Abstract
Periapical radiolucencies, which can be detected on panoramic radiographs, are one of the most common radiographic findings in dentistry and have a differential diagnosis including infections, granuloma, cysts and tumors. In this study, we seek to investigate the ability with which 24 oral and maxillofacial (OMF) surgeons assess the presence of periapical lucencies on panoramic radiographs, and we compare these findings to the performance of a predictive deep learning algorithm that we have developed using a curated data set of 2902 de-identified panoramic radiographs. The mean diagnostic positive predictive value (PPV) of OMF surgeons based on their assessment of panoramic radiographic images was 0.69 (±0.13), indicating that dentists on average falsely diagnose 31% of cases as radiolucencies. However, the mean diagnostic true positive rate (TPR) was 0.51 (±0.14), indicating that on average 49% of all radiolucencies were missed. We demonstrate that the deep learning algorithm achieves a better performance than 14 of 24 OMF surgeons within the cohort, exhibiting an average precision of 0.60 (±0.04), and an F1 score of 0.58 (±0.04) corresponding to a PPV of 0.67 (±0.05) and TPR of 0.51 (±0.05). The algorithm, trained on limited data and evaluated on clinically validated ground truth, has potential to assist OMF surgeons in detecting periapical lucencies on panoramic radiographs.
Highlights
Panoramic radiographs are a common diagnostic tool and a standard imaging modality that is frequently employed in routine clinical practice by dentists and oral and maxillofacial (OMF)surgeons [1,2,3]
2448 images (102 images per OMF surgeon, for 24 OMF surgeons) were annotated in this study. The results from this analysis (Table 2) demonstrate that for the task of detecting radiolucencies using panoramic radiographs, OMF surgeons had a mean positive predictive value (PPV) of 0.69 (±0.13), indicating that on average 31% of cases were falsely diagnosed as positive
The performance of the OMF surgeons was significantly lower in terms of true positive rate (TPR) compared to PPV based on a Wilcoxon signed-rank test (p = 0.003)
Summary
Panoramic radiographs are a common diagnostic tool and a standard imaging modality that is frequently employed in routine clinical practice by dentists and oral and maxillofacial (OMF)surgeons [1,2,3]. Panoramic radiographs are a common diagnostic tool and a standard imaging modality that is frequently employed in routine clinical practice by dentists and oral and maxillofacial (OMF). Assessment of panoramic radiographs may be contracted to radiologists in certain circumstances, in many clinical practices, OMF surgeons often read their own panoramic radiographs. The agreement rate (a proxy for their diagnostic performance) of dental professionals’ assessments of radiographic images seems to vary in part due to individual knowledge, skills and biases [5,6]. Recent research has shown that the rate of misdiagnosis by dentists in determining the depth of caries in a conventional radiograph was as high as 40 percent, and in 20 percent of cases, teeth were misdiagnosed as diseased [9,10]
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