CASE SCIENTIFIC SESSION

MODUL 9
(RADIOLOGI KEDOKTERAN GIGI)

“RADIOGRAFI YANG DIPINDAI SECARA DIGITAL VERSUS FILM

KONVENSIONAL UNTUK MENENTUKAN KEJELASAN
LESI PERIAPIKAL DAN KUALITAS
PERAWATAN SALURAN AKAR”

Diajukan untuk memenuhi syarat dalam melengkapi

Kepaniteraan Klinik pada Modul 9

Oleh :
GANDA DAMAR GALUH
19100707360804117

Pembimbing :
drg. Suci Auliya

RUMAH SAKIT GIGI DAN MULUT

FAKULTAS KEDOKTERAN GIGI
UNIVERSITAS BAITURRAHMAH
PADANG
2020
 MODUL 9
FAKULTAS KEDOKTERAN GIGI
UNIVERSITAS BAITURRAHMAH
PADANG

HALAMAN PENGESAHAN

Telah didiskusikan Case Scientific Session RADIOGRAFI YANG DIPINDAI

SECARA DIGITAL VERSUS FILM KONVENSIONAL UNTUK
MENENTUKAN KEJELASAN LESI PERIAPIKAL
DAN KUALITAS PERAWATAN SALURAN AKAR

Padang, Desember 2020

Disetujui Oleh
Dosen Pembimbing

(drg. Suci Auliya)

 KATA PENGANTAR

Puji syukur penulis ucapkan kehadirat Allah SWT atas limpahan rahmat dan
karunia-Nya sehingga penulis dapat menyelesaikan Case Scientific Session yang
berjudul “Digitally Scanned Radiographs versus Conventional Films For Determining
Clarity of Periapical Lesions and Quality of Root Canal Treatment” untuk memenuhi
salah satu syarat dalam menyelesaikan kepanitraan klinik.
Dalam penulisan ini penulis menyadari, bahwa semua proses yang telah dilalui
tidak lepas dari bimbingan drg. Suci Auliya Selaku dosen pembimbing, bantuan, dan
dorongan yang telah diberikan berbagai pihak lainnya. Untuk itu penulis mengucapkan
terima kasih kepada semua pihak yang telah membantu.
Penulis juga menyadari bahwa laporan ini belum sempurna sebagaimana mestinya,
baik dari segi ilmiah maupun dari segi tata bahasanya, karena itu kritik dan saran sangat
penulis harapkan dari pembaca.
Akhir kata penulis mengharapkan Allah SWT melimpahkan berkah-Nya
kepada kita semua dan semoga laporan kasus ini dapat bermanfaat serta dapat
memberikan sumbangan pemikiran yang berguna bagi semua pihak yang memerlukan.

Padang, Desember 2020

Ganda Damar Galuh

Artikel Penelitian

Radiografi yang Dipindai Secara Digital versus Film Konvensional untuk

Menentukan Kejelasan Lesi Periapikal dan Kualitas Perawatan Saluran Akar

Kholod Almanei1,Rakan Alsulaimani2, Sarah Alfadda3,

Sarah Albabtain4, dan ReemAlsulaimani1
1. Departemen Ilmu Gigi Restoratif, Sekolah Tinggi Kedokteran Gigi,
UniversitasKing Saud, Riyadh, Arab Saudi
2. Sekolah Tinggi Kedokteran Gigi, Universitas King Saud, Riyadh, Arab Saudi
3. Kota Kedokteran Raja Fahad, Riyadh, Arab Saudi
4. Kementerian Kesehatan, Riyadh, Arab Saudi

Jurnal Ilmiah Dunia (Scientifific World Journal)

Volume 2017, ID Artikel 2427060

Tujuan : Untuk membandingkan gambarradiografi konvensional digital dengan

radiografi asli untuk kejelasan lesi periapikal dan kualitas perawatan saluran akar.
Material dan Metode : Seratus empat radiografi periapikal intraoral pasien dengan
gigi yang dirawat endodontik dipilih secara acak. Radiograf didigitalkan
menggunakanpembaca sinar-X USB MD300. Gambar digital dipindahkan ke sebuah
laptop. Tiga evaluator membandingkan setiap radiograf konvensional dengan gambar
digital yang cocok. Gambar tersebut diberi peringkat untuk kejelasan dan dinilai untuk
kualitas diagnostik, data dianalisis menggunakan Perhitungan Keandalan "ReCal" atau
hitung ulang. Hasil : Baik gambar digital maupun film konvensional memiliki
kejernihan dan kualitas diagnostik yang sebanding. Hasil menunjukkan kesepakatan
yang moderat antara penilai. Kesimpulan : Radiografi konvensional yangdi digitalkan
menggunakan Pembaca X-ray USB MD300 memiliki kejernihan dan kualitas
diagnostik yang serupa dengan perbandingan radiograf asli.

