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Clinical Image Quality Assessment in Panoramic Radiography

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Clinical Image Quality Assessment in Panoramic Radiography MÜSBED 2014;4(3):126-132 DOI: 10.5455/musbed.20140610014118 Araştırma / Original Paper Clinical Image Quality Assessment in Panoramic Radiography Meltem Mayil, Gaye Keser, Filiz Namdar Pekiner Marmara University, Faculty of Dentistry, Department of Oral Diagnosis and Radiology, Istanbul - Turkey Ya zış ma Ad re si / Add ress rep rint re qu ests to: Filiz Namdar Pekiner Marmara University, Faculty of Dentistry, Department of Oral Diagnosis and Radiology, Nisantasi, Istanbul - Turkey Elekt ro nik pos ta ad re si / E-ma il add ress: [email protected] Ka bul ta ri hi / Da te of ac cep tan ce: 10 Haziran 2014 / June 10, 2014 ÖZET ABS TRACT Panoramik radyografide kalite değerlendirmesi Clinical image quality assessment in panoramic radiography Amaç: Bu çalışmada elde edilen panoramik radyografilerin kalitesi- nin değerlendirilmesi ve tanı için yetersiz görüntülere neden olan Aim: This study was performed to assess the quality of panoramic hataların tespiti amaçlanmıştır. radiographs obtained and to identify those errors directly responsible Yöntem: Çalışmada Oral Diagnoz ve Radyoloji AD arşivlerinde yer alan for diagnostically inadequate images. 150 adet panoramik radyografi incelenmiştir (Morita Veraviewwopcs Materials and Methods: This study consisted of 150 panoramic model 550 ,Kyoto-Japan, en yüksek KVP of 80, mA=12, monitör 17 inç radiographs obtained from the Department of Oral Diagnosis and TFT LCD, 100-240 VAC 60/50 Hz, Global Opportunities). Bütün grafi- Radiology. All projections were made with the same radiographic ler aynı radyografik ekipman ile yapılmıştır. Görüntüler JPEG (Joint equipment (Morita Veraviewwopcs model 550 (Kyoto-Japan) with Photographic Experts Group ) dosyası olarak kaydedilmiş ve kontrast, the maximum KVP of 80, mA=12, monitor 17 inch TFT LCD, 100-240 parlaklık ve büyütme ve data kompresyonu açısından herhangi bir VAC 60/50 Hz, Global Opportunities). The images were exported düzeltme yapılmamıştır. Elde edilen görüntüler iki maksillofasiyal and saved in Joint Photographic Experts Group (JPEG) file and no radyoloji uzmanı tarafından Klinik Görüntü Kalitesi Değerlendirme adjustment of contrast, brightness and magnification was performed. Çizelgesi kullanarak değerlendirilmiş, panoramik radyografide genel Two oral and maxillofacial radiology specialist evaluated the images görüntü kalitesi sınıflandırılmış ve görüntüleme hatalarının nedenleri using the Clinical Image Quality Evaluation Chart and classified the incelenmiştir. Veri tablolama ve tanımlayıcı istatistik SPSS 15.0 yazılımı overall image quality of the panoramic radiographs and evaluated (SPSS Inc., Chicago. IL., USA) kullanılarak yapılmıştır. the causes of imaging errors. Bulgular: Klinik Görüntü Kalitesi Değerlendirme Çizelgesi ortalama Results: The mean (SD)score was 79.69±14.87. In the classification değeri 79.69±14.87 olarak ölçülmüştür. Görüntü kalitesinin skorlama- of the overall image quality, 28 images were deemed ‘optimal for sında 28 görüntünün tanısal bilgide en iyi görüntü kalitesine sahip obtaining diagnostic information’, 80 were ‘adequate for diagnosis’, olduğu, 80 görüntünün tanı için yeterli olduğu, 37 görüntünün tanı 37 were ‘poor but diagnosable’, and 5 were ‘unrecognizable and too koyma açısından zayıf ama teşhis edilebilir olduğu ve 5 görüntünün poor for diagnosis’. The results of the analysis of the causes of the tanı için yetersiz olduğu belirlenmiştir. Tüm görüntülerde izlenen errors in all the images were as follows: 103 errors in positioning, 15 hataların nedenlerinin analiz sonuçları şu şekildedir: 103 görüntüde in processing, 4 due to radiographic unit, and none of them was due konumlandırma hatası, 15 görüntüde işlem sırasında oluşan hata, 4 to anatomic abnormality. görüntüde ünite kaynaklı hata görülmüş ancak hiçbir radyografide Conclusion: The positioning errors found on panoramic radiographs anatomik abnormaliteye bağlı hata izlenmemiştir. were relatively common in our study. The quality of panoramic Sonuç: Panoramik radyografinin görüntüleme işlemi sırasında hasta radiographs could be improved by careful attention to patient konumlandırma tarafından kaynaklanan hatalar çalışmamızda en positioning. yaygın izlenen hata tipi olarak bulunmuştur. Ancak daha fazla hasta Key words: Oral radiology, assesment, image quality, panoramic grubu ile farklı radyografik yöntemler kullanılarak görüntü kalitesinin radiography, digital imaging değerlendirildiği çalışmalara ihtiyaç duyulmaktadır. Anahtar sözcükler: Oral radyoloji, değerlendirme, görüntü kalitesi, panoramik radyografi, dijital görüntüleme INTRODUCTION tool (1,2). A high quality panoramic radiography has been used for routine screening of patients at various institutions