Oral Radiology

RIYADH COLLEGES OF DENTRISTRY AND PHARMACY
RADIOLOGY DEPARTMENT
PRESENTS
Copyright 2003, Elsevier Science (USA). All rights reserved.
RADIOLOGY SAFETY AND PRACTICE FOR ORAL RADIOGRAPHY
RADIOLOGY DIVISION

The radiology division considered as one of the most important areas since dental treatment of patient will not be completed without going through the routine radiographic examination.
GENERAL OBJECTIVE:
have a clear concept of the professional responsibilities to the patients, colleagues and the nation through service, education, continuing self professional development and adherence to professional ethics. Moreover, have appreciation of the material and financial constraints that affect professional decisions and able to make the best decision for patient care.
FUNCTIONS OF THE AREA

To take radiograph with high quality and efficiency as a service to the patient and their physicians. To serve as an area for practical training of dental students and interns in radiology. To enforce strict radiation hygiene and safety so as to minimize the hazards of ionizing radiation.
LOCATIONS AND FACILITIES
PERIAPICAL EXAMINATION AREA ( 2ND FLOOR)
DIGITAL ORTHOPANTOMOGRAPHY AND CEPHALOMETRIC (2ND FLOOR)

OPG CEPH
Processing area (2nd Floor)
PERIAPICAL AREA 3RD FLOOR
CONVENTIONAL ORTHOPANTOMOGRAPHY AND CEPHALOMETRIC (3RD FLOOR)
Processing area 3rd floor
Automatic Processor (3rd Floor)
Job Description

performs radiographic examination of patients and produces quality radiographs.
DUTIES AND RESPONSIBILITIES
1. Proper patient care.
2. Explain to the patient what to do and what to expect in such examination.
3. Take radiographs of the patients. 4. Maintains the proper utilization of machines and equipment. 5. Identify the problems that have caused the malfunction or failure of machines/ equipment and inform the chief x-ray technician to make action to the maintenance for immediate repair.
SAFETY PRECAUTION
Safety precaution had to be taken to protect our patients and ourselves
A. Lead Apron for patient.

Adult Pedo
b. For x-ray technician

Lead apron and film badge.
Fig. 42-4 The main components of a panoramic unit.
Fig. 42-4
The Head Positioner

Each panoramic unit has a head positioner used to align the patient s teeth as accurately as possible. Each head positioner consists of a chin rest, notched bite-block, forehead rest, and lateral head supports or guides. Each panoramic unit is different, and the operator must follow the manufacturer s instructions on how to position the patient in the focal trough.
Fig. 42-5 The head positioner is used to align the patients teeth in the focal trough.
Fig. 42-5
Common Errors

Patient preparation errors Ghost images: A ghost image looks like the real object except that it appears on the opposite side of the film. Lead apron artifact: If the lead apron is placed too high, or if a lead apron with a thyroid collar is used, a cone-shaped radiopaque artifact results.
Patient seating errors Chin too high Chin too low
Fig. 42-13 Large hoop earrings (A) and ghost images (B). The ghost image of the earring appears on the opposite side of the film.
Fig. 42-13
Fig. 42-14 On a panoramic radiograph, a lead apron artifact appears as a large cone-shaped radiopacity obscuring the mandible.
Fig. 42-14
Fig. 42-16 The patients head is tipped too far upward.
Fig. 42-16
Fig. 42-18 The patients head is incorrectly positioned; the chin is tipped downward.
Fig. 42-18
Positioning of the Teeth

Posterior to focal trough If the patient s anterior teeth are not positioned in the groove on the bite-block and are either too far back on the bite-block or posterior to the focal trough, the anterior teeth appear fat and out of focus on the radiograph.
Anterior to focal trough If the patient s anterior teeth are not positioned in the groove on the bite-block and are either too far forward or anterior to the focal trough, the teeth will appear skinny and out of focus.
Fig. 42-21 The patient is biting too far back on the bite-block.
Fig. 42-21
Fig. 42-22 The anterior teeth appear widened and blurred on a panoramic film when the patient is positioned too far back on the bite-block.
Fig. 42-22
Fig. 42-23 The anterior teeth appear narrowed and blurred on a panoramic film when the patient is positioned too far forward on the bite-block.
Fig. 42-23
Fig. 42-24 If the patient is not standing erect, superimposition of the cervical spine (arrows) may be seen on the center of the panoramic film.
Fig. 42-24
Positioning of the Spine

If the patient s spine is not straight, the cervical
spine will appear as a radiopaque artifact in the center of the film and obscure diagnostic information.
Extraoral Radiography