1. PENDAHULUAN
Radiografi memainkan peran penting dalam semua fase terapi endodontik :
diagnosis, pengobatan, dan evaluasi atau tindak lanjut pasca operasi. Radiografi
periapikal adalah radiografi intraoral utama yang digunakan dalam endodontik, dan
film radiograf ini telah digunakan dalam perawatan saluran akar selama lebih dari
satu dekade1. Film harus dipaparkan ke sumber radiasi sinar-X dan kemudian
diproses secara kimiawi untuk menghasilkan gambar, yang merupakan radiograf
berbasis film konvensional. Namun, dengan evolusi dalam kedokteran gigi klinis,
radiografi digital telah diperkenalkan untuk mengatasi beberapa kekurangan dari
radiografi konvensional2.
Radiografi digital menghasilkan gambar digital yang dapat dimanipulasi oleh
komputer dan ditampilkan di layar. Gambar yang didigitalkan dapat diperoleh baik
secara langsung, dengan sensor intraoral atau perangkat yang dipasangkan dengan
muatan, atau secara tidak langsung, dengan memindairadiograf konvensional dan
mentransfernya ke komputer (pencitraan digital tidak langsung). Salah satu
keuntungan utama dari gambar digital yang dipindai dibandingkan film radiografi
konvensional adalah bahwa gambar yang dipindai dapat dimanipulasi untuk nilai
diagnostik yang optimal3. Gambar ini juga mempromosikan peningkatan gambar
lebih lanjut dengan beragam alat, perubahan kepadatan dan kontras, inversi skala
abu-abu, pembesaran, pseudocolor, dan pseudo-3D4. Selain itu, hal ini membantu
dalam instruksi pasien dan penerimaan terhadap pengobatan pasien5. Gambar yang
dipindai secara digital juga dapat dikirim secara elektronik dan disimpan dalam
catatan pasien untuk dokumentasi yang tepat dan pengambilan lebih mudah6.
Ada beberapa metode digitalisasi dan pemindaian radiografi, termasuk
menggunakan perekaman video, kamera digital, pemindai keras, atau pemindai alas
datar6. Baru-baru ini, pemindai khusus yang disebut pembaca film sinar-X gigi telah
digunakan untuk mengubah film sinar-X gigi menjadi gambar digital.

Gambar 1: Pembaca X-ray USB MD300.

