How is the use of digital dental radiology in a developing country? An overview of Brazil / ¿Cómo es el uso de la radiología dental digital en un país en vías de desarrollo? Una visión general de Brasil

Abstract The aim of this study was to assess the use of digital dental radiology in Brazil, by focusing on the use of image receptors, imaging exams and digital image enhancement tools, also assessing the methods of professional image transfer. Questionnaires were distributed in person on dental meetings and digitally via messaging (WhatsApp®) and mailings list. The sample of this cross-sectional study consisted of 478 questionnaires. Most participants were woman (n=315, 65.9%), with average age of 33.8±9.2 years. Descriptive and frequency analysis was performed. Chi-square and Fisher's exact tests were used (α=0.05). Most dentists worked at shared dental clinics (34.7%) and use digital image receptors (51.1%), but a representative percentage (48.9%) still exclusively use radiographic films. Photostimulable phosphor plate is the most used digital image receptor. Among extraoral exams, panoramic radiography (PAN) is the most used. Regarding dental specialties, oral radiologists and oral and maxillofacial surgeons mostly use cone-beam computed tomography (p<0.001). Most dentists who use digital systems make use of digital image enhancement tools (87.8%), mainly contrast, zoom, brightness and measurements. The most common method of professional image transfer (professional-professional and professional-patiens) is by email, with few dentists using online app and social media (26%). Therefore, while most Brazilian dentists use digital imaging systems, a significant percentage still exclusively use radiographic films. The most extraoral imaging exams used is PAN. Regarding image enhancement tools, brightness and contrast adjustments, zoom and measurements are the most applied. Finally, dentists generally use email for professional image transfer.

Resumen El objetivo de este estudio fue evaluar uso de la radiología dental digital en Brasil, centrándose en uso de receptores de imagen, exámenes de imágenes y herramientas de mejora de imagen digital, evaluando también los métodos de transferencia de imagen profesional. Cuestionarios se distribuyeron de forma presencial en reuniones odontológicas y de forma digital a través de mensajería (WhatsApp®) y lista de correo. Muestra de este estudio transversal estuvo compuesta por 478 cuestionarios. Mayoría de los participantes eran mujeres (n=315, 65,9%), con edad promedio de 33,8±9,2 años. Se realizó un análisis descriptivo y de frecuencias. Se utilizaron las pruebas Chi-cuadrado y exacta de Fisher (α=0,05). La mayoría de los odontólogos trabajaban en clínicas dentales compartidas (34,7%) y utilizan receptores de imágenes digitales (51,1%), pero un porcentaje representativo (48,9%) todavía utiliza exclusivamente películas radiográficas. Placa de fósforo fotoestimulable es el receptor de imagen digital más utilizado. Entre los exámenes extraorales, la radiografía panorámica (PAN) es la más utilizada. En cuanto a las especialidades odontológicas, los radiólogos orales y los cirujanos orales y maxilofaciales utilizan mayoritariamente la tomografía computarizada de haz cónico (p<0,001). Mayoría de los odontólogos que utilizan sistemas digitales utilizan herramientas de mejora de imagen digital (87,8%), principalmente contraste, zoom, brillo y medidas. Método más común de transferencia de imágenes profesionales (profesional-profesional y profesional-pacientes) es por correo electrónico, con pocos dentistas que utilizan aplicaciones en línea y redes sociales (26%). Por lo tanto, mientras que la mayoría de dentistas brasileños utilizan sistemas de imágenes digitales, un porcentaje significativo aún utiliza exclusivamente películas radiográficas. Examen de imagen extraoral más utilizado es el PAN. En cuanto a las herramientas de mejora de imagen, los ajustes de brillo y contraste, el zoom y las medidas son las más aplicadas. Finalmente, los dentistas generalmente usan el correo electrónico para la transferencia de imágenes profesionales.

Análise comparativa da influência de filtros de pós-processamento e da variação dos parâmetros de aquisição na quantificação de artefatos metálicos em imagens de tomografia computadorizada de feixe cônico / Comparative analysis of the influence of post-processing filters and the variation of acquisition parameters in the quantification of metallic artefacts in cone-beam computed tomography

Este estudo teve como objetivo comparar o efeito de 04 filtros de realce de imagem - Multi CDT NR1 e BAR1 - do software e-Vol DX (e-Vol DX, CDT, Brasil) e os filtros 1x e 2x do software Ondemand3D (CyberMed, Seoul, Republic of Korea), na quantificação de artefatos gerados por implantes dentários em imagens de tomografia computadorizada de feixe cônico (TCFC). Foram utilizadas imagens de TCFC de um phantom de mandíbula, adquiridas com variação do material do implante (titânio (Ti) e dióxido de zircônio (ZrO2)), região do implante (incisivo, canino, pré-molar e molar), tamanho do voxel (0,25 mm e 0,30mm) e posição do phantom no FOV (central, anterior, posterior, direita e esquerda). No software ImageJ em corte axial previamente definido, e usado como referência em cada um dos volumes estudados, em imagens com e sem a aplicação dos filtros, foi realizado a quantificação dos artefatos por um radiologista devidamente calibrado (ICC 0,97). Foram definidos grupos experimentais para as análises estatísticas das variáveis 02 a 02, sempre aliadas à variável filtro e seus efeitos na quantificação dos artefatos. Os testes de Shapiro-Wilk e de Bartlett, foram utilizados para avaliar a normalidade e homoscedasticidade. Para estudo das diferenças significativas entre os grupos foram utilizados os testes de ANOVA e Tukey (paramétricos), Kruskal-Wallis seguido de Conover-Iman (não paramétricos). Os resultados evidenciaram que o Ti apresentou menor quantificação em comparação ao ZrO2, nos 02 softwares. A menor quantificação de artefatos foi obtida no software e-Vol DX, filtro BAR 1, Ti e ZrO2. Não houve diferença significativa em relação ao tamanho do voxel para os materiais estudados (p=0,975 e p=0,901), posição do implante (p>0.05) e variações de posição no FOV (p>0.05). O Filtro Multi não apresentou diferenças significativas em relação às imagens sem filtro. Para os filtros do OnDemad3D, não houve diferença entre uso e não uso, independentemente do tamanho do voxel (p>0,05). Em conclusão o filtro BAR 1 apresentou-se como uma promissora ferramenta na redução dos artefatos oriundos de implantes dentários. (AU)