Extraoral radiographs provide images of larger areas such as the skull and jaws. In some instances, an extraoral film may be necessary for handicapped patients who cannot open their mouths for film placement, or because a patient has swelling or severe pain and is unable to tolerate the placement of intraoral films. Extraoral films are also very useful for patients who are uncooperative and may refuse to open their mouths. Images seen on an extraoral film are not as clear or as well defined as the images seen on an intraoral radiograph.
Equipment

Extraoral radiographs may be taken with a standard intraoral x-ray machine. To aid in patient positioning, special head positioning and beam alignment devices can be added to the standard x-ray unit. In addition, panoramic x-ray units may also be fitted with a special device known as a cephalostat. The cephalostat includes a film holder and head positioner that allow the operator to easily position the patient.
Grid

A device used to decrease film fog and increase the contrast of the radiographic image. It does this by reducing the amount of scatter radiation that reaches an extraoral film during exposure. Scatter radiation causes film fog and reduces film contrast.
Fig. 42-27 A grid decreases the amount of scatter radiation that reaches the extraoral film.
Fig. 42-27
Lateral Jaw Projection

Used to view the posterior region of the mandible. This type of projection is very useful for patients with a limited jaw opening and in patients who cannot or will not tolerate intraoral film placement. A lateral jaw projection does not provide as much diagnostic information as a panoramic radiograph. The advantage is that the lateral jaw projection can be taken with a standard x-ray unit.
Lateral Jaw Projection Techniques

Body of mandible projection Ramus of mandible projection
Fig. 42-28 A, The body of the mandible; proper patient and film positioning is shown as viewed from the front and side of the patient. B, The body of the mandible.
Fig. 42-28
Ramus of the Mandible

This film is used to evaluate impacted third molars, large lesions, and fractures that extend into the ramus of the mandible. The ramus from the angle of the mandible to the condyle is visible in this projection.
Fig. 42-29 A, Ramus of the mandible; proper patient and film positioning is shown as viewed from the front and side of the patient. B, An example of a lateral jaw radiograph; the ramus of the mandible.
Fig. 42-29
Skull Radiography

Lateral cephalometric projection Posteroanterior projection Water s projection Submentovertex projection Reverse Towne s projection
Fig. 42-30 B, An example of a lateral cephalometric radiograph.
Fig. 42-30 B
Fig. 42-31 B, An example of a posteroanterior skull radiograph.
Fig. 42-31 B
Fig. 42-33 B, An example of a submentovertex radiograph.
Fig. 42-33 B
Fig. 42-34 B, An example of a reverse Townes radiograph.
Fig. 42-34 B
Temporomandibular Joint Radiography

Radiographs of the temporomandibular joint (TMJ) can be very difficult to examine because of the multiple adjacent bony structures. The articular disc and other soft tissues of the TMJ cannot be examined by radiographs. Special imaging techniques (e.g., arthrography, magnetic resonance imaging) must be used. Radiographic projections of the TMJ can be used to show the bone and the relationship of the jaw joint.
Fig. 42-36 Patient positioned for a transcranial radiograph of the temporomandibular joint.
Fig. 42-36
Digital Radiography

Advances in digital technology have led to a unique filmless imaging system known as digital radiography. Introduced in 1987, digital radiography has influenced both how dental disease is recognized and how it is diagnosed. In the last 2 years, the use of digital radiography is rapidly increasing in both general and specialty dental practices. Numerous companies are producing digital radiography systems.
The Basics of Digital Radiography

Digital radiography uses a sensor to capture a radiographic image, breaking it into electronic pieces and storing the image in a computer. The patient is exposed to less x-radiation than with conventional radiography. The image is displayed on a computer screen rather than on film. The term image (not radiograph) is used to describe the pictures that are produced.
The Basics of Digital Radiography contd

The x-ray beam strikes the sensor. An electronic charge is produced on the surface of the sensor, and this electronic signal is digitized. The digital sensor in turn transmits this information to the computer. Software in the computer is used to store the image electronically.
Fig. 42-38 The size of the electronic sensor is compared with sizes 0, 1, and 2 of traditional intraoral film.
Fig. 42-38
Fig. 42-39 All types of radiographs may be produced in digital format.
Fig. 42-39
Radiation Exposure

Digital radiography requires much less x-radiation than conventional radiography because the sensor is more sensitive to x-rays than to conventional film. Exposure times for digital radiography are 50% to 80% less than that required for radiography using conventional film. With less radiation, the absorbed dose to the patient is significantly lower.
Equipment

