A comparative evaluation of the diagnostic efficacy of film and digital sensors for detection of simulated periapical lesions

Objective. The purpose of this study was to evaluate the diagnostic efficac y of Ektaspeed Plus film (EPF), a charge-coupled device (CCD), and photosti mulable phosphor (PSP)-based digital images for detection of simulated peri apical lesions. Study design. Lesions were simulated in the periapical areas of 24 human ma ndibular sections invested in acrylic using burs of sizes #1, 2, 4, and 6 a nd imaged using EPF, CCD, and PSP sensors. Percent correct response scores, sensitivity, and specificity values were computed for all variables. Repea ted-measures analysis of variance and post hoc testing were performed to de termine the effects of imaging modality, observer, and lesion sizes with re spect to lesion detection. Results. EPF displayed the highest sensitivity and specificity, followed by PSP and CCD images (P < .001). Percent correct score was the highest for 3 of 4 observers when EPF was used. Analysis of variance revealed significan ce (P < .001) with respect to all variables. Observers with experience in d igital image-viewing performed better than those without such experience (P < .001). Intraobserver agreement was fair (<kappa> = 0.5). Conclusions. EPF outperformed CCD and PSP images when observers could manip ulate image characteristics.