This study aimed to compare the effect of 04 image enhancement filters - Multi CDT NR1 and BAR1 - of the e-Vol DX software (e-Vol DX, CDT, Brazil) and the 1x and 2x filters of the Ondemand3D software (CyberMed, Seoul, Republic of Korea), in the quantification of artifacts generated by dental implants in cone beam computed tomography (CBCT) images. CBCT images of a mandible phantom were used, acquired with variation of the implant material (titanium (Ti) and zirconium dioxide (ZrO2)), implant region (incisor, canine, premolar and molar), voxel size (0.25 mm and 0.30 mm) and phantom position in the FOV (central, anterior, posterior, right and left). In the ImageJ software, in a previously defined axial section, and used as a reference in each of the volumes studied, in images with and without the application of filters, the quantification of the artifacts was performed by a properly calibrated radiologist (ICC 0.97). Experimental groups were defined for the statistical analysis of variables 02 to 02, always combined with the filter variable and its effects on the quantification of artifacts. The Shapiro-Wilk and Bartlett tests were used to assess normality and homoscedasticity. To study the significant differences between the groups, the ANOVA and Tukey tests (parametric), Kruskal-Wallis followed by Conover-Iman (non-parametric) were used. The results showed that Ti presented lower quantification compared to ZrO2, in the 02 softwares. The lowest quantification of artifacts was obtained using the e-Vol DX software, BAR 1, Ti and ZrO2 filters. There was no significant difference regarding voxel size for the materials studied (p=0.975 and p=0.901), implant position (p>0.05) and position variations in the FOV (p>0.05). The Multi Filter did not present significant differences in relation to the unfiltered images. For OnDemad3D filters, there was no difference between use and non-use, regardless of voxel size (p>0.05). In conclusion, the BAR 1 filter presented itself as a promising tool in the reduction of artifacts from dental implants (AU)

Medición del espacio tibiofemoral / Measuring the tibiofemoral space

RESUMEN Fundamento: la evaluación del estado actual y de progresión de la gonartrosis necesita de métodos tanto clínicos como imagenológicos, estos últimos necesitan de entrenamiento, mayor tiempo y familiarización por parte del personal médico con la tecnología digital. Objetivo: mostrar dos métodos de medición del espacio articular tibiofemoral en pacientes con gonartrosis. Métodos: la búsqueda y análisis de la información se realizó en un periodo de 56 días (primero de noviembre de 2018 al 26 de diciembre de 2018) y se emplearon las siguientes palabras: tibiofemoral space measure AND knee osteoarthritis, knee joint space narrowing AND knee osteoarthritis, knee joint space width a partir de la información obtenida se realizó una revisión bibliográfica de un total de 272 artículos publicados en las bases de datos PubMed, Hinari, SciELO y Medline mediante el gestor de búsqueda y administrador de referencias EndNote, de ellos, se utilizaron 31 citas seleccionadas para realizar la revisión, 27 de los últimos cinco años. Resultados: se mencionan los métodos aplicables tanto en películas radiográficas convencionales y las de tipo digital. Se hace referencia a la vista radiográfica para la evaluación, gradación e interpretación del espacio articular tibiofemoral. Se exponen dos métodos de medición por pasos. Conclusiones: la medición del espacio tibiofemoral es importante para conocer el estado en que se encuentran los enfermos que padecen de gonartrosis, así como, determinar la respuesta desde el punto de vista imagenológico a diferentes modalidades de tratamiento aplicados tanto conservadores como quirúrgicos.

ABSTRACT Background: the assessment of the current status and progression of gonarthrosis needs both clinical and imaging methods, the last ones require from medical personnel training, more time and acquaintance with digital technology. Objective: to describe two methods to measure the tibiofemoral space in patients suffering knee osteoarthritis. Methods: the information search and analysis was carried out from November 1 to December 26, 2018. The search terms in PubMed, Medline, Hinari and Scielo databases using the EndNote software were: tibiofemoral space measure AND knee osteoarthritis, knee joint space narrowing AND knee osteoarthritis, and knee joint space width. A total of 272 articles were obtained, from which we selected 31, 27 of them from the last five years. Results: here we show that measuring methods of the tibiofemoral space can be done with plain radiographies and digital ones, and also the radiographic image for the assessment, grading and analysis of the tibiofemoral joint space. We described two methods of measurement step by step. Conclusions: the tibiofemoral space measurement is important to establish the status of patients with gonarthrosis, and to evaluate by means of imagenology the outcome of conservative and surgical treatments of the disease.

