William D. McDavid

Radiobiologic risk estimation from dental radiology: Part I. Absorbed doses to critical organs

The aim of the present study was to generate one consistent set of data for evaluating and comparing radiobiologic risks from different dental radiographic techniques. To accomplish this goal, absorbed doses were measured in fourteen anatomic sites from (1) five different panoramic machines with the use of rare-earth screens, (2) a twenty-film complete-mouth survey with E-speed film, long round cone, (3) a twenty-film complete-mouth survey with E-speed film, long rectangular cone, (4) a four-film interproximal survey with E-speed film, long round cone, and (5) a four-film interproximal survey with E-speed film, long rectangular cone. The dose to the thyroid gland, the active bone marrow, the brain, and the salivary glands was evaluated by means of exposure of a tissue-equivalent phantom, fitted with lithium fluoride thermoluminescent dosimeters (TLDs) at the relevant locations.

Correction for spectral artifacts in cross-sectional reconstruction from x rays.

A monoenergetic response correction is described which, along with adequate filtration, may be used to remove the spectral shift artifact encountered in three-dimensional reconstruction from x rays. Reconstructions were carried out by means of a convolution algorithm for simulated data using this method. These are compared with reconstructions obtained using fixed-length water-bath scans as a remedy for the special artifact. These studies suggest that the spectral artifact can be successfully eliminated from computerized cross-sectional scans without resorting to the use of the water bath while, at the same time, improving quantum statistics and/or permitting operation at a lower tube current.

X-ray spectra estimation using attenuation measurements from 25 kVp to 18 MV

Attenuation measurements for primary x-ray spectra from 25 kVp to 18 MV were made using aluminum filters for all energies except for orthovoltage where copper filters were used. An iterative perturbation method, which utilized these measurements, was employed to derive the apparent x-ray spectrum. An initial spectrum or pre-spectrum was used to start the process. Each energy value of the pre-spectrum was perturbed positively and negatively, and an attenuation curve was calculated using the perturbed values. The value of x-rays in the given energy bin was chosen to minimize the difference between the measured and calculated transmission curves. The goal was to derive the minimum difference between the measured transmission curve and the calculated transmission curve using the derived x-ray spectrum. The method was found to yield useful information concerning the lower photon energy and the actual operating potential versus the nominal potential. Mammographic, diagnostic, orthovoltage, and megavoltage x-ray spectra up to 18 MV nominal were derived using this method. The method was validated using attenuation curves from published literature. The method was also validated using attenuation curves calculated from published spectra. The attenuation curves were then used to derive the x-ray spectra.

Deriving Hounsfield units using grey levels in cone beam CT: a clinical application

OBJECTIVE To present a clinical study demonstrating a method to derive Hounsfield units from grey levels in cone beam CT (CBCT). METHODS An acrylic intraoral reference object with aluminium, outer bone equivalent material (cortical bone), inner bone equivalent material (trabecular bone), polymethlymethacrylate and water equivalent material was used. Patients were asked if they would be willing to have an acrylic bite plate with the reference object placed in their mouth during a routine CBCT scan. There were 31 scans taken on the Asahi Alphard 3030 (Belmont Takara, Kyoto, Japan) and 30 scans taken on the Planmeca ProMax 3D (Planmeca, Helsinki, Finland) CBCT. Linear regression between the grey levels of the reference materials and their linear attenuation coefficients was performed for various photon energies. The energy with the highest regression coefficient was chosen as the effective energy. The attenuation coefficients for the five materials at the effective energy were scaled as Hounsfield units using the standard Hounsfield units equation and compared to those derived from the measured grey levels of the materials using the regression equation. RESULTS In general, there was a satisfactory linear relation between the grey levels and the attenuation coefficients. This made it possible to calculate Hounsfield units from the measured grey levels. Uncertainty in determining effective energies resulted in unrealistic effective energies and significant variability of calculated CT numbers. Linear regression from grey levels directly to Hounsfield units at specified energies resulted in greater consistency. CONCLUSIONS The clinical application of a method for deriving Hounsfield units from grey levels in CBCT was demonstrated.

