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) 1 copyright O 2013-2014- Dental Decks 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 2 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 copyright O 2013-2014- Dental Decks 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 copyright 2013-2014- Dental Decks 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 - computer & monitor 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 - computer & monitor 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 5 copyright 0 2013-2014- Dental Decks RADIOLOGY image char Rank the following from LEAST radiopaque to MOST radiopaque. amalgam bone dentin > maxillary sinus enamel copyri ght 2013-2014- Dental Decks RADIOLOGY both statements are true 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 copyright 2013-2014- Dental Decks 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 copyright 2013-2014- Dental Decks 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. copyright 2013-2014- Dental Decks RADIOLOGY normal anat The coronoid process often appears on what periapical image? maxillary incisor maxillary molar mandibular incisor mandibular molar 10 copyright > 2013-2014- Dental Decks RADIOLOGY Res Image 1- hamulus v a.k.a. hamular process small, hook-like projection of bone extends ..fmm the medial Pterygoid jg|atejof^e 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\ copyright O 2013-2014- Dental Decks 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 4. floor of nasal fossa radiopaque line 5. incisive (nasoplatine) foramen radiolucent structure 6. soft tissue outline of tip of nose slightly ra^oplique'^uTrihe 7. alveolar crest radiopaque line "Courtesy Dr. Stuart C White, UCLA School of Dentistry." normal anat Identify the structures labeled 1- 5 on the image below. Courtesy Dr. Stuart C. White, UCLA School of Dentistry." 13 copyright2013-2014-Dental Decks RADIOLOGY normal anat Identify the structures labeled 1 - 8 on the image below. "Courtesy Dr. Stuart C. White, UCLA School of Dentistry.' 14 copyright 2013-2014- Dental Decks 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 "Courtesy Dr. Stuart C. White, UCLA School of Dentistry." < answers 1 - 8 below 2. inferior nasal conchae A- radiopaque mass 3. floor of nasal fossa 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 "Courtesy Dr. Stuart C. White, UCLA School of Dentistry." normal anat Identify the structures labeled 1- 7 on the image below. "Courtesy Dr. Stuart C. White, UCLA School of Dentistry." .. _ copyright 2013-2014- Dental Decks RADIOLOGY normal anat Identify the structures labeled 1- 4 on the image below. "Courtesy Dr. Stuart C. White, UCLA School of Dentistry." 16 copyright 2013-2014- Dental Decks answers 1 - 7 below 1. lingual cusp of 1 st premolar radiopaque area 2. periodontal ligament space 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 "Courtesy Dr. Stuart C. White, UCLA School of Dentistry." answers 1 - 4 below 1. periodontal ligament space radiolucent line 2. mental foramen ovoid radiolucency 3. submandibular gland fossa radiolucent area 4. film clip mark radiolucent artifact "Courtesy Dr. Stuart C. White, UCLA School of Dentistry." normal anat Identify the structures labeled 1 - 3 on the image below. "Courtesy Dr. Stuart C. White, UCLA School of Dentistry." 17 copyright2013-2014-Dental Decks RADIOLOGY normal anat Identify the structures labeled 1- 7 on the image below. "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 3. submandibular gland fossa large radiolucent area "Courtesy Dr. Stuart C. White, UCLA School of Dentistry." 1. inferior nasal conchae radiopaque mass answers 1- 7 below 2. anterior wall of maxillary sinus radiopaque line 3. floor of nasal fossa radiopaque line 4. maxillary sinus radiolucent space 5. floor of maxillary sinus 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 "Courtesy Dr. Stuart C. White, UCLA School of Dentistry." 7. lingual cusp of 1 st premolar radiopaque band normal anat Identify the structures labeled 1- 6 on the image below. "Courtesy Dr. Stuart C. White, UCLA School of Dentistry." 19 copyright 2013-2014- Dental Decks RADIOLOGY normal anat Identify the structures labeled 1 - 6 on the image below. "Courtesy Dr. Stuart C. White, UCLA School of Dentistry." 20 copyright C 2013-2014- Dental Decks RADIOLOGY answers 1 - 6 below 1. floor of nasal fossa radiopaque line 2. lateral wall in incisive canal ) radiopaque line 3. ala of nose radiopaque line 4. anterior wall of maxillary sinus radiopaque line 5. maxillary sinus radiolucent space 6. lingual cusp of 1 st premolar radiopaque band "Courtesy Dr. Stuart C. White, UCLA School of Dentistry." 1. dentino-enamel junction (DEJ) radiopaque line ' answers 1 - 6 below 2. periodontal ligament space 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 "Courtesy Dr. Stuart C. White, UCLA School of Dentistry." normal anat Identify the structures labeled 1- 3 on the image below. "Courtesy Dr. Stuart C. White, UCLA School of Dentistry." 21 copyright 2013-2014-Dental Decks RADIOLOGY normal anat Identify the structures labeled 1 - 4 on the image below. "Courtesy Dr. Stuart C. White, UCLA School of Dentistry." copyright 2013-2014- Dental Decks RADIOLOGY answers 1- 3 below 1. mandibular tori radiopaque masses 2. lingual foramen radiolucent circle 3. genial tubercles donut shaped radiopacity "Courtesy Dr. Stuart C. White, UCLA School of Dentistry." answers 1- 4 below 1. alveolar crest of bone radiopaque structure 2. lamina dura radiopaque line 3. periodontal ligament space radiolucent line 4. bony trabeculations radiopaque lines "Courtesy Dr. Stuart C. White, UCLA School of Dentistry." normal ant Identify the structures labeled 1- 8 on the image below. "Courtesy Dr. Stuart C. White, UCLA School of Dentistry." 2 3 = = _ _ _ _ ^ _ _ ^ _ _ copyright 2013-2014-Dental Decks RADIOLOGY normal anat Identify the structures labeled 1 - 9 on the image below. "Courtesy Dr. Stuart C. White, UCLA School of Dentistry." 24 copyright 2013-2014- Dental Decks RADIOLOGY 1. marrow space radiolucent space answers 1- 8 below 2. periodontal ligament space 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 "Courtesy Dr. Stuart C. White, UCLA School of Dentistry." 8. enamel radiopaque area 1. dentin radiopaque area answers 1 - 9 below 2. bony trabeculations radiopaque lines 3. marrow space radiolucent area 4. pulp canal radiolucent space 5. periodontal ligament space radiolucent line 6. lamina dura radiopaque line 7. alveolar crest radiopaque structure 8. enamel radiopaque band "Courtesy Dr. Stuart C. White, UCLA School of Dentistry." 