Fraudulent use of digital radiography: methods to detect and protect digital radiographs.

Digital radiography has become an indispensable diagnostic tool in dentistry today. To improve vision and diagnosis, dental x-ray software allows image enhancement (eg, adjusting color, density, sharpness, brightness, or contrast). Exporting digital radiographs to a file format compatible with commercial graphic software increases chances that information can be altered, added, or removed in an unethical manner. Dental radiographs are easily duplicated, stored, or distributed in digital format. It is difficult to guarantee the authenticity of digital images, which is especially important in insurance or juridic cases. Image-enhancement features applied to digital radiographs allow mishandling or potential abuse. This has been illustrated by several recently published studies. A standard authentication procedure for digital radiographs is needed. A number of manipulated radiographic images are presented to show concerns about security, reliability, and the potential for fraud. Antitampering techniques and methods of detecting manipulations in digital medical images are discussed.