Transtomography: a new tomographic scanning technique.

OBJECTIVES: To introduce and test a new tomographic technique, namely transtomography, making it possible to expose tomographic images employing the narrow beam of an advanced panoramic machine. METHODS: The working principle of the new technique is described. It combines a translational movement with a pendular movement of the beam that creates motion unsharpness analogous to that of conventional tomography. In order to verify whether the new technique works and results in tomographic images, test radiographs were exposed on phantoms. RESULTS: The principle of transtomography works and give images with properties essentially equivalent to those of conventional tomography. With the transtomographic technique using a narrow beam, tomographic images may be exposed with an advanced panoramic machine. CONCLUSION: Transtomography may be employed to expose tomographic images basically on the same indications as for conventional tomography.

The effect of hyaluronan on bone and soft tissue and immune response in wound healing.

BACKGROUND: The aims of this study were to investigate the anti-inflammatory effect and the effect on bone regeneration of hyaluronan in surgical and non-surgical groups. METHODS: In each of 15 individuals, 2 teeth with defects of similar character and magnitude in the upper or lower jaw were chosen. There were at least 2 teeth between the test and the control sites. In the surgical group, a bioabsorbable membrane was used for both test and control sites, and hyaluronan was placed in the intrabony pocket of the test site. In the non-surgical group, the periodontal pockets were scaled and hyaluronan was administered 3 times with an interval of 1 week in the test pockets. Alveolar bone height and bone healing patterns were analyzed using digital intraoral radiographs. Measurements of bone height were performed in the original digital black-and-white radiographs to obtain quantitative data on bone gain or loss. Bone healing patterns were studied with color-coded radiographs, using specially designed software in a personal computer with subsequent combinations of radiographs. Gingival crevicular fluid immunoglobulin (Ig)G, C3, and prostaglandin E2 (PGE2) responses; periodontal probing depth; bleeding on probing; and the presence of plaque were studied to evaluate the anti-inflammatory effect. Data were obtained at baseline before treatment, and at 2 weeks, and 1, 3, 6, and 12 months after treatment. RESULTS: For the surgical treatments, bone height was increased in the test group treated with hyaluronan (mean value 2.2%, corresponding to an average increase of approximately 0.5 mm) and reduced in the control group (mean value -1.8%, corresponding to an average decrease of approximately - 0.4 mm) (P<0.05) after 12 months. For the non-surgical treatments, bone height was reduced by a mean value of -1.1% (corresponding to an average decrease of approximately -0.25 mm) in the test group treated with hyaluronan and -3.3% (corresponding to an average decrease of approximately -0.75 mm) in the control group after 12 months (N.S.). According to the digital color-coded radiographs, the test sites in the surgical and non-surgical groups showed apposition of bone minerals. Immune responses showed no differences during the 12 months studied for the surgical and non-surgical sites. Mean periodontal probing depths were reduced between 2.5 mm and 4.1 mm in the surgical and non-surgical groups. CONCLUSIONS: The observed difference in bone height between test and control sites in the surgical group after 12 months was less than 1 mm, which was only detectable on radiographs. No statistical difference was found on radiographs in the non-surgical group, where a decrease in bone height was found for both groups after scaling. Probing depth reduction after the surgical treatment, as well as after scaling and root planing, was as expected. Hyaluronan in contact with bone and soft tissues had no influence on the immune system in this study. Further studies are needed to determine the extent to which hyaluronan can lead to clinically significant healing of periodontal lesions.

Comparison of observer reliability in assessing alveolar bone changes from color-coded with subtraction radiographs.

OBJECTIVES: To assess intra- and interobserver agreement on marginal changes in periodontal bone from color-coded compared with subtraction radiographs. METHODS: Sequential radiographs from patients undergoing periodontal treatment were acquired using direct digital intra-oral radiography. Fifty-one pairs of color-coded and subtraction radiographs were produced and evaluated twice by six dentists for changes in marginal bone. Intra- and interobserver agreement were calculated. RESULTS: Intra-observer agreement was significantly higher for the color-coded radiographs (P < 0.05). Interobserver agreement was significantly higher for color-coded radiographs at the second (P < 0.001) but not the first (P = 0.34) evaluation. CONCLUSIONS: Color coding of radiographic differences by means of image addition may be a feasible alternative to the subtraction technique for evaluating periodontal bone changes.

