Performance evaluation of different observers in the interpretation of panoramic radiographs by the mandibular cortical index

Luciana Munhoz, Jun Ho Kim, Moses Park, Eduardo Massaharu Aoki, Reinaldo Abdala Júnior, Emiko Saito Arita

Abstract


OBJECTIVE: Mandibular Cortical Index (MCI) is useful in osteoporosis screening. This study aim was to verify the impact of different expertise levels in the observers’ performances of MCI evaluation in panoramic radiographs (PR).
METHODS: Six participants were recruited: one Oral Radiology professor with previous experience (#1), one master’s degree student and radiologist with previous experience (#2), one PhD student and non-radiologist with previous experience (#3), one PhD student and radiologist with no prior experience (#4) and two master’s degree students with no prior experience (#5 and #6). Observers were trained to use the MCI before analyzing 150 PRs of patients with dual energy X-ray absorptiometry (DXA) examination.
RESULTS: The Spearman’s Correlation test showed inverse and weak to moderate correlation between MCI and T-scores, and it varied was according to the observe that performed the evaluation. Observers #2 and #3 (with previous MCI experience) showed the highest agreement with the professor, followed by students #4, #5 and #6.
CONCLUSION: Students’ expertise using the MCI increased the agreement with the professor regardless of whether the student was an oral radiology specialist; the MCI was correlated with the DXA in all the observer’s evaluations, which indicates that previous training for the MCI can enable any dentist to apply it in osteoporosis screening.


Keywords


osteoporosis; bone mineral density; panoramic radiograph; professional performance.

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References


Kim OS, Shin MH, Song IH, Lim IG, Yoon SJ, Kim OJ, et al. Digital panoramic radiographs are useful for diagnosis of osteoporosis in Korean postmenopausal women. Gerodontology 2016;33(2):185-92.

https://doi.org/10.1111/ger.12134

Zhao R. Immune regulation of bone loss by Th17 cells in oestrogendeficient osteoporosis. Eur J Clin Invest 2013;43(11):1195-202.

https://doi.org/10.1111/eci.12158

Bliuc D, Nguyen ND, Milch VE, Nguyen TV, Eisman JA, Center JR. Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA 2009;301(5):513-21.

https://doi.org/10.1001/jama.2009.50

Palermo A, D’Onofrio L, Buzzetti R, Manfrini S, Napoli N. Pathophysiology of Bone Fragility in Patients with Diabetes. Calcif Tissue Int 2017;100(2):122-32.

https://doi.org/10.1007/s00223-016-0226-3

Nakamoto T, Taguchi A, Ohtsuka M, Suei Y, Fujita M, Tanimoto K, et al. Dental panoramic radiograph as a tool to detect postmenopausal women with low bone mineral density: untrained general dental practitioners’ diagnostic performance. Osteoporos Int 2003;14(8):659-64.

https://doi.org/10.1007/s00198-003-1419-y

Halling A, Persson GR, Berglund J, Johansson O, Renvert S. Comparison between the Klemetti index and heel DXA BMD measurements in the diagnosis of reduced skeletal bone mineral density in the elderly. Osteoporos Int 2005;16(8):999-1003.

https://doi.org/10.1007/s00198-004-1796-x

Dutra V, Yang J, Devlin H, Susin C. Radiomorphometric indices and their relation to gender, age, and dental status. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2005;99(4):479-84.

https://doi.org/10.1016/j.tripleo.2004.09.013

Pisani P, Renna MD, Conversano F, Casciaro E, Muratore M, Quarta E, et al. Screening and early diagnosis of osteoporosis through X-ray and ultrasound based techniques. World J Radiol 2013;5(11):398-410.

https://doi.org/10.4329/wjr.v5.i11.398

Mithal A, Bansal B, Kyer CS, Ebeling P. The Asia-Pacific Regional Audit-Epidemiology, Costs, and Burden of Osteoporosis in India 2013: A report of International Osteoporosis Foundation. Indian J Endocrinol Metab 2014;18(4):449-54.

https://doi.org/10.4103/2230-8210.137485

Kanis JA, Johnell O. Requirements for DXA for the management of osteoporosis in Europe. Osteoporos Int 2005;16(3):229-38.

https://doi.org/10.1007/s00198-004-1811-2

Nguyen TV, Center JR, Eisman JA. Osteoporosis: underrated, underdiagnosed and undertreated. Med J Aust 2004;180(5 Suppl):S18-22.

