Dental Radiology

digital rad
Which type of digital image receptor is most common at this time?

CID (charge injection device)
CMOS/APS (complementary metal oxide semiconductor/active pixel sensor)
CCD (charge-coupled device)
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RADIOLOGY
digital rad
Which of the following are advantages of direct digital radiography.
Select all that apply.
superior gray-scale resolution
' reduced patient exposure to x-radiation
increased speed of image viewing
' lower equipment and film costs
sensor size
increased efficiency
effective patient education tool
enhancement of diagnostic image
RADIOLOGY
i
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copyright 2013-2014- Dental Decks
^>tA4S03lS
^
Digital imaging
filmless imaging system
method of capturing a radiographic image
with a sensor, breaking the image into electronic
pieces and presenting & storing the image using
a computer
Direct digital image production requires
x-ray source
digital intraoral sensor
computer
high-resolution monitor
software & printer
Digital i nt raoral sensor
small intraoral detector used to capture a
radiographic image
when x-rays strike the sensor, an electronic
charge is produced on the surface of the
sensor, this electronic charge is digitized or
converted to digital form
may be wired or wireless
sensor transmits information to computer
Pixel or pi ct ure element
discrete unit of information
consists of a small electron well where the x-
ray or light energy is deposited upon exposure
(/di gi t al image is composed ofpixejsh
CCD (charge-coupled device)
(CCDTjHi arge-coupl ed device)
most common digital image receptor
in the intraoral sensor, a solid-state detector
that contains a silicon chip with an embedded
electronic circuit
sensitive to light or x-rays
640 x 480 pixels in size
CMOS/ APS (complementary metal oxide
semiconductor/active pixel sensor)
Jatest development in direct digital sensor
tecnnSlogy
externally identical to CCD
i differs in the way pixels are read
advantages include lower production cost of
* the chip, lower power requirements & greater
'. durability
smaUef.acjtive
a r e a
f
r
image acquisition
VCIDjJfcharge injection device)
another sensor technology
silicon based solid-state imaging receptor
similar to CCD
no computer is required to process the images
system features CID x-ray sensor, cord and
plug that are inserted into a light source on a
camera platform
Advantages of digital imaging
superior gray scale resolution
256 shades of gray used instead of the 16-25 shades
used with film
reduced exposure to radiation
radiation exposure is 50% to 90% less than what is
used to expose E-speed film
increased speed of image viewing
images can be viewed instantly which allows for
immediate intetpretation
lower equipment and film cost
no need for purchase of film and related processing
supplies and equipment
increased efficiency
allows dental professionals to be more productive;
image storage and communication are easier with
digital networking
enhancement of diagnostic image
features such as colorization and zooming allow for
highlighting of conditions; the gray scale may be re-
YSBjed. (digital subtraction)
effective patient education tool
the size of images displayed monitor are easier for
the patient to see; allows for chairside education and
interaction
8
' superior gray-scale resolution
' reduced patient exposure to x-radiation
> increased speed of image viewing
> lower equipment and film costs
' increased efficiency
' effective patient education tool
' enhancement of diagnostic image
Disadvantages of digital imaging
sensor size
some sensors are thicker and less flexible than
film and may stimulate the gag reflex
initial set up costs
significant initial cost for purchase of digital
equipment as well as maintenance and repairs
resolution / image quality
conventional x-ray film has a resolution of 12
n - 20 lp/mm (linepairs per millimeter); digital
Mmaging using a CCD has a resolution of 10
lp/mm; because human eye can only perceive 8
N>- 10 lp/mm digital imaging performs at
least as well as traditional radiography
infection control
some sensors cannot withstand heat steriliza-
tion; barrier protection is required
wear & tear
sensors are subject to damage, wear & tear and
have a limited lifespan
legal issues
because digital images can be enhanced, there
may be legal implications
digital rad
A method of obtaining a digital image where the sensor captures the image
and immediately transfers it to a computer is termed:
indirect digital imaging
direct digital imaging
storage phosphor imaging
3
RADIOLOGY
digital rad
A patient is extremely concerned about radiation exposure. Which of the fol-
lowing is best for limiting the amount of exposure he will receive during a full
mouth series?
use of digital imaging
use of E-speed films
use of F-speed films
substitute a panoramic image for the full mouth series
4
RADIOLOGY
' direct digital imaging
Digital imaging
filmless imaging system
methods of obtaining a digital image:
direct and indirect
Direct digital imaging
required components
- x-ray machine
- intraoral sensor
- computer & monitor
utilizes a sensor with a fiberoptic cable that is
linked to a computer
sensor is placed intraorally and exposed to
x-radiation
images are captured via a sensor
(CCD, CMOS/APS or CID)
the sensor transmits the image to a computer
monitor
images appear on monitor within seconds of
exposure
software is used to enhance & store the image
Indirect digital imaging
scanning of traditional films
storage phosphor imaging
Scanning of traditional films
required components
- CCD camera
existing films are scanned and digitized using a
CCD camera
CCD camera scans radiograph, converts the
image and displays it on monitor
is inferior to direct digital imaging
image is a "copy" not an "original"
^Steage, phosphor imaging ss P{>
required components
.-phosphor- coated plate
- electronic processor/scanner
a "wireless" digital imaging system
a reusable imaging plate coated with phosphors
is used instead of a sensor with a fiberoptic cable
plates are similar to intraoral film in size, shape
& thickness
image recorded on plate
after exposure, plate is placed in electronic
processor where a laser scans the plate; image
is transferred to the monitor within time frame
nf'jQ.s.gcciridr
1
to 5 minutes
also referred to as photo-stimulable phosphor
imaging or PSP imaging
use of digital imaging
Digital imaging
requires LESS radiation than conventional films because the sensor is more sensitive to
x-rays than dental film
exposure time for digital imaging is approximately 5-0% less than what is required for F-
speed film
intraoral, panoramic and other extraoral films may all be obtained digitally
Int raoral film speed
E-speed film is no longer available
Only D-speed film and F-speed film are available for use with intraoral radiography
F-speed film is recommended by the ADA
Q*^^Sdj !2
u
j
r e s
6p%_qf the exposure time of D-speed
Ot her ways to limit exposure to x-radiation
proper prescribing of dental radiographs based on individual needs of patient
use of lead apron & thyroid collar
use of proper dental x-ray equipment
use of rectangular position-indicating device (PID)
use of beam alignment devices
use of proper technique
proper sensor handing
proper image retrieval
image char
A radiograph that exhibits areas of black and white is termed high contrast
and is said to have a short contrast scale; a radiograph the exhibits many
shades of gray is termed low contrast and is said to have a long contrast scale.
To limit image magnification, the longest target-receptor distance and short-
est object-receptor distance are used. ^He
both statements are true
both statements are false
the first statement is true, the second is false
the first statement is false, the second is true
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RADIOLOGY
image char
Rank the following from LEAST radiopaque to MOST radiopaque.
amalgam
bone
dentin
> maxillary sinus
enamel
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RADIOLOGY
contrast
the difference in degrees of blackness (densi-
tjg) between adjacent areas on a dental radi-
ograph.
high contrast describes an image that ap-
pears mostly black & white; shades of gray
are absent
low contrast describes an image with
many shades of gray; few areas of black
and white
scales of contrast
the range of useful densities seen on a dental
radiograph.
short-scale contrast
describes a high contrast image
with densities of black & white
that results from using a .low
kilovoltage.
^Mi l i um V ,
long-scale contrast
describes a low contrast image
with many shades of gray that
results from using a highkilo-
voltaee.
magnification
a radiographic image that appears larger than
the actual size of the object it represents; mag-
nification is influenced by the target-receptor
distance and the object-receptor distance.
target-receptor distance -
distance between the source of x-rays and
the image receptor*film / W. * ^
a longer PID results in a longer target-recep-
tor distance and helps to limit magnification
object-receptor distance '
s
^*f-Q^*
distance between the tooth and the image
receptor
the closer the receptor is to the tooth, the less
magnification is seen on the image
to limit magnification
use a long target-receptor distance/I target-
receptor distance
use a short object-receptor distance/J, object
-receptor distance
bus cm
i
LOW CONTRAST LONG-SCALE CONTRAST
HV**t kvp
'image receptor=digital sensor or x-ray film
sinus bone dent i n enamel
fit
radiolucent structures
lack density
permit the passage of x-radiation
absorb very little x-radiation
'.a.fj.o.w more x-rays to reach the receptor*
appear dark or black on an image
amalgam
radiopaque structures
are dense
resist the passage of x-radiation
absorb the x-radiation
allow few_xjay.s to reach the receptor
appear light or white on an image
Examples of radiolucent structures/mate-
rials BLACK or DARK
air space images
soft tissue images
canals
foramens
fossas
sinuses
sutures
caries
pulp cavities
periodontal ligament space
denture acrylic
some composite restorations
Examples of radiopaque structures/mate-
rials _ WHITE or LIGHT
enamel
dentin
bone
lamina dura
septa
tubercles
tuberosities
ridges
processes
amalgams, metal restorations
implants
gutta percha
LUCENT means TRANSPARENT and
suggests something that lacks density
something that lacks density permits the pas-
sage of x-rays & appears RADIOLUCENT
%
^ S
OPAQUE means NOT TRANSPARENT
and suggests something that is more dense
something that is more dense resists the
passage of the x-rays & appears RA-
DIOPAQUE
*receptot=digital sensor or x-ray film
misc.
