Fractal dimension evaluation of cone beam computed tomography in patients with bisphosphonate-associated osteonecrosis.

OBJECTIVES: The aim of this study was to (1) evaluate the fractal dimension (FD) in regions of the mandible on cone beam CT (CBCT) images of patients with bisphosphonate-associated osteonecrosis of the jaws (BP-ONJ) and (2) to select the most suitable region of interest (ROI) for further study on detection of bone alterations associated with bisphosphonates. METHODS: CBCT images of patients with BP-ONJ were included with matched controls. Values of FD were compared between groups. Selected ROIs were: ROI-1 - below the mandibular foramen; ROI-2 - above the mandibular foramen; ROI-3 - anterior to the mental foramen; ROI-4 - above the mandibular canal. The area of bone exposure was included as ROI-5. The results were analysed using generalized estimating equations and conditional logistic regression. RESULTS: There were 36 patients (67% female) with a mean age of 60.7 years. The mean FDs were: ROI-1 - 1.678 for controls and 1.673 for patients (P = 0.81); ROI-2 - 1.657 for controls and 1.653 for patients (P = 0.78); ROI-3 - 1.661 for controls and 1.684 for patients (P = 0.17); and ROI-4 - 1.670 for controls and 1.698 for patients (P = 0.03). The value of the FD in the area of exposed bone was the highest (1.729). The odds of being a BP-ONJ patient vs being a control was six times as high for individuals with a higher FD score at ROI-4, although the confidence interval was quite wide owing to the small sample size. CONCLUSION: In this preliminary study, BP-ONJ patients had higher FD values than controls at regions close to the alveolar process. The results suggest that FD is a promising tool for detection of bone alterations associated with BP-ONJ.

Periodontitis and perceived risk for periodontitis in elders with evidence of depression.

BACKGROUND: Depression and periodontitis are common conditions in older adults. There is some evidence that these two conditions may be related. AIMS: To study a population of dentate elders and assess the prevalence of depression, self-assessment of risk for periodontitis and tooth loss, in relation to periodontal disease status. MATERIAL AND METHODS: Data were obtained from 701 older subjects (mean age 67.2 years (SD+/-4.6), of whom 59.5% were women. Self-reports of a diagnosis of depression, scores of the Geriatric Depression Scale (GDS), and self-assessment of risk for future tooth loss and periodontitis were compared with a diagnosis of periodontitis based on probing depth, and bone loss assessed from panoramic radiographs. Other systemic diseases and smoking habits were also determined and studied in relation to depression. RESULTS: A history of depression was reported by 20% of the subjects. GDS scores >/=8 were reported by 9.8% of the elders. Periodontitis was identified in 48.5% of the subjects. Depression was associated with heart attack (p<0.05), stroke (p<0.01), high blood pressure (p<0.02), all combined cardiovascular diseases (p<0.001), chronic pain (p<0.01), osteoarthritis (p<0.001), and osteoporosis (p< 0.001) but not with periodontitis (p=0.73). Subjects with depression had a higher self-reported risk score for future tooth loss (p<0.02). No group difference emerged for self-perceived risk for periodontitis. Logistic regression analysis demonstrated that a past history of tooth loss (p<0.001), self-perceived risk for periodontitis (p<0.02), the number of years with a smoking habit (p<0.02), and male gender (p<0.02) were associated with a diagnosis of periodontitis but neither measure of depression could be included in an explanatory model for periodontitis. CONCLUSIONS: Evidence of depression (self-report or by GDS) is not associated with risk for periodontitis in older subjects but is associated with tooth loss and chronic conditions associated with pain.

Assessment of periodontal conditions and systemic disease in older subjects.

