title: The impact of digital image processing artefacts mimicking pathological features associated with restorations.
abstract: BACKGROUND
  Image processing of digital X-ray images is known to have the potential to produce artefacts that may mimic pathology. A study was conducted at a UK dental radiology conference to demonstrate this effect in dentistry.
  
  
  METHODS
  Sixteen digital X-rays of single teeth containing restorations were randomly presented in both unprocessed and processed formats to an auditorium of 42 participants. Participants interactively scored each image on a scale from 1-5 where 1 was definitely no pathology and 5 was definitely pathology. The display conditions were confirmed for each participant using a validated threshold contrast test.
  
  
  RESULTS
  The results show that 52% (81/157) of responses at level 1 for the unprocessed images changed to levels 4 or 5 after image processing.
  
  
  CONCLUSIONS
  This study illustrates the potential for image processing artefacts to mimic pathology particularly at high contrast boundaries and introduces the risk of unnecessary interventions. In order to minimise this risk, it is recommended that for digital radiographs containing pathology relating to high contrast boundaries, non-related high contrast features such as unrelated restorations or tooth/bone margins are also considered to exclude the possibility of artefact. If there is doubt, reference should be made to the unprocessed data.
authors.affiliation: Medical Physics and Engineering, 1st Floor Bexley Wing, St James's University Hospital, Leeds, LS9 7TF. dsb@medphysics.leeds.ac.uk
authors.forename: D
authors.initials: D
authors.lastname: Brettle
authors.forename: F
authors.initials: F
authors.lastname: Carmichael
mesh_terms: D016477:Artifacts; D003442:Crowns / Q000009:adverse effects; D003731:Dental Caries / Q000000981:diagnostic imaging*; D019232:Dental Restoration Failure; D003793:Dental Restoration, Permanent / Q000009:adverse effects*; D003951:Diagnostic Errors; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D011856:Radiographic Image Enhancement / Q000379:methods; D019252:Radiography, Dental, Digital / Q000379:methods*; D011862:Radiography, Panoramic / Q000379:methods; D012008:Recurrence