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Biomedical subjects

R L Webber

Publications and source records attributed to R L Webber.

At least 37 records · Page 2Linked to original sources

An in vivo comparison of diagnostic information obtained from tuned-aperture computed tomography and conventional dental radiographic imaging modalities.

OBJECTIVE: The purpose of this study was to compare diagnostic information obtained by means of 3-dimensional tuned-aperture computed tomography (TACT) and by means of conventional radiography of patients requiring surgery. STUDY DESIGN: TACT produced digital images that yielded a series of tomographic slices viewed interactively. Controls were conventional periapical and/or panoramic radiographs. Each of 4 independent dentists performed 2 tasks, one requiring an estimation of confidence in their clinical assessments of the patient and the other requiring an estimation of the resulting diagnostic potential for altering associated treatment options. Data were analyzed through use of the nonparametric Mann-Whitney U Wilcoxon rank sum W test. RESULTS: A statistically significant difference for both tasks was observed (2-sided; P<.001). CONCLUSIONS: TACT displays were more diagnostically informative and had more impact on potential treatment options than did conventional radiographs.

Adult↗

Effect of number of projections on accuracy of depth discrimination using tuned-aperture computed tomography for 3-dimensional dentoalveolar imaging of low-contrast details.

OBJECTIVE: The purpose of this study was to test the hypothesis that the number of projections influences the accuracy of a simple depth discrimination task when tuned-aperture computed tomography is used. STUDY DESIGN: In each of 4 partially edentulous mandibles, 2 radiopaque steel spheres were attached to the facial and lingual surfaces and 1 ceramic sphere was place in the apical region of an open tooth socket. Errors in estimates of the depth of the apically positioned ceramic sphere relative to the 2 steel spheres were determined from 3-dimensional tuned-aperture computed tomography reconstructions. These data were compared with actual measurements produced independently by means of an optical micrometer. Multiple projections were produced from radially symmetric exposures bearing an angular disparity of 15 degrees. The number of symmetrically dispersed projections per tuned-aperture computed tomography reconstruction was varied systematically (2, 4, 8, 12, and 16 projections). The consequences of this variable, as well as specimen and observer effects, were evaluated in a balanced factorial experimental design. Depth estimates were performed by 10 trained observers. The depth reported was that corresponding to the tuned-aperture computed tomography slice perceived to yield the image of the ceramic sphere in sharpest focus. Resulting data were normalized by logarithmic transformation and analyzed statistically by analysis of variance. RESULTS: No statistically meaningful effects were found for the number of projections (P = .607) or for different observers (P = .093), but a significant specimen effect was demonstrated (P = .006). CONCLUSIONS: Factors other than high contrast limit the perception of image sharpness under these conditions. Depth may be estimated accurately from relatively small numbers of projections.

Analysis of Variance↗

A method for correcting for errors produced by variable magnification in three-dimensional tuned-aperture computed tomography.

OBJECTIVES: To develop and test a method for correcting tomosynthetic misregistration caused by variation in projective magnification. METHODS: A tooth from a monkey was radiographed from various angles and distances using a solid-state sensor to which a plastic spacer with a wire frame was attached. The position of the tooth was fixed relative to both the frame and the sensor. Information derived from the frame's shadow was used to produce a series of tomosynthetic slices using tuned-aperture computed tomography (TACT(R)). One series was corrected for magnification errors and the other was not. Corresponding slices from each series were compared. RESULTS: The corrected slice exhibited much less artifactual blur than its uncorrected counterpart. Linear traces through corresponding portions of these slice images demonstrated discrepancies in homologous dimensions attributable to systematic variations in projective magnification. CONCLUSIONS: Correcting for differences in projective magnification reduces both misregistration and scaling artifacts in tomosynthetically reconstructed volumes.

Algorithms↗

Effects of projection geometry and number of projections on accuracy of depth discrimination with tuned-aperture computed tomography in dentistry.

OBJECTIVE: The purpose of this study was to determine the degree to which the number and angular disparity of component projections influence depth discrimination with tuned-aperture computed tomography. STUDY DESIGN: Groups of three tiny steel spheres served as fiducial references on and in four partially edentulous mandibles. Two spheres were attached to the facial and lingual surfaces of each mandible, and the third was fixed in the apical region of an open tooth socket. Errors in estimates of the depth of the apically positioned sphere relative to the other two spheres were determined from three-dimensional tuned-aperture computed tomography reconstructions. These data were compared with actual measurements produced independently with an optical micrometer. Multiple projections required by the tuned-aperture computed tomography reconstruction algorithm were produced from radially symmetric exposures bearing angular disparities of 5, 15, 30, and 45 degrees. The number of symmetrically dispersed projections per tuned-aperture computed tomography reconstruction likewise was varied systematically (2, 4, 8, 12, and 16 projections). These variables were manipulated through the use of a balanced factorial design. Depth estimates were performed by trained observers; the estimates were based on the determination of tuned-aperture computed tomography slices perceived as imaging the respective apical spheres in sharpest focus. Specimen and observer effects were also considered as independent variables. Resulting data were normalized by logarithmic transformation and analyzed statistically by analysis of variance. RESULTS: Significant differences (p < 0.005) were demonstrated for angular disparity and specimen effects, but the number of projections and the effect of the observer were not found to be statistically significant. CONCLUSIONS: In dentistry, angular disparities of 15 degrees or greater should be used when tuned-aperture computed tomography is being applied to diagnostic tasks requiring maximal depth discrimination accuracy.

