Direct digital radiography for the detection of periapical bone lesions: a clinical study

The aim was to compare the observer performance of direct digital radiography, with and without image processing, with that of conventional radiography, for the detection of periapical bone lesions. For 50 patients, a conventional periapical radiograph using E-speed film was taken. Then, a direct digital image of the same area was made. The images presenting the periapical bone tissue of 59 roots were assessed by seven observers using a 5-point confidence scale. The digital images were first presented as original images, with default contrast and brightness set by the computer system. Following this, the observers were allowed to use the processing facilities for greyscale treatment. The results for original and processed direct digital images and for conventional radiographs were compared by Receiver Operating Characteristic (ROC) analysis. The area under the ROC curve, calculated as P(A) value, was 0.88 for conventional film, 0.82 for original digital images and 0.78 for processed images. Corresponding Az values were slightly higher, 0.89, 0.84 and 0.81. Statistically significant differences between ROC areas calculated as P(A) values for the methods were found. Comparison between Az values showed no significant differences between conventional radiographs and original digital images, whereas the difference between Az values for original and processed digital images was still significant. It was concluded that conventional film radiography performed slightly better for the detection of periapical bone lesions than direct digital radiography and that image processing did not improve the observer performance.