A comparative evaluation of the diagnostic efficacy of film and digital sensors for detection of simulated periapical lesions

Objective. The purpose of this study was to evaluate the diagnostic efficacy of Ektaspeed Plus film (EPF), a charge-coupled device (CCD), and photostimulable phosphor (PSP)-based digital images for detection of simulated periapical lesions. Study design. Lesions were simulated in the periapical areas of 24 human mandibular sections invested in acrylic using burs of sizes #1, 2, 4, and 6 and imaged using EPF, CCD, and PSP sensors. Percent correct response scores, sensitivity, and specificity values were computed for all variables. Repeated-measures analysis of variance and post hoc testing were performed to determine the effects of imaging modality, observer, and lesion sizes with respect to lesion detection. Results. EPF displayed the highest sensitivity and specificity, followed by PSP and CCD images (P < .001). Percent correct score was the highest for 3 of 4 observers when EPF was used. Analysis of variance revealed significance (P < .001) with respect to all variables. Observers with experience in digital image-viewing performed better than those without such experience (P < .001). Intraobserver agreement was fair (<kappa> = 0.5). Conclusions. EPF outperformed CCD and PSP images when observers could manipulate image characteristics.