Algorithms↗

TACT imaging of primary caries.

OBJECTIVE: Tuned-aperture computed tomography, a new method for creating 3-D radiographic information based on optical aperture theory, was evaluated for diagnostic efficacy in primary caries detection. STUDY DESIGN: Sixty-four extracted teeth with 89 carious lesions were imaged with D-speed film, direct digital, and TACT modalities. A commercially available, 8-bit, charge-coupled device was used in the later two modalities. Six trained observers were asked to identify the presence or absence and depth of interproximal and occlusal lesions for all three modalities. The teeth were sectioned and examined microscopically to determine ground truth. Logistic regression analysis was performed for all three imaging systems for the detection task. Analysis of variance was used for depth determination. Detection of lesion, depth of lesion accuracy, and time for diagnosis were also examined. RESULTS: For caries detection TACT and film were not different (p = 0.2216) with the Wald statistic. Film and TACT were significantly more accurate than the digital system (p = 0.0001). Scheffe's post hoc test revealed that TACT and film were more accurate than the direct digital system for determining lesion depth (p = 0.05) but not statistically different when compared with each other. The detection data were substantiated further by receiver operating characteristic analysis that demonstrated similar statistical relationships. Time required per diagnosis was not shown to be statistically different among the three imaging modalities. CONCLUSIONS: We conclude for caries detection and depth determination that TACT could not be distinguished from film despite the significant relative loss of information capacity in the charge-coupled device receptor. The relatively poorer performance yielded by the digital control images suggests that increased information capacity associated with more modern charge-coupled device detectors may improve diagnostic performance for both direct digital and TACT displays over that demonstrated in this investigation.

Analysis of Variance↗

Tuned-aperture computed tomography (TACT). Theory and application for three-dimensional dento-alveolar imaging.

OBJECTIVES: To introduce a new method for creating three-dimensional (3-D) radiographic displays based on optical aperture theory known as tuned-aperture computed tomography (TACT). With a number of advantages over conventional plain film and tomographic imaging. METHODS: The TACT algorithm and some of its capabilities are explained and published with results of in vitro simulations produced from a well-tested multi-tube tomosynthetic x-ray system. Examples of TACT reconstructions of a tooth with naturally occurring caries which were produced from multiple projections and generated with a new servo-controlled single-tube prototype are illustrated. Current imaging strategies in dentistry and their shortcomings in the detection of dento-alveolar disease are reviewed. Pertinent theoretical aspects of the TACT reconstruction algorithm are described and dental applications discussed in light of these limitations. RESULTS: Results of several published in vitro investigations derived from a prototype TACT system are referenced. Sample images of a tooth with naturally occurring caries derived from an even newer system are displayed. All data are consistent with the hypothesis that TACT imaging yields diagnostic performance either comparable, or superior, to that obtainable from conventional control modalities depending on the diagnostic task. Moreover, all investigations cited demonstrated conclusively the obvious theoretical benefits associated with the acquisition of multiple projections in three dimensions. CONCLUSIONS: TACT shows promise as a supplement to film-based dental radiography and as a digital alternative to conventional tomographic systems used in dento-alveolar applications.

Algorithms↗

Computerized tomosynthetic radiography in operative dentistry.

A study of 15 extracted teeth with carious lesions and artificially prepared defects adjacent to restorations compared the macroscopic morphology of the lesions and the extent of the defects with their appearance on conventional and computerized tomosynthetic radiography. Tuned Aperture Computerized Tomography offers advantages for the diagnosis of the extent of carious lesions and of defective restorations. The display of computer sections through teeth (slice images) allows a three-dimensional view to permit an assessment of the extent of carious lesions, restorations, and defects often masked in conventional radiography.

Dental Restoration, Permanent↗

Change in trabecular architecture as measured by fractal dimension.

The objective of this work was to expose dried trabecular bone material to a decalcifying environment and to quantify the change in the spatial distribution of the bone with a fractal measure. Digitized radiographic images were produced from four separate slices of human vertebral bone as they dissolved within a solution of nitric acid. Pixel data from a region of interest (ROI) within the trabecular bone were used to estimate the time-dependent change in fractal dimension of the ROI as the bone dissolved. Results demonstrated that a change in the spatial distribution of trabecular material may be expressed in terms of a concurrently changing estimate of the fractal dimension.