The perceptibility curve test applied to direct digital dental radiography.

OBJECTIVE: To compare the effect of an additional scintillator layer on the psychophysical properties of a CCD detector for digital dental radiography. METHODS: Radiographs of a test object containing ten holes of increasing depth were obtained throughout the exposure range of two CCD detectors at 70 and 90 kVp. One was the original detector for the Sens-A-Ray system (Regam Medical Systems, Sundsvall, Sweden) and the other the same detector covered by a scintillator layer. Ten viewers evaluated the radiographs for the number of perceptible holes. From these data and the dose response functions for the two detectors, the minimum perceptible exposure difference was found. The reciprocal values of this parameter were plotted against the logarithm of exposure to create Perceptibility Curves (PCs). RESULTS: The four PCs had essentially the same shape and height. There was a shift to lower exposures in the PCs for the detector covered by a scintillator. CONCLUSIONS: The two detectors have essentially the same psychophysical properties. Since the detector covered by a scintillator layer is more sensitive, it should be preferred for clinical practice since the dose to the patient is reduced.

Comparison of arthroscopy and radiography in patients with temporomandibular joint symptoms and generalized arthritis.

OBJECTIVE: To compare arthroscopy with radiography in patients with temporomandibular joint (TMJ) symptoms and generalized joint disease. METHODS: Twenty patients with generalized osteoarthritis (GOA) and TMJ symptoms and 21 patients with rheumatoid arthritis (RA) and TMJ symptoms were examined with arthroscopy and radiography (individualized oblique lateral transcranial projections and sagittal and frontal tomography). RESULTS: In the GOA group there was a significant correlation between pronounced degenerative changes at arthroscopy and flattening of the eminence and reduced joint space superiorly and posteriorly on radiographs and between moderate to pronounced bone or disk remodelling and reduced joint space superiorly and posteriorly. In the RA group there was a significant correlation between moderate to pronounced degenerative changes at arthroscopy and radiographically extensive erosions in the condyle and between moderate to pronounced fibrosis and reduced translation. CONCLUSION: Compared with conventional tomography, arthroscopy revealed TMJ pathology earlier and more frequently. It may therefore in individual cases be the first choice examination, particularly as treatment can be given simultaneously.

A sensitometric comparison of four dental X-ray films and their diagnostic accuracy.

OBJECTIVES: To compare the sensitometric properties and accuracy in the diagnosis of approximal caries of two E-speed (Ektaspeed Plus and EV 57) and two D-speed (Ultra-speed and DV 57) films. METHODS: Speed and contrast for the four films were determined following 30 exposures for each film. Base plus fog density was measured on unexposed films and the increase was studied over a 18-month period. Seventy-five extracted premolars with known pathology were radiographed under standardized conditions and the radiographs assessed by nine observers for approximal caries. Receiver Operating Characteristic (ROC) curve technique was used to analyse the diagnostic accuracy. RESULTS: The sensitometric analysis showed that the Ektaspeed Plus film had the highest speed of the four films. At a density of 1.0 it was 2.28 times faster than Ultra-speed. The contrast of Ektaspeed Plus was comparable with that of the other films and base plus fog density plateaued at 0.4 ten months before expiry date. There were no statistically significant differences in diagnostic accuracy for white spot lesions between the four films. For cavitations there was a significant difference between EV 57 and DV 57 and Ektaspeed Plus (P = 0.005) but not between Ultra-speed and Ektaspeed Plus nor between Ultra-speed and EV 57 and DV 57. CONCLUSION: Ektaspeed Plus film is comparable with D-speed and a conventional E-speed film. Since it is at present the fastest available dental film it should be recommended for general dental practice.

Methods of reducing observer variation in age estimation from panoramic radiographs.

