Title: Replacing X-Rays with Infrared Imaging in Paediatric Dentistry
Funder: Barts Charity

Abstract: Dental X-ray imaging is commonplace and the primary source of X-Ray exposure for most people. However, there is no safe level of X-Rays because every exposure to ionising radiation increases a person?s risk of developing cancer. Proximal caries (tooth decay in-between teeth) is a common dental problem, especially in children. Diagnosis is challenging because lesions cannot be easily seen without taking an X-Ray. However, X-Ray images are difficult to interpret, making diagnosis error-prone leading to nearly a quarter of unnecessary fillings being proximal. Therefore, management of childhood caries is a significant challenge. Dentists aim to conserve teeth, rather than extract, by using modern minimally invasive treatments. Paradoxically, this strategy relies upon multiple X-Rays for treatment monitoring. Additional repeated X-Ray imaging is not uncommon in children due to patient movement. To overcome these problems, we have developed a 3D dental imaging system based upon optical coherence tomography (OCT). OCT uses infrared light to look inside and between teeth. Light is an excellent alternative to X-Rays, it is completely safe and provides clear dental images that can see early stage, treatable lesions. This seed funding will get our lab based imaging system ready for a clinical trial. Key Aims 1. Establish a reproducible imaging protocol Using an in vitro model, an intra-oral imaging protocol will be defined ready for clinical translation. The protocol will optimise the following key parameters; total imaging time (contrast vs. camera-shake), number of imaging viewpoints (more information vs. time and complexity), imaging wavelength (contrast, sensitivity and imaging depth vs. speed and cost) and the number of image sensors (imaging time vs. complexity and cost). Parameters will be explored by modifying equipment using hardware purchased with this funding. 2. Diagnostic Accuracy Assessment Pilot work has shown that proximal carious lesions can be detected using infrared light. Clinical trials require a sample size calculation based upon expected diagnostic performance. This project will assess diagnostic accuracy in vitro by imaging natural proximal lesions arranged into a dental arch. Gold-standard 3D reference image volumes will be obtained using our dental X-Ray-Micro-Computed-Tomography (XMT) Facility in addition to conventional bitewing radiographs. Our OCT Imaging Facility will provide 1300nm wavelength pre-clinical OCT technology. New 800/900nm OCT platforms will be modified for dental imaging and made available as part of the facility. Two clinicians will provide expert assessment of lesion severity for comparison. Diagnostic accuracy of OCT will be compared to both visual and radiographic assessment. 3. Present 3D infrared image data appropriately for clinicians. Dentists are trained to assess radiographic images. Our infrared images provide more detail than clinicians are familiar with. To assist dental professionals, novel image processing techniques will be used to transform infrared OCT images to appear similar to high-resolution, high-contrast radiographs. Dr Tomlins has supervised successful projects in related tasks. This project will focus upon combining multiple-view dental OCT images to make them appear like high quality dental X-Rays that dentists can readily interpret without additional training. A high-performance PC and graphics hardware are requested for processing the multi-gigabyte 3D datasets acquired.


Research activity codes: 4.2 EVALUATION OF MARKERS AND TECHNOLOGIES;4.1 DISCOVERY AND PRECLINICAL TESTING OF MARKERS AND TECHNOLOGIES
Health categories: ORAL AND GASTROINTESTINAL