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Comparison of Image Clarity between Digital

and Conventional Radiography

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Shaifulizan Abdul Rahman Mon Mon Tin Oo

University of Science Malaysia University of Science Malaysia
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Mohammad Khursheed Alam

University of Science Malaysia
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 International Medical Journal Vol. 20, No. 3, pp. 329 - 331 , June 2013 329
ORAL SURGERY

Comparison of Image Clarity between Digital and

Conventional Radiography

Ong Ki Wei, Shaifulizan Ab Rahman, Ramizu Shaari, Mon Mon Tin Oo,
Mohammad Khursheed Alam

ABSTRACT

Introduction: The manipulation of radiographic images is possible in digital radiograph, thus the exposure time can be
reduced nevertheless the processing time is shorter if compared to conventional radiography.
Objective: The aim of the study was to compare the image clarity between conventional and digital intraoral radiograph.
Methods: Digital and conventional radiographs were captured the image of an extracted maxillary incisor with constant set-
ting of the x-ray source at 70 kVp and 5mAs. Then three series of the digital radiographic of the same specimen was captured at
66 kVp, 63 kVp, 60 kVp. Images were presented to 46 fourth year dental students to evaluate the image quality considering the
clarity of tooth pattern. The percentage of observers determined which images were superior or same among digital or conven-
tional were recorded.
Results: Digital setting at 66 kVp images were rated as the most superior among all the 4 settings by 67.4% of observers fol-
lowed by 65.2% for voltage setting 70 kVp, 63.0% for voltage setting 63 kVp and 56.5% for voltage setting 60 kVp. Although
the percentage of choosing the most superior image started to be decreased in digital setting in 70 kVp and after 66 kVp howev-
er, it was still better than conventional method.
Conclusion: Digital radiographic image taking on extracted tooth specimen with the setting of 66 kVp was the most superior
among other setting. Conventional radiography showed inferior to digital image at any setting. This study suggested that the
image of digital radiography was superior to conventional radiographic.

KEY WORDS
image clarity, digital radiography, conventional radiography, intraoral

INTRODUCTION Science of Universiti Science Malaysia (USM) is using CMOS-based

Film has been an inexpensive and reliable image receptor in den-
tal radiograph for a long time. This may be the reason why attempts
to introduce alternatives to (non-screen) dental film never were as
successful. However, the challenge to find alternatives is comprehen-
sive because of some disadvantages of film-based techniques (White
et al., 1984). The conventional intraoral radiograph was found to
have limitations especially deal with image processing such as clini-
cal contamination, processor, x-ray film storage and processing room
which required no light exposure (Versteeg et at., 1997).
In 1987 the first direct digital systems have been developed and
became commercially available as an alternative to conventional
radiography. Consequently, specialized intraoral radiograph systems
that use X-ray sensors instead of intraoral X-ray film are become
necessary (Sanderink et al., 2003). For some years it has been possi-
ble to digitally acquire manipulate, store, retrieve and exchange radi-
ographic information, and many aspects this is a major technical
development (Versteeg et at., 1996). There are two fundamentally
different concepts for direct digital image acquisition, the CCD-based
(charged-coupled device/complementary metal oxide semiconductor)
and phosphor storage (SP) systems but currently in School of Dental
systems. In the CMOS system, a chip is used as a sensor for radiation
image. A cable connects the sensor to the computer, and the image is
displayed almost immediately on a computer monitor after exposure
of the sensor (Sanderink et al., 2003).
It has been found that the patient dose with digital intraoral radi-
ography is low. Moreover, owing to the various advantages of digital
images over film, thus, the image quality still get the better result
compare to conventional radiography. It is believed that radiography
will become increasingly digitalized in the future (Kitafusa et al.,
2006). The purpose of this study is to compare between images quali-
ty of digital radiography and conventional radiography. Besides that,
regard to visual the image quality in the various setting of the dose of
digital radiography by dental students through use of one tooth
(Purmal et al., 2013).
MATERIALS AND METHODS
One specimen of maxillary incisor with sound structure was cho-

Received on June 8, 2012 and accepted on September 5, 2012

School of Dental Sciences, Health Campus, Universiti Sains Malaysia
Correspondence to: Shaifulizan Ab Rahman
(e-mail: shaifulrahman@lycos.com)

