title: Effect of display type, DICOM calibration and room illuminance in bitewing radiographs.
abstract: OBJECTIVE
  To compare observer performance in the detection of both anatomical structures and caries in bitewing radiographs using consumer grade displays with and without digital imaging and communications in medicine (DICOM) calibration, tablets (third generation iPad; Apple, Cupertino, CA) and 6-megapixel (MP) displays under different lighting.
  
  
  METHODS
  30 bitewing radiographs were blindly evaluated on four displays under bright (510 lx) and dim (16 lx) ambient lighting by two observers. The dentinoenamel junction, enamel and dentinal caries, and the cortical border of the alveolar crests were evaluated. Consensus was considered as reference. Intraobserver agreement was determined. The proportion of equivalent ratings and weighted kappa were used to assess reliability.
  
  
  RESULTS
  The proportion of equivalent ratings with consensus differed significantly between uncalibrated and DICOM-calibrated consumer grade display in enamel caries in upper and lower molars in bright (p = 0.013 and p = 0.003) lighting, and in dentinal caries in lower molars in both bright (p = 0.022) and dim (p = 0.004) lighting. The proportion also differed significantly between DICOM-calibrated consumer grade and 6-MP display in dentinal caries in lower molars in bright lighting (p = 0.039), tablet and consumer grade display in enamel caries in upper molars (p = 0.017) in bright lighting, tablet and 6-MP display in dentinal caries in lower molars (p = 0.003) in bright lighting and in enamel caries in lower molars (p = 0.012) in dim lighting.
  
  
  CONCLUSIONS
  DICOM calibration improves the detection of enamel and dentinal caries in bitewing radiographs, particularly in bright lighting. Therefore, a calibrated consumer grade display can be recommended as a diagnostic tool for viewing bitewing radiographs.
authors.affiliation: 1 Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.|2 Medical Research Center Oulu, Oulu University Hospital, and University of Oulu, Oulu, Finland.
authors.forename: Soili
authors.identifier: http://orcid.org/0000-0002-3911-2814
authors.initials: S
authors.lastname: Kallio-Pulkkinen
authors.affiliation: 3 Department of Oral Pathology and Radiology, Institute of Dentistry, University of Turku, Turku, Finland.|4 Department of Diagnostic Imaging, Turku University Hospital, Turku, Finland.
authors.forename: Sisko
authors.initials: S
authors.lastname: Huumonen
authors.affiliation: 1 Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.|2 Medical Research Center Oulu, Oulu University Hospital, and University of Oulu, Oulu, Finland.
authors.forename: Marianne
authors.initials: M
authors.lastname: Haapea
authors.affiliation: 1 Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.|2 Medical Research Center Oulu, Oulu University Hospital, and University of Oulu, Oulu, Finland.
authors.forename: Esa
authors.initials: E
authors.lastname: Liukkonen
authors.affiliation: 1 Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
authors.forename: Annina
authors.initials: A
authors.lastname: Sipola
authors.affiliation: 1 Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.|2 Medical Research Center Oulu, Oulu University Hospital, and University of Oulu, Oulu, Finland.|5 Unit of Medical Imaging, Physics and Technology Research, University of Oulu, Oulu, Finland.
authors.forename: Osmo
authors.initials: O
authors.lastname: Tervonen
authors.affiliation: 1 Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.|2 Medical Research Center Oulu, Oulu University Hospital, and University of Oulu, Oulu, Finland.|5 Unit of Medical Imaging, Physics and Technology Research, University of Oulu, Oulu, Finland.
authors.forename: Miika T
authors.initials: MT
authors.lastname: Nieminen
mesh_terms: D000539:Alveolar Process / Q000000981:diagnostic imaging; D002138:Calibration; D034201:Computers, Handheld; D003626:Data Display; D003731:Dental Caries / Q000000981:diagnostic imaging; D003743:Dental Enamel / Q000000981:diagnostic imaging; D003804:Dentin / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008029:Lighting; D008963:Molar / Q000000981:diagnostic imaging; D015588:Observer Variation; D016300:Radiography, Bitewing / Q000379:methods*; D019252:Radiography, Dental, Digital / Q000379:methods; D015203:Reproducibility of Results
keywords: ambient light; bitewing radiographs; calibration; digital radiography; display