Effect of two X-ray tube voltages on detection of approximal caries in digital radiographs. An in vitro study

This study evaluated the effect of two different tube voltages on clinicians’ ability to diagnose approximal carious lesions in digital radiographs. One hundred extracted teeth were radiographed twice at two voltage settings, 60 and 70 kV, using a standardized procedure. Seven observers evaluated the radiographs on a standard color monitor pre-calibrated according to DICOM part 14. Evaluations were made at ambient light levels below 50 lx. All observations were analyzed with receiver operating characteristic curves. A histological examination of the teeth served as the criterion standard. A paired t test compared the effects of the two voltages. The significance level was set to p < 0.05. Weighted kappa statistics estimated intra-observer agreement. No significant difference in accuracy of approximal carious lesion diagnosis was found between the two voltage settings. But five observers rated dentin lesions on radiographs exposed at 70 kV better than on radiographs exposed at 60 kV. Intra-observer agreement differed from fair to moderate. There was no significant difference in accuracy of approximal carious lesion diagnosis between digital radiographs exposed with 60 or 70 kV.