Optimization of dental CBCT exposures through mAs reduction.

OBJECTIVES: To investigate the effect of tube current-exposure time (mAs) reduction on clinical and technical image quality for different CBCT scanners, and to determine preliminary minimally acceptable values for the mAs and contrast-to-noise ratio (CNR) in CBCT. METHODS: A polymethyl methacrylate (PMMA) phantom and an anthropomorphic skull phantom, containing a human skeleton embedded in polyurethane, were scanned using four CBCT devices, including seven exposure protocols. For all protocols, the mAs was varied within the selectable range. Using the PMMA phantom, the CNRAIR was measured and corrected for voxel size. Eight axial slices and one coronal slice showing various anatomical landmarks were selected for each CBCT scan of the skull phantom. The slices were presented to six dentomaxillofacial radiologists, providing scores for various anatomical and diagnostic parameters. RESULTS: A hyperbolic relationship was seen between CNRAIR and mAs. Similarly, a gradual reduction in clinical image quality was seen at lower mAs values; however, for several protocols, image quality remained acceptable for a moderate or large mAs reduction compared with the standard exposure setting, depending on the clinical application. The relationship between mAs, CNRAIR and observer scores was different for each CBCT device. Minimally acceptable values for mAs were between 9 and 70, depending on the criterion and clinical application. CONCLUSIONS: Although noise increased at a lower mAs, clinical image quality often remained acceptable at exposure levels below the manufacturer's recommended setting, for certain patient groups. Currently, it is not possible to determine minimally acceptable values for image quality that are applicable to multiple CBCT models.

Three-dimensional cephalometric analysis in orthodontics: a systematic review.

CONTEXT: The scientific evidence of 3D cephalometry in orthodontics has not been well established. OBJECTIVE: The aim of this systematic review was to evaluate the evidence for the diagnostic efficacy of 3D cephalometry in orthdontics, focusing on measurement accuracy and reproducibility of landmark identification. DATA SOURCES: PubMed, EMBASE and the Cochrane library (from beginning to March 13, 2012) were searched. Search terms included: cone-beam computed tomography; tomography, spiral computed; imaging, three-dimensional; orthodontics. STUDY SELECTION: Two reviewers read the retrieved articles and selected relevant publications based on pre-established inclusion criteria. The selected publications had to elucidate the hierarchical model of the efficacy of diagnostic imaging systems by Fryback and Thornbury. DATA EXTRACTION: The data was then extracted according to two protocols, which were based on the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. Next, levels of evidence were categorized into 3 groups: low, moderate and high evidence. DATA SYNTHESIS: 571 publications were found by database search strategies and 50 additional studies by hand search. A total of 35 publications were included in this review. CONCLUSIONS: Limited evidence for the diagnostic efficacy of 3D cephalometry was found. Only 6 studies met the criteria for a moderate level of evidence. Accordingly, this systematic review reveals that there is still need for methodologically standardized studies on 3D cephalometric analysis.

An in vitro comparison of subjective image quality of panoramic views acquired via 2D or 3D imaging.

OBJECTIVES: The objective of this study is to compare subjective image quality and diagnostic validity of cone-beam CT (CBCT) panoramic reformatting with digital panoramic radiographs. MATERIALS AND METHODS: Four dry human skulls and two formalin-fixed human heads were scanned using nine different CBCTs, one multi-slice CT (MSCT) and one standard digital panoramic device. Panoramic views were generated from CBCTs in four slice thicknesses. Seven observers scored image quality and visibility of 14 anatomical structures. Four observers repeated the observation after 4 weeks. RESULTS: Digital panoramic radiographs showed significantly better visualization of anatomical structures except for the condyle. Statistical analysis of image quality showed that the 3D imaging modalities (CBCTs and MSCT) were 7.3 times more likely to receive poor scores than the 2D modality. Yet, image quality from NewTom VGi® and 3D Accuitomo 170® was almost equivalent to that of digital panoramic radiographs with respective odds ratio estimates of 1.2 and 1.6 at 95% Wald confidence limits. A substantial overall agreement amongst observers was found. Intra-observer agreement was moderate to substantial. CONCLUSIONS: While 2D-panoramic images are significantly better for subjective diagnosis, 2/3 of the 3D-reformatted panoramic images are moderate or good for diagnostic purposes. CLINICAL RELEVANCE: Panoramic reformattings from particular CBCTs are comparable to digital panoramic images concerning the overall image quality and visualization of anatomical structures. This clinically implies that a 3D-derived panoramic view can be generated for diagnosis with a recommended 20-mm slice thickness, if CBCT data is a priori available for other purposes.

Forensic odontology in the disaster victim identification process.

