Fundamentals of image acquisition and processing in the digital era

To review the historic context for digital imaging in dentistry and to outline the fundamental issues related to digital imaging modalities.

Digital dental X-ray images can be achieved by scanning analog film radiographs (secondary capture), with photostimulable phosphors, or using solid-state detectors (e.g. charge-coupled device and complementary metal oxide semiconductor). There are four characteristics that are basic to all digital image detectors; namely, size of active area, signal-to-noise ratio, contrast resolution and the spatial resolution. To perceive structure in a radiographic image, there needs to be sufficient difference between contrasting densities. This primarily depends on the differences in the attenuation of the X-ray beam by adjacent tissues. It is also depends on the signal received; therefore, contrast tends to increase with increased exposure. Given adequate signal and sufficient differences in radiodensity, contrast will be sufficient to differentiate between adjacent structures, irrespective of the recording modality and processing used. Where contrast is not sufficient, digital images can sometimes be post-processed to disclose details that would otherwise go undetected. For example, cephalogram isodensity mapping can improve soft tissue detail.

It is concluded that it could be a further decade or two before three-dimensional digital imaging systems entirely replace two-dimensional analog films. Such systems need not only to produce prettier images, but also to provide a demonstrable evidence-based higher standard of care at a cost that is not economically prohibitive for the practitioner or society, and which allows efficient and effective workflow within the business of dental practice.