Memindai gambar dapat ditransfer dari pembaca film ke komputer pribadi

melalui kabel universal serial bus (USB).Radiografi dengan derajat kejelasan yang
tinggi membantu ahli endodontik dalam menentukan kualitas terapi saluran akar dan
ada atau tidaknya lesi periapikal7. Meskipun radiografi digital memiliki beberapa
keunggulan dibandingkan radiografi konvensional, penelitian telah mengungkapkan
bahwa radiografi digital memiliki kualitas interpretatif yang serupa dengan film
konvensional8,9. Disisi lain, beberapa penelitian telah menunjukkan bahwa gambar
kamera digital dan gambar yang dipindai tidak menghasilkan gambar dengan
kualitas diagnostik3,5. Namun, tidak ada penelitian yang menunjukkan perbedaan
antara film konvensional dan gambar digital radiografi konvensional yang dipindai
dari pembaca film sinar-X gigi. Karena itu, tujuan penelitian ini adalah untuk
membandingkan radiograf periapical yang dipindai secara digital oleh pembaca
sinar-X gigi dengan film konvensional asli untuk perbedaan dalam kejelasan lesi
periapical yang dirasakan dan kualitas perawatan saluran akar.
2. BAHAN DAN METODE
Sebanyak 104 radiografi periapikal pasca operasi dari klinik endodontik sarjana
dari sekolah gigi Universitas King Saud digunakan untuk penelitian ini. Radiografi
ini menggambarkan gambar perawatan endodontik gigi akar tunggal dan akar jamak.
Radiografi diperoleh dengan menggunakan film radiografi tipe E ukuran 1 (untuk
gigi anterior) dan ukuran 2 (untuk gigi posterior) (EktaspeedPlus, Kodak Company,
Rochester, NY, USA) dalam unit sinar-X (Siemens Heliodent“DS” X- ray, Jerman)
pada 7mA dan 60 kVp mengikuti teknik paralel. Radiograf diproses menggunakan
prosesor otomatis (DENT-X 9000/810 Prosesor Dasar, NY, USA).Semua radiografi
periapikal didigitalkan menggunakan MD300 USB X-ray Reader (Risheng, China)
(Gambar 1). Gambar digital segera ditransfer ke komputer (Notebook PC HP
Pavilion g6 dengan monitor LED 15,6 inci, dengan resolusi layar 1366) × 768)
menggunakan kabel USB. Semua gambar disimpan sebagai file JPEG (lebar 480
piksel, tinggi 640 piksel, dan resolusi horizontal dan vertikal 96 dpi) (Gambar 2).
Tiga evaluator yang dikalibrasi (seorang mahasiswa kedokteran gigi sarjana,
seorang dokter gigi umum, dan seorang ahli endodontik)membandingkan gambar
digital yang dibuat dari pembaca sinar-X dengan film konvensional. Radiografi
konvensional diperiksa pada kotak tampilan tanpa pembesaran, sedangkan gambar
digital dilihat pada monitor laptop tanpa pembesaran. Dua variabel yang dievaluasi
adalah kejelasan lesi periapikal dan kualitas perawatan saluran akar. Jika gambar
digital menunjukkan visibilitas yang lebih besar dari lesi periapikal dan bentuk yang
salah dari pada radiografi konvensional, itu dinilai sebagai positif (+). Jika citra
digital menunjukkan visibilitas lesi periapikal dan bentuk yang kurang dari pada
radiografi konvensional, skornya negatif ( -). Terakhir, jika gambar memiliki
visibilitas yang sama dari lesi periapikal dan bentuk yang salah, mereka diberi skor
sama (=). Kecukupan obturasi, panjang, dan kepadatan juga dievaluasi seperti yang
dijelaskan sebelumnya10. Jika citra digital menunjukkan panjang atau kerapatan yang
lebih tidak memadai daripada radiografi konvensional, itu dinilai sebagai positif (+).
Jika gambar digital menunjukkan panjang atau kepadatan yang lebih memadai
daripada radiografi konvensional, itu dinilai sebagai negatif (-). Jika gambar
memiliki kecukupan panjang dan kepadatan yang sama, gambar tersebut diberi skor
sama (=). Hasilnya dibandingkan secara statistik. Uji kappa digunakanuntuk
mengukur tingkat kesesuaian antara ketiga evaluator.

3. HASIL
Tabel 1 menyajikan hasil evaluasi yang membandingkan gambar digital dengan
radiografi konvensional dalam menentukan kejelasan lesi periapikal dan kualitas
perawatan saluran akar. Dalam rangka untuk memeriksa kesepakatan dalam
peringkat antara evaluator pada perbandingan gambar digital dan film konvensional,
statistik kappa dihitung dengan menggunakan Kalkulator Reliabilitas “ReCal”11.
Kappa Cohen dihitung untuk interrater, menghasilkan tingkat kesepakatan antara dua
metode (radiografi digital dan konvensional) darin = 0,635, yang dianggap sebagai
tingkat kesepakatan yang baik12. Persentase kesepakatan antara penilai yang
menggunakan film digital versus film konvensional adalah 82,9%. Kappa Fleiss
biasa memeriksa kesepakatan antara penilai, hasil menunjukkan persetujuan sedang
(n= 0,594) dan rata-rata kesepakatan berpasangan sebesar 81,2% (Tabel 2). Secara
keseluruhan, temuan ini menunjukkan bahwa kedua metode penilaian memberikan
hasil yang sebanding. Oleh karena itu, terdapat kesepakatan umum di antara penilai
yang berbeda yang menggunakan gambar digital dan film konvensional.
4. PEMBAHASAN
Gambar radiografi digital memiliki keunggulan yang berbeda dibandingkan film
konvensional3. Gambar yang didigitalkan memungkinkan pengarsipan gambar dan
sistem komunikasi yang lebih mudah untuk diimplementasikan13. Karena
kemungkinan teknologi yang tersedia melalui perangkat lunak digital, gambar digital
dapat meningkatkan kondisi diagnosis gigi, perencanaan perawatan, dan tindak
lanjut14.
Studi ini menunjukkan perbedaan antara radiografi yang dipindai secara digital
dan film konvensional dalam hal kejelasan lesi periapikal dan kualitas perawatan
saluran akar.