Schwartz EN, Steinberg DM. Prescreening tools to determine who needs DXA. Curr Osteoporos Rep 2006;4(4):148-52.

https://doi.org/10.1007/s11914-996-0023-4

Taguchi A. Triage screening for osteoporosis in dental clinics using panoramic radiographs. Oral Dis 2010;16(4):316-27.

https://doi.org/10.1111/j.1601-0825.2009.01615.x

Gulsahi A, Yüzügüllü B, Imirzalioglu P, Genç Y. Assessment of panoramic radiomorphometric indices in Turkish patients of different age groups, gender and dental status. Dentomaxillofac Radiol 2008;37(5):288-92.

https://doi.org/10.1259/dmfr/19491030

Devlin H, Whelton C. Can mandibular bone resorption predict hip fracture in elderly women? A systematic review of diagnostic test accuracy. Gerodontology 2015;32(3):163-8.

https://doi.org/10.1111/ger.12077

Gomes CC, de Rezende Barbosa GL, Bello RP, Bóscolo FN, de Almeida SM. A comparison of the mandibular index on panoramic and crosssectional images from CBCT exams from osteoporosis risk group. Osteoporos Int 2014;25(7):1885-90.

https://doi.org/10.1007/s00198-014-2696-3

Taguchi A, Suei Y, Sanada M, Ohtsuka M, Nakamoto T, Sumida H, et al. Validation of dental panoramic radiography measures for identifying postmenopausal women with spinal osteoporosis. AJR Am J Roentgenol 2004;183(6):1755-60.

https://doi.org/10.2214/ajr.183.6.01831755

Klemetti E, Kolmakov S, Kröger H. Pantomography in assessment of the osteoporosis risk group. Scand J Dent Res 1994;102(1):68-72.

https://doi.org/10.1111/j.1600-0722.1994.tb01156.x

Valerio CS, Trindade AM, Mazzieiro ET, Amaral TP, Manzi FR. Use of digital panoramic radiography as an auxiliary means of low bone mineral density detection in post-menopausal women. Dentomaxillofac Radiol 2013;42(10):20120059.

https://doi.org/10.1259/dmfr.20120059

Munhoz L, Cortes AR, Arita ES. Assessment of osteoporotic alterations in type 2 diabetes: a retrospective study. Dentomaxillofac Radiol 2017: doi: 10.1259/dmfr.20160414.

https://doi.org/10.1259/dmfr.20160414

Bhatnagar S, Krishnamurthy V, Pagare SS. Diagnostic efficacy of panoramic radiography in detection of osteoporosis in post-menopausal women with low bone mineral density. J Clin Imaging Sci 2013;3:23.

https://doi.org/10.4103/2156-7514.113140

Erdogan O, Incki KK, Benlidayi ME, Seydaoglu G, Kelekci S. Dental and radiographic findings as predictors of osteoporosis in postmenopausal women. Geriatr Gerontol Int 2009;9(2):155-64.

https://doi.org/10.1111/j.1447-0594.2009.00518.x

Marandi S, Bagherpour A, Imanimoghaddam M, Hatef M, Haghighi A. Panoramic-based mandibular indices and bone mineral density of femoral neck and lumbar vertebrae in women. J Dent (Tehran) 2010;7(2):98-106.

Taguchi A, Asano A, Ohtsuka M, Nakamoto T, Suei Y, Tsuda M, et al. Observer performance in diagnosing osteoporosis by dental panoramic radiographs: results from the osteoporosis screening project in dentistry (OSPD). Bone 2008;43(1):209-13.

https://doi.org/10.1016/j.bone.2008.03.014

Jowitt N, MacFarlane T, Devlin H, Klemetti E, Horner K. The reproducibility of the mandibular cortical index. Dentomaxillofac Radiol 1999;28(3):141-4.

https://doi.org/10.1038/sj.dmfr.4600427

Shintaku WH, Enciso R, Covington JS, Migliorati CA. Can dental students be taught to use dental radiographs for osteoporosis screening? J Dent Educ 2013;77(5):598-603.

Devlin CV, Horner K, Devlin H. Variability in measurement of radiomorphometric indices by general dental practitioners. Dentomaxillofac Radiol 2001;30(2):120-5.

https://doi.org/10.1038/sj.dmfr.4600594

Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser 1994;843:1-129.

Taguchi A, Ohtsuka M, Nakamoto T, Naito K, Tsuda M, Kudo Y, et al. Identification of post-menopausal women at risk of osteoporosis by trained general dental practitioners using panoramic radiographs. Dentomaxillofac Radiol 2007;36(3):149-54.

https://doi.org/10.1259/dmfr/31116116

Amorim MA, Takayama L, Jorgetti V, Pereira RM. Comparative study of axial and femoral bone mineral density and parameters of mandibular bone quality in patients receiving dental implants. Osteoporos Int 2007;18(5):703-9.

https://doi.org/10.1007/s00198-006-0295-7

Taguchi A, Tanimoto K, Suei Y, Otani K, Wadamoto M, Akagawa Y, et al. Observer agreement in the assessment of mandibular trabecular bone pattern from panoramic radiographs. Dentomaxillofac Radiol 1997;26(2):90-4.

https://doi.org/10.1038/sj.dmfr.4600213




DOI: http://dx.doi.org/10.15448/1980-6523.2018.1.29202

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