Radiographic determination of canal length: Direct digital radiography versus conventional radiography

This research compared the length determination images produced by Trophy and Regam direct digital radiographic systems with conventional E-speed radiographs. Size #15 K files were placed in the canals of 19 teeth of cadaver specimens and radiographed in a geometrically standardized bench device. Three evaluators estimated the length adjustment necessary to position the file at the apex. The mean estimated adjustment lengths were compared with the true, anatomically determined adjustment lengths. Statistical analysis with analysis of variance and the Student-Newman-Keuls test indicated no significant difference between direct digital thermal print images and conventional radiographs (p > 0.10). Length adjustment estimates with conventional radiographs were significantly more accurate than Regam high-resolution computer monitor images (p < 0.01). Additionally, it was determined that length adjustment estimates were significantly more accurate when the file was placed short of the apex (p < 0.001). The clinical relevance of these differences is discussed.

Absorbed dose determination for tomographic implant site assessment techniques

A set of data to compare the absorbed dose delivered by tomographic implant site assessment techniques was generated. Absorbed doses were measured in fourteen anatomic sites from (1) computed tomography scans and (2) a series of tomographic cuts performed on a linear tomography unit. The doses to the thyroid gland, the active bone marrow, the brain, the salivary glands, and the eyes were determined with the use of a tissue-equivalent phantom with lithium fluoride thermoluminescent dosimeters at the appropriate locations.

Radiobiologic risk estimation from dental radiology. Part II. Cancer incidence and fatality.

With the use of the measured absorbed doses from part I of this article, the specific radiobiologic risk to the patient from (1) five different panoramic machines with rare-earth screens, (2) a 20-film complete-mouth survey with E-speed film, long round cone, (3) a 20-film complete-mouth survey with E-speed film, long rectangular cone, (4) a 4-film interproximal survey with E-speed film, long round cone, and (5) a 4-film interproximal survey with E-speed film, long rectangular cone, was calculated. The estimated risks are expressed in two ways: the probability of radiation-induced cancer in specific organs per million examinations and the probability of expression of a fatal cancer per million examinations. The highest risks calculated were from the complete-mouth survey with the use of round collimation. The lowest risks calculated were from panoramic radiography and four interproximal radiographs with rectangular collimation.

The effect of viewing conditions on the perceptibility of radiographic details

The effect of viewing conditions on the visual detection of radiographic detail has been studied by the method of perceptibility curves. Extraneous light and improper masking of radiographs reduce the amount of information available to the viewer.

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.

6-Bit and 8-bit digital radiography for detecting simulated periodontal lesions

The purpose of this study was to compare the diagnostic performance of a digital radiography system that uses 6- and 8-bit displays with conventional D-speed film for the detection of simulated periodontal bone lesions. Eleven human hemimandibles were used as specimens. Simulated lesions were created at the buccal cortical plate in the marginal bone area with the use of a round bur 1.4 mm in diameter. Lesions were created in a defined sequence to preclude visual cues as to the depth of the lesions. Lesion size progressed in 0.5 mm increments. At each stage the mandibles were imaged with a Sens-A-Ray system (REGAM Medical Systems AB, Sundsvall, Sweden) and D-speed film. Exposure parameters for each specimen/receptor combination were standardized by either the mean optical density or mean gray value at the approximal crestal bone area. Film images and digital images displayed with 64 and 256 gray levels were presented to six observers for evaluation. Observers were ask to rate their confidence as to the presence or absence of a lesion using a 5-point confidence scale. A total of 96 lesion sites and 96 control sites were presented to the observers. Receiver operating characteristic curves were generated for each system. The area under the curve was used as the index of diagnostic accuracy. The mean receiver operating characteristic areas for 6-bit and 8-bit displays and D-speed film were 0.746 +/- 0.043, 0.717 +/- 0.056 and 0.742 +/- 0.059, respectively. Analysis of variance was used to compare the means. No statistical difference was found between any of the three image displays (p > 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)