The effect of patient dental history on cone beam computed tomography interpretation of periapical findings in endodontics

Introduction Cone beam computed tomography (CBCT) is capable of creating a 3-dimensional image that is reconstructed by computer software providing greater clarity of both the natural anatomy and potential pathology. One of these limitations is false-negative errors in imaging interpretation known as Satisfaction of Search (SOS). SOS describes the process by which a clinician locates a finding that satisfies the reason a radiograph was ordered, and thus ceases further investigation. This perceptual-cognitive error is a major limitation on image interpretation, but has rarely been studied in dentistry and has not been studied on CBCT use in endodontics.;Purpose The purpose of this study was to investigate the effect of SOS due to patient dental history on the interpreting ability to locate secondary findings in CBCTs ordered for endodontic therapy.;Materials and Methods Ten CBCT columes previously taken at Saint Louis University in conjunction with endodontic diagnostic or therapeutic procedures were selected. Six examiners interpreted the 10 CBCT scans twice both with and without patient dental history with the sessions separated by a minimum of 3 months. Evaluators were instructed to rate any pathology on a scale of 1-5, definitely normal to definitely abnormal, respectively.;Results A total of 84 findings were reported with patient dental history and 105 without patient dental history, a 25% increase in reporting. In 18 of the 60 interpretation sets (30%) the Delphi panel teeth not included in the dental history were reported without history, but then were not reported with dental history on another tooth. Endodontic residents averaged reporting 13 of the 20 findings, endodontists with less than 3 years of CBCT experience average 17.5, and the endodontist with greater than 5 years of experience averaged 20.5. Both endodontic residents and practicing endodontist averaged 3 SOS errors per 10 sets of CBCT interpretations.;Conclusion In conclusion, the presence of patient dental history prior to CBCT interpretation decreased the number of reported radiographic findings by 25%. Individuals with less CBCT interpretation experience tended to report fewer findings. SOS false-negative errors occurred in 30% of interpretations and affected all clinicians similarly despite experience.