Automatic exposure compensation and subjective image enhancement in the radiographic diagnosis of caries

Abstract This study aims to assess the influence of high-density material on the radiographic diagnosis of proximal caries in digital systems with automatic exposure compensation, and to evaluate the effect of subjective adjustment of brightness and contrast to undertake this diagnostic task. Twenty bitewing radiographs of forty posterior human teeth with non-cavitated carious lesions, confirmed by micro-CT, were obtained with two digital systems. A porcelain-fused-to-metal crown attached to a titanium implant was inserted into the exposed area, and all the radiographs were repeated. Five radiologists assessed the radiographs and diagnosed proximal carious lesions. Afterwards, the observers were asked to adjust image brightness and contrast, based on their subjective perception, and to reassess the images. Thirty percent of each experimental group was reassessed to test intraobserver reproducibility, totaling 208 images per observer. Intraobserver and interobserver agreements ranged from fair to substantial. Sensitivity, specificity, predictive values, and area under the ROC curve were calculated and compared for each radiographic system, using ANOVA (α = 0.05). Overall, presence of high-density material and adjustment of brightness and contrast did not significantly influence the radiographic diagnosis of proximal caries (p ≥ 0.05). Regarding Digora Optime, adjustment of brightness and contrast significantly increased (p < 0.05) the diagnostic accuracy of proximal carious lesions in the presence of high-density material. In conclusion, the presence of high-density material in the X-rayed region does not influence radiographic diagnosis of proximal caries. However, when it is present in the X-rayed area, subjective adjustment of brightness and contrast is recommended for use with the Digora Optime digital system.

Research progress of imaging examination in male infertility / 国际外科学杂志

At present,male infertility has become a serious social and medical burden in all countries in the world,and reduce people's happy life index.Base on this,radiologists and clinicians are trying to find some new technologies of the medical image examination methods,including X-rays,B-ultrasound,magnetic resonance imaging,etc,attempt to obtain the exact etiology diagnosis of male infertility in order to get more effective treatments and benefits with more happy families.This article of reviews the application and research progress of the latest imaging techniques in the etiological diagnosis of male infertility in recent years.

Research progress of imaging examination in male infertility / 国际外科学杂志

At present, male infertility has become a serious social and medical burden in all countries in the world, and reduce people′s happy life index. Base on this, radiologists and clinicians are trying to find some new technologies of the medical image examination methods, including X-rays, B-ultrasound, magnetic resonance imaging, etc, attempt to obtain the exact etiology diagnosis of male infertility in order to get more effective treatments and benefits with more happy families. This article of reviews the application and research progress of the latest imaging techniques in the etiological diagnosis of male infertility in recent years.

Método fácil para la medición de las deformidades angulares de la rodilla / Easy method to measure angular knee deformities

RESUMEN Fundamento: las deformidades angulares de la rodilla son muy frecuentes en pacientes con artrosis, existen varios métodos de medición clínicos y radiográficos, con características propias. Objetivo: proponer un método de medición para la desviación angular de la rodilla que sea fácil y rápido. Métodos: la búsqueda y revisión de la información se realizó en un periodo de cuatro meses (primero de abril de 2018 al 30 de junio de 2018) y se emplearon las siguientes palabras: knee angular deformities, measurement of knee deformities, measures and knee angular deformities, a partir de la información obtenida se realizó una revisión bibliográfica de un total de 213 artículos publicados en las bases de datos PubMed, Hinari, SciELO y Medline mediante el gestor de búsqueda y administrador de referencias EndNote, de ellos se utilizaron 32 citas seleccionadas para realizar la revisión, 29 de los últimos cinco años. Desarrollo: se describen las características clínicas y radiográficas de los pacientes con desviación angular de la rodilla. En caso de las radiografías se hace referencia a la vista específica para la medición de esta deformidad. Se mencionan las ventajas y desventajas de los métodos de medición del eje mecánico y anatómico. Basados en la revisión de este tema, se propone un método de medición que puede ser llevado a cabo en radiografías digitales y películas. Conclusiones: el método propuesto es aplicable a nuestro medio y puede ser llevado a cabo en radiografías digitales y películas radiográficas.

ABSTRACT Background: knee angular deformities are common in patients suffering from osteoarthritis. There are many clinic and radiographic methods to measure knee deformities, each one has its own features. Objective: to propose an easy and quick method to measure angular knee deformities. Methods: a four month research was conducted from April 1st, 2018 to June 30th, 2018. It was included 213 articles published in PubMed, Hinari, SciELO and Medline databases using EndNote. The words used were knee angular deformities, measurement of knee deformities, measures and knee angular deformities. Thirty two citations were selected for the review, of them twenty nine within the last five years. Development: clinical and radiographic features in patients with angular deformities were described. Specific X-ray view features were pointed out to measure deformity. Advantages and disadvantages about mechanic and anatomic axis measures were mentioned. Based on literature review a new method is proposed to be used in digital and plain radiographic slides. Conclusions: the proposed measure method can be used in digital and plain radiographic slides at our health institutions.

Applicability of the Cobb angle measurement in idiopathic scoliosis using scanned imaging / Aplicabilidade da medida do ângulo de Cobb na escoliose idiopática usando imagem digitalizada / Aplicabilidad de la medición del ángulo de Cobb en la escoliosis idiopática usando imagen digitalizada

ABSTRACT Objectives: To compare the measurement of the Cobb angle on printed radiographs and on scanned radiographs viewed through the software "PixViewer". Methods: Preoperative radiographs of 23 patients were evaluated on printed films and through the software "PixViewer". The same evaluator, a spine surgeon, chose the proximal and distal limiting vertebrae of the main curve on printed radiographs, without identification of patients, and measured the Cobb angle based on these parameters. The same parameters and measurements were applied to scanned radiographs. The measurements were compared, as well as the choice of limiting vertebrae. Results: The average variation of the Cobb angle between methods was 1.48 ± 1.73°. The intraclass correlation coefficient (ICC) was 0.99, demonstrating excellent reproducibility. Conclusion: The Cobb method can be used to evaluate scoliosis through the "PixViewer" tool with the same reliability as the classic method on printed radiographs.

