Comparative evaluation of the sensitometric properties of screen-film systems and conventional dental receptors for intraoral radiography.

This investigation determined the sensitometric properties of 27 rare-earth screen-film combinations and compared them to E- and D-speed films and xeroradiography, the current standards for intraoral radiography. A series of exposures from base plus fog to film saturation were made to determine the Hurter and Driffield curve of each image receptor. The base plus fog, film saturation, speed, gamma, average gradient, and resolution were determined. When dental receptors and screen-film systems are compared on the basis of radiographic quality (contrast and resolution), many screen-film systems have similar resolution (greater than 10 line pairs/mm), significantly greater contrast (greater than 2.0), and a substantial speed advantage (greater than 10). Thus selected screen-film systems may be an alternative to conventional dental receptors for intraoral radiography.

Rare earth filters for intraoral radiography: exposure reduction as a function of kV(p) with comparisons of image quality.

Radiographs of phantoms were produced using E-speed film and various rare earth X-ray beam filters. The rare earth filters considerably reduced the amount of radiation needed to produce diagnostic quality images and, in many cases, improved image quality. These filters can be implemented easily and inexpensively in a clinical setting, resulting in radiation exposure reductions of up to 71%.

Effect of developer temperature changes on the sensitometric properties of direct exposure and screen-film imaging systems.

A heat exchanger was developed and incorporated into the recirculation system of a dental processor to maintain strict temperature control. Without the heat exchanger, developer temperature rose steadily over 8 h to a maximum of 35.7 degrees C: with the heat exchanger it was maintained, regardless of ambient conditions, at the desired temperature with virtually no fluctuation. Sensitometric properties of base and fog, speed, and average gradient were measured for D and E speed films and Lanex Regular/T-Mat G and Lanex Fast/T-Mat Hscreen-film systems at developer temperatures of 21.1, 23.8, 26.7, 29.4 and 32.2 degrees C. Small changes in these properties were found for D and E speed films: on the other hand, Lanex Regular/T-Mat G showed a 65% increase in base and fog and Lanex Fast/T-Mat H a 43% increase in average gradient over the temperature range studied. Although these changes may not be clinically significant for intra-oral and dental radiography, the variations in image quality may compromise controlled imaging experiments and clinically compromise radiographic quality when using screen-film systems.

Bayesean-deblurred Planar and SPECT nuclear bone imaging for the demonstration of facial anatomy and craniomandibular disorders.

Ambiguities in diagnoses can often be resolved when images from different imaging modalities are compared, and when images are processed with algorithms that improve resolution and contrast. Bayesean deblurring algorithms were developed and applied to Planar and SPECT images of the maxillofacial and temporomandibular joint regions. The combined use of Planar and SPECT imaging with Bayesean deblurring were complementary and provided more diagnostic information than either modality individually. A facial imaging protocol using Planar and SPECT imaging and Bayesean deblurring is described. SPECT maxillofacial anatomy is presented, as well as the application of the imaging protocol of craniomandibular dysfunction. Although not recommended for all patients with craniomandibular disorders, combined use of Planar and SPECT images and Bayesean deblurring techniques appears to be useful in diagnostically difficult or refractory cases.

Emission imaging of patients with craniomandibular dysfunction.

Signs and symptoms of craniomandibular dysfunction in 37 patients were compared with the results of corrected cephalometric tomography and an emission imaging protocol consisting of both planar and single photon emission computed tomography (SPECT) (7500 ZLC Orbiter) images. The planar images and the single photon emission computed tomography projection views were processed with a bayesian deblurring algorithm to improve image quality. The correlation of emission imaging with craniomandibular dysfunction, as indicated by temporomandibular joint pain and joint noise, showed a high sensitivity (93%) and a high specificity (86%), whereas the correlation of corrected cephalometric tomography with temporomandibular joint pain and joint noise showed a relatively high sensitivity (89%) but a low specificity (27%). These results indicate that emission imaging is a sensitive and accurate indicator of craniomandibular dysfunction.

Radiographic detection of dental calculus.

To determine the sensitivity and specificity of the radiographic detection of calculus, 275 proximal tooth surfaces from 18 patients were evaluated. Standardized periapical radiographs obtained before extraction were coded, batch processed, and evaluated independently by two investigators under optimum viewing conditions. After extraction, the teeth were photographed and evaluated both microscopically and by planimetry on 40 X linear projections. Evaluation of calculus by conventional radiography showed low sensitivity: radiographic deposits were detected on only 44% of surfaces that demonstrated calculus microscopically. Specificity was high and the rate of false positives was only 7.5%. Detection of calculus was influenced by the thickness of calculus, the percentage of root surface occupied by calculus, and by tooth type; but not by attachment loss, probing depth, proximal surface, or arch location. These results show that present radiographic techniques are not appropriate for detecting calculus on root surfaces.

Magnetic resonance imaging of the TMJ disc in asymptomatic volunteers.