BACKGROUND: An increased risk for periodontitis has been associated both with type-1 or insulin dependent diabetes (IDDM) and with type-2 or non-insulin dependent diabetes (NIDDM). AIMS: 1) To describe and analyze periodontal conditions in older low-income ethnic diverse subjects with or without a diagnosis of diabetes. 2) To assess to what extent diabetes mellitus is associated with periodontal status, and 3) how periodontitis ranks as a coexisting disease among other diseases in subjects with diabetes mellitus. MATERIAL AND METHODS: Radiographic signs of alveolar bone loss were studied in 1101 older subjects 60-75 years old (mean age 67.6, SD+/-4.7). The number of periodontal sites and the proportions of teeth with probing depth (PD) > or =5 mm, clinical attachment levels (CAL) > or =4 mm were studied in a subset of 701 of the subjects. RESULTS: IDDM was reported by 2.9% and NIDDM by 9.2% of the subjects. The number of remaining teeth did not differ by diabetic status. The number of sites with PD > or =5 mm and the proportion of PD with > or =5 mm was significantly smaller in the non-diabetic group (chi2=46.8, p<0.01, and chi2=171.1, p<0.001, respectively). Statistical analysis failed to demonstrate group differences for the number and proportions of sites with CAL > or =4 mm and for radiographic findings of alveolar bone loss. Combining all periodontal parameters revealed that the Mantel-Haenszel common odds of having IDDM/NIDDM and periodontitis was 1.8 : 1 (95% CI: 1.1-3.1, p<0.03). The common odds ratio estimate of an association between heart disease and diabetes was 3.6 : 1 (95% CI: 2.1-2.6, p<0.001). CONCLUSIONS: Probing depth differences between IDDM/NIDDM vs. non-diabetic subjects may reflect the presences of pseudo-pockets and not progressive periodontitis in many subjects with diabetes mellitus. Periodontitis is not a predominant coexisting disease in older subjects with diabetes mellitus.

Assessment of periodontal conditions and systemic disease in older subjects. I. Focus on osteoporosis.

BACKGROUND: Osteoporosis (OPOR) is a common chronic disease, especially in older women. Patients are often unaware of the condition until they experience bone fractures. Studies have suggested that OPOR and periodontitis are associated diseases and exaggerated by cytokine activity. Panoramic radiography (PMX) allows studies of mandibular cortical index (MCI), which is potentially diagnostic for OPOR. AIMS: i). To study the prevalence of self-reported history of OPOR in an older, ethnically diverse population, ii). to assess the agreement between PMX/MCI findings and self-reported OPOR, and iii). to assess the likelihood of having both a self-reported history of OPOR and a diagnosis of periodontitis. MATERIALS AND METHODS: PMX and medical history were obtained from 1084 subjects aged 60-75 (mean age 67.6, SD +/- 4.7). Of the films, 90.3% were useful for analysis. PMXs were studied using MCI. The PMXs were used to grade subjects as not having periodontitis or with one of three grades of periodontitis severity. RESULTS: A positive MCI was found in 38.9% of the subjects, in contrast to 8.2% self-reported OPOR. The intraclass correlation between MCI and self-reported OPOR was 0.20 (P < 0.01). The likelihood of an association between OPOR and MCI was 2.6 (95%CI: 1.6, 4.1, P < 0.001). Subjects with self-reported OPOR and a positive MCI had worse periodontal conditions (P < 0.01). The Mantel-Haentzel odds ratio for OPOR and periodontitis was 1.8 (95%CI: 1.2, 2.5, P < 0.001). CONCLUSIONS: The prevalence of positive MCI was high and consistent with epidemiological studies, but only partly consistent with a self-reported history of osteoporosis with a higher prevalence of positive MCI in Chinese women. Horizontal alveolar bone loss is associated with both positive self-reported OPOR and MCI.

Assessment of periodontal conditions and systemic disease in older subjects. II. Focus on cardiovascular diseases.

BACKGROUND: Panoramic radiographs (PMX)s may provide information about systemic health conditions. AIMS: i). To study clinical periodontal conditions and collect self-reported health status in a cohort of 1084 older subjects; ii). to study signs of alveolar bone loss and carotid calcification from panoramic radiographs obtained from these subjects; and iii). to study associations between study parameters. MATERIAL AND METHODS: PMXs from 1064 adults aged 60-75 (mean age 67.6, SD +/- 4.7) were studied. Signs of alveolar bone loss, vertical defects, and molar furcation radiolucencies defined periodontal status. Medical health histories were obtained via self-reports. Signs of carotid calcification were identified from panoramic radiographs. RESULTS: The PMX allowed assessment of 53% of the films (Seattle 64.5% and Vancouver 48.4%). A self-reported history of a stroke was reported by 8.1% of men in Seattle and 2.9% of men in Vancouver (P < 0.01). Heart attacks were reported by 12% of men in Seattle and 7.2% in Vancouver (N.S.). PMX evidence of periodontitis was found in 48.5% of the subjects, with carotid calcification in 18.6%. The intraclass correlation score for PMX findings of carotid calcification and stroke was 0.24 (95% CI: 0.10-0.35, P < 0.001). The odds ratio for PMX carotid calcification and periodontitis was 2.1 (95% CI: 1.3-3.2, P < 0.001), and for PMX carotid calcification and stroke 4.2 (95% CI: 1.9-9.1, P < 0.001). The associations disappeared when smoking was accounted for. A history of a heart attack was associated with stroke, gender, age, and PMX scores of alveolar bone loss. CONCLUSIONS: PMXs may provide valuable information about both oral conditions and signs of carotid calcification, data that are consistent with self-reported health conditions. Alveolar bone loss as assessed from PMXs is associated with cardiovascular diseases.