OBJECTIVE: To compare inter- and intra-observer variation in age estimation using subjective and objective methods. METHODS: Fifty-six panoramic radiographs of patients aged 13 to 25 years were assessed subjectively twice by four observers for the stage of root development of the lower third molars on a seven-point scale. Two of the observers were calibrated before the first evaluation, and the other two before the second. The same observers also digitized predefined reference points in a subsample of the third molars ten times by means of a computer-based digitizer system. Observer variation in classifying different root stages and in digitizing coordinates and measuring root lengths were studied. RESULTS: Significant systematic differences existed between two of the observers in the subjective assessment. One non-pre-calibrated observer changed her pattern most. Scattergrams from the digitizer measurements showed a good precision within and between observers with no significant differences in calculating root lengths. When, however, the teeth were analysed separately, some significant differences were found. CONCLUSIONS: The overall observer agreement was best using the objective method on several teeth. With only one tooth there were some significant differences. Subjective evaluation was improved by prior calibration.

Radiographic changes in the temporomandibular joint in patients with generalized osteoarthritis and rheumatoid arthritis.

This is the first study concerned with radiographic characteristics in patients with generalized osteoarthritis and signs and symptoms of temporomandibular joint involvement. For comparison, patients with rheumatoid arthritis and temporomandibular joint involvement were used. The patient material comprised 20 patients with generalized osteoarthritis (20 joints) and 21 patients with rheumatoid arthritis (21 joints). The radiographic methods were corrected sagittal tomography (hard tissue changes, joint space, and condylar position), frontal tomography (hard tissue changes), and individualized oblique lateral transcranial projections (condylar translation). Sixteen (80%) joints in the group of patients with generalized osteoarthritis and 15 (71%) joints in the group with rheumatoid arthritis revealed structural changes. The condyle was the predominant location. No radiographic criterion was pathognomonic for generalized osteoarthritis or rheumatoid arthritis. However, osteophytes, flattening of the condyle, or a reduced joint space was observed more often in joints with generalized osteoarthritis, whereas erosions in the condyle were more common in joints with rheumatoid arthritis. The radiographic findings in patients with generalized osteoarthritis are more similar to those seen in patients who have the common form of temporomandibular joint osteoarthritis than to those in patients with rheumatoid arthritis.

Absolute measures of image quality for the Sens-A-Ray direct digital intraoral radiography system.

To study the noise characteristics of the Sens-A-Ray (Regam Medical Systems AB, Sundsvall, Sweden) system, 20 radiographs were obtained at each of three different exposure levels at 70 and 90 kVp with a homogeneous x-ray field. Exposures were measured with an ionization chamber. Noise power spectra were calculated over three areas within each radiograph, and ensemble averages were subsequently found from 60 data files at each exposure level. Noise equivalent quanta were calculated with the noise power spectra and modulation transfer function data from previous studies. Finally, the detective quantum efficiency was calculated by dividing the noise equivalent quanta by the estimated incident photon fluence at the different exposures. The system has a maximum detective quantum efficiency of approximately 0.030 at 70 kVp and 0.025 at 90 kVp. A broad maximum exists at approximately 2 cycles/mm, indicating that the signal-to-noise ratio is most favorable at this spatial frequency.

A simple method for measuring MTF in direct digital intraoral radiography. Technical note.

Conventional methods for measuring the modulation transfer function require the exposure of a narrow slit or straight edge followed by computationally intense data analysis. An alternative method applicable to digital systems uses the standard deviation of gray levels within different frequency regions of a bar pattern. To verify that this method gave reliable results, measurements performed for two systems for intraoral radiography with the use of this method have been compared with modulation transfer function values calculated from Fourier transformations of line spread functions measured for the two systems. The almost identical results confirm the consistency of both sets of modulation transfer function measurements and demonstrate the utility of the bar pattern method for performing rapid measurements.

Color coding of radiographic changes over time by means of image addition.