Algorithms↗

Comparison of film, direct digital, and tuned-aperture computed tomography images to identify the location of crestal defects around endosseous titanium implants.

This study compared diagnostic performance obtained from two-dimensional and three-dimensional x-ray images. The latter were produced with a new tomosynthetic method based on aperture theory called tuned-aperture computed tomography. Seven human cadaver mandibular segments containing a total of 20 endosseous implants with a small randomly positioned alveolar crestal defect at each implant site were imaged in two dimensions with periapical film and with a charge-coupled digital detector, and digitally with the same detector in three dimensions with tuned-aperture computed tomography and subtracted tuned-aperture computed tomography techniques. Seven trained dentists viewed randomized displays of all modalities. Outcomes of the diagnostic task of identifying the locations of crestal defects were quantified with accuracy, confidence, and time performance measures. Analyses of variance demonstrated that differences between either three-dimensional technique and either two-dimensional modality were significant for all measures (p < 0.001). These findings suggest that clinically applied TACT methods hold promise as an improvement over the status quo.

Alveolar Bone Loss↗

Detection of peri-implant bone changes with axial tomosynthesis.

Tuned aperture computed tomography was used to assess bone defects at implant sites that are normally obscured in conventional periapical projections. Titanium implants were placed in incisor, premolar, and molar areas of an edentulous dry human mandible. The alveolar crest adjacent to each implant was circumferentially grooved with progressively larger round burs (no. 1/4 to no. 6). After each increment of bone removal, axial tuned aperture computed tomography slice images were produced. From these, digital subtraction images were generated with incremental and baseline slices. A panel of eight dentists reviewed randomized pairs of images that showed defects that differed by a single bur size. Images were masked to limit observation to mesial, distal, facial, or lingual regions. Observers accurately identified larger lesions in 76% of the unsubtracted tuned aperture computed tomography images and in 90% of the subtracted images. Logistic regression analysis suggested significant differences as a result of lesion size (p < 0.036) and imaging modality (p < 0.020).

Alveolar Process↗

Future trends in dental radiology.

Direct digital dental radiographic systems offer the potential to radically change the way dentists diagnose and treat dental pathoses. They offer instantaneous availability of radiographs, markedly lower patient radiation exposure, and the elimination of developing chemicals and developing equipment. The storage of dental radiographs as digital data permits their transmittal over phone lines facilitating phone consultations and may someday allow expedited authorization of treatment plans by dental insurance companies. With the use of digital subtraction radiology the dental practitioner will be able to diagnose periodontal disease progression and dental caries progression long before current techniques can detect a change. With tuned aperture computed tomography, the owner of a filmless digital system can make tomographic radiographs that allow the visualization of slices through areas of interest without having to buy additional hardware. Computer-aided diagnosis will facilitate the detection of proximal dental caries and osteoporosis, and may someday allow automated tracing of cephalometric radiographs.

Humans↗

Evaluation of off-axis projection geometry in dental panoramic radiography.

New electronic imaging capabilities afforded by the use of linear charged-couple device arrays allow acquisition of three-dimensional information through simultaneous recordings from multiple sensors situated at different fixed angles. In theory, the resulting data can be processed to yield images tailored to specific diagnostic tasks that can be produced and manipulated on demand after exposure. The first step to determine the practical potential of such a system in panoramic radiography is to demonstrate the degree to which specific changes in projection geometry can be used to improve performance of selected diagnostic tasks of clinical interest in dentistry. Hence, the purpose of this investigation was to explore the potential to reduce proximal overlap that exist in current panoramic radiographs and also to displace the blurred image of the spine from areas of diagnostic interest through the use of off-axis projection geometry of the slit beam of radiation. As the off-axis angulation increased, more embrasures in the different areas of the dental arches of skull specimens were opened; the effects of beam angulation in the number of open embrasures was statistically significant (ANOVA, p < 0.05). A hypothetical multibeam system significantly improved the projection geometry toward the creation of images that contain little, if any, proximal overlap when compared with the conventional bilaterally symmetrical projection geometry system (t test, p < 0.001). At 6 degrees off-axis projection angle, the system was able to clear completely the anterior area from the superimposing shadow of the spinal column. The results show that multibeam alternatives to the single beam projection can significantly improve diagnostic quality in panoramic radiographs.

Analysis of Variance↗

Oral imaging as a diagnostic tool for assessing osseous changes.