Fractal dimension on dental radiographs.

OBJECTIVES: (1) To compare fractal dimension (FD) from periapical radiographs with FD from panoramic radiographs; (2) to correlate FD with cortical thickness and morphology; and (3) to correlate FD with a reported history of osteoporotic fractures. METHODS: Information on fracture and smoking history was obtained by a telephone interview with 281 elderly (>60 years of age) patients who had periapical and panoramic radiographs exposed on the same date. FD was measured in several locations on both types of radiograph. Mandibular cortical thickness and morphology were obtained from the panoramic radiograph. RESULTS: FD measured in the mandible was lower than FD in the maxilla. Same-jaw measurements had a higher correlation than same-side measurements. FD measured on panoramic radiographs was lower than FD from periapical radiographs. There was a negative correlation between cortical thickness and FD. FD was higher in subjects with more mandibular cortical porosities and resorption. The mean panoramic FD from subjects with a history of osteoporotic fractures was significantly higher, after adjusting for smoking, gender, age, height and weight. CONCLUSIONS: FD measured on panoramic radiographs is lower than FD measured on periapical radiographs. FD is higher in both types of radiograph in subjects with a thinner, severely eroded mandibular cortex and a history of osteoporotic fractures. This study confirms other reports that FD increases when bone mass decreases. In addition, it suggests that panoramic radiographs can be used as a possible alternative for the measurement of FD to periapical radiographs.

Parameters of radiologic care: An official report of the American Academy of Oral and Maxillofacial Radiology.

The American Academy of Oral and Maxillofacial Radiology developed these Parameters of Care to provide national guidelines for the use of radiographs prescribed for the diagnosis of disease, treatment planning, and follow-up care of patients with abnormalities of the oral and maxillofacial region. The Parameters cover radiographic techniques, imaging of the temporomandibular joint, imaging of diseases of the jaws, and imaging of dental implant sites.

Case challenge: painful swelling of the temporomandibular joint.

A 59-year old woman was referred by her dentist to an Oral Medicine practice for evaluation of acute pain and swelling in her right temporomandibular joint (TMJ).

Case-control study on self-reported osteoporotic fractures and mandibular cortical bone.

OBJECTIVES: The purpose of this case-control study was to determine whether the radiographic appearance of the mandibular cortical bone in patients who were elderly and noninstitutionalized was related to a self-reported history of osteoporotic fractures. STUDY DESIGN: Patients who had a billing statement at the School of Dentistry dated between 1993 and 1996, who were older than 60, and who had a panoramic radiograph were invited to be interviewed regarding fracture history (circumstances and year of fracture) and risk factors for osteoporosis. Cases (n = 93) were individuals reporting osteoporotic fractures (fractures occurring after minor impact). Controls (n = 394) were individuals reporting traumatic fractures (n = 105) or no fractures (n = 289). Blinded to case-control status, we evaluated the mandibular cortex on a panoramic radiograph and classified them as normal (even and sharp endosteal margin), moderately eroded (evidence of lacunar resorption or endosteal cortical residues), or severely eroded (unequivocal porosity). In addition, cortical thickness was measured below the mental foramen. RESULTS: After adjustment for potentially confounding factors, the odds ratio for an osteoporotic fracture associated with moderately eroded and severely eroded mandibular cortices was 2.0 (95% CI, 1.2 to 3.3) and 8.0 (95% CI, 2.0 to 28.9), respectively. After adjusting for all potentially confounding factors, we found that the cortex was 0.54 mm (or 12%) thinner in subjects with an osteoporotic fracture compared with controls (95% CI, 0.25 to 0.84 mm). CONCLUSIONS: Subjects with a self-reported history of osteoporotic fractures tend to have increased resorption and thinning of the mandibular lower cortex.

