title: Usefulness of MRI-CBCT image registration in the evaluation of temporomandibular joint internal derangement by novice examiners.
abstract: OBJECTIVE
  To assess whether novice examiners can more reliably determine temporomandibular joint (TMJ) disk derangements with the use of fused images of magnetic resonance imaging and cone beam computed tomography (MRI-CBCT) compared with MRI images alone.
  
  
  METHODS
  Thirty dental students with minimal exposure to TMJ imaging received a 30-minute calibration session in which TMJ diagnostic imaging and the normal anatomy of the TMJ internal derangement were explained. The students evaluated the disk positions of 16 TMJs in two sets of images (MRI images alone and MRI-CBCT images) randomly and independently. The disk positions evaluated by two experienced radiologists were used for comparison.
  
  
  RESULTS
  The internal consistency among all students improved from an unacceptable consistency (α = 0.40) with MRI images alone to a good consistency (α = 0.84) with MRI-CBCT images. The agreement in evaluation between the students and the radiologists improved from a poor agreement with MRI images alone (k mean = 0.07 ± 0.12) to a moderate agreement with MRI-CBCT images (k mean = 0.55 ± 0.25). This improvement in the agreement was significant (P < .001).
  
  
  CONCLUSIONS
  The use of fused MRI and CBCT images to visualize the TMJ in a single display significantly improved the examiners' reliability and accuracy of assessment of disk positions. The improvement of novice readers in assessing the disk positions highlights the potential use of MRI-CBCT image fusion as an educational tool.
authors.affiliation: Orthodontic Graduate Program, School of Dentistry, University of Alberta, Edmonton Clinic Health Academy (ECHA), Edmonton, Alberta, Canada. Electronic address: m.alsaleh@ualberta.ca.
authors.forename: Mohammed A Q
authors.initials: MAQ
authors.lastname: Al-Saleh
authors.affiliation: Assistant Professor, School of Dentistry, University of Alberta, Edmonton Clinic Health Academy (ECHA), Edmonton, Alberta, Canada; Assistant Professor, College of Dentistry, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Noura
authors.initials: N
authors.lastname: Alsufyani
authors.affiliation: Assistant Professor, School of Dentistry, University of Alberta, Edmonton Clinic Health Academy (ECHA), Edmonton, Alberta, Canada.
authors.forename: Hollis
authors.initials: H
authors.lastname: Lai
authors.affiliation: Assistant Professor, School of Dentistry, University of Alberta, Edmonton Clinic Health Academy (ECHA), Edmonton, Alberta, Canada.
authors.forename: Manuel
authors.initials: M
authors.lastname: Lagravere
authors.affiliation: Assistant Professor, Department of Radiology and Diagnostic Imaging, Faculty of Medicine and Dentistry, University of Alberta, W.C. Mackenzie Health Science Center, Edmonton, Alberta, Canada.
authors.forename: Jacob L
authors.initials: JL
authors.lastname: Jaremko
authors.affiliation: Lead, School of Dentistry, Professor and Chair, Faculty of Medicine and Dentistry, University of Alberta, Edmonton Clinic Health Academy (ECHA), Edmonton, Alberta, Canada.
authors.forename: Paul W
authors.initials: PW
authors.lastname: Major
mesh_terms: D002983:Clinical Competence; D054893:Cone-Beam Computed Tomography / Q000379:methods*; D004497:Education, Dental; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D015203:Reproducibility of Results; D013705:Temporomandibular Joint Disorders / Q000000981:diagnostic imaging*