A new digital tool for radiographic bone level measurements in longitudinal studies.

BACKGROUND: The reproducibility of measurements on radiographs is influenced by the techniques by which the images as well as the measurements are obtained. Thus, bias resulting from errors in the image and/or image examinations at two points in time may result in wrongful registrations of true biological or pathological changes. The aim of the present study was to propose and evaluate an indirect radiological examination technique, by which bias, when measuring radiographic bone level, could be substantially reduced as compared to the technique using direct mm measurements. METHODS: A plugin to ImageJ was designed to reduce bias when measuring bone loss on radiographic images. In human dry mandibles, radiographic images of 20 teeth were obtained parallel with the tooth axis (alpha = 0) and at an angle of 30 degrees deviation. The direct technique of measuring radiographic bone level (RBL) and the indirect, length-adjusted RBL were registered by four researchers in a double blinded fashion. RESULTS: When mean RBL measured at 0 degrees angle was 7.0 mm, the corresponding mean RBL measured at 30 degrees angle was 7.8 mm, signifying an 11.4% increase (p = 0.032), whereas the mean length-adjusted RBL increased by 0.6% (p = 0.9). CONCLUSIONS: This study showed that the use of the original, direct technique (ImageJ) resulted in markedly biased radiographic bone level at 30 degrees angle, while the proposed indirect length-adjusted technique (ImageJ plugin) did not.