Magnetic resonance imaging of the temporomandibular joint: interobserver agreement in subjective classification of disk status.

OBJECTIVES: To determine interobserver agreement in interpretation of magnetic resonance images of the temporomandibular joint by independent observers and to evaluate interobserver agreement within each subjectively assigned category. STUDY DESIGN: Sixty magnetic resonance images of adolescent temporomandibular joints were randomly drawn for evaluation by 4 observers who had not previously worked together. All observers independently classified disk position on sagittal magnetic resonance images according to written classification criteria consisting of 6 categories. RESULTS: Kappa statistics of agreement show moderate agreement among all observers for both medial (95% CI, 0.486-0.622) and lateral (95% CI, 0.450-0.566) components of the joint. Disk displacement without reduction was the category with the greatest agreement among all observers (kappa = 0.914). CONCLUSION: Moderate to substantial observer agreement across all defined categories of disk status may be achieved among a number of observers when standardized classification criteria are used. Interobserver agreement is, however, not uniform across all categories of disk position described.

Relationship between bone mineral density and tooth loss in elderly Japanese women.

OBJECTIVE: To evaluate the relationship between vertebral bone mass and tooth loss and jaw bone mass in elderly Japanese women. METHODS: Mandibular cortical bone mass, alveolar bone height and number of teeth present (total, anterior, and posterior) were compared with the 3rd lumbar vertebral bone mineral density (L3BMD), measured by dual energy computed tomography (DEQCT), in 90 Japanese women by means of multiple regression analysis, controlling for body mass index, menopausal status, years since menopause and self-reported periodontal condition. RESULTS: Mandibular cortical bone mass and number of posterior teeth were associated with both alveolar bone height and L3BMD, but there was no association between alveolar bone height, number of anterior teeth present and L3BMD. CONCLUSION: Our results suggest that the loss of posterior teeth may be associated with a decrease not only in alveolar bone height, but also alveolar bone mineral density (BMD). The latter may be related to a decrease of lumbar vertebral BMD.

Comparison of clinical and magnetic resonance imaging diagnosis in patients with disk displacement in the temporomandibular joint.

OBJECTIVE: The purpose of this study was to validate the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) for the diagnostic subgroup of disk displacement with reduction, with magnetic resonance imaging used as a gold standard. STUDY DESIGN: The diagnoses from the clinical examination of 78 joints in 39 patients, each with disk displacement with reduction in at least one TMJ, were compared with magnetic resonance imaging diagnoses. The readers of the magnetic resonance images were blinded to the clinical diagnoses. The data analysis included kappa statistics and calculation of predictive values. RESULTS: The predictive value of the RDC/TMD for disk displacement with reduction was 0.65. For disk displacement alone-the movement of the disk on opening not being considered-the predictive value was 0.92. The diagnostic agreement between RDC/TMD and magnetic resonance imaging diagnoses for all joints examined was 53.8%. Most of the disagreement was due to false negative clinical diagnoses for asymptomatic joints. CONCLUSIONS: A positive RDC/TMD examination is predictive for internal derangement but not reliable with regard to the type of disk displacement; such examination is therefore of limited value in determining the true disk position and its functional movements.

Skeletal and dental disturbances in children after facial burns and pressure garment use: a 4-year follow-up.

Pressure garment use alters facial growth during rehabilitation after a facial burn injury. We previously studied 3 children with full facial burns and 3 children with partial facial burns who wore pressure garments for 1 year, and we found that maxillary horizontal growth and mandibular anterior-inferior growth are inhibited during the time of pressure garment use. The purpose of this follow-up study was to prospectively document skeletal and dental changes after pressure garment use was discontinued. We found that although the growth and development of the facial bones seem to return to normal, lasting changes remain. The use of pressure garments after skin grafting is still recommended. However, it is also recommended that an orthodontist be included in the team of burn care specialists for children with facial burns to monitor facial and dental development. Close attention to facial development during and after pressure garment use is necessary to maintain normal dental and facial relationships.

Interobserver reliability in quantitative MRI assessment of temporomandibular joint disk status.

