituição, tais como a diminuição na dose de exposição do paciente, a possibilidade de manipulação das imagens para aprimorar o diagnóstico, a facilidade de comunicação com os pacientes e entre profissionais, além do impacto ambiental positivo, atendimento célere aos pacientes e radioproteção ao usuário, ao profissional e à equipe.