Dental radiographs are the legal property of the:
patient
dentist
state
> none of the above
7
RADIOLOGY
misc.
A dental hygienist in your practice has an adult recall patient without evi-
dence of caries who states she needs bite-wing x-rays because it has been 6
months since her last dental images. The hygienist should tell the patient
that:
yes, she is correct, it is time for new x-ray images
bite-wings should be taken only once per year, not twice
images should be taken based on patient need instead of a set time frame
none of the above
s
RADIOLOGY
Dental radiographs
original radiographs are legally the
property of the dentist even though the
patient or an insurance company may have
paid for them
the radiographs are the property of the
dentist because they are indispensable to the
dentist as part of the patient record
radiographs should be kept indefinitely
Patient access to radiographs
patients have a right to reasonable access
of their dental radiographs
access includes copies of original radi-
ographs (not originals) forwarded to the
dentist who will be responsible for the pa-
tient's dental care
dentist
Patients who refuse dental radiographs
when a patient refuses to have dental ra-
diographs, the dentist must decide whether
diagnosis and treatment can take place
without the recommended radiographs
no document can be signed by the patient
that releases the dentist from liability
Very important: the patient record, includ-
ing radiographs, is legal documentation of a
patient's condition.
Patient record must contain documentation of
informed consent
number & type of radiographs exposed
rationale for taking radiographs
diagnostic information obtained from in-
terpretation
images should be taken based on patient need instead of a set time
Prescribing dental radiographs
the dentist is responsible for prescribing the number, type and frequency of dental ra-
diographs
each patient's condition is different and therefore each patient must be evaluated for
radiographs on an individual basis
a radiographic examination should never include a set number and type of images at
a set interval
guidelines for prescribing dental radiographs are published by the American Dental
Association (ADA) in conjunction with the Food & Drug Administrations (FDA)
visit www.ADA.org for current guidelines
patients with caries, periodontal disease, tooth mobility, pain and impacted teeth need
more frequent radiographic examinations
Guidelines for radiographs in the recall patient
with clinical caries or risk of caries
bite-wings at 6 - 12 month intervals
with no clinical caries or risk of caries
bite wings at 24 - 36 month intervals
with periodontal disease
clinical judgement for radiographs needed to evaluate periodontal disease; selected
bite-wings & periapicals
normal anat
Identify the structures indicated in the images below.
Image 1 Image 2
Reprinted from Haring, Joen Iannucci and Laura Jansen: Dental Radiography:
Principles and Techniques: Third Edition. 2000, with permission from Elsevier.
RADIOLOGY
normal anat
The coronoid process often appears on what periapical image?
maxillary incisor
maxillary molar
mandibular incisor
mandibular molar
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RADIOLOGY
Res
Image 1- hamulus
v
a.k.a. hamular process
small, hook-like projection of bone
extends ..fmm the medial Pterygoid
jg|atejofê
m
sjp;hjenoidjbone
located posterior to the maxillary
tuberosity
appears radiopaque
on a maxillary molar periapical image,
appears as a hook-like radiopaque struc-
ture
varies in length, shape & density
not always visible, depends on receptor
placement
hamulus
' maxillary tuberosity
*b
Image 2- maxillary tuberosity
rounded prominence of bone that ex-
tends distal to the third molar region
appears radiopaque
on a maxillary molar periapical
image, appears as a rounded ra-
diopaque bulge distal to the third
molar region
varies in size, shape and density
not always visible, depends on re-
ceptor placement
maxillary molar
Coronoid process
coronoid means "resembling the beak of a crow"
large prominence of bone on anterior ramus of mandible
is thin and triangular in shape
serves as an attachment site for one of the muscles of mastication
appears radiopaque
on a maxillary molar periapical image, appears as a beak-shaped radiopacity located
inferior to, or superimposed over, the maxillary tuberosity
varies in shape and density
not always visible, depends on receptor placement
Reprinted from Haring, Joen Iannucci and Laura Jansen Lind: Radiographic
Interpretation for the Dental Hygienist. 1993, with permission from Elsevier.
normal anat
Identify the structures labeled 1 - 8 on the image below.
"Courtesy Dr. Stuart C. White, UCLA School of Dentistry." y\
RADIOLOGY
normal anat
Identify the structures labeled 1- 7 on the image below.
"Courtesy Dr. Stuart C White, UCLA School of Dentistry." 1 2
copyright 2013-2014-Dental Decks
RADIOLOGY
' answers 1-8 below
1. lateral wall of the incisive (nasopalatine) canal
radiopaque line
2. anterior wall of the maxillary sinus
radiopaque line
3. nasopalatine fossa
radiolucent space
4. floor of nasal fossa
radiopaque line
5. soft tissue outline of the nose
slightly radiopaque outline
6. lamina dura
radiopaque line
7. border of maxillary sinus
radiopaque line
"Courtesy Dr. Stuart C. White, UCLA
School of Dentistry."
8. periodontal ligament space
radiolucent line
answers 1- 7 below
1. anterior nasal spine
radiopaque line
2..lateral wall of nasopalatine canal
radiopaque line
3. median palatal suture
radiolucent line
radiopaque line
5. incisive (nasoplatine) foramen
radiolucent structure
6. soft tissue outline of tip of nose
slightly raôplique'ûTrihe
7. alveolar crest
radiopaque line
"Courtesy Dr. Stuart C White, UCLA
normal anat
Courtesy Dr. Stuart C. White, UCLA School of Dentistry."
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RADIOLOGY
normal anat
"Courtesy Dr. Stuart C. White, UCLA School of Dentistry.'
14
RADIOLOGY
answers 1- 5 below
1. nutrient canal
radiopaque lines
2. bony trabecular plate
radiopaque line
3. inferior border of mandibular canal
radiopaque line
4. submandibular gland fossa
radiolucent space
5. inferior border of mandible
radiopaque structure
1. anterior wall of maxillary sinus
radiopaque line
< answers 1 - 8 below
2. inferior nasal conchae A-
radiopaque mass
radiopaque line
4. inferior border of zygomatic process of maxilla
j-shaped radiopaque line C/*
5. posterior wall of zygomatic process of maxilla
radiopaque line
6.jnieiifljLboxdt:.QLzygoma # ^
radiopaque line
7. floor of maxillary sinus
radiopaque line
8. mucosa over alveolar bone
slightly radiopaque structure
normal anat
"Courtesy Dr. Stuart C. White, UCLA School of Dentistry." .. _
RADIOLOGY
normal anat
"Courtesy Dr. Stuart C. White, UCLA School of Dentistry."
16
answers 1 - 7 below
1. lingual cusp of 1
st
premolar
radiopaque area
radiolucent line
3. film holder
radiopaque area
4. genial tubercles
donut shaped radiopacity
5. lingual foramen
radiolucent circle
6. bony trabeculations
radiopaque lines
7. marrow space
radiolucent area
answers 1 - 4 below
radiolucent line
2. mental foramen
ovoid radiolucency
radiolucent area
4. film clip mark
radiolucent artifact
normal anat
17
RADIOLOGY
normal anat
"Courtesy Dr. Stuart C. White, UCLA School of Dentistry." 1 8
copyright e 2013-2014- Dental Decks
RADIOLOGY
18
answers 1 - 3 below
1. cement-enamel junction (CEJ)
radiopaque line
2. mental foramen
ovoid radiolucency
large radiolucent area
1. inferior nasal conchae
radiopaque mass
answers 1- 7 below
radiopaque line
radiopaque line
4. maxillary sinus
radiolucent space
radiopaque line
6.inferior border of the zygomatic
Ti Vl l l l l l l WWI I IIIIMI ijitilllll mi I I . Nil,? ,
process of the maxilla
radiopaque area
st
premolar
radiopaque band
normal anat
"Courtesy Dr. Stuart C. White, UCLA School of Dentistry." 19
RADIOLOGY
normal anat
20
copyright C 2013-2014- Dental Decks
RADIOLOGY
answers 1 - 6 below
radiopaque line
2. lateral wall in incisive canal )
radiopaque line
3. ala of nose
radiopaque line
radiopaque line
5. maxillary sinus
radiolucent space
st
premolar
radiopaque band
1. dentino-enamel junction (DEJ)
radiopaque line
' answers 1 - 6 below
radiolucent line
3. lamina dura
radiopaque line
4. periodontal ligament space of
palatal root
radiolucent line
5. film holder
radiopaque area
6. mucosa over alveolar bone
slightly radiopaque structure
normal anat
21
copyright 2013-2014-Dental Decks
RADIOLOGY
normal anat
RADIOLOGY
answers 1- 3 below
1. mandibular tori
radiopaque masses
2. lingual foramen
radiolucent circle
3. genial tubercles
donut shaped radiopacity
answers 1- 4 below
1. alveolar crest of bone
2. lamina dura
radiopaque line
radiolucent line
radiopaque lines
normal ant
"Courtesy Dr. Stuart C. White, UCLA School of Dentistry." 2 3
= = _ _ _ _ ^ _ _ ^ _ _ copyright 2013-2014-Dental Decks
RADIOLOGY
normal anat
RADIOLOGY
1. marrow space
radiolucent space
answers 1- 8 below
radiolucent line
3. bony trabecular plate
radiopaque line
4. lamina dura
radiopaque line
5. pulp canal
radiolucent space
6. alveolar crest
radiopaque area
7. dentin
radiopaque area
8. enamel
radiopaque area
1. dentin
radiopaque area
answers 1 - 9 below
radiopaque lines
3. marrow space
radiolucent area
4. pulp canal
radiolucent space
radiolucent line
6. lamina dura
radiopaque line
7. alveolar crest
8. enamel
radiopaque band
9. pulp chamber
radiolucent space
normal anat
Identify the structures labeled 1-12 on the image below.