Since its introduction into the dental practise, panoramic and private clinics because it allows examination of the radiography has become a popular and valuable diagnostic entire dentition, alveolar bone, temporomandibular joints, 126 Marmara Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi Cilt: 4, Sayı: 3, 2014 / Journal of Marmara University Institute of Health Sciences Volume: 4, Number: 3, 2014 - http://musbed.marmara.edu.tr M. Mayil, G. Keser, F. Namdar-Pekiner and adjacent structures easily (3,4). All radiation exposures clinical and diagnostic purposes. All projections were made must be kept as low as reasonably achievable (ALARA) with the same radiographic equipment (Morita while having all kinds of radiographs including panoramic Veraviewopcs model 550 (Kyoto-Japan) with the maximum radiography. This could be achieved in three ways, using KVP of 80, mA=12, monitor 17 inch TFT LCD, 100-240 VAC physical methods of minimizing dose, applying selection 60/50 Hz, Global Opportunities) and all radiography were criteria, and consistently producing high quality radiograph carried out by the same technician. The images were to avoid repeat exposure (5). exported and saved in Joint Photographic Experts Group A non-diagnostic quality image often requires a need (JPEG) file and no adjustment of contrast, brightness and for supplementary images and a repetition of examinations magnification was performed; and all the images were (6,7). A non-diagnostic quality image which leads to reviewed under identical conditions on the computer repetition is a result of errors made by the operator during screen. patient positioning and processing of the image (8-11). Also, there are a number of factors inherent to panoramic Training of clinical image evaluators and clinical radiology, not applicable to intraoral imaging, which reduce image evaluation using a clinical image quality its diagnostic quality and which should be considered evaluation chart when examining its diagnostic value. These include the limitations imposed by the film/screen/cassette To ensure a professional and efficient evaluation, two combination, tomographic blur, superimposed soft tissue oral diagnosis and radiology clinicians working in the and ‘ghost’ shadows, the overlap of adjacent teeth and Department of Oral Diagnosis and Radiology evaluated the variations in magnification (5). clinical images. During meetings for the pilot study, these Among the various types of image quality evaluation, two clinicians were trained to evaluate panoramic images, clinical imaging evaluation is the most important inspection by a specialist who had been working in the Department of that enables actual and comprehensive evaluation since it Oral Diagnosis and Radiology for more than fifteen years. reflects the entire quality assurance process, and it must be An agreement on the objective criteria for the qualitative performed continuously (11,12). Choi et al. (11) investigated evaluation of the images was forged among the evaluators. the image quality of panoramic radiographs taken at dental We investigated the level of clinical image quality for hospitals and clinics across Korea using a Clinical Image panoramic radiographs using a slightly modified version of Quality Evaluation Chart. As no appropriate guideline on the Clinical Image Quality Evaluation Chart (Table 1) used quality control has been prepared in Turkey, we investigated by Choi et al. (11) at a study investigating the image quality the level of clinical image quality for panoramic radiographs of panoramic radiographs taken at dental hospitals and and to provide a basis for clinical image evaluation by using clinics across Korea. very few differences on this Clinical Image Quality The chart was used to evaluate the image quality of a Evaluation Chart. The aim of this study is to determine and panoramic radiograph while viewing the images; and if evaluate the frequency of common errors that could there was any inconsistency between their evaluations, an happen in panoramic imaging and to identify the causes for agreement was made through discussion. It was worked on these errors in order to eliminate them to reach the most during multiple meetings of evaluators. diagnostic perfectibility. After evaluating images using the forementioned chart the two clinician calculated the total score. The perfect MATERIALS AND METHODS score in the clinical image evaluation was 100 points. The image quality grade was classified into the following 4 150 panoramic radiographs that were taken between grades:1. Optimal for obtaining diagnostic information December 2012 and February 2013 were obtained from the (100-80), 2. Adequate for diagnosis (80-60), 3. Poor but archives of the Department of Oral Diagnosis and Radiology, diagnosable/unrecognizable (60-40), and 4. Too poor for Marmara University Faculty
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