RESUMO Objetivo: Comparar a aferição do ângulo de Cobb em radiografias impressas e em radiografias digitalizadas, visualizadas por meio da ferramenta "PixViewer". Métodos: Foram avaliadas as radiografias pré-operatórias de 23 pacientes em filmes impressos e pelo software "PixViewer". O mesmo avaliador, cirurgião de coluna, elegeu as vértebras limites proximal e distal da curva principal nas radiografias impressas, sem identificação dos pacientes, e realizou a aferição do ângulo de Cobb baseado nesses parâmetros. Os mesmos parâmetros e aferições foram aplicados às radiografias digitalizadas. As aferições foram comparadas, assim como a escolha das vértebras limites. Resultados: A variação média do ângulo de Cobb entre os métodos foi de 1,48 ± 1,73°. O coeficiente de correlação intraclasse (CCI) foi de 0,99, demonstrando replicabilidade excelente.. Conclusão: O método de Cobb pode ser utilizado para avaliação da escoliose por meio da ferramenta "PixViewer" com a mesma confiabilidade que pelo método clássico em radiografias impressas.

RESUMEN Objetivo: Comparar la medición del ángulo de Cobb en radiografías impresas y en radiografías digitalizadas vistas a través de la herramienta "PixViewer" . Métodos: Se evaluaron las radiografías preoperatorias de 23 pacientes en películas impresas y a través del software "PixViewer". El mismo evaluador, cirujano de columna, eligió las vértebras proximal y distal límites de la curva principal en las radiografías impresas, sin identificación de los pacientes, y realizó la medición del ángulo de Cobb en base a estos parámetros. Los mismos parámetros y mediciones se aplicaron a las radiografías digitalizadas. Las mediciones fueron comparadas, así como la elección de las vértebras límites. Resultados: La variación promedio del ángulo de Cobb entre los métodos fue de 1,48 ± 1,73°. El coeficiente de correlación intraclase (CCI) fue de 0,99, demostrando reproducibilidad excelente. Conclusión: El método de Cobb puede ser utilizado para la evaluación de la escoliosis a través de la herramienta "PixViewer" con la misma fiabilidad que el método clásico en radiografías impresas.

Repeat analysis of intraoral digital imaging performed by undergraduate students using a complementary metal oxide semiconductor sensor: An institutional case study

PURPOSE: This study was performed to quantify the repeat rate of imaging acquisitions based on different clinical examinations, and to assess the prevalence of error types in intraoral bitewing and periapical imaging using a digital complementary metal-oxide-semiconductor (CMOS) intraoral sensor. MATERIALS AND METHODS: A total of 8,030 intraoral images were retrospectively collected from 3 groups of undergraduate clinical dental students. The type of examination, stage of the procedure, and reasons for repetition were analysed and recorded. The repeat rate was calculated as the total number of repeated images divided by the total number of examinations. The weighted Cohen's kappa for inter- and intra-observer agreement was used after calibration and prior to image analysis. RESULTS: The overall repeat rate on intraoral periapical images was 34.4%. A total of 1,978 repeated periapical images were from endodontic assessment, which included working length estimation (WLE), trial gutta-percha (tGP), obturation, and removal of gutta-percha (rGP). In the endodontic imaging, the highest repeat rate was from WLE (51.9%) followed by tGP (48.5%), obturation (42.2%), and rGP (35.6%). In bitewing images, the repeat rate was 15.1% and poor angulation was identified as the most common cause of error. A substantial level of intra- and interobserver agreement was achieved. CONCLUSION: The repeat rates in this study were relatively high, especially for certain clinical procedures, warranting training in optimization techniques and radiation protection. Repeat analysis should be performed from time to time to enhance quality assurance and hence deliver high-quality health services to patients.

Multispectral X-ray imaging to distinguish among dental materials

PURPOSE: Dual-energy X-ray imaging is widely used today in various areas of medicine and in other applications. However, no similar technique exists for dental applications. In this study, we propose a dual-energy technique for dental diagnoses based on voltage-switching. MATERIALS AND METHODS: The method presented in this study allowed different groups of materials to be classified based on atomic number, thereby enabling two-dimensional images to be colorized. Computer simulations showed the feasibility of this approach. Using a number of different samples with typical biologic and synthetic dental materials, the technique was applied to radiographs acquired with a commercially available dental X-ray unit. RESULTS: This technique provided a novel visual representation of the intraoral environment in three colors, and is of diagnostic value when compared to state-of-the-art grayscale images, since the oral cavity often contains multiple permanent foreign materials. CONCLUSION: This work developed a technique for two-dimensional dual-energy imaging in the context of dental applications and showed its feasibility with a commercial dental X-ray unit in simulation and experimental studies.

Spine gunshot wounds at the central military hospital in Mexico / Feridas por projétil de arma de fogo na coluna vertebral no hospital central militar de México / Heridas por proyectil de arma de fuego en la columna vertebral en el hospital central militar de México

ABSTRACT Objective: To compare the measurement of the Cobb angle in printed radiographs and digitalized radiographs displayed with the "PixViewer" tool. Methods: Pre-operative radiographs of 23 patients were performed in printed films and using the software "PixViewer". The same evaluator, a spine surgeon, chose the proximal and distal end vertebrae at the limit of the main curve in printed radiographs without identifying patients, and measured the Cobb angle based on these parameters. The same parameters and measurements were performed in digitalized radiographs. The measurements were compared, as well as the choice of end vertebrae. Results: The average change in the Cobb angle between the methods was 1.48±1.73°. The intraclass correlation coefficient (ICC) was 0.99, demonstrating excellent reproducibility. Conclusion: The Cobb method can be used to evaluate scoliosis through the "PixViewer" tool with the same reliability of the classic method on printed radiographs.