(a) (b) (c)

(d) (e) (f)

Gambar 2: Gambar radiografi periapikal konvensional sebelum operasi (a, b, c) dan pasca
operasi (d, e, f) menggunakan MD300 USB X-ray Reader.

Tabel 1: Skor evaluasi yang membandingkan gambar digital dengan radiograf konvensional
oleh evaluator.
Pemeriksa 1 Pemeriksa 2 Pemeriksa 3
n % n % n %
Kehadiran cacat
- 4 3.8 6 5.8 13 12.5
+ 5 4.8 4 3.8 10 9.6
= 95 91.3 94 90.4 81 77.9
Kepadatan
obturasi
- 5 4.8 8 7.7 6 5.8
+ 9 8.7 20 19.2 11 10.6
= 90 86.5 76 73.1 87 83.7
Panjang obturasi
 - 2 1.9 9 8.7 8 7.7
+ 10 9.6 20 19.2 9 8.7
= 92 88.5 75 72.1 86 82.7
Lesi periapikal
- 9 8.7 13 12.5 12 11.5
+ 4 3.8 10 9.6 7 6.7
= 91 87.5 81 77.9 85 81.7
Catatan. Ketika pengevaluasi menentukan bahwa gambar digital menunjukkan detail
yang lebih besar daripada radiograf, diberi skor "+", jika sama dengan diberi skor "="
, dan jika detailnya kurang dinilai" - ".

Tabel 2. Ringkasan Hasil

Perbandingan Kappa Rata-rata
Interater .634 82.9
Intrarater .594 81.2

Hasil penelitian menunjukkan bahwa citra digital danfilm konvensional

memiliki kejelasan dan kualitas diagnostik yang sebanding.Beberapa studi telah
dilakukan untuk mengeksplorasi kualitas radiografi digital dibandingkan dengan
rekan konvensional mereka. Namun, hasil penelitian ini tidak sesuai3. Fuge dkk.3
membandingkan gambar digital dengan film konvensional untuk kejelasan file
endodontik dalam kaitannya dengan apeks radiografi. Mereka menemukan bahwa
gambar digital lebih rendah daripada radiografi konvensional dalam menentukan
titik akhir k-file berukuran 6 di saluran akar molar.
Goga dkk.5 mengevaluasi kejelasan dan kualitas diagnostik dari radiografi
digital dibandingkan dengan radiografi konvensional. Hasil penelitian mereka
menunjukkan bahwa radiografi periapikal digital tidak meningkatkan kejelasan dan
kualitas diagnostik dibandingkan dengan radiografi konvensional. Namun, temuan
kami menunjukkan kesamaan antara gambar yang dipindai secara digital dan film
konvensional dalam hal kejelasan dan kualitas diagnostik. Kontroversi ini bisa jadi
karena penggunaan alat pemindai yang berbeda dalam digitalisasi radiografi. Dalam
penelitian ini, MD300 USB X-ray Reader (Risheng, Cina) digunakan untuk
mendigitalkan film konvensional periapikal, pembaca ini memperbesar film sinar-X
hingga 50 kali. Dengan peralatan ini, sinar-X dapat diubah menjadi gambar digital
dan segera dikirim ke komputer melalui kabel USB. Pembaca ini dapat membaca
film X-ray gigi standar dan menyesuaikan kontras, kecerahan, dan warna
gambar.Gambar dapat diperlakukan menjadi buram, dipertajam, dibalik, dan
diwarnai secara salah. Pembaca juga dapat mentransfer data korelatif ke perangkat
penyimpanan.
Di sisi lain, Schmitd et al.4 mempelajari pengukuran radiografi yang diperoleh
dengan pencitraan digital konvensional dan tidak langsung selama perawatan
endodontik. Mereka menyimpulkan bahwa kualitas gambar digital yang dipindai
lebih baik dari film konvensional asli. Demikian pula, Malleshi et al. 15 menganalisis
kejelasan dan nilai diagnostik dari gambar digital dibandingkan dengan radiografi
intraoral konvensional. Mereka mendemonstrasikan bahwa gambar digital
menghasilkan kejernihan gambar yang lebih baik dan kualitas diagnostik yang lebih
baik. Namun, temuan mereka tidak didukung oleh penelitian ini. Kontradiksi ini
dapat dikaitkan dengan penggunaan berbagai jenis perangkat lunak di mana gambar
yang dipindai secara digital dapat disesuaikan dengan kecerahan dan kontras
variabel.
 Untuk penelitian ini, kesepakatan intra pemeriksa baik. Kesepakatan
semi-rendah di antara para penguji dapat dijelaskan oleh perbedaan tahun
pengalaman di antara para penguji.Kesimpulannya, digitalisasi radiografi gigi
konvensional menggunakan MD300 USB X-ray Reader menghasilkan gambar
dengan kejernihan dan kualitas diagnostik yang sama dengan radiografi
konvensional. Berdasarkan hasil ini, MD300 USB Xray Reader tampaknya menjadi
alat yang dapat diterima untukmendigitalkan film konvensional. Namun, studi lebih
lanjut tentang alat penyempurnaan pemindaian sistem sinar-X diperlukan untuk
memaksimalkan manfaat digitalisasi sinar-X.

