title: Cone-beam Computed Tomography Uses in Clinical Endodontics: Observer Variability in Detecting Periapical Lesions.
abstract: BACKGROUND
  The accurate interpretation of a cone-beam computed tomographic (CBCT) volume is critical in identifying the presence of disease correctly and consistently. The aim of this clinical study was to determine the effect of experience level on the detection of periapical lesions in CBCT volumes.
  
  
  METHODS
  CBCT volumes of 22 maxillary molars were interpreted by 3 endodontic faculty, 3 endodontic residents, and 3 dental students. These groups were compared with the consensus opinion of 2 experienced oral and maxillofacial radiologists. The observers determined the presence or absence of apical radiolucencies for each root using a 5-point Likert scale.
  
  
  RESULTS
  Compared with the radiologists, the average weighted kappa value for endodontic faculty was 0.49, for endodontic residents it was 0.35 and for dental students it was 0.32. Intrarater reliability for each group showed endodontic faculty having the highest average weighted kappa value of 0.68 followed by endodontic residents (0.48) and dental students (0.28).
  
  
  CONCLUSIONS
  Clinicians' experience level appears to be correlated with their ability to correctly diagnose periapical disease in CBCT volumes. In addition, experience leads to better inter-rater reliability. In neither of these 2 categories was agreement found to be excellent, suggesting that more can be done to improve the CBCT interpretation skills of clinicians at various levels of experience.
authors.affiliation: Department of Endodontics, UNC School of Dentistry, Chapel Hill, North Carolina. Electronic address: Jparkerdmd@gmail.com.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Parker
authors.affiliation: Department of Diagnostic Sciences, UNC School of Dentistry, Chapel Hill, North Carolina.
authors.forename: André
authors.initials: A
authors.lastname: Mol
authors.affiliation: Department of Endodontics, UNC School of Dentistry, Chapel Hill, North Carolina.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Rivera
authors.affiliation: Department of Endodontics, UNC School of Dentistry, Chapel Hill, North Carolina.
authors.forename: Peter Z
authors.initials: PZ
authors.lastname: Tawil
mesh_terms: D000328:Adult; D002983:Clinical Competence; D054893:Cone-Beam Computed Tomography / Q000379:methods; D006801:Humans; D008963:Molar / Q000000981:diagnostic imaging; D015588:Observer Variation; D010483:Periapical Diseases / Q000000981:diagnostic imaging*
keywords: Cone-beam computed tomographic imaging; maxillary molar; periapical lesions