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


  • Luciana Munhoz São Paulo University - Dentistry School
  • Jun Ho Kim São Paulo University - Dentistry School
  • Moses Park São Paulo University - Dentistry School
  • Eduardo Massaharu Aoki São Paulo University - Dentistry School
  • Reinaldo Abdala Júnior São Paulo University - Dentistry School
  • Emiko Saito Arita São Paulo University - Dentistry School



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


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.

Author Biographies

Luciana Munhoz, São Paulo University - Dentistry School

Departamento de Estomatologia. Mestranda em diagnóstico bucal, ênfase em radiologia e imaginologia odontológica

Jun Ho Kim, São Paulo University - Dentistry School

Departamento de Estomatologia. Mestrando em diagnóstico bucal, ênfase em radiologia e imaginologia odontológica

Moses Park, São Paulo University - Dentistry School

Departamento de Estomatologia. Mestrando em diagnóstico bucal, ênfase em radiologia e imaginologia odontológica

Eduardo Massaharu Aoki, São Paulo University - Dentistry School

Departamento de Estomatologia. Doutorando em diagnóstico bucal, ênfase em radiologia e imaginologia odontológica

Reinaldo Abdala Júnior, São Paulo University - Dentistry School

Departamento de Estomatologia. Doutorando em diagnóstico bucal, ênfase em radiologia e imaginologia odontológica

Emiko Saito Arita, São Paulo University - Dentistry School

Professora associada da disciplina de radiologia e imaginologia odontológica


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Original Article