9. pulp chamber radiolucent space normal anat Identify the structures labeled 1-12 on the image below. "Courtesy Dr. Stuart C. White, UCLA School of Dentistry." 25 copyright 2013-2014- Dental Decks RADIOLOGY normal anat Identify the structures labeled 1 - 8 on the image below. "Courtesy Dr. Stuart C. White, UCLA School of Dentistry." 2 6 copyright 2013-2014- Dental Decks RADIOLOGY answers 1-12 below 1. bony trabeculations radiopaque lines 2. marrow space radiolucent area 3. tooth #10 maxillary lateral incisor 4. lamina dura radiopaque line 5. dentin radiopaque area 6. periodontal ligament space radiolucent line 7. alveolar crest radiopaque structure 8. pulp canal radiolucent space 9. pulp chamber radiolucent space 10. enamel radiopaque band lljraUdJiJmdot radiopaque circle 12. dentino-enameTjunction radiopaque line % "Courtesy Dr. Stuart C. White, UCLA School of Dentistry." 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 7. periodontal ligament space radiolucent line "Courtesy Dr. Stuart C. White, UCLA School of Dentistry." 8. lamina dura radiopaque line normal anat Identify the structures labeled 1 -15 on the image below. "Courtesy Dr. Stuart C. White, UCLA School of Dentistry." RADIOLOGY 27 copyright2013-2014-Dental Decks normal anat Identify the structures labeled 1 -13 on the image below. "Courtesy Dr. Smart C. White, UCLA School of Dentistry." 28 copyright 2013-2014- Dental Decks 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 "Courtesy Dr. Stuart C. White, UCLA School of Dentistry." 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 radiopaque structure 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 5. floor of maxillary sinus radiopaque line 6. soft palate radiopaque structure 7. air between soft palate & tongue radiolucent space 8.._dorsum of the tongue radiopaque line 9. ghost ima^eofop^> ositerartius ^TndTcateTrjy radiopaque dote 10. mental foramen ovoid radiolucency 11. shadow of cervical spine diffuse opacity "Courtesy Dr. Stuart C. White, UCLA School of Dentistry." 12. submandibular gland fossa 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. 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 29 copyright2013-2014-Dental Decks 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 copyright 2013-2014- Dental Decks RADIOLOGY both statements are true 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.Wackjnel^icjy]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 copyri ght S> 2013-2014- Dental Decks 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 copyri ght 6> 2013-2014- Dental Decks ' 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 copyright 2013-2014- Dental Decks RADIOLOGY Dose equivalent is expressed in terms of: coulombs/kilogram (C/kg) gray (Gy) sievert (Sv) quality factor (QF) rad biology RADIOLOGY 34 copyright 2013-2014- Dental Decks 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 copyright 2013-2014- Dental Decks 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 copyright 2013-2014- Dental Decks 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 ratej^anjount 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 copyright 2013-2014- Dental Decks 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. 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 38 copyright 2013-2014- Dental Decks 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 both statements are true 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 copyright 2013-2014- Dental Decks 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 ^ c^iookv^i 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 copyright 2013-2014- Dental Decks 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 copyright2013-2014-Dental Decks 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 copyright 2013-2014- Dental Decks 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 copyright2013-2014-Dental Decks 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 copyright O 2013-2014- Dental Decks 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. 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 46 copyright 2013-2014- Dental Decks 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 * % . both statements are false 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 copyright 2013-2014- Dental Decks RADIOLOGY rad protection Identify each component of inherent filtration: insulating oil unleaded glass window lead lined PID tubeheadseal 48 copyright 2013-2014- Dental Decks 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 copyright 2013-2014- Dental Decks 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. 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 50 copyright 2013-2014- Dental Decks 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 stand behind a barrier holdthe PID hold the film if the patient cannot stabilize it 49 copyright 2013-2014- Dental Decks 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. 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 50 copyright 2013-2014- Dental Decks 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. stand behind a barrier 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 both statements are true 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 copyright 2013-2014- Dental Decks 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 copyright 2013-2014- Dental Decks 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 copyright 2013-2014- Dental Decks 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 is insufficient/too flat 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 copyright 2013-2014- Dental Decks 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 copyright 2013-2014- Dental Decks 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 vertical angulation is insufficient/too flat incorrect horizontal angulation beam not centered over receptor poor receptor placement RADIOLOGY 56 copyright 2013-2014- Dental Decks 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 copyright 2013-2014- Dental Decks RADIOLOGY incorrect horizontal angulation 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 copyright 2013-2014- Dental Decks 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 copyright 2013-2014- Dental Decks 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 copyright 2013-2014- Dental Decks 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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