As many of you know, ODIS has a discussion list, which at least for me as a specialist, many times keep me updated in general clinical dentistry. Some time ago (September 1999) we had a small discussion about manipulated radiographs. It is today possible to manipulate digital radiographs after the exposure. Several softwares are available, with which the image can be edited. It is only to use the software's different tools and for example "paint" some splashes of white color in a pulp chamber, thereby indicating a root canal treatment. Or to paint some black color in the apical area indicating an osteitis.

During our discussion one of our list members (dr. Anders Wikander) manipulated an original radiograph (figure 1) and created an image as described above and seen in figure 2.

 
Figure 1

 
Figure 2

I was really astonished of seeing the manipulation, I was completely cheated. And sometimes I wondered if I had a bad luck, perhaps most attempts in the same direction were unveiled. But some months´later I found an article in a Journal showing that image manipulations, which had altered the diagnostic image content were unlikely to be detected by dentists ( Dentomaxillofacial Radiology Vol. 26. 1. January 199. Can dentist recognize manipulated digital radiographs?).

The researchers showed twelve radiographs for dentists and six of these were manipulated. For example in one of these manipulated images, subgingival calculus and periodontal bone lesions were removed from one of the original radiographs. Another manipulation was to compose one radiograph of two originals.

And the results were astonishing. Of 39 dentist none could find all the six manipulated. Five dentists could only find one of the manipulated images. One authentic radiograph scores highest as a manipulation!

The ease of digital manipulation seems to be overlooked today. I wonder how much our responsible authorities (e.g.National Board of Health and Welfare in Sweden) has considered these matters.