RADIOLOGY
normal anat
2
6
RADIOLOGY
answers 1-12 below
radiopaque lines
2. marrow space
radiolucent area
3. tooth #10
maxillary lateral incisor
4. lamina dura
radiopaque line
5. dentin
radiopaque area
radiolucent line
7. alveolar crest
8. pulp canal
radiolucent space
9. pulp chamber
radiolucent space
10. enamel
radiopaque band
lljraUdJiJmdot
radiopaque circle
12. dentino-enameTjunction
radiopaque line
%
answers 1- 8 below
1. tooth #3
maxillary first molar
2. amalgam restoration
3. plastic bite block
faint opacity
4. film dot
rounajradiolucency
5. black letters - PLS
indicates Kodak Ektaspeed plus film
6. lamina dura
radiopaque line
radiolucent line
8. lamina dura
radiopaque line
normal anat
Identify the structures labeled 1 -15 on the image below.
"Courtesy Dr. Stuart
C. White, UCLA
RADIOLOGY
27
normal anat
Identify the structures labeled 1 -13 on the image below.
"Courtesy Dr. Smart
C. White, UCLA
28
RADIOLOGY
answers 1-15 below
1. air in nasal fossa
raHTolucenTspace
2. nasal septum
radiopaque line
3-lateralwaU of nasal septum
medial wall of maxillary sinus
radiopaque lines
4. infraorbital rim
radiopaque line
5- wall of infraorbital canal
radiopaque line
6. pterveomaxillary fissure
radiolucent space
7. pterygoid spine of sphenoid
radiopaque line
8. zygomatic arch
radiopaque mass
9. posterior wall of maxillary sinus
radiopaque line
10. posterior wall of the zygomatic
process of the maxilla
radiopaque line
11. ear lobe
radiopaque mass
12. inferior border of the mandibular canal
radiopaque line
13. anterior nasal spine
v-shaped radiopacity
14. inferior border of the mandible
radiopaque band
15. hyoid bone
answers 1-13 below
1. tip of nose
radiopaque area
2. hard palate / floor of nasal fossa
radiopaque line
3. orbit
radiolucent area
4. hard palate / floor of nasal fossa
radiopaque line
radiopaque line
6. soft palate
7. air between soft palate & tongue
radiolucent space
8.._dorsum of the tongue
radiopaque line
9. ghost imaêofop^> ositerartius
^TndTcateTrjy radiopaque dote
10. mental foramen
ovoid radiolucency
11. shadow of cervical spine
diffuse opacity
broad radiolucent area
13. articular eminence / articular tubercle
radiopaque prominence
processing
The pattern of stored energy on an exposed film is termed the latent image;
this image remains invisible until it undergoes processing.
The function of the developer solution is to chemically reduce the exposed,
energized silver halide crystals to black metallic silver.
29
RADIOLOGY
processing
Which ingredient in the fixer solution functions to remove all unexposed and
underdeveloped silver halide crystals from the emulsion?
fixing agent
acidifier
hardening agent
preservative
none of the above
30
RADIOLOGY
Film processing
converts the latent image to a visible image and
preserves the image on film
Latent image
the film emulsion absorbs x
:
rays during ex-
jffgnni r^ We s the energy,within the silver
halide crystals
the stored energy forms a pattern and creates
an invisible image
the pattern of stored energy cannot be seen
and is referred to as the latent image; it re-
mains invisible until chemical processing
Black areas of the visible image
appear radiolucent f-;y
created by deposits of black metallic silver
structures that permit the passage of the
x-ray beam allow more x-rays to reach the
film & energize more silver halide crystals
more energized silver halide crystals result
in more deposits of black metallic silver
White areas of the visible image
appear radiopaque ^?Ci
results from .unexposed silver halide crystals
structures that resist the passage of the x-ray
beam restrict or limit amount of x-rays that
reach the film resulting in no energized silver
halide crystals and no deposits of black metal-
lic silver
Film processing steps
1. development - developer solution removes
halide portion of exposed silver halide crystals;
this reduction of exposed crystals results in pre-
cipitated.Wackjnelîcjy]yer (6^FJsJheopti-
mal temperature for developer)
2. rinsing - water removes developer & stops
development process
3. fixing - fixer solution removes unexposed sil-
ver halide crystals & hardens the film
4. washing - water removesaTTexcess chemi-
cals from the emulsion
5. drying
Developer composition
developing agent contains 2 chemicals hy-
Cdroquinone & cloijj hydroquinone slpjvly con-
verts silver halide crystals & generates black
tones ;elon-quickly converts silver halide crys-
tals & generates gray tones
preservative is Sodium sulfite; prevents oxi-
dation of developer agents
accelerator is sodium carbonate; activates
the developer & softens emulsion
^ ^t^*-*******.."""-'^
restrainer ts;potassium bromide; prevents
developer from deveToping unexposed crystals
Fixer composition
fixing agent (a.k.a. clearing agent or
hypo) i s^xl i u^Jhi oj ul &t eorammoni um
thiosulfate; removes or clears" all un-
exposed & underdeveloped silver halide
crystals from emulsion; clears the film so
that black image produced by the devel-
oper can be seen
preservative is,si{Uumjmlfite (same as
in developer); prevents the deterioration of
the fixing agent
hardeni ng agent is pot assi um alum;
shrinks and hardens the gelatin in the
emulsion
acidifier is acj ^j i ci dj ) r sulfuric acid;
neutralizes the alkaline developer and
stops development process & provides
necessary acidic environment for fixer
Safelighting
lighting that is required in darkroom for
safe illumination while processing x-ray
film
Q
J
^JJQdak^BXd
t
S^hMM?r with a
15-watt bulb at least 4 feet away from
working surface
fixing agent
Film processing steps
1. development
2. rinsing
3. fixing
4. washing
5. drying
Manual film processing
a.k.a. hand processing or tank processing
method used to process films where all
steps are performed manually
equipment needed includes processing
tanks with covers, thermometer, timer,
film hangers and stirring rod
typical processing times include:
5 minutes in developer > 30 second rinse
> 10 minutes in fixer at leastdQanm-
utgsjriwash
as a rule, fixing time is twice as long as
developing time
Automatic film processing
method used to process films using
where all steps of film processing are au-
tomated
automatic processor is required
total processing time is 4-6 minutes
processing
Your assistant has processed three panoramic films today. She noticed the
films are progressively getti ng lighter and lighter. What should be done to
correct t he problem?
decrease the temperature of the developer
increase the temperature of the fixer
replenish the developer
process the films a second time
decrease the ti me in the developer
31
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RADIOLOGY
processing
Your assistant has just processed a film that appears too dark. Identify each of
the potential causes of this probl em.
inadequate ti me in developer
excessive time in developer
developer solution too cool
developer solution too hot
depleted developer
concentrated developer
RADIOLOGY
32
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' replenish the developer
Replenisher solutions
a replenisher is a superconcentrated solu-
tion that is added to the existing processing
solutions to compensate for the loss of vol-
ume and strength that occurs due to oxida-
tion
'
:
-
r
'
both the developer and fixer must be re-
plenished daily to maintain adequate fresh-
ness
replenishment maintains adequate con-
centrations of chemicals which ensures uni-
form processing
failure to use replenishing solutions results
in non-diagnostic radiographs
Processing solutions
include developer, fixer & replenisher
must follow manufacturer directions for
storage, mixing & replenishing
the developer and fixer must be changed at
the same time every 3-4 weeks or more often
with high volume of processing
tanks must be scrubbed and cleaned when
changing solutions
Developer solution life is affected by
cleanliness of tank
size of films processed
number of films processed
temperature
evaporation
Depleted developer
is weakened, lacks concentration
does not fully develop the latent image
produces a non-diagnostic image with red-
uced density and contrast
results in underdeveloped films
underdeveloped films appear light
Underdeveloped film
appears light
causes
- time/inadequate time in developer
- temperature/developer too cool
- concentration/depleted developer
solutions
- time/! time in developer
- temperature/t temperature
- concentration/replenish developer
excessive time in developer
developer solution too hot
concentrated developer
Time and Temperature: Problems and Solutions
Example
Underdeveloped
film
Overdeveloped
film
Reticulation of
emulsion
Appearance
Light
Dark
Cracked
Problems
- Inadequate development time
- Developer solution too cool
- Inaccurate timer or thermometer
- Depicted or contaminated
developer solution
- Excessive developing time
- Developer solution too hot
- Inaccurate timer or thermometer
- Concentrated developer solution
Sudden temperature change
between developer and water bath
Solutions
- Check development time
- Check developer temperature
- Replace faulty timer or thermometer
- Replenish developer with fresh
solutions as needed
- Check development time
- Check developer temperature
- Replace faulty timer or thermometer
- Replenish developer with fresh
solutions as needed
Check temperature of processing
solutions and water bath; avoid
drastic temperature differences
Reprinted from Iannucci, Joen M. and Laura Jansen: Dental Radiography Principles and Techniques. Fourth Edition, d
from Elsevier Saunders
2012, with permission
processing
Black branching lines appear on a processed him. Which of the following is
the most likely cause?
