In clinical practice, digital radiographs taken for caries diagnostics are viewed on varying types of displays and usually in relatively high ambient lighting (room illuminance) conditions. Our purpose was to assess the effect of room illuminance and varying display types on caries diagnostic accuracy in digital dental radiographs. Previous studies have shown that the diagnostic accuracy of caries detection is significantly better in reduced lighting conditions. Our hypothesis was that higher display luminance could compensate for this in higher ambient lighting conditions. Extracted human teeth with approximal surfaces clinically ranging from sound to demineralized were radiographed and evaluated by 3 observers who detected carious lesions on 3 different types of displays in 3 different room illuminance settings ranging from low illumination, i.e. what is recommended for diagnostic viewing, to higher illumination levels corresponding to those found in an average dental office. Sectioning and microscopy of the teeth validated the presence or absence of a carious lesion. Sensitivity, specificity and accuracy were calculated for each modality and observer. Differences were estimated by analyzing the binary data assuming the added effects of observer and modality in a generalized linear model. The observers obtained higher sensitivities in lower illuminance settings than in higher illuminance settings. However, this was related to a reduction in specificity, which meant that there was no significant difference in overall accuracy. Contrary to our hypothesis, there were no significant differences between the accuracy of different display types. Therefore, different displays and room illuminance levels did not affect the overall accuracy of radiographic caries detection.

BackgroundFinnish national combination treatment trials [1, 2] have demonstrated excellent outcomes in patients with (ERA) including 90% of patients reaching DAS28 remission at 6 months. Whether similar results are reached in clinical praxis is not known.ObjectivesWe describe characteristics, disease activity, and DAS28-remission rates at 3 months in ERA patients treated in 5 Finnish outpatient clinics.MethodsFIN-ERA is the first national multicenter observational cohort of adult patients with early inflammatory arthritis clinically diagnosed as RA between Oct 2011 and Sep 2014. Data comprising demographic, clinical and treatment characteristics were collected as a part of routine care. Treatment decisions were made by treating rheumatologists with cooperation with the patient at each clinic. Finnish treatment recommendations emphasize early and active therapy with csDMARDs and prednisolone starting at the diagnosis, and unlimited glucocorticoid injections to all swollen joints.ResultsOut of 605 recruited patients, 586 completed baseline and 3 months visit and had full data for disease activity score (DAS28-3) with ESR. In the entire cohort, the mean age was 56±16 yrs, the median (IQR) duration of symptoms was 6 (3,11) mo, rheumatoid factor (RF) and anti cyclic-citrullinated peptide antibodies (anti-CCP) were positive in 68% (data for N=569) and 69% (data for N=584), respectively. Twenty three percent of patients had radiographic erosions at baseline. A total of 498 (85%) fulfilled the ACR/EULAR 2010 classification criteria for RA. Figure 1 represents the mean DAS28-3 at baseline and at 3 mo at FIN-ERA clinics A-E. The respective mean HAQ and DAS28 (with ESR, 4 variables,DAS28-4) were 0.4±0.5 (data for N=431) and 2.2±1.0 (data for N=457). A total of 68% (data for N=457) met DAS28-4 remission at 3 mo. Remission rates were similar in patients classified as undifferentiated arthritis (15% of the cohort).DAS28-4 remission rates at sites A-E were 75% (data for N=188), 64% (data for N=78), 70% (Data for N=54), 61% (Data for N=54) and 60% (data for N=83).ConclusionsTwo thirds of ERA patients reach early DAS28 remission in Finland at 3 months.ReferencesMöttönen T, et al. Comparison of combination therapy with single-drug therapy in early rheumatoid arthritis: A randomised trial. FIN-RACo trial group. Lancet 1999Leirisalo-Repo M, et al. Infliximab for 6 months added on combination therapy in early rheumatoid arthritis: 2-year results from an investigator-initiated, randomised, double-blind, placebo-controlled study (the NEO-RACo Study). Ann Rheum Dis 2012.AcknowledgementsWe would like to thank study nurses L. Miina, S. Sarakari, M.Lemmetty, K.Arvola, and T.Reini.This study was supported by Pfizer.Disclosure of InterestNone declared