Practical use of images for diagnosis of osseous abnormalities presumes cost-effective technology that targets known physiologic processes. The most obvious modalities for such applications are radiographic, and the newest are characterized by quantitative methods expressed both tomographically and by means of digital subtraction registered in two and three dimensions. Quantitative nuclear medicine and possibly electron spin resonance spectroscopy also appear promising. New analytic techniques for interpreting osseous images include characterization of trabecular patterns by fractal descriptors and micromorphometry.

Dental Impression Technique↗

Fractal dimension from radiographs of peridental alveolar bone. A possible diagnostic indicator of osteoporosis.

The purpose of this study was to investigate whether a radiographic estimate of osseous fractal dimension is useful in the characterization of structural changes in alveolar bone. Ten dry mandibular bone segments were radiographed from three controlled projection angles (-5, 0, +5 degrees), before and after acid-induced partial decalcification. Fractal dimension was estimated by regression analysis of power spectra computed by Fourier transform of selected regions of interest in digitized images of the radiographs. Repeated-measures ANOVA showed that fractal dimension so determined varied over anatomic locations (p less than .01), but increased after acid-induced demineralization (p less than .0005), irrespective of the radiographic projection angles (p greater than .99). In vivo fractal dimension was computed from randomly selected intraoral radiographs of six premenopausal (ages, 32.8 +/- 3.9) and six postmenopausal (ages, 62.5 +/- 4.1) women. A significantly (p less than .01) higher fractal dimension was observed in the older group.

Adult↗

Digital subtraction radiography for the assessment of bone changes in rheumatoid arthritis.

A digital subtraction radiography (DSR) method was developed to assess changes of bony erosions in the hands of patients with rheumatoid arthritis (RA). The method initially was validated in vitro using simulated lesions in cadaver hands. The sensitivity, specificity and accuracy in detecting simulated lesions were 84.6, 100, and 92.3%, respectively. This technique was then pilot tested clinically using 17 patients with RA and 5 controls with no arthritis. All subjects received the nonsteroidal antiinflammatory drug, flurbiprofen, during the 6-month study period. No progressive changes in bone were observed in the control group; however, 18% of the target joints studied in the group with RA showed significant erosive changes (positive or negative) which correlated with the clinical assessment. The results indicate that DSR may be useful in detecting small changes in erosions on hand/wrist radiographs of patients with RA.

Adult↗

Magnetic resonance imaging of canine salivary glands after ductal ligation and stimulation by pilocarpine.

We performed magnetic resonance imaging in six dogs after submandibular ductal ligation on one side, followed by secretory stimulation with intraperitoneal injection of pilocarpine (5 mg/kg). On the images obtained after ductal ligation but before stimulation, there was no significant change in signal intensity on either side. After injection of pilocarpine the signal intensity of the ligated gland increased significantly (p less than 0.01) in T2-weighted images and nonsignificantly in inversion recovery images, and remained constant in T1-weighted images. Significant (p less than 0.01) volume increases of the glands after ligation and stimulation were measured for the T1, T2, and inversion recovery protocols. These findings likely reflect the retention of saliva caused by pilocarpine stimulation and the absence of drainage through the obstructed duct. The results indicate that the T2-weighted images obtained after pilocarpine stimulation may be useful for studying patients with disturbance of major salivary gland function and may provide an objective basis for the noninvasive diagnosis of unilateral stenosis.

Animals↗

Studies on focal alveolar bone healing with technetium (Tc)-99m labeled methylene diphosphonate and gold-collimated cadmium telluride probe.

The benefit of using a collimator for a miniaturized cadmium telluride probe was evaluated by monitoring the bone-healing processes for 13 weeks after the induction of small iatrogenic alveolar bone lesions in one side of the mandible in beagles. Technetium (Tc)-99m labeled methylene diphosphonate (200 to 300 MBq, 5.1 to 8.1 mCi, in a solution of 0.5 to 1 ml, intravenously) was used as a bone-seeking radiopharmaceutical. The radioactivity over the bone lesion (L) and the contralateral normal site (C) in the mandible were measured between 1.5 and 2 hours after injection of the tracer, and the activity ratio L/C served as an index of relative bone uptake. A study of six dogs revealed that the healing response to a hemispheric bone defect of 2 mm diameter in the cortical bone could not be detected by an uncollimated probe, and in a repeated study in two dogs the use of a gold collimator (5 mm in diameter, 5 mm in length) did not increase the L/C ratio significantly. A second study in six dogs with 5 mm lesions showed that although systematic trends in the time courses of the L/C ratio obtained both with and without the collimator could be demonstrated, the L/C ratio of collimated versus uncollimated measurements was significantly (p less than 0.005) increased. In three of the latter six dogs, abscesses developed after 9 weeks, leading to a second increase (p less than 0.05) of the L/C ratio with collimation compared with the noninflammation group; without collimation no significant (p greater than 0.15) difference between the two groups could be demonstrated.(ABSTRACT TRUNCATED AT 250 WORDS)

Alveolar Process↗