fixer cut-off
developer cut-off
fingernail damage
static electricity
air bubbles
33
RADIOLOGY
Dose equivalent is expressed in terms of:
coulombs/kilogram (C/kg)
gray (Gy)
sievert (Sv)
quality factor (QF)
rad biology
RADIOLOGY
34
static electricity
Film Handling: Problems and Solutions
Example
Developer
cut-off
Fixer
cut-off
Over-
lapped
films
Air
bubbles
Fingernail
artifact
Finger-
pri nt
artifact
Static
,eh?ctricity
Scratched
film
Appearance
Straight white
border
Straight black
border
White or dar k areas
appear on film where
overlapped
White spots
Black crescent-
shaped marks
Black fingerprint
Thin, black,
branching lines
White lines
Problems
Underdeveloped portion of
film due to low level of
developer
Unfixed portion of film due to
low level of fixer
Two films contacting each
other during processing
Air trapped on the film
surface after being placed in
the processing solutions
Film emulsion damaged by
the operator's fingernail during
rough handling
Film touched by fingers that
are contaminated with fluoride
or developer
- Occurs when film packet is
opened quickly
- Occurs when film pack is
opened before the radiographer
touches a conductive object
Soft emulsion removed from
the film by a sharp object
Solutions
Check developer level before
processing; add solution if
needed
Check fixer level before pro-
cessing; add solution if needed
Separate films so that no contact
takes place during processing
Gently agitate film racks after
placing in processing solutions
Gently handle films holding
them on the edges only
Wash and dry hands thoroughly
before processing
- Open film packet slowly
- Touch a conductive object
before unwrapping films
Use care when handling films
and film racks
Reprinted from lannucci, Joen M. and Laura Jansen: Denial Radiography Principles and Techniques. Fourth Edition. 2012, with permission
from Elsevier Saunders
si evert (Sv)
Exposure measurement
exposure refers to the measurement of ion-
ization in air produced by x-rays
roentgen (R) is a way of measuring radia-
tion exposure by determining the amount of
ionization that occurs in air
R is limited to measurement in air
there is no SI unit for exposure that is equiv-
alent to the R
exposure expressed in Coulombs per kilo-
gram (C/kg)
Dose measurement
dose refers to amount of energy absorbed
by a tissue
rad is a unit of absorbed dose that is equal
to the deposition of 100 ergs/g of tissue
the SI unit for rad is gray (Gy)
Dose equivalent
rem is traditional unit of dose equivalent
used to compare the biologi&.ffects_of dif-
ferent Jypes of radiation on a tissue or organ
is the product of Gy x QF (quality factor)
specific for the radiation type
for x-rays, QF=1
5Tumt for rem is sievert (Sv)
Uni t Definition Conver si on
Traditional System (older system)
roentgen (R)
radiation
absorbed close
(rad)
1 rem = rads X QF
roentgen
equivalent (in)
man (rem)
SI system (newer system)
lR = 87erg/g
1 rad = 100 erg
1R =
2. 58X10 "' C/kg
1 rad = 0.01 Gy
Coulombs
per kilogram
(C/kg)
gray (Gy)
sievert (Sv)
1 Gy = 0.01 J/kg
l Sv = Gy XQF | 1
1 rem = 0.01 Sv
1 C/kg = 3880 R
is*si
10 rads
: Sv = 100 rerh>
rad biology
List the following cells from most RADIORESISTANT to most RADIOSENSITIVE.
muscle
small lymphocyte
skin
thyroid gland
35
RADIOLOGY
rad biology
After the bombings of Hiroshima, there were many persons exposed to radi-
ation. Symptoms such as hair loss did not occur until days following the ex-
posure. The time between exposure and onset of symptoms is termed:
latent period
period of cell injury
recovery period
cumulative effects period
36
RADIOLOGY
muscle thyroid gland skin small lymphocyte
all ionizing radiations are harmful
to living tissues
radiation produces chemical changes
that results in biologic damage in living
tissues
not all cells respond to radiation in the
same manner
cells respond to radiation based on mi-
totic activity, differentiation and cell
metabolism
cells that are dividing and immature
are most susceptible to radiation
radiosensitive cells are susceptible to ra-
diation exposure
the most radiosensitive cell is the small
lymphjaq&e
radioresistant cells are resistant to radi-
ation exposure
the most radioresistant cells are muscle
anrlnjejye
radiation effects are classified as somatic
(occur in person irradiated) or genetic
(passed on to future generation)
Sensitivity Radiosensitive Radioresistant Cells Sensitivity
high
high
high
high
fairly high
fairly high
fairly high
small lymphocyte
bone marrow
reproductive cells
intestinal mucosa
skin
lens of eye
oral mucosa
muscle tissue
nerve tissue
mature bone/cartilage
salivary gland
thyroid gland
kidney
liver
low
low
fairly low
fairly low
fairly low
fairly low
fairly low
latent period
Mechanisms of radiation injury
ionization & free radical formation are re-
sponsible for cell injury
free radical formation is the primary mecha-
nism responsible for damage
Theories of radiation injury
direct theory - cell damage results when ra-
diation directly hits critical areas within the cell
& direct alteration of the cell occurs
indirect theory - suggests that x-ray photons
are absorbed within the cell and cause the for-
mation free radicals & toxins which result in cell
damage K- f*W+$wa - ^W, W * eeAi,
Dose-response curve
a dose-response curve is used to demonstrate
the response of tissues to the dose of radiation
received
a threshold dose does not exist & response of
tissues is directly proportional to the dose
injury from radiation depends on total dose,
.dose ratejânjount of tissue affected, cgjl sen-
sitivity and age
Stochastic & nonstochastic effects
stochastic effects occur as a direct function of
dose (cancer, genetic mutations)
nonstochastic effects have a threshold and in-
crease in severity with increased dose (hair loss,
decreased fertility)
Radiation injury sequence
latent period - period of time between exposure
and onset of symptoms
period of injury - follows latent period and may
result in cell death, change in cell function or ab-
normal mitosis
period of recovery - follows injury; depending on
a number of factors, cells can repair the damage
caused by radiation
Radiation effects
short term effects occur when large amounts are
absorbed in a short period of time (not applicable
to dentistry)
long term effects occur when small amounts are
absorbed over a long period of time; linked to in-
duction of cancer, birth & genetic effects
cumulative effects occur; radiation damage is ad-
ditive and unrepaired damage accumulates in the tis-
sues and leads to health problems (cancer, cataract
formation, birth defects)
Radiation effects on cells
the cell nucleus is more sensitive to radiation than
cytoplasm; DN A is affected
cell division is disrupted which may lead to dis-
rupted cell function or cell death
radiation causes cell death by damaging chromo-
somes
rad biology
A patient with a large squamous cell carcinoma of the lateral border of the
tongue is scheduled for a radical neck dissection. Prophylactic extractions of
hopeless teeth must be done to prevent which of the following?
osteoradionecrosis
bisphosphonate osteoradionecrosis
periodontal disease
rampant caries
none of the above
37
RADIOLOGY
rad biology
The most common oral problems that occur following radiation and
chemotherapy include mucositis, infection, pain and bleeding.
The oral cavity is irradiated during the course of treating radiosensitive oral
malignancies, usually squamous cell carcinoma.