C 2013 Japan International Cultural Exchange Foundation

& Japan Health Sciences University
330 Wei O. K. et al.
Figure 1. Percentage of image quality between conventional and
digital intraoral radiograph at standard kVp setting
(70kVp)
Figure 2-b. Percentage of image quality between conventional
intraoral radiographs at 70 kVp setting with digital
intraoral radiograph at 63 kVp setting
Figure 3. Result of comparing the frequency of image quality
within different voltage of digital radiograph
sen. X-ray source was set at the constant setting of 70 kVp and 5 mAs,
specimen was attached with digital receptor & conventional receptor.
Further that, the various kVp values were set to capture radiograph at
66, 63, 60 kVp from digital radiography. Fourth year dental students
which were in clinical year phase in the school of dental science in
University Science Malaysia were invited to observe the image quality
by considering the clarity of tooth pattern. The evaluation was done by
determining that image of digital radiography better, conventional bet-
ter or both are same. SPSS version 18.0 was used for data analysis. For
this study, descriptive statistics were used to determine the image qual-
ity between digital and conventional radiography.
RESULTS
Please see Figure 1, 2-a, 2-b, 2-c, 3.
Figure 2-a. Percentage of image quality between conventional
intraoral radiographs at 70 kVp setting with digital
intraoral radiograph at 66 kVp setting
Figure 2-c. Percentage of image quality between conventional
intraoral radiographs at 70 kVp setting with digital
intraoral radiograph at 60kVp setting
DISCUSSION
The participants consisted of 46 fourth year dental students. In
the Figure 1, consist of two images which are digital radiograph and
conventional radiograph in 70 kVp; 5 mAs. There was 65.2% voted
for digital radiograph have a better image than conventional radi-
ograph. Followed by 28.3% voted for conventional radiograph has
better image than conventional radiograph. There was 6.5% said that
both have the same image quality. In the Figure 2-a, consist of two
different voltage with digital radiograph in 66 kVp; 5 mAs and con-
ventional radiograph remain 70 kVp; 5 mAs. There was 67.4% voted
for digital radiograph which has better image than conventional radi-
ograph. 32.6% thought that conventional radiograph is better. No
vote gained from observant for both have same image quality.
For all the observers, in the Figure 2-b, was found consist of two
images which the digital image with the reduced kVp to 63 kVp; 5 mAs
and standard voltage of conventional image showed the result that digital
image have the better image which was 63%, however there was 34.8%
thought that conventional image better quality than digital image. There
was 2.2% of the observers think that both were same. At last, in the
Figure 2-c with digital setting of 60 kVp; 5 mAs reported that there was
56.5% observers voted for digital radiograph has better image. However
it was reported that there was 43.5% votes for film X-ray.
With regard to comparison of image quality in digital radiograph,
in the Figure 3 showed that digital setting in 66 kVp has the highest
percentage among the 4 settings which was 67.4%, followed by digital
setting in 70 kVp which has the second highest 65.2%. In the voltage
setting of 63 kVp of digital radiograph has 63.0%. The lowest percent-
age in the digital setting was 56.5% which was 60 kVp. Although the
percentage in digital setting after 66 kVp started to decrease but then
the percentage still higher than any conventional method.
The use of digital radiographic resources has demonstrated several
advantages over conventional radiographic film. The sensitivity of the
conventional radiographic method is not the problem, but rather the ability
of clinicians to interpret the images. In this context, the digital method has
several advantages, due to its versatility and possibility of image manipu-
 Image Clarity between Digital and Conventional Radiography
lation. The digitized images may enhance the conditions for diagnosis,
treatment planning and follow-up compared to conventional radiographs,
due to the technological possibilities available through digital software. In
the current study compared the quality of radiographic images and indirect
digitization. The examiners scored 64.5% of images as good in conven-
tional radiographs and 100% in indirectly digitized images. The factor that
most contributed to the improvement in image quality was the adjustment
of brightness and contrast, performed by the examiners according to their
own judgment (Hohl et al., 2005).