Konflik Kepentingan
Para penulis menyatakan bahwa tidak ada konflik kepentingan mengenai
penerbitan artikel ini.

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Hindawi
e Scientific World Journal
Volume 2017, Article ID 2427060, 5 pages
https://doi.org/10.1155/2017/2427060

Research Article
Digitally Scanned Radiographs versus Conventional
Films for Determining Clarity of Periapical Lesions and
Quality of Root Canal Treatment

Kholod Almanei,1 Rakan Alsulaimani,2 Sarah Alfadda,3

Sarah Albabtain,4 and Reem Alsulaimani1
1
Department of Restorative Dental Science, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
2
College of Dentistry, King Saud University, Riyadh, Saudi Arabia
3
King Fahad Medical City, Riyadh, Saudi Arabia
4
Ministry of Health, Riyadh, Saudi Arabia

Correspondence should be addressed to Kholod Almanei; kalmanei@ksu.edu.sa

Received 9 July 2017; Revised 19 October 2017; Accepted 30 October 2017; Published 15 November 2017

Academic Editor: Stefania Staibano

Copyright © 2017 Kholod Almanei et al. This is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly
cited.

Aim. To compare digital images of conventional radiographs with the original radiographs for perceived clarity of periapical lesions
and the quality of root canal treatment. Materials and Methods. One hundred and four intraoral periapical radiographs of patients
with endodontically treated teeth were randomly selected. The radiographs were digitized using an MD300 USB X-ray Reader. The
digital images were transferred to an HP laptop. Three evaluators compared each conventional radiograph with the matching digital
image. The images were ranked for clarity and assessed for diagnostic quality; data were analyzed using the Reliability Calculation
“ReCal.” Results. Both the digital images and conventional films had comparable clarity and diagnostic quality. Results indicated a
moderate agreement between the evaluators. Conclusions. Conventional radiographs digitized using an MD300 USB X-ray Reader
have similar clarity and diagnostic quality in comparison to the original radiographs.

