Improvements in image quality after optimization in digital intraoral radiographs

J Am Dent Assoc . 2022 Nov 16;S0002-8177(22)00570-0. doi: 10.1016/j.adaj.2022.09.008. Online ahead of print. Abstract Background: Digital intraoral radiographic exposures are optimized largely on the basis of subjective assessment of diagnostic image quality. This study presents an objective approach to optimize radiographic exposure settings for digital intraoral radiographic systems. Methods: Seven size 2 digital intraoral systems were assessed for image quality and determination of optimal exposure following the protocol specified in American National Standard Institute/American Dental Association Standard No. 1094: Quality Assurance for Digital Intra-Oral Radiographic Systems. A ProX radiograph unit (Planmeca) at 63 kVp and 6 mA was used to obtain radiographs of the Dental Digital Quality Assurance phantom. ImageJ software (National Institutes of Health) was used to quantify dynamic range and spatial resolution, and contrast perceptibility was evaluated visually. Optimal exposure is the setting with the maximal contrast perceptibility and spatial resolution while displaying the full dynamic range. After image optimization, a custom phantom consisting of an endodontically prepared tooth was imaged to evaluate the file position relative to the apex for each system. Differences in distances between file position relative to the root apex at the optimal exposure as well as 1 increment above and below were measured. Results: Radiographic images obtained at the optimal exposure yielded better visualization and more accurate measurements of the file tip relative to the apex. Conclusions: Optimizing radiographic exposures improves image quality and accuracy in clinical decisions. Practical implications: Improvement in image quality and better accuracy in actual distance of the endodontic file to the radiographic apex coupled with complete cleaning, shaping, and obturation of the canal should lead to better endodontic treatment outcomes.