Differences between sequential radiographs may be displayed in color if the individual radiographs are transformed into monochromatic images and then added. Information in regions where the radiographs are identical is retained whereas differences are emphasized by the color coding that comes about in a quantitative manner from the gray level values in the sequence of radiographs. By using the three additive primary colors, red, blue, and green, two or three radiographs from a sequence may be added. Every possible state of a bone disease, progression, regression, or any combination, will produce a different and specific color code. Different development cycles are described, and the color coding that appears when color image addition is performed is analyzed. The color addition technique should constitute a useful substitute or alternative to subtraction.

Resolution as defined by line spread and modulation transfer functions for four digital intraoral radiographic systems.

Line spread functions for four commercially available systems for direct digital intraoral radiography were determined from images of a slit of negligible width. From the fitted line spread functions presampling modulation transfer functions were calculated. The four systems were the Sens-A-Ray (Regam Medical System AB, Sundsvall, Sweden), the VIXA/Visualix (Gendex, Chicago Ill.), the RVG (Trophy Radiologic, Paris, France), and the Flash Dent (Villa Sistemi Medicale srd, Buccinasco, Italy). Digital intraoral radiography is in a state of rapid development, and detectors as well as computer hardware and software are continually modified and improved resulting in successively changing system parameters. As this occurs the present work provides a method that may be used to determine comparable data on future systems.

Radiographic interproximal angulations: implications for rotational panoramic radiography.

Axial radiographs were taken on 160 subjects at the screening clinic of the Dental School, University of Texas Health Science Center at San Antonio. Intermeatal and midsagittal lines, together with coordinate axes and polynomial curves that represent the average dental arch form, were overlaid on each radiograph. Coordinate references for interproximal tangents at 3154 contacts along the average dental arch form were digitized and angulations between the arch form and midsagittal plane calculated. Interproximal angulations at the average arch form were found to vary greatly but the average fluctuated around 90 degrees over the length of the arch. Optimal beam angulations were shown to be considerably different from central ray angulations of current panoramic machines, and although most machines demonstrated favorable interproximal beam angulation in the anterior region, discrepancy in the premolar region ranged from 15 degrees to over 40 degrees. Overall the OrthOralix SD (Gendex Dental Systems, S.r.l., Monza, Italy) orthogonal projection and PM 2002 CC (Planmeca Inc. Helsinki, Finland) deviate least from optimal interproximal angulation over most of the dental arch. However, the Planmeca gives a better angulation in the canine/premolar region, whereas the OP5/10 (Palomex Instrumentarium Corp., Helsinki, Finland) is comparable with the OrthOralix SD in the molar region.

Layer thickness in panoramic radiography as defined by different noise-equivalent passbands.

The layer thickness in rotational panoramic radiography is presented with the use of the concept of the noise-equivalent passband. Conventionally, the layer thickness has been calculated only from one-dimensional data in the horizontal or rotational dimension of panoramic radiography. In the present study, results from calculations using both one- and two-dimensional data are presented. When the vertical dimension is included in the calculations, the layer is wider than when calculated from data in the horizontal dimension only. It is pointed out that the wider layer that follows from the introduction of the vertical dimension may be the most reliable measure of layer thickness in panoramic radiography.

Basic technical properties of a system for direct acquisition of digital intraoral radiographs.

The Sens-A-Ray system for direct digital intraoral radiography may be used with any computer compatible with an IBM PC/AT. The system relies on a charge-coupled device designed for direct conversion of x-ray energy to an electronic signal. It is the first such device for direct acquisition of radiographs. Technical properties of charge-coupled device detectors when exposed to radiation energies in the range of x-rays used in dental radiography have been studied. Even in the absence of light or x-radiation there is a spontaneous generation of charge within a charge-coupled device detector that gives rise to a background signal, a dark current. It was found that the dark current is a linear function of exposure time. The dose response of the charge-coupled device detector was determined at nominal kilovoltages that range from 50 to 90 kVp. The dose response was shown to be a linear function of exposure. The functions for all kVp settings were practically identical. The charge-coupled device detector is more sensitive to x-radiation than conventional dental films and, consequently, its exposure range is more narrow. The signal-to-noise ratio was calculated from the digital radiographs used for the dose response test. The ratio is above 10 for exposures higher than about 2 microC/kg. The line spread function was determined from test radiographs of a 10 microns wide slit in a test object of 1.5 mm thick tantalum. After curve fitting, the line spread function could be expressed as the sum of a Gaussian and an exponential function. Presampling modulation transfer functions valid at the detector plane and at an object plane were calculated from fitted data on the line spread function. It is concluded that the Sens-A-Ray system has such technical properties that it may replace conventional film-based systems.