1. Introduction the conventional radiographs and transferring them to the

Radiographs play an essential role in all phases of endodontic
therapy: diagnosis, treatment, and postoperative evalua-
tion/or follow-up. Periapical radiographs are the main intrao-
ral radiographs used in endodontics, and these radiograph
films have been utilized in root canal treatment for more than
a decade [1]. The films must be exposed to an X-ray radiation
source and then be chemically processed to produce images,
which are conventional film-based radiographs. However,
with the evolution in clinical dentistry, digital radiography
has been introduced to overcome some drawbacks of conven-
tional radiographs [2].
Digital radiography produces a digitized image that can
be manipulated by a computer and displayed on-screen.
Digitized images can be obtained either directly, by intraoral
sensor or charge-coupled device, or indirectly, by scanning
computer (indirect digital imaging). One major advantage of
a scanned digital image over a conventional radiographic film
is that the scanned image can be manipulated for optimum
diagnostic value [3]. This image also promotes further image
enhancement with a wide array of tools, density and contrast
alteration, gray scale inversion, magnification, pseudocolor,
and pseudo-3D [4]. In addition, it aids in patient instruction
and in the patient’s acceptance of the treatment [5]. A digitally
scanned image can also be transmitted electronically and
stored in patient records for proper documentation and easier
retrievability [6].
There are several methods of radiographic digitization
and scanning, including using video capture, a digital camera,
a hard scanner, or a flatbed scanner [6]. Recently, a specialized
scanner called a dental X-ray film reader has been used to
convert dental X-ray films into digital images. These scanned
2 The Scientific World Journal
Figure 1: MD300 USB X-ray Reader.
images can be transferred from the film reader to a personal
computer through a universal serial bus (USB) cable.
Radiographs with a high degree of clarity aid endodon-
tists in determining the quality of root canal therapy and the
presence or absence of periapical lesions [7]. Although dig-
ital radiography holds several advantages over conventional
radiographs, studies have revealed that digital radiographs
are similar in interpretive quality to conventional films [8, 9].
On the other hand, a few studies have demonstrated that
digital camera images and scanned images did not produce
images of diagnostic quality [3, 5]. However, no study showed
the differences between conventional films and the digital
images of scanned conventional radiographs from a dental
X-ray film reader. Therefore, the purpose of this study is to
compare periapical radiographs digitally scanned by a dental
X-ray reader with original conventional films for differences
in perceived clarity of periapical lesions and the quality of
root canal treatment.
2. Materials and Methods
A total of 104 postoperative periapical radiographs from
the undergraduate endodontic clinic of the dental school
of King Saud University were used for the study. These
radiographs depicted images of endodontic treatment of
single- and multirooted teeth. The radiographs were obtained
using size 1 (for anterior teeth) and size 2 (for posterior teeth)
type E radiographic film (EktaspeedPlus, Kodak Company,
Rochester, NY, USA) in an X-ray unit (Siemens Heliodent
“DS” X-ray, Germany) at 7 mA and 60 kVp following a
paralleling technique. The radiographs were processed using
an automatic processor (DENT-X 9000/810 Basic Processors,
NY, USA).
All the periapical radiographs were digitized using the
MD300 USB X-ray Reader (Risheng, China) (Figure 1). The
digital images were immediately transferred to a computer
(HP Pavilion g6 Notebook PC with 15.6-inch LED monitor,
with a screen resolution of 1366 × 768) using a USB cable.
All images were saved as JPEG files (width 480 pixels, height
640 pixels, and horizontal and vertical resolution 96 dpi)
(Figure 2).
Three calibrated evaluators (an undergraduate dental
student, a general dental practitioner, and an endodontist)
compared the digital images created from the X-ray reader
with the conventional films. The conventional radiographs
were examined on a viewing box without magnification,
while the digital images were viewed on a laptop monitor
without magnification or zooming. The two variables evalu-
ated were the clarity of periapical lesions and the quality of
root canal treatment. If the digital image showed a greater
visibility of periapical lesions and misshapes than did the
conventional radiograph, it was scored as positive (+). If
the digital image exhibited less visibility of periapical lesions
and misshapes than did the conventional radiograph, it was
scored as negative (−). Lastly, if the images were equal in
their visibility of periapical lesions and misshapes, they were
scored as equal (=). The adequacy of obturation, length,
and density was also evaluated as previously described [10].
If the digital image showed more inadequacy in length or
density than did the conventional radiograph, it was scored
as positive (+). If the digital image revealed more adequacy
in length or density than did the conventional radiograph, it
was scored as negative (−). If the images were equal in their
adequacy of length and density, they were scored as equal
(=). The results were compared statistically. The kappa test
was used to measure the level of agreement between the three
evaluators.
3. Results
Table 1 presents evaluation results comparing digital images
to conventional radiographs in determining the clarity of
periapical lesions and the quality of root canal treatment.
In order to examine the agreement in ratings between the
evaluators on the comparison of the digital images and
conventional film, kappa statistics were computed using the
Reliability Calculator “ReCal” [11]. Cohen’s kappa was calcu-
lated for the interrater, yielding a level of agreement between
the two methods (digital and conventional radiographs) of
𝜅 = .635, which was considered a good level of agreement
[12]. The percent of agreement between raters using digital
versus conventional film was 82.9%. Fleiss’s kappa was used to
examine the agreement between raters; the results indicated
moderate agreement (𝜅 = .594) and an average pairwise
agreement of 81.2% (Table 2). Overall, these findings suggest
that both methods of assessment yield comparable results.
Hence, there is a general sense of agreement among different
raters using digital images and conventional films.
4. Discussion
The digitized radiograph image has distinct superiority
over the conventional film [3]. Digitized images allow an
easier picture archiving and communication system to be
implemented [13]. Because of the technological possibilities
available through digital software, digital images can enhance
the conditions of dental diagnosis, treatment planning, and
follow-up [14].
This study shows the differences between digitally
scanned radiographs and conventional films in terms of the
clarity of periapical lesions and the quality of root canal
treatment. The results showed that the digital images and
The Scientific World Journal 3

(a) (b) (c)

(d) (e) (f)

Figure 2: Digitized images of preoperative (a, b, c) and postoperative (d, e, f) conventional periapical radiographs using the MD300 USB
X-ray Reader.

