Inter- and intra-examiner variability in interpretation of early periodontal disease by radiographs.
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Biomedical subjects
Publications and source records attributed to R W Beideman.
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A follow-up study was conducted to evaluate the performance of the rating system for third-party carriers which was developed and instituted in 1976. Further, the technical quality of radiographs submitted under the system was evaluated. The conditions and parameters of the second study were identical to those of the original work. Statistical comparison of the data from both studies shows a significant decrease in the frequency of error occurrences over the 3-year span between the studies.
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A population of 7 diabetic and 13 nondiabetic rhesus monkeys (Macacca mulatta) were examined radiographically using bitewing imaging techniques. Each subject was scored radiographically for bone levels, periodontal ligament (PDL) widening, radiographic calculus, and carious lesions. Prior to examinations blood samples were obtained for fasting blood glucose levels. Results indicated that all clinical variables were generally greater for the diabetic group, with bone loss being the only statistically significant parameter. Calculus levels, however, were found to be greater radiographically in the nondiabetic group. In viewing the study population as a single group of 20 monkeys, decreased bone levels were found to be positively correlated with PDL widening and blood glucose levels suggesting an association of hyperglycemic states with possible decreased resistance to infection. It was concluded that carbohydrate intolerance with hyperglycemia in diabetes mellitus may be associated with the radiographic variable of increased bone resorption using an objective system of measurement for evaluation and scoring. Without a quantitative system of measurement such as devised in this study, other radiographic variables such as PDL widening, calculus deposits, and carious lesions may not be accurately tested against one another or correlated with other experimental clinical parameters.
The application of image intensification to sialography is presented. The advantages of better visualization of noncalcified or poorly calcified pathologic conditions, more accurate localization of strictures and soft-tissue tumors, and determination of gland function are discussed. These advantages over the conventional static sialographic technqiue would appear to outweigh the disadvantage of some increased exposure of patient and operator to radiation. In the authors' experience image intensification is the technique of choice in the majority of cases.
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An easy, efficient system for rating radiographs was developed and applied to 1,000 preauthorization case submissions. The films were evaluated and the frequency distribution of errors determined. Results showed the majority of the examined full-mouth and partial-mouth radiograph series submitted to Pennsylvania Blue Shield were substandard. Recommendations for screening radiographs to upgrade their technical quality are offered.
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