RESUMO Objetivo: Comparar a aferição do ângulo de Cobb em radiografias impressas e em radiografias digitalizadas visualizadas com a ferramenta "PixViewer". Métodos: Foram avaliadas as radiografias pré-operatórias de 23 pacientes em filmes impressos e com o software "PixViewer". O mesmo avaliador, cirurgião da coluna, elegeu a vértebra limite proximal e distal da curva principal nas radiografias impressas, sem identificação dos pacientes, e realizou a aferição do ângulo de Cobb baseado nesses parâmetros. Os mesmos parâmetros e aferições foram realizados nas radiografias digitalizadas. As aferições foram comparadas, assim como a escolha das vértebras limite. Resultados: A variação média do ângulo de Cobb entre os métodos foi de 1,48 ± 1,73°. O coeficiente de correlação intraclasse (CCI) foi de 0,99, demonstrando replicabilidade excelente. Conclusão: O método de Cobb pode ser utilizado para avaliação da escoliose com a ferramenta "PixViewer" com a mesma confiabilidade que através do método clássico em radiografias impressas.

RESUMEN Objetivo: Comparar la medición del ángulo de Cobb en radiografías impresas y en radiografías digitalizadas visualizadas con la herramienta "PixViewer". Métodos: Se evaluaron las radiografías preoperatorias de 23 pacientes en películas impresas e con el software "PixViewer". El mismo evaluador, cirujano de columna, eligió la vértebra límite proximal y distal de la curva principal en las radiografías impresas, sin identificar a los pacientes, y se realizó la medición del ángulo de Cobb con base en estos parámetros. Los mismos parámetros y mediciones se realizaron en las radiografías digitalizadas. Las mediciones fueron comparadas, así como la elección de las vértebras límite. Resultados: La media del cambio en el ángulo de Cobb entre los métodos fue de 1,48 ± 1,73°. El coeficiente de correlación intraclase (CCI) fue de 0,99, demostrando excelente reproducibilidad. Conclusión: El método de Cobb puede ser utilizado para evaluación de la escoliosis con la herramienta "PixViewer" con la misma fiabilidad del método clásico con radiografías impresas.

Evaluation of the optical density of composite resins with the use of nanotechnology by means of intraoral radiographic system (CMOS) / Avaliação da densidade óptica de resinas compostas de nanotecnologia por meio de sistema radiográfico intraoral (CMOS)

The aim of this study was investigate the optical density of four different brands of composite resins of nanotechnology. The composite resins Estelite Sigma Quick® (Tokuyama), Esthet ­X HD® (Dentsply), 4 Seasons® (Ivoclar Vivadent) and Filtek Z350XTTM (3M-ESPE) were inserted into cavities in transparent acrylic sheets, separated by thickness into 1, 2 and 3 mm. The images were imported into the software ImageTool® 3.0 (UTHSCSA, EUA). Data were submitted to ANOVA and Tukey. The mean values of the composite resins 4 Seasons® (2.71±0.20) and Filtek Z350XTTM (2.64±0.26) did not differ statistically for samples with thickness of 1 and 2 mm. However, for both thickness Estelite Sigma Quick® (1.92±0.11) and Esthet-X HD® (3.57±0.29) showed significant differences compared to the other composite resins (p = .012). All 3 mm-thick samples showed significant differences among themselves (Estelite Sigma Quick® p < .001, Esthet-X HD® p < .001, 4 Seasons® p=.001 and Filtek Z350XTTM p = .003). Conclusion: Among the three thicknesses evaluated, Estelite Sigma Quick® showed the lowest optical density, whereas the highest values were observed for Esthet X HD®. The resins are studied according to the rules of optical density value thus being favorable clinical use.

O objetivo deste estudo foi investigar a densidade óptica de quatro diferentes marcas comercias de resinas compostas desenvolvidas com nanotecnologia. As resinas Estelite Sigma Quick® (Tokuyama), Esthet ­X HD® (Dentsply), 4 Seasons® (Ivoclar Vivadent) e Filtek Z350 XT ® (3M-ESPE) foram inseridas em orifícios existentes em placas de acrílico com espessuras de 1, 2 e 3 mm. As imagens foram importadas para o programa ImageTool® 3.0 (UTHSCSA, EUA). Os dados foram submetidos à análise de variância Anova e de Tukey. Nas espessuras de 1 e 2 mm, a média das resinas 4 Season® (2.71±0.20) e Z350XT® (2.64±0.26) não diferiram de forma estatística significante entre si (p = .012). No entanto, a Estelite Sigma Quick® (1.92±0.11) e a Esthet-X HD® (3.57±0.29) apresentaram diferenças estatisticamente significantes em relação a 4 Season® e Z350XT® . Na espessura 3 mm, todas apresentaram diferenças estatisticamente significantes entre si (Estelite Sigma Quick® p < .001, Esthet-X HD® p < .001, 4 Seasons® p = .001 and Filtek Z350XTTM p = .003). A Estelite Sigma Quick® apresentou os menores valores nas espessuras estudadas, os maiores valores observados na Esthet X HD®, para as três espessuras avaliadas. As resinas estudadas estão de acordo com a normativa de densidade óptica, portanto favorável ao uso clínico.

Aplicabilidade clínica da radiografia digital na Odontologia / The clinical applicability of digital radiography in dentistry

As primeiras radiografias digitais surgiram em 1987. Esta tecnologia é considerada um grande avanço, pois possibilita inúmeras vantagens sobre a radiografia tradicional, por exemplo, redução da dose de exposição aos raios-x, aumentando a segurança e a qualidade do procedimento, além de o custobenefício da radiografia digital ser melhor quando comparada à convencional. Revisão de literatura: As principais vantagens da radiografia digital comparada às radiografias tradicionais são: diminuição da dose de exposição, eliminação do processo químico de revelação/fixação, a possibilidade de manipulação das imagens, a obtenção de novas imagens sem a realização de novas tomadas radiográficas e menor desconforto para o paciente. Objetivos: Este trabalho tem como objetivo, revisar a literatura abordando as vantagens e desvantagens da radiografia digital comparada à radiografia convencional, bem como verificar sua aplicabilidade real na clínica odontológica. Conclusão: O presente trabalho conclui que a radiografia digital possui uma margem de erro menor quando comparada à radiografia convencional, o que leva a diagnósticos fidedignos de situações em região oral e maxilofacial, levando também a um aperfeiçoamento no tratamento...

