Kenji Tokumori

Assessment of image quality in dental radiography, part 2 Optimum exposure conditions for detection of small mass changes in 6 intraoral radiography systems

OBJECTIVE The purpose of this study was to compare 2 film systems and several digital intraoral systems with regard to visual image quality through use of a test phantom developed for this purpose. STUDY DESIGN The detectors used for digital imaging were as follows: Computed Dental Radiography (CDR), Digora, Dixel, and Sens-A-Ray without scintillator layer. Two types of digital images were prepared for the observer performance test: one with original gray scales and another with contrast enhancement. Images with and without enhancement from the 4 systems were displayed to 7 observers. The change in the average number of perceptible holes was plotted against exposure, and modified perceptibility curves were created and compared with curves for the film systems. The exposure level at which the maximum number of holes was perceived was defined to be optimum. The optimum exposure levels were determined for each digital system and compared with that of the film systems. At the optimum exposure, the average maximum numbers of perceptible holes in each digital system with and without contrast enhancement were compared with the maximum numbers for the film systems. The minimum exposure levels were determined to be those at which the number of perceptible holes exceeded the number for film, and the possibility of exposure reduction was evaluated. RESULTS All digital systems except the Digora system showed lower optimum exposures than E-speed film. In all digital images without enhancement, however, the maximum number of perceptible holes was significantly lower than that for the film systems at that exposure. With contrast enhancement, all digital systems except the Sens-A-Ray system showed visibility superior to that of the film systems. With the CDR, Digora, and Dixel systems, exposures could be further reduced by a considerable amount, with greater retention of information than was associated with film. CONCLUSIONS Our results strongly suggest that digital systems, if properly used, can exceed film systems in the detection of small mass changes.

Volume Changes in Human Masticatory Muscles between Jaw Closing and Opening

Most jaw muscles are complex, multipennate with multiple components. The morphologic heterogeneity of masticatory muscles reflects their functions. We hypothesized that the volume of masticatory muscles changes between jaw closing and opening, and that there is a difference in the volume change among the muscles. Magnetic resonance images of the entire head were obtained in ten normal young adult subjects before and after maximum jaw opening. The volume changes of the masseter, medial, and lateral pterygoid muscles were measured. Only slight changes were seen in the masseter and medial pterygoid muscles. The lateral pterygoid muscle, however, significantly decreased its volume during jaw opening. The results provide normative values of muscle volume in living subjects, and suggest that the volume changes differ among jaw muscles.

Three-dimensional analysis system for orthognathic surgery patients with jaw deformities

INTRODUCTION Traditionally, lateral and frontal cephalograms are used with facial photographs to evaluate a patients maxillofacial skeletal and facial soft-tissue morphology. However, the enlargement and distortion of 2-dimensional radiography made it difficult to accurately conceptualize the patients anatomy. The purpose of this article was to introduce a new method for comparing 3-dimensional (3D) standard values of the maxillofacial skeletal and facial soft-tissue morphology before and after orthognathic surgery. METHODS Normative 3D standard values of the maxillofacial skeletal and facial soft-tissue morphology were calculated from normal women. The pre- and postoperative morphology of one woman who underwent orthognathic surgery was compared with the normative data. RESULTS This 3D analysis has clinical value to evaluate patients before and after surgical treatment. CONCLUSIONS This quantitative assessment of 3D maxillofacial morphology can evaluate the area and degree of displacement and rotation of the facial skeleton and facial soft tissues. This method is sufficiently useful for routine clinical applications.

Assessment of image quality in dental radiography, part 1 ☆ ☆☆ ★ ★★: Phantom validity

OBJECTIVE The purpose of this study was to describe and validate an image-quality phantom to be used in dental radiography for comparison of film and digitally acquired images. STUDY DESIGN An aluminum block of 12 steps, with 7 holes in each step, was covered by acrylic blocks. This phantom was radiographed with Kodak Ultra-speed and Ektaspeed Plus films at 70, 65, and 60 kVp with the whole exposure range available. All together, 50 dental films were randomly sequenced and presented to 7 observers. The average number of perceptible holes from all steps was plotted against exposure for each tube voltage and film type, generating a modified perceptibility curve. The tentative optimum exposure level was determined from perceptibility curves in each experimental condition and compared with that determined by means of the standard aluminum stepwedge and the preset time of the x-ray machine. The density range of this phantom at the optimum exposure was compared with that of clinical dental radiographs. Validity of the phantom was evaluated according to the optimum exposure level from the modified perceptibility curves and the overall density range. Finally, the average maximum numbers of perceptible holes at the tentative optimum exposure level were compared for each tube voltage and film type. The statistical test used was a 2-way factorial analysis of variance. RESULTS The exposure at the perceptibility curve peak approximated that obtained by means of the standard aluminum step-wedge and the time preset by the manufacturer. The overall density range at the perceptibility curve peak covered the clinical density range for each tube voltage and film type. There were no statistically significant differences between film types or among tube voltages. CONCLUSIONS The x-ray attenuation range for this phantom seemed to approximate clinical conditions. In addition, differences in image quality could be quantitatively evaluated by means of the number of the holes seen in the phantom.