> the first statement is true, the second is false
38
RADIOLOGY
Definition
most serious possible complication facing the
oral cancer patient
condition of non-vital bone in a site of radio-
therapy; bone dies as a complication of radio-
therapy
is not an infection
Cause
radiation therapy destroys cancerous cells but
also destroys normal cells, damaging small ar-
teries and reducing circulation
insufficient blood supply to the irradiated area
decreases the ability to heal, and any subse-
quent infections to the jaw can pose a huge risk
to the patient
patients receiving high dQjt_Qf,xadiation
>40 Gv) to the jaw area are at risk
Histologic features- 3 H' s
v* hypocellular bone
v^hypovascular tissue
v""hypoxic tissue & bone
Prevention
extract all hopeless teeth 3 weeks prior to ra-
diotherapy
if extracting after radiotherapy, use of systemic
antibiotics is warranted
hyperbaric oxygen treatments before and
after radiotherapy may be helpful
osteoradionecrosis
Clinical features
may involve the maxilla or mandible
more common in the mandible
most frequently occurs when an insult to the bone
is sustained in the irradiated area, such as related
subsequent surgery, biopsy, tooth extractions or
denture irritations
may also be precipitated by periodontal disease
or occur spontaneously
symptoms may include pain, swelling, reduced
mobility, drainage, exposed bone in the involved
area and destruction of bone
symptoms may occur months or years after the
radiotherapy
Management
difficult to manage
prevention is key
debridement of infected bone may be required
advanced cases may require radical surgery
patients must be followed closely by physicians
and dentist regularly
Radiation therapy of oral cavity
used to treat radiosensitive oral malignant tu-
mors, usually squamous cell carcinoma
indicated when the tumor is radiosensitive,
advanced, or, cannot be treated surgically be-
cause it is deeply invasive
fractionation
- total radiation dose is delivered in smaller
multiple doses
- provides greater tumor destruction than a sin-
gle large dose
- allows for increased cellular repair of nor-
mal tissues
- increases mean oxygen tension resulting in
tumor cells that arc more radiosensitive
WMMI MM n
Radiation effects on the teeth
irradiation of developing teeth severely retards
growth
adult teeth are radioresistant\3^<'
Radiation effects on bone
irradiation of bone results in damage to the
fine vasculature
normal marrow may be replaced with fatty
maiTOW or fibrous connective tissue
necrosis may occur and exhibits loss of os-
teoblastic and osteoclastic activity
Radiation effects on oral tissues Ks
occurs by end of 2
nd
weekpf therapy *5jf
mucositis results; appears as areas of redness and
inflammation
as therapy continues, the oral tissues break down
resulting in formation of white pseudomembranes
oral condition worsens with continued therapy
and candidiasis often occurs
following therapy, oral tissues heal within ap-
proximately 2 months ifogut 8
Radiation effects on taste buds /-'
taste buds are radiosensitive
radiation therapy damages taste buds
a loss of taste may first occur during the 2
nd
or
3
rd
week of radiation therapy
Radiation effects on salivary glands
radiation therapy damages salivary gland tissues
there is a marked & progressive loss of salivary
secretion; extent of reduced flow is dependent on
dose
causes decreases in saliva, pH & buffering ca-
pacity
causes increased viscosity
dry moutn (xerostomia) results & makes the pa-
tient susceptible to radiation caries - a rampant
form of caries
xerostomia causes tenderness of oral tissues and
difficulty in swallowing
rad char
In the dental x-ray tube, the number of electrons flowing per second is meas-
ured by:
kilovoltage peak (kVp)
milliamperage (mA)
time (in seconds)
all of the above
39
RADIOLOGY
rad char
When the PID length is changed from 8" to 16", the target-receptor distance
is doubled. According to the Inverse Square Law, the resultant x-ray beam is:
1/4 as intense
1/8 as intense
four times more intense
eight times more intense
none of the above
40
copyright e 2013-2014- Dental Decks
RADIOLOGY
W~ TJu^-^
milliamperage (mA)
^rrv*4
^ V t i
x_
ray beam intensity
time and distance
x-ray beam quality & kVp
quality refers to the average energyor 7 ^ intensity is the total energy contained in
penetrating power of the x-ray beam and the x-ray beam at a specific area at a given
is controlled by the kilovoltage peak (kVp) time
kVp controls the speed & energy of the ~ Qrfntensity is affected by kVp, mA, exposure
electrons and determines the penetrating
power of the beam >
kVp range for dental radiography is A s^^k ^
cîookvî Tt<y
x-ray beam quantity & mA - *.
quantity refers to the number of x-rays J ^ ^ H, a*
1
produced and is controlled by the mil-'
e
\^
l
%
liamperage (mA)
mA controls the amperage of the fila-
ment current and the amount of electrons
that pass through the filament
mA controls the temperature of the fil-
ament
as the mA increases, more electrons pass
through the filament and more x-rays are
produced
JTIA range for dental radiography is
j ^ l 5mAP
^" Ti Hmmi i ni i M urn-
to remember, think alphabetical order ...
kVp= quality ( k & 1)
mA = quantity ( m & n )
Adjustment
T
1
r
i
T
i
kVp
kVp
mA
mA
time
time
Film
appears
darker
lighter
darker
lighter
darker
lighter
to IN CREASE film density & make it darker,
IN CREASE:
mA
kVp
time
to DECREASE film density & make it lighter,
DECREASE:
mA
kVp
time
Inverse Square Law
defined as:
the intensity of the radiation is inversely
proportional to the square of the distance
from the source of radiation
inversely proportional means that as one
variable increases, the other decreases
when the target-receptor distance is in-
creased, the intensity is decreased
original intensity . new intensity
new distance
2
original distance
2
OS
"V
closer
Reprinted from lannucci, Jocn M. and Howerton,
Laura Jansen: Dental Radiography Principles and
Techniques. Fourth edition 2012, with permission
from Elsevier Saunders.
1/4 as intense
Example:
If the PID length is changed from 8" to 16", how
does this increase in target-receptor distance af-
fect the intensity of the beam?
plug numbers into the mathematical for-
mula:
x/ 8
2
4*
/
U
K \IW
solve for x
1 / x= 16
2
/ 8
2
1 / x= 256 / 64
1 / x= 4 / 1
x= 1/4 answer
doubling the distance results in a beam that
is % as intense
the x-ray beam that exits an 8" PID is more
intense than one the exits a 16" PID (see dia-
gram)
The distance traveled by the x-ray beam affects
the intensity; distances to be considered include
the following:
target-surface distance is the distance from
the source of radiation to the surface of the pa-
tient's skin
target-object distance is the distance from
the source of radiation to the tooth
target-receptor distance is the distance from
the source of radiation to the receptor ffilm or
sensor)
rad char
A 6'5" muscular male with a large mandible requires a complete series of den-
tal images. You plan to increase the kVp because of his size. Identify each of
the following that results with the increased kVp:
a more penetrating beam
' a less penetrating beam
a reduced subject contrast
an increased subject contrast
long scale contrast
short scale contrast
41
RADIOLOGY
rad char
Identify each of the following that influence the density of an image:
kVp
mA
exposure ti me
use of a 2-film packet
42
RADIOLOGY
Increased kVp
produces x-rays with increased energy
(speed) and shorter wavelength
increases the penetrating power of the x-
ray beam
is needed for larger patients with large
bones and significant amounts of soft tissue
results in increased density (makes image
darker)
results in reduced or low contrast which is
long-scale contrast
Contrast
refers to how sharply dark and light areas
are separated or differentiated on an image
the difference in degrees of blackness be-
tween adjacent areas on a dental radiograph
a more penetrating beam
a reduced subject contrast
long scale contrast
Long-scale contrast
LONG scale =
JLOW contrast =
LOTS of gray
a low contrast image exhibits many shades
of gray
a low contrast image does not exhibit black
& white
Adjustment
T
(High)
4
(Low)
kVp
kVp
Contrast
scale
LONG
lots of gray
SHORT
black & white
Contrast
LOW
HIGH
Contrast & kVp
adjustment of kVp affects contrast
with low kVp (65-70), a high contrast
image results
with high kVp (90), a low contrast image
results
Patient size & kVp
large patients need increased kVp;
if not increased image appears LIGHT
small patients need decreased kVp;
if not decreased image appears DARK
Density description
a visual characteristic of a radiographic
image
overall blackness or darkness of an image
when a dental image viewed, the relative
transparency of areas depends on the distri-
bution of black silver particles
density is the degree of.silver blackening
an image of correct density allows one to
view the black areas (air space images),
white areas (enamel, dentin, bone) and gray
areas (soft tissue)
Factors that influence density
exposure factors
-kVp
- mA
- exposure time
thickness of subject
adjustments in kVp, mA and exposure time
can be made to compensate for size variations
an increase in any exposure factor , sepa-
rately or combined, increases the density of
an image
\9
Adjustment
T
4
r
4.
T
4
t
x
4
kVp
kVp
mA
mA
time
time
thickness
thickness

.
kVp
mA
exposure time
Densitv Film
t
4
t
4
T
4
4
T
appears
darker
lighter
darker
lighter
darker
lighter
lighter
darker
Size of patient
thickness of subject also affects density;
with a large patient (thick bones, excess soft
tissue), fewer x-rays reach the receptor and
as a result, the image appears lighter
with increased thickness, a decreased den-
sity results
with decreased thickness, an increased
density results
Note: the use of a 2-film packet does not affect
the density of the image
rad physics
Which of the following converts electrons into x-rays?
positive anode
1
negative anode
' positive cathode
negative cathode
43
RADIOLOGY
rad physics
Which of the following focuses the electrons into a narrow beam and directs
the beam across the tube toward the tungsten target of the anode?
copper stem
tungsten filament
insulating oil
molybdenum cup
lead collimator
44
RADIOLOGY
positive anode
X-ray tube
heart of the x-ray generating system
critical to the production of x-rays
glass vacuum tube from which all the air has
been removed
component parts include leaded glass hous-
_ing, negative cathode & positive anode
Leaded-glass housing
leaded-glass vacuum tube that prevents x-
rays from escaping in all directions
a "window" permits the x-ray beam to exit
the tube
Reprinted from Iannucci, Jocn M. and Howerton, Laura
Jansen: Dental Radiography Principles and Techniques.