OBJECTIVE: The purpose of this study was to investigate interobserver reliability of a new technique for quantification of magnetic resonance images of temporomandibular joint disk status. STUDY DESIGN: Sixty magnetic resonance images of adolescent temporomandibular joints were randomly drawn for analysis. Four experienced observers traced the articular disk and osseous structures on sagittal magnetic resonance slice images. Quantitative measurements of disk length and disk displacement were recorded for each slice of 57 joints traced by each observer through use of a new quantification technique. Intraclass correlation coefficients were computed to assess interobserver agreement in the tracing of joint structures. RESULTS: The calculated intraclass correlation coefficient was 0.681 for disk length and 0.830 for disk displacement. In addition, the mean variability among observers was 1.041 mm for measurement of disk length and 0.972 mm for measurement of disk displacement. CONCLUSIONS: Interobserver agreement is high when the new quantification technique is used to interpret magnetic resonance images.

Alveolar bone levels in AIDS and HIV seropositive patients and in control subjects.

Alveolar bone levels were studied from intraoral radiographs of 24 non-hospitalized patients with AIDS, 17 HIV seropositive subjects, and 39 matched control subjects. The AIDS/HIV subjects were seeking dental care in a faculty practice. The matched control subjects came from those non-HIV-infected patients seeking dental care at the University of Washington. Magnified intraoral radiographs were used to assess the distance between the cemento-enamel junction (CEJ) and the alveolar bone level (BL). The extent of vertical defects and furcation invasions was also assessed. The mean age of the AIDS, HIV, and control subjects was 38.9 +/- 6.6 years, 37.1 +/- 7.6, and 39.9 +/- 5.6, respectively, and was not statistically different. Among the AIDS patients, 75% were smokers, while 88.2% of the HIV subjects were cigarette smokers. Therefore, the matched control subjects were also smokers to the same extent. The mean difference in distance CEJ-BL was 0.1 mm (mesial) and 0.3 mm (distal) and greater in the HIV/AIDS group than in the control group, but not statistically different. No vertical defects > or = 3.0 mm were found in 69.2% of the control subjects and in 58.5% of the combined HIV/AIDS group. None of the HIV/AIDS subjects had more than 5 defects > 3.0 mm, while 7.6% of the control subjects had such defects. Significant associations were found between smoking and extent of alveolar bone loss (distance) (P < 0.001) as well as the number and extent of vertical defects (P < 0.01), but were not associated with HIV status. The extent of furcation invasions, as read radiographically, did not differ between groups. In conclusion, smoking but not HIV status was the primary factor for alveolar bone loss.

Assessment of alveolar bone levels from intraoral radiographs in subjects between ages 15 and 94 years seeking dental care.

Studies have shown that <20% of the US population has periodontal disease. Studies of radiographs have shown that alveolar bone loss increases with age. Bone loss assessed from intraoral radiographs describing 10,282 teeth from 416 subjects seeking dental care during a 3 month period at the University of Washington were studied. The mean age of the subjects was 47.2 years (SD+/-15.2). The youngest subjects (15-24) had on average 29.6 teeth (SD+/-2.2) and the oldest subjects (75-94) 19.3 teeth (SD+/-6.6). This difference was statistically significant (F=16.57, p<0.001). No association was found between alveolar bone loss (CEJ-ABC), and TMD symptoms. Smoking was significantly associated with both general bone loss (CEJ-ABC) (chi(2)=114.9, p<0.0001), and vertical bone defects (angular) (chi(2)=101.8, p<0.0001). In this study population (15-94 years), alveolar bone loss progressed as defined by the slope (beta=0.29) between age 15-44, but was almost flat from age 50 years (beta=0.04). The data suggested an overall rate of alveolar bone loss of 0.02 mm per year. Stepwise multiple regression analysis showed that smoking was the primary factor in bone loss (t= 7.7, p<0.0001), followed by age (t=7.0, p<0.001) and gender (t=3.0, p<0.01). TMD symptoms could not explain the presence and severity of horizontal or vertical defects. If the CEJ-ABC distance above the mean plus 2x the SD was used as the cutoff value to define abnormal bone levels, 10.9% of the younger (15-45 years), and 10.7% of the older subjects (50-94) had significant alveolar bone loss. 73.9% of the younger and 100% of the older subjects with such extent of alveolar bone loss were smokers.

Horizontal alveolar bone loss and vertical bone defects in an adult patient population.