Table 1: Evaluation scores comparing digital images to conventional radiographs by evaluator.

Examiner 1 Examiner 2 Examiner 3

𝑛 % 𝑛 % 𝑛 %
Presence of misshapes
− 4 3.8 6 5.8 13 12.5
+ 5 4.8 4 3.8 10 9.6
= 95 91.3 94 90.4 81 77.9
Obturation density
− 5 4.8 8 7.7 6 5.8
+ 9 8.7 20 19.2 11 10.6
= 90 86.5 76 73.1 87 83.7
Obturation length
− 2 1.9 9 8.7 8 7.7
+ 10 9.6 20 19.2 9 8.7
= 92 88.5 75 72.1 86 82.7
Periapical lesion
− 9 8.7 13 12.5 12 11.5
+ 4 3.8 10 9.6 7 6.7
= 91 87.5 81 77.9 85 81.7
Note. When the evaluator determined that the digital image showed greater detail than the radiograph a “+” was scored, if they were equal a “=” was scored,
and if the detail was less a “−” was scored.
4 The Scientific World Journal
Table 2: Summary of results.
Comparison Kappa Average pairwise agreement
Interrater .634 82.9
Intrarater .594 81.2
conventional films had comparable clarity and diagnostic
quality.
Several studies have been conducted to explore the quality
of digitized radiographs in comparison with their conven-
tional counterparts; however, the results of these studies have
been discordant [3]. Fuge et al. [3] compared digital images
with conventional films for the clarity of the endodontic
file in relation to the radiographic apex. They found that
digitized images were inferior to conventional radiographs
in determining the end point of size 6 K-files in molar root
canals.
Goga et al. [5] evaluated the clarity and diagnostic
quality of digitized radiographs compared with conventional
radiographs. The result of their study indicated that digitized
periapical radiographs did not improve the clarity and diag-
nostic quality in comparison to conventional radiographs.
However, our findings showed a similarity between digitally
scanned images and conventional films in terms of clarity and
diagnostic quality. This controversy could be due to the use of
different scanner tools in the digitization of radiographs. In
the present study, the MD300 USB X-ray Reader (Risheng,
China) was used to digitize the periapical conventional films;
this reader enlarges the X-ray film by up to 50 times. With
this piece of equipment, X-rays can be converted to digital
images and transmitted to computers immediately through a
USB cable. This reader can read any standard dental X-ray
film and adjust the image’s contrast, brightness, and color.
Images can be treated to be blurred, sharpened, reversed, and
falsely colored. The reader can also transfer correlative data
onto a storage device.
On the other hand, Schmitd et al. [4] studied the
radiographic measurements obtained with conventional and
indirect digital imaging during endodontic treatment. They
concluded that the quality of scanned digital images was
superior to that of original conventional films. Similarly,
Malleshi et al. [15] analyzed the clarity and diagnostic value
of digital images in comparison with conventional intrao-
ral radiographs. They demonstrated that digitized images
resulted in enhanced image clarity and improved diagnostic
quality; however, their findings were not substantiated by the
present study. This contradiction could be attributed to the
use of multiple types of software in which digitally scanned
images can be adjusted to variable brightness and contrast.
For the present study, intraexaminer agreement was good;
however, the interexaminer agreement was fair to good. This
semi-low agreement among the examiners can be explained
by the difference in years of experience among the examiners.
In conclusion, digitizing conventional dental radiographs
using the MD300 USB X-ray Reader produced images with
the same clarity and diagnostic quality of conventional
radiographs. Based on these results, the MD300 USB X-
ray Reader seems to be an acceptable tool with which to
digitize conventional films. However, further studies on the
enhancement tools of scanning X-ray systems are required to
maximize the benefit of X-ray digitization.
Conflicts of Interest
The authors declare that there are no conflicts of interest
regarding the publication of this paper.
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