Dimensional reproduction in direct digital rotational panoramic radiography.

A linear x-ray detector array can be used to perform rotational panoramic radiography provided a technique for data acquisition is used that emulates the dimensional reproduction of a conventional rotational panoramic radiographic system. This may be accomplished with the use of a variable integration time throughout the excursion. The required interval depends upon the scanning geometry, the selected image plane, and the size of pixels used in the digital image. In a prototype device developed around an Orthopantomograph Model OP10 with 0.225 mm square pixels, the integration times range from about 8 milliseconds to 28 milliseconds. An experimental test was performed by radiographing a number of steel spheres positioned at different object depths. Within the limits of experimental error, there was satisfactory agreement between the measured and theoretical magnification.

Direct digital extraoral radiography of the head and neck with a solid-state linear x-ray detector.

A narrow fan beam of x-rays intercepted by a linear array detector was used to acquire transmission data for a radiographic phantom moved across the beam. The digital data were displayed as images representing a variety of extraoral views of the head and neck. Projections investigated include the straight lateral view, two frontal projections, and a half-axial projection. The digital images appear to provide adequate contrast and resolution for common diagnostic tasks. In addition, the use of a scanning linear detector reduces the amount of scatter, which increases contrast relative to images made with an area detector. The system appears to provide a versatile and convenient means for the acquisition of extraoral views relevant to dental practice while it eliminates the logistical difficulties and errors associated with film processing.

CT reconstruction algorithm for a dental panoramic x-ray unit.

A variable Jacobian and weighted backprojection algorithm, used for medical CT, was adapted to perform CT reconstructions on data obtained with a dental panoramic x-ray unit. A detector array, fitted to the unit for the purpose of acquiring digital panoramic radiographs, was used to collect the data. Compensations were made for the incomplete (230 degrees) rotation of the panoramic x-ray unit, the non-fixed centre of rotation, the irregular rotation of the x-ray target and detector, and the resulting variances in magnification. The algorithm was tested on mathematically simulated phantoms and on acquired data. Reconstruction of simulated data proved the success of the algorithm. Real data reconstructions showed some defects as a result of inaccuracies in quantifying the experimental panoramic device.

Design and implementation of an image management and communications system (IMACS) for dentomaxillofacial radiology.

An Image Management and Communications System for digital dentomaxillofacial radiology is under development at the Department of Dental Diagnostic Science at the University of Texas Health Science Center at San Antonio, Texas, USA. In its final stage, the system will provide a method of integrating different direct digital image acquisition modalities such as intraoral, panoramic and extraoral radiography. A review of the design criteria necessary for establishing such a system for clinical dentistry is discussed and the first phase of its implementation described.

Preliminary evaluation of a digital system for rotational panoramic radiography.

A prototype system for direct digital panoramic radiography has been evaluated with respect to density, contrast, magnification, distortion, resolution, and overall image quality. Density and contrast depend on detector calibration and may be modified by the display system or by digital processing of the captured image. Variation of magnification in the horizontal and vertical dimensions gives rise to distortion phenomena that are identical to those encountered in film-based systems. Resolution in the vertical dimension is determined by the pitch of the detector elements. In the horizontal dimension, resolution is limited by the effective width of the detector elements. To evaluate the clinical acceptability of the images, radiologists and general practice residents were asked to assess the perceptibility of important radiographic landmarks in film-based and digital images of both a radiographic phantom and a patient. The digital system performed on a par with film in the representation of normal morphologic structures of the clinical human subject whereas more differences were apparent in the phantom images. The general practice residents consistently rated the digital images higher than their radiologist counterparts did. No consistent trends were found to indicate any inherent deficiencies of the digital system in the depiction of any one area. The results indicate the promise of direct digital acquisition as a method of panoramic imaging.