Objective: Anecdotal reports suggest that digital imaging may result in technique errors not previously demonstrated with film-based imaging. The purpose of this study was to evaluate the number and type of clinical technique errors between the two systems: 1) intra-oral film and 2) PSP digital-based imaging. Methods: A total of 405 full series was exposed by 63 dental hygiene students from years 2001 to 2003. Samples were identified randomly, three from each student. One examiner assessed each projection for 1) horizontal, 2) vertical, 3) cone centering, 4) packet placement, and 5) artifact errors. Ten series were randomly chosen for re-evaluation to determine intra-rater reliability. All projections were evaluated using the same viewing conditions for film and a 17″ computer monitor for digital images (1024 x 768 pixels). No enhancement features were used to modify the digital image. The data were analyzed using a non-linear mixed model allowing for multi-level random effects. Intra-rater reliability was analyzed using Kappa (k=0.96). Results: The results were based on 183 full series (1514 film and 1754 digital projections). The probability of error for digital images was found to be statistically greater than that for film images (p<0.0001). The odds ratio for the probability of any error for digital images relative to film is 1.46 (95% CI 1.293, 1.657, p<0.0001). Packet placement was the most common diagnostically unacceptable technique error using the PSP sensor when compared to film (228 vs 90). The odds ratio for the probability of a diagnostically unacceptable error for digital images relative to film images is 2.11 (95% CI 1.617, 2.751 p<0.0001). Conclusions: This study showed that more technique errors occurred with the use of the PSP digital receptor when compared to film. Further research should be conducted evaluating film holding devices used with the PSP receptors.

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