Oral and maxillofacial radiology
Effect of monitors on approximal caries detection in digital radiographs—standard versus precalibrated DICOM part 14 displays: An in vitro study

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Objectives

The aim of this study was to evaluate if different ways of adjusting brightness and contrast of monitors with different technical standards influence the diagnosis of carious lesions in digital radiographs.

Study design

One hundred extracted teeth (premolars and molars) were radiographed. Seven observers evaluated images for approximal carious lesions on 3 monitors: a standard color monitor with brightness and contrast manually adjusted for viewing radiographs, a Digital Imaging and Communication in Medicine (DICOM) part 14 precalibrated color monitor, and a DICOM part 14 precalibrated monochromatic monitor. All evaluations were made in ambient light <50 lux. Receiver operating characteristic curves were plotted to evaluate results. The standard criterion was a histologic examination of sliced teeth. Kappa statistic evaluated intraobserver agreement.

Results

No significant difference in accuracy of approximal carious lesion diagnosis was found between the monitors. Intraobserver agreement varied between fair and good.

Conclusion

No differences that could affect clinicians' abilities to detect carious lesions in digital radiographs existed between the standard monitor and the color and monochrome DICOM part 14 precalibrated monitors.

Section snippets

Materials and Methods

From a group of extracted teeth, 100 human teeth (40 premolars and 60 molars), whose approximal surfaces on visual inspection were intact or had small carious lesions of varying sizes, were selected. One-half of the selected teeth were visually healthy, and one-half had carious lesions of different extensions on the approximal surfaces. The teeth were mounted in 30 blocks made of President putty (Coltène Whaledent, Cuyahoga Falls, OH), 3 or 4 teeth in each block. Radiographs were acquired in a

Results

The histologic evaluations showed that 100 surfaces were sound and that 100 surfaces had a carious lesion. The 2 observers disagreed in 31% of the cases. Disagreement was confined to grades 0 and 1. Table II presents differences in carious lesion depth.

Data from the 7 observers were pooled in the ROC curve for each radiograph. Table III presents mean areas under the ROC curves for each monitor according to lesion grade. Differences in diagnostic accuracy between the monitors regarding

Discussion

This study found no difference in diagnostic accuracy between the evaluated monitors regarding approximal carious lesions. All displays were calibrated or adjusted for the special task of viewing digital radiographs. Ambient light level in the evaluation room was <50 lux, as recommended by AAPM.3

The results indicate that a standard monitor, whether color or monochromatic, is suitable for diagnosing faint objects such as small carious lesions if display brightness and contrast are optimized.

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