In digital systems, there are several advantages such as fast commu-
nication of images, the small storage space needed, and lower contami-
nation of the environment. Digital systems allow for recording of elec-
tronic patient files, saving of time and digital image analysis such as
zooming and optimal window and level settings. Several authors report-
ed a dose reduction of about 40-70% in digital panoramic radiography
compared with the conventional panoramic system. Subjective image
qualities of conventional and digital panoramic radiographs were investi-
gated in previous studies and they found the digital images to be compa-
rable with conventional panoramic images (Peker et al., 2009).
The variable quality seen in conventional radiographs that is
caused by the process of developing the X-ray films is eliminated with
the use of digital radiography. In addition, radiologic reporting of
images on the display screen eliminates the cost of film material and
X-ray film archiving. Digital radiography will play an important role in
this evolution because conventional radiographs are the most frequent-
ly obtained images in medical imaging. Furthermore, chest radiographs
represent about 25% of all diagnostic radiography examinations and
are often obtained repeatedly for the follow up of patients. Recently,
amorphous silicon radiography systems with direct readout capabilities
became commercially available. The diagnostic performance of this
new amorphous silicon flat-panel detector radiography technology still
requires evaluation, but it is expected to be at least as good as that of
conventional radiography. Previous experimental and clinical studies
have shown that excellent image quality is achieved with the silicon
flat-panel detector radiography system compared with the image quali-
ty produced by the conventional film screen radiography and the com-
puted radiography systems (Bacher et al., 2003). The quality of images
obtained on the Digora system was higher because brightness and
contrast could be adjusted. This is an advantage of this software over
conventional radiographs because the adjustment of images of lower
quality avoids repetitions and consequently reduces the patient expo-
sure to radiation (Hohl et al., 2005).
Radiation safety is an important issue in dental radiography. The
desired amount of information must be obtained with the smallest possi-
ble amount of radiation. The dose reduction obtained by digital radiogra-
phy as compared with film-based radiography has been emphasized
since the introduction of digital imaging in dental radiography in the
1980s (Berkhout et al., 2002). A survey on the use of digital radiography
in general dental practice in Norway showed that the mean reduction in
exposure time was 55% (Wenzel et al., 1995). Besides that, an important
characteristic of the amorphous silicon flat-panel detector radiography
system is that its quantum detection efficiency is higher than either com-
puted radiography or film-screen radiography systems. Quantum detec-
tion efficiency combines spatial resolution image noise to provide a mea-
sure of the signal-to-noise ratio of all frequency components of the
image. Hence, higher quantum detection efficiency provides improved
capability to reveal an object in a noisy background, in addition to the
possibility of reducing the patient radiation dose with no loss of diagnos-
tic information. Previous studies have postulated that a dose reduction
might be possible with the amorphous silicon flat panel detector radiog-
raphy system. In our study, the flat-panel detector radiography system
showed a strong and significant dose reduction compared with that pos-
sible with computed radiography or film-screen radiography systems
(Bacher et al., 2003). Another study showed that assertion of that an
amorphous silicon flat-panel detector radiography system only needs
30% of the exposure required by a film-screen radiography system to
achieve the same contrast-detail detectability. The image quality assess-
ment proved that despite the significant dose reduction, image quality
had been not affected. The overall performance of the amorphous silicon
flat-panel detector radiography system was significantly superior to the
performances of the computed radiography (Rahman et al., 2013) and
the film-screen radiography systems (Aufrichtig et al., 1999). Therefore,
amorphous silicon flat-panel detector radiography systems could be a
cost-effective replacement for conventional radiography systems in the
future (Bacher et al., 2003). Another study showed that RVG-S permit-