Fourth edition 2012 with permission from Elsevier-Saun-
ders.
to remember,
think CATN AP. . .
cathode is negative
| Cathode/negative electrode!
supplies electrons necessary to generate x-
rays
consists of a tungsten wire filament in a
molybdenum cup-shaped holder
tungsten filament (coiled tungsten wire)
produces electrons when heated
molybdenum cup focuses the electrons
into a narrow beam and directs the beam
across the tube toward the tungsten target of
the anode
Ano node/positive electrode ode
isTnto x- converts electronslivto x-ray photons
consists of a wafer-thin tungsten plate em-
bedded in a solid copper rod
tungsten target serves as a focal spot and
converts bombarding electrons into x-ray
photons
copper stem functions to dissipate the heat
away from the tungsten target
molybdenum cup
Production of x-rays
tungsten filament is heated and electrons
are produced
molybdenum cup focuses the electrons
into a narrow beam and directs the beam to-
wards the tungsten target in the anode
x-rays are generated when the beam is sud-
denly stopped by the tungsten target
4fafi.enigy_of motion is converted to x-ray
energy (1%) and heat (99%)
insulating oil that surrounds the x-ray tube
absorbs the heat
x-rays that are produced are emitted in all
directions; leaded-glass housing of tube pre-
vents the x-rays from escaping
small number of x-rays exit the x-ray tube
through the unleaded glass window area
x-rays travel through unleaded glass win-
dow, through the tubehead seal and then the
aluminium disks
the lead collimator restricts the size of the
beam and the x-ray beam travels down the
lead lined position -indicating device (PID)
and exits at the opening
Reprinted from Haring, Joen Iannucci and Laura lansen: Dental Radiogra
phy: Principles and Techniques: Third Edition. 2000, with permission front
Elsevier.
Component functions
tungsten filament of cathode produces
electrons when heated
molybdenum cup of cathode focuses the
electrons into a narrow beam and directs
the beam towards the tungsten target in the
anode
tungsten target in anode stops the elec-
trons and converts the energy into x-rays &
heat
(copper stenijjserves to dissipate the heat
that is createdwith the production of x-rays
|i_Metal
ji housing
of x-ray
1 tube-
1
J
a-lnsulating
: oil
K. . -
Lead Unleaded glass
collimator window of
x-ray tube
'osition
indicating
device
rad physics
Identify each of the following that are properties of x-rays:
no weight
travel at speed of sound
have no charge
cannot be deflected or scattered
are invisible
are absorbed by matter
do not damage living cells
do not cause fluorescence
45
RADIOLOGY
rad physics
Rectification is the conversion of a direct current (DC) to an alternating cur-
rent (AC).
The dental x-ray tube acts as self-rectifier in that in changes DC to AC while
producing x-rays.
46
RADIOLOGY
Properties of x-rays
appearance
invisible and cannot be detected by
any of the senses
mass
have no mass or weight
charge
have no charge
speed
travel at the speed of light
wavelength
travel in waves and have short wave-
lengths with a high frequency\V""
path of travel
travel in straight lines and can be de-
flected, or scattered
focusing capability
cannot be focused to a point and al-
ways diverge from a point
no weight
have no charge
are invisible
are absorbed by matter
penetrating power
can penetrate liquids, solids, and gases;
the composition of the substance deter-
mines whether x-rays penetrate or pass
through, or are absorbed
absorption
absorbed by matter; the absorption de-
pends on the atomic structure of mat-
ter and the wavelength of the x-ray
ionization capability
can interact with materials they pene-
trate and cause ionization
fluorescence capability
can cause certain substances to fluo-
resce or emit radiation in longer wave-
lengths (e.g., visible light and
ultraviolet light)
effect on film
can produce an image on photographic
film
effect on living tissues
cause biologic changes in living cells
electricity is the energy used to make x-
rays; electrical energy consists of a flow of
electrons through a conductor; this flow is
known as the electrical current
electrical current is termed direct current
(DC) when the electrons flow in one direc-
tion through the conductor
alternating current (AC) describes an elec-
trical current in which the electrons flow in
two, opposite directions
rectification is the conversion of AC to DC
dental x-ray tube acts as a self-rectifier in
that it changes AC into DC while producing
x-rays; ensures that current is always flowing
in the same direction from cathode to anode
amperage is the measurement of the num-
ber of electrons moving through a conductor,^,
c7irrentls~measured in amperes (A) or mil-
liampcres (mA)
voltage is the, measurement of electrical
force that causes electrons to move from a
negative pole to a positive one; measured in
volts (V) or kilovolts (kV)
circuit is a path of electrical current; two
electrical circuits are used to produce x-rays:
a low-voltage/filament circuit and a high-
voltage circuit
* % .
low voltage/filament circuit uses 3 to 5
volts, regulates the flow of electrical current
to the filament; controlled by mA settings
high-voltage circuit uses 65,000 to 100,000
volts, provides the high voltage required to
accelerate; controlled by kVp settings
transformer is a device that is used to either
increase or decrease the voltage in an electri-
cal circuit; it alters the voltage of the incom-
ing current and then routes the electrical
energy to the x-ray tube; three types of trans-
formers are used to adjust the electrical cir-
cuits (see below)
step-down transformer is used to decrease
the voltage from the incoming 110- or 220-
line voltage to the 3 to 5 volts used by the fil-
ament circuit
high-voltage circuit uses both a step-up
transformer and autotransformer
step-up transformer is used to increase the
voltage from the incoming 110- or 220-line
voltage to the 65,000 to 100,000 volts used
by the high-voltage circuit
autotransformer serves as a voltage com-
pensator that corrects for minor fluctuations
in the current
rad physics
Which of the following occurs only at 70 kVp or higher and accounts for a very
small part of the x-rays produced in the dental x-ray machine?
compton scatter
coherent scatter
characteristic radiation
general (Bremsstrahlung) radiation
47
RADIOLOGY
rad protection
Identify each component of inherent filtration:
insulating oil
unleaded glass window
lead lined PID
tubeheadseal
48
RADIOLOGY
> characteristic radiation
Types of x-rays
not all x-rays produced in the x-ray tube are
the same; x-rays differ in energy and wave-
length
energy and wavelength varies based on how
the elections interact with the tungsten in the
anode
kinetic energy_of electrons isconverted to
x-ray photons via general (braking or Brem-
sstrahlui'g) radiation or characteristic radiat-
ion
general/braking radiation is produced
when speeding electrons slow down due to in-
teractions with the nuclei of the tungsten tar-
get atoms
- braking refers to the sudden stopping or
slowing of high-speed electrons when they
hit or come close to the tungsten target
- 70% of the x-ray energy produced is gen-
eral radiation
characteristic radiation is produced when
a high-speed electron dislodges an inner-shell
electron from the tungsten atom and causes
ionization " I
- the remaining electrons rearrange to fill the
vacancy resulting in a loss of energy & pro-
duction of x-ray photon
- only a small % of x-rays produced; occurs
only at > 70 kVp
Definitions
primary radiation is the penetrating x-ray
beam that is produced at the target of the
anode and exits the tubehead; a.k.a. primary
or useful beam
secondary radiation is x-radiation that is
created when the primary beam interacts with
matter; ig less penetrating thanprimaryradia-
tion
scatter radiation, a form of secondary rad-
iation, is the result of an x-ray deflected from
its path by the interaction with matter; deflect-
ed in all directions by the patient's tissues;
detrimental to tissues
id Compton scatter] ionization takes place;
& \ an x-ray photon collides with an n outer-shell
C^*> > electron and gives up part of its energy to
'% eject the electron from its orbit; x-ray photon
*J*Hoses energy and continues in a different dir-
% ection (scatters) at a lower energy level; ac-
counts forJ>2% of the scatter that occurs
coherent or unmodified scatter occurs
when a low-energy x-ray photon interacts
with an outer-shell electron; no change in the
atom occurs; x-ray photon of scattered radiat-
ion is produced; x-ray photon is scattered in
a different direction from that of the incident
photon; noJoss of energy and no ionization
occur; accounts for 8% of the interactions
insulating oil
< unleaded glass window
' tubehead seal
inherent filtration takes place when the
primary beam passes through the glass
window of the x-ray tube, the insulating
oil, and the tubehead seal
inherent filtration of the dental x-ray
machine is approximately 0.5 to 1.0 milli-
meter (mm) of aluminum
inherent filtration alone does not meet
the standards regulated by state and federal
laws; added filtration is required
OvtiioKjljtJ
. i
OMMUMHW <k<
4r
^> -st ow e*<av*
Reprinted from Iannucci, Joen M. and Howerton, Laura Jansen: Den^' **^5l$
lal Radiography Principles and Techniques. Fourth edition 2012 (/
willi permission from Elsevier-Saunders.
Aluminum filter
~
r>K
- 1
Long and short
wavelengths
Short
wavelenotbs
Enlargement o! detail
added filtration refers to the placement
of aluminum discs in the path of the x-
ray beam between the collimator and the
tubehead seal
aluminum discs can be added to the
tubehead in 0.5 mm increments
purpose of the aluminum discs is to fil-
ter out the longer-wavelength, low-en-
ergy x-rays from the x-ray beam
low-energy, longer wavelength x-rays
are harmful to the patient and are not
useful in diagnostic radiography
filtration of the x-ray beam results in
a higher energy & more penetrating
useful beam
state and federal laws regulate the re-
quired thickness of total filtration = in-
herent filtration + added filtration
dental x-ray machines operating at ,<
70 kVp require a minimum total of 1.5
mm aluminum filtration
dental x-ray machines operating at
> 70 kVp require a minimum total of 2.5
mm aluminum filtration
rad protection
Identify each of the following that is recommended for operator protection
during exposure.
stand 3 feet away from x-ray tubehead
stand at a 45-75 degree angle to the beam
wear a lead apron
stand behind a barrier
hold the PID
hold the film if the patient cannot stabilize it
49
RADIOLOGY
rad protection
Prior to x-ray exposure, the proper prescribing of radiographs and the use of
proper equipment can minimize the amount of radiation that a patient re-
ceives.