The objectives of the present investigation were to analyze intraoral radiographs and to study 1) the distribution of the distance between the cemento-enamel junction (CEJ) and the alveolar bone level (BL) and 2) the prevalence and severity of vertical defects, and furcation lesions in 416 individuals seeking dental care. Full mouth radiographs were enlarged 7.5 times and the mesial and distal distances between CEJ and bone level were measured. The extent of interradicular molar radiolucencies was also measured. Images of 10,282 teeth were studied. Subjects were between 15 to 94 years (mean age: 47.2, S.D.+/-15.2). On average they had 24.8 teeth (S.D.+/-5.5). The mean distance CEJ-BL increased significantly up to age 45 (r2=0.07; beta=0.29; P < 0.0001) and remained stable thereafter r2=0.09, beta=-0.02, N.S.). The mean distance CEJ-bone level was 1.4 mm (S.D.+/-0.7) in the 15 to 24 age group; 3.0 (S.D.+/-1.5) in the 45 to 54 age group; and 3.02 (S.D.+/-1.4) in the 75 to 94 age group. No vertical defects were found in 163 participants (39.3%); vertical defects > or = 3.0 mm were found in 30.2% (126). Mesial defects were significantly more common that distal defects (P < 0.001). The extent of horizontal bone loss was correlated to extent of vertical defects (r2=0.88; P < 0.0001). The number of remaining teeth was not associated with horizontal or vertical bone loss. In conclusion, the study indicated that few of the individuals had extensive horizontal bone loss. Vertical defects suitable for guided tissue regeneration procedures however, were found in many patients.

Characteristics of an oral and maxillofacial radiology department. Report of the ad hoc Department Characteristics Committee of the American Academy of Oral and Maxillofacial Radiology.

Oral and maxillofacial radiology is a dynamic and multifaceted discipline that plays a critical role in patient care, the education of general dentists and dental specialists, and the academic health of the dental school. Diagnostic and treatment advances in temporomandibular joint disorders (TMD), implants trauma and orthognathic surgery, and craniofacial abnormalities depend heavily on conventional and advanced imaging techniques. Oral and maxillofacial radiology contributes to the education of pre- and post-doctoral dental students with respect to biomedical and clinical knowledge, cognitive and psychomotor skills, and the professional and ethical values necessary to properly prescribe, obtain, and interpret radiographs. The development of an active and successful oral and maxillofacial radiology department, division, or section requires the committment of institutional resources. This document may serve as a guide to dental schools committed to excellence in oral and maxillofacial radiology.

Skeletal and dental disturbances after facial burns and pressure garments.

Pressure garments alter facial growth. We conducted a prospective study of facial growth in children wearing such garments to quantify these skeletal and dental disturbances. Three children with total face masks and three children with devices covering the lower face were studied. Panoramic and cephalometric radiographs were obtained at the start of treatment, approximately 6 months later, and at the end of the treatment. Clinical examinations were performed to document occlusal status and subsequent changes. Total face masks affected maxillary horizontal growth more than vertical growth. Mandibular growth changed from the normal anterior and inferior direction to a more inferior direction. With partial face masks, the most notable change was increased proclination of anterior teeth. Facial growth and the position of anterior teeth appear to be affected by the combination of the extent of the burn and skin graft and the type of pressure garments worn during the time of rehabilitation.

Radiovisiography versus conventional radiography for detection of small instruments in endodontic length determination. II. In vivo evaluation.

Radiovisiography was compared clinically to conventional D-speed and E-speed radiographs viewed with X 2 magnification using the mesiobuccal root of maxillary molars of 22 patients. Clarity of size 8 and 10 endodontic file tips in relation to the radiographic apex was the object of comparison. Five images of radovisiography, (original, enhanced, negative-to-positive mode), were compared to D-speed and E-speed radiographs. D-speed radiographs were also compared to E-speed radiographs. D-speed radiographs were statistically superior to all five radiovisiography images. Four of the radiovisiography images were equivalent to E-speed radiographs. D-speed radiographs provided superior recognition of small file tips when compared to E-speed radiographs 100% of the time. Accurate identification of the small file tips was achieved on 95% of D-speed and 70% of E-speed radiographs. With radiovisiography, identification was achieved on 95% of the zoom images in the negative-to-positive mode, 86% of enhanced, 82% of standard zoom, and 77% of the images in negative-to-positive conversion.