The first digital radiography came up in 1987. This technology is considered an important achievement, since it allows several advantages on traditional radiography, for example, by reducing the dose of exposure to X-Rays, by increasing the security and the quality of procedure, besides the fact that the cost benefit of digital radiography is better than the conventional one. Literature review: The main advantages of digital radiography when compared to the traditional one are: reduction of exposure dose, elimination of chemical process of revelation/fixation, the possibility of manipulating images and achieving new images without the need of new capture and lower discomfort to the patient. Objectives: The objective of this paper is reviewing the literature, taking into account the advantages and disadvantages of digital radiography when compared to the conventional one, and verifying its applicability in the Dentistry service. Conclusion: The present work concludes that the digital radiography has a lower margin of error than the conventional radiography, what leads to an important diagnosis of oral and maxillofacial region situations, also leading to a an improvement in the treatment...

Evaluation of three root canal filling techniques through digital radiograph

Introduction: Endodontic obturation consists of root canal filling by antiseptic or inert materials that promote a three-dimensional sealing and stimulate the repair process without interfering with it. Different obturation techniques and materials have been proposed to meet this requirement. Objective: To compare the root canal filling promoted by lateral condensation technique, Tagger's hybrid technique and McSpadden technique by assessing the filling quality through digital radiograph. Material and methods: A total of 45 extracted single-rooted human teeth were used and randomly divided into three experimental groups. After instrumentation, the teeth were filled by lateral condensation (n=15), Hybrid Tagger (n=15), and McSpadden techniques (n=15). Then, digital radiographs were taken with projected increased 10 times, at mesial-distal and buccolingual directions. Results: Visually, few empty spaces were detected at the three root thirds of teeth filled by different techniques. However, statistical analysis (Kruskal-Wallis) found no differences among the different groups, neither among the different thirds nor between both incidences evaluated. Conclusion: It was concluded that the three obturation techniques exhibited similar behavior in relation to the sealing of the root canal through digital radiograph.

Digital evaluation of the influence of interruption of the fixation process on radiographic contrast and base-plus-fog density in three commercial brands of radiographic films / Avaliação digital da influência da interrupção da fixação no contraste radiográfico e na densidade base e velamento em três marcas comerciais de filmes radiográficos

Introduction : With the interest in anticipating access to the result of intraoral radiography, the radiographic processing is frequently neglected, compromising image quality. Objective: The aim of this study was to evaluate the influence of interrupting the fixation process on the radiographic contrast and base-plus-fog density (BPFD) in three brands of periapical films. Material and Method: Ninety radiographs were taken of an aluminum stepwedge and a lead plate for each brand, and they were divided according to the time of initial immersion in the fixative in: control group (without interrupting the fixing), 5, 10, 20, 30 and 40 seconds. During processing, films had the fixing stage stopped and were exposed to a negatoscope for 1 minute, then the fixation time of 10 minutes was completed. The radiographs were digitized and exported to Image Tool 3.0.software. Result: Kodak(r) film showed no statistically significant differences between groups, while Agfa(r) film presented difference in BPFD compared with Group 5 seconds, and Dentix(r) film showed statistical difference in all groups in comparison with the control group. Conclusion: Under the conditions studied, Kodak(r) film is not influenced by disruption of fixation as regards BPFD and image contrast, enabling early access to the results of radiographs, whereas Agfa(r) film requires at least 10 seconds of initial fixation, and Dentix(r) film obtains better results when the process of fixation is not interrupted. .

Introdução: Com a preocupação em antecipar o acesso ao resultado de radiografias intrabucais, o processamento radiográfico é muitas vezes negligenciado, comprometendo a qualidade da imagem. Objetivo: O objetivo deste trabalho foi avaliar a influência da interrupção do processo de fixação no contraste radiográfico e na densidade base e velamento (DBV) em 3 marcas comerciais de filmes periapicais. Material e Método: Foram realizadas 90 radiografias de um stepwedge de alumínio e uma placa de chumbo para cada marca, e as mesmas foram divididas de acordo com o tempo de imersão inicial no fixador em: grupo controle (sem interrupção na fixação), 5, 10, 20, 30 e 40 segundos. Durante o processamento, os filmes tiveram a fixação interrompida e foram expostos à luz de um negatoscópio por 1 minuto, e então completaram o tempo de fixação de 10 minutos. As radiografias foram digitalizadas e analisadas no software Image Tool 3.0. Resultado: O filme Kodak(r) não apresentou diferenças estatísticas significantes entre os grupos, enquanto que o filme Agfa(r) apresentou diferença na DBV em relação ao grupo de 5 segundos, e o filme Dentix(r) apresentou diferença estatística em todos os grupos comparando-os ao grupo controle. Conclusão: Sob as condições estudadas, o filme Kodak(r) não sofreu influência da interrupção da fixação na DBV e no contraste da imagem, possibilitando o acesso antecipado ao resultado do exame radiográfico, enquanto que o filme Agfa(r) necessita de pelo menos 10 segundos de fixação inicial e o filme Dentix(r) obtém melhores resultados quando não interrompido o processo de fixação. .

