Efficacy of identifying maxillofacial lesions in cone-beam computed tomographs by orthodontists and orthodontic residents with third-party software

Introduction: The purpose of this study was to determine the ability of orthodontists and orthodontic residents to identify nonorthodontic incidental findings and false positives in cone-beam computed tomography scans.

Methods: Two groups of 10 cone-beam computed tomography scans containing equal numbers of scans with no, 1, or several abnormal nonorthodontic lesions were selected from a database. Eight orthodontists and 8 orthodontic residents screened the 2 groups of scans before and after a basic cone-beam computed tomography training course. The paired t test was used for statistical analyses.

Results: In the initial screening, the orthodontists and residents correctly identified 41.1% of the lesions. This lesion-detection rate improved significantly to a mean of 56.7% after the training course (P <0.0005). In parallel with these findings, the mean percentage of correctly identified extragnathic lesions improved significantly, from 22% to 48% (P <0.0005), and correctly identified temporomandibular joint lesions improved from 20% to 55% (P = 0.01) after the training. In contrast, the rate of correctly identified dentomaxillofacial lesions remained largely unchanged before and after the training. Both groups of evaluators had approximately 5 false positives per 10 scans before training and demonstrated significant decreases in false positives after training.

Conclusions: Relative to known error rates in medical radiology, both groups of evaluators had high error rates for missed lesions and false positives before and after training. Given these findings and since the most frequent cause of medical radiology malpractice litigation is due to missed lesions, it is recommended that an appropriately trained radiologist should be involved in reading and interpreting cone-beam computed tomography scans.