Radiographs must be prescribed by the dentist based on the individual needs
of the patient.
50
RADIOLOGY
rad protection
Identify each of the following that is recommended for operator protection
during exposure.
stand 3 feet away from x-ray tubehead
stand at a 45-75 degree angle to the beam
wear a lead apron
holdthe PID
hold the film if the patient cannot stabilize it
49
RADIOLOGY
rad protection
Prior to x-ray exposure, the proper prescribing of radiographs and the use of
proper equipment can minimize the amount of radiation that a patient re-
ceives.
Radiographs must be prescribed by the dentist based on the individual needs
of the patient.
50
RADIOLOGY
Operator protection guidelines
must use proper protection during exposure
to avoid the primary beam, scatter radiation
etc.
must avoid the primary beam
distance, position and shielding are all im-
portant for protection
Distance recommendations
must stand at least 6' away from the tube-
head
if distance is not possible, a protective bar-
rier must be used
Primary beam
Y '
"... ' -:.,.\:.-: :.::.-:: ' $ '
l W
'
Radiographer
135"
Reprinted from Iannucci, Joen M. and Howerton, Laura Jansen:
Dental Radiography Principles and Techniques. Fourth edition
D 2012 with permission from Elsevier-Saunders.
Position recommendations
must stand perpendicular to the primary
beam, or, at a 0-135 degree angle to the
beam " '
never hold a film in place for a patient dur-
ing exposure
never hold the PID during exposure
Shielding recommendations
whenever possible, stand behind a protec-
tive barrier, such as a wall
Maximum permissible dose (MPD)
MPD is the dose of radiation the body can
endure with little or no injury
for non-occupationally exposed person limit
is 0.001 Sv/year
for occupationally exposed person limit is
0.05 Sv/year
for occupationally exposed pregnant person
limit is 0.001 Sv/year
ALARA concept
As Low As Reasonably Achievable concept
states that all exposure to radiation must be
kept to a minimum
applies to patients & operators
Patient protection before exposure
proper prescribing of dental radi-
ographs
use of proper equipment including
filtration, collimation and PID
the rectangular PID (instead of
round) is most effective in reducing pa-
tient exposure
use of a long PID is more effective
than use of a short PID
Patient protection during exposure
use of thyroid collar for intraoral
films and lead apron for all films
use of digital imaging or use fastest
film available (F-speed)
use of beam alignment devices
use of correct exposure factors (kVp,
mA & exposure time)
use of proper technique
Patient protection after exposure
proper sensor or film handling
proper image retrieval or film pro-
cessing
Guidelines for prescribing of dental
radiographs
dentist is responsible for ordering im-
ages & uses professional judgment to
make decisions concerning the num-
ber, type and frequency of dental radi-
ographs
radiographic exam should never in-
clude a predetermined number of
films
radiographs should never be taken at
predetermined time intervals
radiographs should be ordered based
on the individual needs of the patient
guidelines for prescribing dental ra-
diographs have been determined by
the ADA and FDA
rad protection
Which of the following is used to restrict the size and shape of the x-ray beam
and to reduce patient exposure?
aluminum discs
collimation
inherent filtration
total filtration
51
copyright > 2013-2014- Dental Decks
RADIOLOGY
51
tech
If a processed film appears light with herringbone or tire track pattern on it,
which of the following is the likely cause?
the film was bent during placement
the film was reversed (placed backwards) during exposure
the film was exposed twice
the patient moved during exposure
52
RADIOLOGY
collimation
Collimation
used to restrict the size and shape of
the x-ray beam & to reduce patient
exposure
a collimator is a lead plate with hole
in the middle, is fitted over the open-
ing of the machine housing where the
beam exits
collimator may have a round or rec-
tangular opening
rectangular collimator restricts the
size of the beam to slightly larger than
a size 2 film and significantly re-
stricts patient exposure
circular collimator produces a cone
shaped beam & restricts the size of the
beam to 2.75" in diameter
when using a circular collimator, fed-
eral regulations re quire that the
beam be restricted to 2.75" as it exits
the PID and reaches the skin of the pa-
tient
Position indicating device (PID)
the PID or cone is an extension of the
x-ray tubehead used to direct the
beam
types of PID include conical, round
and rectangular
a conical PID is a closed plastic cone
that produces scatter radiation;no longer
used in dentistry
a round PID is a tubular open ended
lead- lined extension; no PID scatter is
produced
a rectangular PID is a rectangular
open ended lead-lined extension; is
most effective in reducing patient ex-
posure; no PID scatter is produced
both round and rectangular PIDs are
available in two lengths: short (8")
and long (16")
^"VtMJangPID is preferred because less
V'uivergence of me*x-ray beam occurs
the film was reversed (placed backwards) during exposure
A reversed
film is light &
exhibits a
herringbone
pattern.
A double exposure appears dark &
exhibits a double image.
A bent film appears stretched & distorted.
With movement of the patient or PID, a blurred
image results.
Images reprinted from Iannucci, Joen M. and Howerton, Laura Jansen: Dental Radiography Principles and Techniques. Fourth edition 2012
with permission from Elsevier-Saunders.
tech
Of the following factors that influence the geometric characteristics of an
image, which one is NOT able to be changed by the operator?
target-receptor distance
object-receptor distance
film composition
focal spot size
object-receptor alignment
53
RADIOLOGY
tech
A periapical image shows stretched and elongated maxillary central incisors.
Which of the following is the likely cause?
vertical angulation is excessive/too steep
vertical angulation is insufficient/too flat
incorrect horizontal angulation
any of the above
54
RADIOLOGY
-.
focal spot size
Magnification
enlargement of an image that results
from the divergent paths of x-ray beam
some degree of magnification is pres-
ent in every image due to divergent paths
influenced by target-receptor distance
and object-receptor distance
target-receptor distance (or source to
receptor distance) is the distance be-
tween the source of x-rays & image re-
ceptor
PID determines target-receptor distance
short er PID results in more magnifi-
cation; longer PID results in lessjnagni-
JBcatjori
object-receptor distance is the dis-
tance between the tooth & image recep-
tor
if there is decreased distance between
the tooth & receptor, less magnification
occurs
if there is increased distance between
the tooth & receptor, more magnification
occurs
Focal spot size
tungsten target in anode is focal spot
size ranges from0.6 -1.0 minj^nd is de-
termined by the manufacturer (cannot be
controlled by operator)
the size of focal spot influences the
image sharpness
the smaller the focal spot, the sharper
the image
In dental radiography, the most accurate
image:
use the smallest focal spot size
use the LONGEST target-receptor dis-
tance
use the SHORTEST object-receptor
distance
direct the central ray of the x-ray beam
perpendicular to the receptor and tooth
keep the receptor parallel to the tooth
being imaged
Vertical angulation
refers to the positioning of the PID in a
vertical, or up-and-down plane
correct vertical angulation results in an
image that is the same length as the tooth
incorrect vertical angulation results in
ELONGATION or FORESHORTEN IN G
an elongated image appears long & results
from too flat vertical angulation
a foreshortened image appears short & re-
sults from too steep vertical angulation
0 degree vertical angulation = PID parallel
with floor
positive vertical angulation = PID pointing
DOWN to floor/PID above occlusal plane
negative vertical angulation = PID point-
ing UP to ceiling/PID below occlusal plane
H
Vortical angulation
refers to the positioning of the PID in a
horizontal or side-to-side plane
when tire central ray is directed through the
interproximal contacts of the teeth, correct
horizontal angulation results and open con-
tacts on seen the dental image
incorrect horizontal angulation results in
overlapped contacts (contacts are superim-
posed over each other)
ELONGATION results
when the vertical angula-
tion is TOO FLAT;
teeth look long &
stretched
FORESHORTENING
results when the vertical
angulation is TOO
STEEP; teeth look short
Both photos reprinted from Haring, Joen Iannucci and Laura
Jansen: Dental Radiography: Principles and Techniques: Third
Edition. 2000, with permission from Elsevier.
tech
Identify the cause of this panoramic image error seen below:
chin tipped too far upward
chin tipped too far downward
' head tipped to one side
RADIOLOGY
Identify the cause of this distorted periapical film seen below:
tech
film bending
film creasing
phalangioma
double exposure
movement
Reprinted from Haring,
Joen Iannucci and
Laura Jansen: Dental
Radiography: Princi-
ples and Techniques:
Third Edition. 2000,
with permission from
Elsevier.
