title: Quantitative light-induced fluorescence images and digital photographs - Reproducibility of manually marked demineralisations.
abstract: OBJECTIVE
  Hard tooth tissue demineralisation is an undesirable side effect of orthodontic treatment with fixed appliances. Whereas both clinically and in digital photographs (DP), demineralisations appear as white spot lesions, WSLs appear as dark areas when quantitative light-induced fluorescence (QLF) imaging is used. This study aims at comparing the reproducibility of the detection of decalcified tooth areas in DP and QLF.
  
  
  METHODS
  DP and QLF pairs were acquired from 139 teeth of 32 patients after braces removal. Three raters manually marked the decalcified area on both DP and QLF images. The markings were repeated after 2 weeks. A ground truth was estimated for each tooth and modality using the simultaneous truth and performance level estimation (STAPLE) algorithm. The Dice coefficients (DC) of each rater marking to the ground truth were calculated for all teeth and modalities to quantify the spatial agreement. A three-way repeated measures analysis of variance (ANOVA) was used to compare the means of the DCs for both modalities ([Formula: see text]). Intra-observer and intercycle variabilities were assessed comparing the means across the raters and the cycles for both modalities.
  
  
  RESULTS
  ANOVA revealed a statistical significant difference between the modalities [[Formula: see text], [Formula: see text]]. The standard deviation of the DC for the photographs are lower than those for the QLF images. Intra-observer and intercycle differences are rather small as compared to the intermodality differences.
  
  
  CONCLUSIONS
  The results indicate a higher spatial reproducibility in identifying a decalcified area on a tooth surface using visual inspection of DP rather than QLF images.
authors.affiliation: Aachen Institute for Advanced Study in Computational Engineering Science (AICES), RWTH Aachen University, Schinkelstr. 2, 52062, Aachen, Germany. tatano@aices.rwth-aachen.de.
authors.forename: Rosalia
authors.initials: R
authors.lastname: Tatano
authors.affiliation: Uniklinik RWTH Aachen, Klinik für Kieferorthopädie, Pauwelsstr. 30, 52074, Aachen, Germany.
authors.forename: Eva E
authors.initials: EE
authors.lastname: Ehrlich
authors.affiliation: Aachen Institute for Advanced Study in Computational Engineering Science (AICES), RWTH Aachen University, Schinkelstr. 2, 52062, Aachen, Germany.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Berkels
authors.affiliation: Uniklinik RWTH Aachen, Institut für Medizinische Informatik, Pauwelsstr. 30, 52074, Aachen, Germany.
authors.forename: Ekaterina
authors.initials: E
authors.lastname: Sirazitdinova
authors.affiliation: Uniklinik RWTH Aachen, Institut für Medizinische Informatik, Pauwelsstr. 30, 52074, Aachen, Germany.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Deserno
authors.affiliation: Uniklinik RWTH Aachen, Klinik für Kieferorthopädie, Pauwelsstr. 30, 52074, Aachen, Germany.
authors.forename: Ulrike B
authors.initials: UB
authors.lastname: Fritz
mesh_terms: D000293:Adolescent; D000328:Adult; D003731:Dental Caries / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology*; D005260:Female; D005453:Fluorescence; D006801:Humans; D008029:Lighting / Q000379:methods; D008297:Male; D008856:Microscopy, Fluorescence / Q000379:methods*; D016910:Orthodontic Brackets / Q000009:adverse effects*; D023861:Photography, Dental / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D055815:Young Adult
keywords: Demineralisation; Digital photograph; QLF; Reproducibility; STAPLE algorithm