Forty-two temporomandibular joints (TMJs) in 21 asymptomatic volunteers were visualized by magnetic resonance imaging (MRI). The subjects, 12 males and nine females, were between 23 and 43 years of age and had no history of TMJ pain, joint noise, limited opening, or previous treatment for TMJ disorder. A cephalometric head-holder was designed to position the TMJ in an accurate and reproducible manner and multisection parasagittal images were obtained perpendicular to the longitudinal axis of the condyle. MR images depicted anterior disc position in 32% of the asymptomatic joints (8/24 males, 5/18 females). Anterior disc position in asymptomatic subjects may be a predisposing factor to TMJ dysfunction or simply an anatomic variant whose prevalence must be considered when evaluating TMJ dysfunction.

Quantitative organ visualization using SPECT.

Quantitative organ visualization (QOV) was performed using single photon emission computed tomography (SPECT). Organ size was calculated from serial, contiguous ECT images taken through the organ of interest with image boundaries determined using a maximum directional gradient edge finding technique. Organ activity was calculated using ECT counts bounded by the directional gradient, imaging system efficiency, and imaging time. The technique used to perform QOV was evaluated using phantom studies, in vivo canine liver, spleen, bladder, and kidney studies, and in vivo human bladder studies. It was demonstrated that absolute organ activity and organ size could be determined with this system and total imaging time restricted to less than 45 min to an accuracy of about +/- 10% providing the minimum dimensions of the organ are greater than the FWHM of the imaging system and the total radioactivity within the organ of interest exceeds 15 nCi/cc for dog-sized torsos. In addition, effective half-lives of approximately 1.5 hr or greater could be determined.

Order of magnitude dose reduction in intraoral radiography.

This comparative clinical investigation concerns the radiation dose from intraoral radiography using E-speed film and rectangular and circular beam collimation. Dose to organs not of diagnostic importance (brain, lens of the eye, thyroid, and breast) is reduced by approximately an order of magnitude when rectangular collimation and E-speed film are used in periapical radiography. And dose to the thyroid and breast is further reduced by a third with the use of a full leaded apron and thyroid shield.

Exposure reduction of 96% in intraoral radiography.

This study compared the diagnostic quality of E-speed film, xeroradiographic cassettes, and a screen-film imaging system used in medical radiology. The surfaces of defects simulating caries were scored for the presence and depth of the defects under ideal viewing conditions by independent observers. Receiver Operator Characteristics analysis of the data showed no significant differences regarding diagnostic potential among the three systems. The true-positive fraction was 1.00 for all systems and all operators, and the false-positive fraction was .011, .011, and .007, respectively. An exposure of 5.5 mR was used to produce images with the screen-film combination, and 150 mR was used for standard dental systems. This study showed that an exposure reduction of 96% is possible while maintaining high-quality radiographs for the diagnosis of caries.

Reduced radiation-absorbed dose to tissues with partial panoramic radiography for evaluation of third molars.

The radiation-absorbed doses from panoramic radiography, distal molar radiography, and a partial panoramic radiographic technique that exposes only the third molar region to radiation are compared. Doses of radiation to the submandibular salivary gland were comparable by all three techniques, but doses of radiation to the head and neck were reduced greatly by the partial panoramic radiographic technique. Partial panoramic radiography is a diagnostically satisfactory and a radiologically safer technique for evaluation of third molar pathosis than is panoramic or distal molar radiography.

Computed tomography of the meniscus of the temporomandibular joint: preliminary observations.

Anterior displacement of the meniscus of the temporomandibular joint (TMJ) was diagnosed in nine patients who had undergone arthrography, and they were later examined with computed tomography (CT) to see if this modality could supplant arthrography in some patients with TMJ dysfunction. The anteriorly displaced menisci were visualized in all nine patients by using sagittal reformations and the blink mode. Four of the nine patients had the diagnosis confirmed at surgery. The precise protocol for the CT examination and how to interpret it are discussed. We are optimistic that CT may replace TMJ arthrography in selected patients.

Evaluation of irradiated mandibles using emission tomography, bone scans, and radiography.

This study compared radiographs, bone scans, and computed emission tomograms with histologic findings in irradiated mandibles of adult Rhesus monkeys. Although osteocytes were lost in the path of the beam, many vessels were partially or totally occluded, the periosteum degenerated, the marrow became fibrotic, and cancellous bone proliferated abundantly, no changes were noted with radiography, conventional bone scanning, or computed emission tomograms. These clinical methods of examination may misrepresent the true condition of irradiated bone because of inadequate sensitivity or balance among factors that control radioactive tracer uptake in bone.

An optimized collimator for single-photon computed tomography with a scintillation camera.

The problem of nonuniform response, which is inherent in scintillationcamera emission computed tomography, can be minimized by proper collimator design. A specially fabricated collimator, optimized for emission computed tomography, was designed. This collimator has a calculated full width at half maximum of 1 cm at 15 cm in front of the collimator. When this collimator is used in conjunction with averaged opposed views, excellent uniformity across the reconstruction plane is achievable.

Facial bone scanning by emission tomography.

A single-photon emission tomographic system was used to study the normal anatomy of the facial bones and the usefulness of emission computed tomography in evaluating diseases of the bones of the face. The examination was performed following routine bone scintigraphy and took an additional 20-30 min. The anatomy of the facial bones was well defined, with clear separation of deep and superficial structures. Early experience with tumor, infection, bone grafts, and postirradiation osteonecrosis indicates that useful added diagnositc information can be obtained by this method.