58
RADIOLOGY
58
chin tipped too far downward
chin tipped too far downward \ /
(see image on reverse side)
mandibular incisors appear blurred
loss of detail in anterior apical region
condyles may not be visible
results in severe interproximal over-
lapping
occlusal plane has excessive upward
curve
exaggerated smile line is seen
chin tipped too far forward A
(see image below) ' ^
hard palate & floor of nasal cavity ap-
pear superimposed over maxillary teeth
maxillary incisors appear blurred
maxillary incisors appear magnified
occlusal plane downward curve
reverse smile line (frown) is seen
film bending
Film bending
images appear stretched & distorted
occurs due to curvature of hard palate
Film creasing
crease appears as a thin black line
represents where the emulsion of the film has
cracked
Phalangioma
the bone of the patient's finger seen on the
image
results when finger is in front of the receptor
instead of behind it (seen with use of bisecting
technique where patient holds the film not
recommended)
Light film
may result from underexposure too short
of exposure time, too low kVp or too low mA
Dark film
may result from overexposure - too long of
exposure time, too high kVp or too high mA
Fogged film -s^-"""
appears gray & lacks contrast
occurs when film is exposed to radiation other
than primary beam (e.g., scatter)
may result from improper safelighting or light
leaks in dark room
All three photos reprinted from Haring, Joen iannucci and Laura Jansen:
Dental Radiography: Principles and Techniques: Third Edition. 2000,
with permission from Elsevier.
Black film
exposed to light
Clear film
film is unexposed
A light film results from
underexposure
a dark film results
from overexposure
a fogged film ap-
pears gray and
lacks contrast
tech
A periapical image shows overlapped contacts. This error is cause by:
vertical angulation is excessive/too steep
beam not centered over receptor
poor receptor placement
RADIOLOGY
56
tech
Use the two images below to determine the spatial position of the round ob-
ject. Following the exposure of image # 1, the x-ray tubehead was moved and
the beam was directed from a mesial angulation in image #2. Given this in-
formation, where is the round object located?
lingual to the first molar
buccal to the first molar
in soft tissue
in bone
<
c
6>
Film #1 Film #2
55
RADIOLOGY
Overlapped contacts
if the central ray is not directed through
the interproximal contacts of the teeth, the
horizontal angulation is incorrect
incorrect horizontal angulation results in
overlapped contacts seen on the image
Cone-cut
if the beam is not centered over the recep-
tor, a clear unexposed area or cone-cut is
seen on the image
the PID or "cone" is said to "cut" the image
a cone-cut may occur with the use of a rect-
angular or round PID
a conecut may occur with or without the
use of a beam alignment device
poor receptor placement
a periapical image shows the entire tooth
and root, including the apical area and must
be placed to cover those areas
incorrect periapical receptor placement
may result in absence of apical structures or
a tipped or tilted occlusal plane
a bite-wing image shows the crowns of both
the maxillary and mandibular teeth, the inter-
proximal areas and crestal bone
incorrect bite-wing receptor placement
may result in absence of teeth or teeth surf-
faces on an image, tipped occlusal plane
Incorrect hori-
zontal angulation
results in over-
lapped contacts.
If the beam is not cen-
tered over the recep-
tor, a cone-cut results
& a clear unexposed
area is seen.
Improper place-
ment (if entire
root is not cov-
ered) will result in
no apices appear-
ing on the image.
Images reprinted from Haring, Joen Iannucci and Laura Jansen: Dental
Radiography: Principles and Techniques: Third Edition. 2000, with
permission from Elsevier.
lingual to the first molar
Buccal object r ul e
a.k.a. t ube shift technique
used to determine an object' s spatial po-
sition/buccal-lingual relationship within
the jaws
two images are obtained, each exposed
with a different angulation
used to compare the object' s position
with respect to a reference point (e.g., root
of a tooth)
Example
if the PID is moved mesially and the ob-
ject in the second image appears to have
moved in the same direction, the object
lies to the lingual
if the PID is moved mesially and the ob-
ject in the second image appears to have
moved in the opposite direction, the ob-
ject lies to the buccal
use the acronym SLOB to remember the
buccal object rule
In image #1, note
the location of the
object in reference
to the mesial root
of the first molar.
In image #2, the
PID was moved
mesially; the ob-
ject in reference
to the mesial root
of the first molar
has also moved
mesially.
L - O - B RULE
Same = Lingual
extraoral
Identify the radiopaque areas labeled 1 & 2 on the image below.
Reprinted from Iannucci, Joen M. and Howerton, Laura Jansen: Dental Radiography Principles and
Techniques. Fourth edition 2012 with permission from Elsevier-Saunders.
72
RADIOLOGY
extraoral
Based on the image below, identify the approximate age of the patient.
Reprinted from Iannucci, Joen M. and Howerton, Laura Jansen: Dental Radiography Principles and Techniques.
Fourth edition 2012 with permission from Elsevier-Saunders.
73
copyright o 2013-2014- Dental Decks
RADIOLOGY
answers 1-2 below
Reprinted from Iannucci, joen M. and Howerton, Laura Jansen: Dental Radiography
Principles and Techniques. Fourth edition 2012 with permission from Elsevier-Saunders.
1. Hoop earring
2. Ghost image of hoop earring
Ghost image
defined as a radiopaque artifact on a
panoramic image that is produced when a
radiodense object is penetrated twice by the
x-ray beam
occurs If all metallic or radiodense ob-
jects (e.g., eyeglasses, earrings, necklaces,
hairpins, removable partial dentures, com-
plete dentures, orthodontic retainers, hear-
ing aids, napkin chains) are not removed
before exposure of panoramic receptor
obscures diagnostic information
Ghost image appearance
resembles its real counterpart
found on the opposite side of the image;
appears indistinct, larger, & highepthan
its actual counterpart
a ghost image of a hoop earring appears
on the opposite side of the image as a ra-
diopacity that is larger & higher than the
real hoop earring; appears blurred in both
horizontal and vertical directions
to avoid ghost images, instruct the pa-
tient to remove all radiodense objects in the
head-and-neck region prior to exposure of
the panoramic receptor
' < 9 years old
Reprinted from Iannucci, Joen M. and Howerton, Laura Jansen: Dental Radiography Prin-
ciples and Techniques. Fourth edition 2012 with permission from Elsevier-Saunders.
The erupted permanent teeth are highlighted in gray in the charts below. Based on this in-
formation, the panoramic film appears to represent a child of < 9 years old.
Permanent teeth
eruption charts
Maxillary
Central incisor
Lateral incisor
Canine
First premolar
Second premolar
First molar
Second molar
Third molar
Age at eruption
7-8
8-9
11-12
10-12
10-12
6-7
12-13
17-21
Mandibular
Central incisor
Lateral incisor
Canine
First premolar
Second premolar
First molar
Second molar
Third molar
Age at eruption
6-7
7-8
9-10
10-12
11-12
6-7
11-13
17-21
tech
Identify each one of the following that is an advantage of using the parallel-
ing technique.
' receptor placement
i comfort
accuracy
simplicity
' duplication
59
RADIOLOGY
tech
Identify each one of the following that is a disadvantage of using the bisect-
ing technique.
decreased exposure time
can be used wi thout a beam alignment device
distortion
angulation problems
60
RADIOLOGY
Parelling technique
based on concept of parallelism
preferred technique for intraoral films
Basic principles
receptor is placed parallel to the long axis
of the tooth being imaged
central ray is directed perpendicular to
both the receptor & long axis of the tooth
a beam alignment device must be used to
keep the receptor parallel to the tooth
the object-receptor distance must be in-
creased to keep the receptor and tooth paral-
lel
the target-receptor distance must be in-
creased to make certain the most parallel rays
will be aimed at the tooth and receptor (16"
target-receptor distance)
Long axis
ol toolh
accuracy
simplicity
duplication
Advantages
accuracy - image is highly representative
of the actual tooth
simplicity - simple & easy to learn and use
duplication - easy to standardize and can be
accurately duplicated when serial images are
needed
Disadvantages
receptor placement - it may be difficult for
operator to place the beam alignment device
in some patients
discomfort - the beam alignment device
may cause discomfort
^to Positions of the receptor, tooth and central ray in the paral-
>ft ^% leling technique. The receptor & long axis of the tooth are par-
**
<*
allel. The central ray is perpendicular to the tooth and receptor.
An increased target-receptor distance (16") is required.
Reprinted from Haring, Joen Iannucci and Laura Jansen: Dental Radiography:
Principles and Techniques: Third Edition. 2000. with permission from El-
sevier.
Bisecting technique
based on rule of isometry
technique used for periapicals
Basic principles
receptor must cover area of interest
receptor must be placed so 1/8" ex-
t endi ng beyond the occlusal or incisal
surfaces
central ray is directed perpendicular
to the imaginary bisector
cent ral ray is directed t hrough the
contact areas of the teeth
x-ray beam must be centered over the
receptor so that the entire receptor is ex-
posed
distortion
angulation problems
Advantages
can be used without a beam alignment
device and therefore may be more read-
ily accepted by patients
requires a short er exposure time
Disadvantages
image distortion (magnification) oc-
curs when a short (8") PTD is used
angulation probl ems may occur be-
cause no beam alignment device is used
resulting in images that are elongated or
foreshortened
Length of image
The image on the receptor is equal to the length of the
tooth when the central ray is perpendicular to the "imag-
inary bisector". A short (8 ") target-receptor distance is
required.
Reprinted from Haring, Joen Iannucci and Laura Jansen: Dental Radiography: Princi-
ples and Techniques: Third Edition. 2000, with permission from Elsevier.

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