Disaster victim identification (DVI) is an intensive and demanding task involving specialists from various disciplines. The forensic dentist is one of the key persons who plays an important role in the DVI human identification process. In recent years, many disaster incidents have occurred that challenged the DVI team with various kinds of difficulties related to disaster management and unique situations in each disaster. New technologies have been developed to make the working process faster and more effective and the different DVI protocols have been evaluated and improved. The aim of this article is to collate all information regarding diagnostic tools and methodologies pertaining to forensic odontological DVI, both current and future. It can be concluded that lessons learned from previous disaster incidents have helped to optimize working protocols and to develop new tools that can be applied in future DVI operation. The working procedures have been greatly improved by newly developed technologies.

Human dental age estimation using third molar developmental stages: Accuracy of age predictions not using country specific information.

Unquestionable forensic age investigations are based on statistical models constructed on a sample containing subjects of identical origin as the examined individual. In cases where corresponding models are unavailable, the established report has to describe the possible effects of this unrelated information on the predicted age outcome. The aim of this study is to collect country specific databases of third molar development and to verify how the related dental age estimations are influenced if we were to use dental developmental information only from Belgium or from all collected countries together. Data containing third molar developmental stages scored following Gleiser and Hunt (modified by Köhler) were collected from 9 country specific populations (Belgium, China, Japan, Korea, Poland, Thailand, Turkey, Saudi-Arabia and South-India). Age predictions were obtained from a training dataset and validated on a test dataset. Bayes rule using the repeated third molar scores is applied to get age predictions and prediction intervals. Three age predictions were compared for males and females separately. For the first prediction, the training dataset contains only Belgian subjects. For the second prediction, the training dataset for each country consists only of subjects of the country itself. For the final prediction, subjects from all countries are pooled into one common training dataset. Besides the (absolute) difference between the chronological age and the predicted age, specific interest lies in the juvenile-adult distinction. In the age range from 16 to 22 years 6982 subjects (3189 male and 3793 female) were analyzed. Using information on third molar development from Belgium compared to information from the country specific databases hardly increased the mean absolute differences (MAD) and mean squared errors (MSE): the MAD and MSE increased on average with 0.5 and 2.5 months with maximal increases of, respectively 1.6 and 7.3 months. Using information from all countries pooled compared to country specific information provided even on average negligible increases (0.05 and 0.2 months for MAD and MSE, respectively). For the juvenile-adult discrimination, using information from all countries instead of country specific information yielded comparable performances. Using Belgium instead of country specific information increased the percentage of correctly identified juveniles, but decreased the percentage of correctly identified adults. The adult-juvenile discrimination based on information used from Belgium provides judicially the best applied reference.

Forensic oral imaging quality of hand-held dental X-ray devices: comparison of two image receptors and two devices.

Recently, different portable hand-held and battery-powered dental X-ray units have become available. Especially for forensic odontological purposes, they offer diverse advantages such as for use in disaster areas and crime-scene locations as also in autopsy rooms and mortuaries. For any application, the most important feature of these hand-held devices is the delivered image quality. The aim of this study is to evaluate the radiographic image quality acquired by two portable X-ray devices in combination with two types of image receptors and to compare the findings with the image quality of a standard intra-oral X-ray device. Eleven samples consisting of eight teeth, two dry skeletal specimens and one formalin-fixed mandible part were mounted on blocks for standardised (re)positioning. Radiological images were acquired with two hand-held (AnyRay 60 kVp, 0.02-4.00 mAs and NOMAD 60 kVp, 0.023-2.277 mAs) and one wall-mounted (MinRay 60/70 kVp 0.14-22.4 mAs) X-ray device combined with two image receptor systems (VistaScan phosphor storage plate (PSP) and SIGMA M CMOS Active Pixel technology sensor). The effect of X-ray source-to-object distance (SOD) was checked at 20 cm in conjunction with object to image receptor distances (OIDs) of 0.8 and 2.5 cm. For each parameter setup, the exposure times were run from low till high. An expert consent statement was achieved by agreement of four expert observers selecting the optimal images based on a developed four point quality rating system. Next, a selection of the images was assembled in a set of 198 observation screens and scored by seven observers. The observation screens were designed to compare observer scores, relations between devices, receptors and OIDs and images obtained from the different devices at equal exposure levels (mAs). All results were statistically analysed. Radiological image quality was significantly higher for phosphor plate compared with the CMOS digital receptor system (p<0.0001). Furthermore, a significantly superior image quality was obtained for OID=0.8 than for OID=2.5 (p=0.039). A significant difference in image quality between the three devices was also established (p=0.02). The present study demonstrated the feasibility of portable X-ray systems for forensic odontological applications based on rendering optimal image quality, provided an in vitro guideline of optimal parameter settings and offered a radiological image database usable in further research.