Alterations in imaging and histopathology after aspiration of nucleus pulposus of rabbit lumbar intervertebral disc / 中国组织工程研究

BACKGROUND:It remains unclear what kind of changes in imaging and histopathology would appear in intervertebral disc after removal of nucleus pulposus over time. OBJECTIVE:To observe the alteration in imaging and histopathology of rabbit lumbar intervertebral disc after nucleus pulposus aspiration. METHODS:A total of 32 Japanese rabbits were subjected to nucleus pulposus aspiration in posterior lateral L 3/4 intervertebral disc with a 21-gauge hypodermic needle. L 2/3 intervertebral disc served as a normal control. At 2, 4, 8 and 12 weeks after aspiration, eight rabbits according to grouping received radiograph in the lateral position of lumbar vertebra. The height of L 3/4 and L 2/3 intervertebral space was measured and intervertebral disc height index was calculated. Rabbits received median sagittal MRI examination and histopathological examination of intervertebral disc. RESULTS AND CONCLUSION:The intervertebral disc height degraded slowly at 2, 4, 8, and 12 weeks after aspiration. However, the difference between 8 and 12 weeks was reduced. Compared with normal control, intervertebral disc height index significantly reduced at various time points (P<0.05). The nucleus pulposus signal intensity was gradual y reduced at 2, 4, 8, and 12 weeks after aspiration, and reached grade 4 of modified Thompson grading criteria at 8 weeks. After aspiration, gelatinous nucleus pulposus of disc slowly exhibited fissures with time, morphous was slowly disordered and showed significant fibrosis performance at 12 weeks. In nucleus pulposus region, more cartilage-like cells were found at 4 weeks after operation. The cells were active. Nucleus pulposus cells decreased significantly. At 8 and 12 weeks after operation, fibroblasts increased in nucleus pulposus region, and the number of cartilage-like cells reduced. The annulus fibrosus gradual y became distorted, disordered, with processes and layers, and fiber breakage appeared. These results indicated that after puncturing lateral annulus fibrosus and aspirating the nucleus pulposus, radiograph height of the intervertebral disc and MRI T2-weighted signal intensity gradual y reduced. Pathological changes were observed. However, the degeneration al eviated between 8-12 weeks.

Effect of digital noise reduction on the accuracy of endodontic file length determination

PURPOSE: The aim of the present study was to evaluate the measurement accuracy of endodontic file length on periapical digital radiography after application of noise reduction digital enhancement. MATERIALS AND METHODS: Thirty-five human single-rooted permanent teeth with canals measuring 20-24 mm in length were selected. ISO #08 endodontic files were placed in the root canals of the teeth. The file lengths were measured with a digital caliper as the standard value. Standard periapical digital images were obtained using the Digora digital radiographic system and a dental X-ray unit. In order to produce the enhanced images, the noise reduction option was applied. Two blinded radiologists measured the file lengths on the original and enhanced images. The measurements were compared by repeated measures ANOVA and the Bonferroni test (alpha=0.05). RESULTS: Both the original and enhanced digital images provided significantly longer measurements compared with the standard value (P0.05). CONCLUSION: Noise reduction digital enhancement did not influence the measurement accuracy of the length of the thin endodontic files on the digital periapical radiographs despite the fact that noise reduction could result in the elimination of fine details of the images.

Comparação entre subtração radiográfica digital e radiografia digital direta na detecção de reabsorções radiculares / Comparison between radiographic digital subtraction and direct digital radiography in the detection of root resorption

A reabsorção severa da raiz diagnosticada tardiamente pode acarretar a perda dentária. Devido ao fato de a técnica de subtração radiográfica digital ser um importante recurso para detecção precoce de alterações minerais, este estudo propôs avaliar a eficiência no diagnóstico precoce da reabsorção radicular externa simulada nas regiões apical e lingual, pelas técnicas de subtração radiográfica digital e radiografia digital. Foram utilizados 14 dentes incisivos de mandíbulas humanas maceradas com reabsorções de diferentes dimensões, simuladas nas regiões apical e lingual, e radiografados com variação de ângulos de projeção. As radiografias foram subtraídas pelo programa Regeemy®, e para avaliação de desempenho dos métodos de diagnóstico, pares de radiografias periapicais e imagens subtraídas foram apresentadas a dois radiologistas. De acordo com os resultados, não foram observadas diferenças estatisticamente significantes entre os métodos na detecção de reabsorções linguais, independentemente do tamanho da lesão. Também não houve diversidade entre os métodos na detecção de reabsorções apicais, com exceção do examinador dois quanto às variações angular vertical e horizontal de 10º, utilizando o maior nível de desgaste, que apresentou a radiografia digital como método superior na avaliação em relação à subtração radiográfica. Também foi observado que o aumento do nível de desgaste permitiu melhor avaliação nas regiões de reabsorções apicais e linguais, e a menor variação dos ângulos verticais e horizontais nas detecções de reabsorções apicais e linguais permitiu uma melhor avaliação da imagem, principalmente no menor nível de desgaste.

The delay on diagnose severe root resorption can lead to tooth loss. Due to the fact that digital subtraction radiography is an important resource to detect initial mineral changes, this study aimed at evaluating the effectiveness of the digital subtraction radiography and digital radiography in early diagnosis of the simulated apical and lingual external root resorption. Fourteen human lower incisors, submitted to simulated apical and lingual resorption cavities of different sizes, imaged with different angle projection variations were included in this study. The images were subtracted by the Regeemy® program, and receiver operating characteristic analysis was used to evaluate the diagnostic performance for each imaging system, and the diagnostic accuracy of both diagnosis methods for detecting lesions was conducted by the assessment of the pairs of radiography (digital and subtracted) by two radiologists. According to the results, there were no statistically significant differences between the methods in detecting lingual resorption, independently of the lesion dimension. There was also no difference on the apical resorption detection, except by the viewer two as to 10º horizontal and vertical angles, who related that on the larger cavity, the digital radiography was more reliable than the subtraction radiography. It was also further noticed that the deeper the cavity size, the better the apical and lingual resorption detection; and the radiography taken of the apical and lingual resorption, with the smaller vertical and horizontal angles variation ensured a better assessment of the image, mainly on the shallower cavity size.