ted a dose reduction of 50-65% when compared to Ektaspeed film and of
73-76% when compared to Ultraspeed film for individual exposures
331
(Wakoh et al., 1994). In the study of patient in charge-coupled device
based full-mouth intraoral radiography. The patient dose received during
film-based intraoral radiographic examinations has been evaluated thor-
oughly. Currently, however, the rate by which the patient dose decreases
in digital radiography is assumed to be simply a factor of the relative
sensitivity of the CCD compared with that of film (Kitafusa et al., 2006).
Sato et al. reported effective doses of 1.6, 2.2, 4.9, and 6.7 Sv
for fields of 2.4 x 4.0 cm2, 3.0 x 4.0 cm2, 6 cm f, and 7 cm f, respec-
tively, at tube potentials of 60-0 kV with E-speed film using intraoral
radiography. A 55%-75% reduction in patient dose is possible by
using a rectangular beam with CCD-based intraoral radiographic sys-
tems (Ito et al., 2001).
CONCLUSION
Digital intra-oral radiography is a well-accepted diagnostic tool in
dental practice. Comparison between intraoral digital sensors and con-
ventional radiographic film for root canal length determination and
measurement of endodontic files of different sizes has been previously
performed and it is better to recommend the use of the digital system
because of the possibility of reducing the patient's exposure to ionizing
radiation and time reduction in obtaining and processing digital
images. Although the dose reduction per exposure is real when using
digital radiograph system but then it requires additional training before
the quality of imaging procedure in hands among dental students in
clinical year. Since that digital intra-oral radiography seems to have
good potential, some improvement of image quality by image manipu-
lation, and automated analysis of digital images may contribute to bet-
ter radio diagnosis. Direct digital imaging is an efficient technique, in
both economic and diagnostic sense. However, this imaging technique,
like any other, needs to be studied continuously, with the emphasis on
safety of patients and diagnostic quality of the images.
REFERENCES
Aufrichtig R. (1999). Comparison of low-contrast detectability between a digital amor-
phous silicon and a screen-film-based imaging system for thoracic radiography. Med
Phys, 26, 1349-1358.
Bacher K, Smeets P, et al. (2003). Dose reduction in patients undergoing chest imaging:
digital amorphous silicon flat-panel detector radiography versus conventional film-
screen radiography and phosphor-based computer radiography. AJR, 181.
Berkhout E, Sanderink Gand van der Stelt. (2004). Digital intra-oral radiography in den-
tistry: Diagnostic efficacy and dose considerations. Oral Radiol, 19, 1-13.
Hohl C, Mahnken AH, Klotz E, Das M, Stargardt A, Muhlenbruch G, Schmidt T, Gunther
RW, Wildberger JE. (2005). Radiation dose reduction to the male gonads during
MDCT: the effectiveness of a lead shield. Ajr, 184(1), 128-130.
Ito K, Gomi Y, Sato S, et al. (2001). Clinical application of a new compact CT-system to
assess 3-D images for the preoperative treatment planning of implants in the posterior
mandible. A case report. Clin Oral Implants Res, 12, 539-42.
Kitafusa M, Sato K, Yosue T. (2006). Patient dose in charge-coupled device-based full-
mouth intraoral radiography. Oral Radiol, 22, 62-68.
Peker I, Toraman AM, Usalan G, Altunkaynak B. (2009). The comparison of subjective image
quality in conventional and digital panoramic radiography. Indian J Dent Res, 20, 21-5.
Purmal K, Alam MK, Nambiar P. (2013). Patients' Perception on Dental Radiographs.
International Medical Journal, 20, 235-238.
Rahman SA, Yue CP, Alam MK. (2013). The measurement of effective dose absorption by
Thyroid tissue during Cone beam computed tomography (CBCT). International
Medical Journal, 20, 172-175.
Sanderink GC, Huiskens R, van der Stelt PF, et al. (2003). Image quality of direct digital
intra-oral x-ray sensor in assessing root canal length. Oral Surg Oral Med Oral Pathol
Oral Radiol Endod, 96, 223-8.
Versteeg CH, Sanderink GCH, van der Stelt PF. (1997). Efficacy of digital intra-oral radi-
ography in clinical dentistry. J Dentistry, 25, 215-224.
Wakoh M, Farman AG, Scarfe WC, Kelly MS, Kuroyanagi K. (1994). Radiation exposure
with the RVG-S and conventional intraoral X-ray film. Oral Radiol, 1, 33-40.
Wenzel A, GrSndahl H-G. (1995). Direct digital radiography in the dental office. I Dent J,
45, 27-34.
White SC, Hollender L, Gratt BM. (1984). Clinical science comparison of xeroradiographs
and film for detection of periapical lesions. JDR, 63(6), 910-913.