In vivo Cross-sectional Area of Human Jaw Muscles Varies with Section Location and Jaw Position

Muscle cross-sectional area (CSA) is used as a measure for maximum muscle force. This CSA is commonly determined at one location within the muscle and for one jaw position. The purpose of this study was to establish a method to standardize the analysis of the CSA of the masticatory muscles in vivo, and to compare the CSAs along their entire length for two different jaw positions (opened and closed). The CSAs in the planes perpendicular to the long axes of the masseter, medial, and lateral pterygoid muscles were measured in ten normal young adult subjects by magnetic resonance imaging. Our results showed large differences among the muscles and a non-uniform change in CSA after jaw-opening. The method enables the CSA measurement to be standardized in vivo, and allows for a correct comparison of CSAs in different skull morphologies.

Size and Orientation of Masticatory Muscles in Patients with Mandibular Laterognathism

Size measurements of jaw muscles reflect their force capabilities and correlate with facial morphology. Using MRI, we examined the size and orientation of jaw muscles in patients with mandibular laterognathism in comparison with a control group. We hypothesized that the muscles of the deviated side would be smaller than those of the non-deviated side, and that the muscles of both sides would be smaller than in controls. In patients, a comparison of deviated and non-deviated sides showed, in orientation, differences for masseter and medial pterygoid muscles, but, in size, differences only for the masseter muscle. Nevertheless, muscle sizes in patients were much smaller than in controls. Lateral displacement of the mandible can explain the orientation differences, but not the smaller muscle size, in patients. It is possible that the laterodeviation initiates an adaptive process in the entire jaw system, resulting in extensive atrophy of the jaw muscles.

Four-dimensional analysis of stomatognathic function

Many researchers have attempted to clarify the complex relationships between stomatognathic function and craniofacial morphology. Most studies investigated the trajectories of incisal or condylar points and measured temporomandibular morphology projected onto 2-dimensional radiographic films. Although these methods provided valuable information, their diagnostic capabilities were limited. We introduce a new 4-dimensional (4D) analysis of stomatognathic function that combines the 3-dimensional (3D) computed tomography of the cranium and mandible, dental surface imaging with a noncontact 3D laser scanner, and mandibular movement data recorded with a 6 degrees of freedom jaw-movement analyzer. This method performs dynamic and precise simulations that can analyze and display condyle to fossa distances and occlusal contacts during mandibular function. These comprehensive relationships can be analyzed and displayed not only at intercuspal position, but also at any mandibular position during functional movements. We believe that our 4D analyzing system will be useful for diagnosing temporomandibular disorders of patients with jaw deformities and other malocclusions.

Attempt at Visualizing Breast Cancer with X-ray Dark Field Imaging

X-ray dark-field imaging (DFI) can clearly visualize breast cancer phantoms and cancer cell nests, stroma, fat tissue, ductus lactiferi, muscle, collagen fibers at stroma and calcification in a 2.8-mm-thick breast cancer pathological specimen. The system comprises a Bragg asymmetric-cut monochro-collimator and a 2.124-mm-thick Si 440 Laue diffraction analyzer at 35 keV. Both optical elements are Floating Zone made silicon crystals. The view size of 33 mm (H) ×19.5 mm (V) and the spatial resolution of 10 µm or better are obtainable at the vertical wiggler beamline BL14B at the Photon Factory.

A 3-dimensional method for analyzing facial soft-tissue morphology of patients with jaw deformities.

INTRODUCTION Traditional cephalometric radiographs can analyze facial soft-tissues 2 dimensionally. Because they cannot provide information about the nose, lips, cheeks, and mouth, another method is needed to analyze these soft tissues. We introduce a new method for analyzing the 3-dimensional (3D) shape and size of facial soft-tissue morphology. METHODS A 3D average face model was constructed based on 3D computed tomography images of Japanese male and female adult volunteers who had well-balanced faces and normal occlusions. To test the feasibility of evaluating the quantitative effects of surgery, preoperative and postoperative 3D computed tomography images of facial soft tissues of 1 man and 1 woman were superimposed on the average faces. RESULTS This quantitative assessment provided a comprehensive evaluation of the characteristics that separate size and shape. It was possible to view the superimposed images from any desired angle on a personal computer. CONCLUSIONS This method provides easy-to-understand information for patients and appears to be useful for clinical diagnosis and pretreatment and posttreatment soft-tissue morphologic evaluations of patients with jaw deformities.

Development of a fluorescent x‐ray source for medical imaging

A fluorescent x‐ray source for medical imaging, such as K‐edge subtraction angiography and monochromatic x‐ray CT, has been developed. Using a 6.5 GeV accumulation ring in Tsukuba, fluorescent x rays, which range from about 30 to 70 keV are generated by irradiating several target materials. Measurements have been made of output intensities and energy spectra for different target angles and extraction angles. The intensities of fluorescent x rays at a 30 mA beam current are on the order of 1–3×106 photons/mm2/s at 30 cm from the local spot where the incident beam is collimated to 1 mm2. A phantom which contains three different contrast media (iodine, barium, gadolinium) was used for the K‐edge energy subtraction, and element selective CT images were obtained.