For digital radiography, special equipment is required. The essential components include: Dental x-ray unit Intraoral sensor Computer
Types of Digital Imaging

Direct digital imaging Indirect digital imaging Storage phosphor imaging The difference between each method is in how the image is obtained and in what size the receptor plates are available (e.g., panoramic).
Fig. 42-40 Computer with modified image.
Fig. 42-40
Fig. 42-15: If the tongue is not placed on the roof of the mouth, a radiolucent shadow will be superimposed over the apices of the maxillary teeth.
Fig. 42-15

Oral Radiology

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RIYADH COLLEGES OF DENTRISTRY AND PHARMACY

Copyright 2003, Elsevier Science (USA). All rights reserved.

RADIOLOGY SAFETY AND PRACTICE FOR ORAL RADIOGRAPHY

Copyright 2003, Elsevier Science (USA). All rights reserved.

Copyright 2003, Elsevier Science (USA). All rights reserved.

Copyright 2003, Elsevier Science (USA). All rights reserved.

FUNCTIONS OF THE AREA

Copyright 2003, Elsevier Science (USA). All rights reserved.

LOCATIONS AND FACILITIES

Copyright 2003, Elsevier Science (USA). All rights reserved.

PERIAPICAL EXAMINATION AREA ( 2ND FLOOR)

Copyright 2003, Elsevier Science (USA). All rights reserved.

DIGITAL ORTHOPANTOMOGRAPHY AND CEPHALOMETRIC (2ND FLOOR)

Copyright 2003, Elsevier Science (USA). All rights reserved.

Processing area (2nd Floor)

Copyright 2003, Elsevier Science (USA). All rights reserved.

PERIAPICAL AREA 3RD FLOOR

Copyright 2003, Elsevier Science (USA). All rights reserved.

CONVENTIONAL ORTHOPANTOMOGRAPHY AND CEPHALOMETRIC (3RD FLOOR)

Copyright 2003, Elsevier Science (USA). All rights reserved.

Processing area 3rd floor

Copyright 2003, Elsevier Science (USA). All rights reserved.

Automatic Processor (3rd Floor)

Copyright 2003, Elsevier Science (USA). All rights reserved.

Copyright 2003, Elsevier Science (USA). All rights reserved.

performs radiographic examination of patients and produces quality radiographs.

Copyright 2003, Elsevier Science (USA). All rights reserved.

DUTIES AND RESPONSIBILITIES

Copyright 2003, Elsevier Science (USA). All rights reserved.

1. Proper patient care.

Copyright 2003, Elsevier Science (USA). All rights reserved.

2. Explain to the patient what to do and what to expect in such examination.

Copyright 2003, Elsevier Science (USA). All rights reserved.

Copyright 2003, Elsevier Science (USA). All rights reserved.

Safety precaution had to be taken to protect our patients and ourselves

Copyright 2003, Elsevier Science (USA). All rights reserved.

A. Lead Apron for patient.

Copyright 2003, Elsevier Science (USA). All rights reserved.

b. For x-ray technician

Lead apron and film badge.

Copyright 2003, Elsevier Science (USA). All rights reserved.

Copyright 2003, Elsevier Science (USA). All rights reserved.

Copyright 2003, Elsevier Science (USA). All rights reserved.

Copyright 2003, Elsevier Science (USA). All rights reserved.

Fig. 42-4 The main components of a panoramic unit.

Copyright 2003, Elsevier Science (USA). All rights reserved.

The Head Positioner

Copyright 2003, Elsevier Science (USA). All rights reserved.

Copyright 2003, Elsevier Science (USA). All rights reserved.

Patient seating errors Chin too high Chin too low

Copyright 2003, Elsevier Science (USA). All rights reserved.

Copyright 2003, Elsevier Science (USA). All rights reserved.

Copyright 2003, Elsevier Science (USA). All rights reserved.

Fig. 42-16 The patients head is tipped too far upward.

Copyright 2003, Elsevier Science (USA). All rights reserved.

Copyright 2003, Elsevier Science (USA). All rights reserved.

Positioning of the Teeth

Copyright 2003, Elsevier Science (USA). All rights reserved.

Copyright 2003, Elsevier Science (USA). All rights reserved.

Copyright 2003, Elsevier Science (USA). All rights reserved.

Copyright 2003, Elsevier Science (USA). All rights reserved.

Copyright 2003, Elsevier Science (USA). All rights reserved.

Positioning of the Spine

The Basics of Digital Radiography contd