Radiographic analysis of pixel intensity with aluminum step-wedgeand different spatial resolutions / Análise radiográfica da intensidade de pixel com a utilização de penetrômetro de alumínio e diferentes resoluções espaciais

Objective: To evaluate the pixel intensity and to compare it with different spatial resolutions, using an aluminum step-wedge. Methods: The sample consisted of three bone chips of two dry pig mandibles. Then, each bone chip and the aluminum step-wedge were placed on periapical radiographs in order to take the images with Ekta Speed film, with an exposure time of 0.2 seconds and focal length of 25 cm. All radiographs were scanned with spatial resolutions of 150 and 300 dpi and saved as JPEG files. The images were measured using the histogram tool provided by the Image Tool program (UTHSCSA, Texas, USA) selecting specific areas on the bone chips and on the aluminum step-wedge. Results: The data were analyzed by ANOVA and Tukey statistical tests which showed that there was no significant difference in pixel intensity between bone chips and step 3 (3.6 mmEq/Al) of the aluminum step-wedge (p>0.05). It was also observed that there were no significant differences in pixel intensity value measured on step-wedges 2 (3.3 mmEq/Al), 3 (3.6 mmEq/Al), 4 (3.9 mmEq/Al) and on the bone chips, between spatial resolutions of 150 and 300 dpi. Conclusion: Small differences in spatial resolution did not interfere with the evaluation of pixel intensity. It is recommended to measure pixel intensity on digitalized radiographs using an aluminum step-wedge as a reference density value.

Objetivo: Avaliar a intensidade de pixels de fragmentos de tecido ósseo mandibular, bem como compará-la em diferentes resoluções espaciais, utilizando um penetrômetro de alumínio. Métodos: A amostra consistiu de 3 fragmentos ósseos, provenientes de 2 mandíbulas secas de suínos. Em seguida, cada fragmento ósseo, juntamente com o penetrômetro de alumínio, foram posicionados sobre filmes radiográficos periapicais. As radiografias foram realizadas com filme Ekta Speed, tempo de exposição de 0,20 segundos e distância focal de 25 cm. Todas as radiografias foram digitalizadas com resoluções espaciais de 150 e 300 dpi e, em seguida, arquivadas em JPEG. As imagens foram medidas por meio da ferramenta histograma do programa Image Tool (UTHSCSA, Texas, USA) selecionando-se áreas nos fragmentos ósseos e no penetrômetro de alumínio. Resultados: A análise dos resultados pelos testes estatísticos ANOVA e Tukey mostrou que não houve diferença significativa de intensidade de pixel entre os fragmentos ósseos e o degrau 3 do penetrômetro de alumínio (3,6 mmEq/Al) (p>0,05). Observou-se ainda que não houve diferenças significativas dos valores da intensidade de pixel dos degraus 2 (3,3 mmEq/Al), 3 (3,6 mmEq/Al) e 4 (3,9 mmEq/Al) e os fragmentos ósseos, entre as resoluções espaciais avaliadas nesse estudo. Conclusão: Pequenas diferenças de resolução espacial não interferiram nos valores de intensidade de pixel. É recomendável medir esta intensidade com a utilização de penetrômetro de alumínio como referência para valor de densidade.

Avaliação dos métodos de mensuração da altura patelar na radiografia digital / Assessment of patellar height measurement methods from digital radiography

OBJETIVO: Analisar os métodos mais comuns de medida da altura patelar e o impacto da experiência do observador na correlação com os outros avaliadores utilizando a radiografia digital. MÉTODOS: Sessenta radiografias digitais do joelho na incidência em perfil foram analisadas por quatro observadores, sendo um médico residente do segundo ano de ortopedia (R2), um médico residente do terceiro ano de ortopedia (R3), um ortopedista especialista em joelho (EJ) e um radiologista especialista na área musculoesquelética (ER). Os índices estudados foram: Insall-Salvati (IS), Blackburne-Peel (BP), Caton-Deschamps (CD) e Insall-Salvati modificado (ISM). Foi calculada a concordância interobservadores por meio do coeficiente de concordância Kappa (κ). RESULTADOS: Os maiores coeficientes de correlação foram obtidos com o método de IS seguido pelo método de CD. A pior correlação foi observada no método de ISM. A maior concordância interobservadores foi obtida entre o ortopedista especialista em joelho e o radiologista especializado na área musculoesquelética nos quatro métodos de aferição utilizados. CONCLUSÃO: Utilizando a radiografia digital, os índices de Insall-Salvati e Caton-Deschamps apresentaram maior concordância interobservadores, sendo esta também influenciada positivamente pela experiência do observador.

OBJECTIVE: To analyze the most common methods for measuring patellar height and the impact of observer experience in correlations with the other observers using digital radiography. METHODS: Sixty digital radiographs of the knee in lateral view were analyzed by four observers: a physician in the second year of medical residence in orthopedics (R2); a physician in the third year of medical residence in orthopedics (R3); an orthopedic surgeon who was a specialist in knee surgery (SK); and a radiologist who was a specialist in musculoskeletal radiology (SR). The indices used were: Insall-Salvati (IS), Blackburne-Peel (BP), Caton-Deschamps (CD) and modified Insall-Salvati (ISM). The interobserver agreement was calculated using the kappa coefficient (k). RESULTS: The highest correlation coefficients were found when using the IS method followed by the CD method. The worst correlation was observed in the ISM method. The highest interobserver agreement was found between the orthopedic surgeon specializing in knee surgery and the radiologist specializing in musculoskeletal radiology, for the four measurement methods used. CONCLUSION: Using digital radiography, the Insall-Salvati and Caton-Deschamps indexes presented the highest interobserver agreement, and this was also positively influenced by the observer's level of experience.