Introduction: Dental Radiography and Radiology Script 1 3-feb-2013 Welcome to the new course dent 325, the first

course of oral radiology, which is mainly about physics of radiation, and radiation protection. You can check the syllabus for more information about the course. Many books are recommended. But the main reference for you is Dental
Radiography: Principles and Techniques which is available in the book shop.

Midterm exam will be after the seventh lecture enshaAllah.

The doctor will not give us slides as he said.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Introduction: Dental Radiography and Radiology What is the difference between radiography and radiology? Radiography: it is the science of making the picture, how you can make and capture a radiograph. The techniques involved in producing the various radiographic images. Radiology: it is the science of interpretation, interpretation of pathology on the radiograph. You are dealing with interpretation. However after the invention of the 3D imaging modalities we stopped to say interpretation it is more said visualization. Because we can see the disease, we can rotate the image since they are 3D images. In the past we only had 2D image like panorama. So we have to interpret, we have to imagine. But nowadays we have visualization. For this year we are mainly concerned about how to make and capture the image, and how to process the film. As you can see here this is a bitewing radiograph, in which you can see the maxillary and mandibular teeth on the same film. I can see the enamel, dentine, pulp and high contrast amalgam fillings (the contrast or the density of amalgam is higher than enamel).

2|Page

Q- Why enamel is radiopaque and why the pulp is radiolucent?

Because enamel totally stops the X-ray so it looks radiopaque (white), While the pulp its mineral content is low comparable to enamel so it allows all the X-ray to pass then it will be radiolucent.

Q- What will happen if we increase the dose of the radiograph?

The enamel will start to become radiolucent; finally your image will be black.

So the final image depends on your dose and also on the body you are capturing.many factors we will take about them later on.
The amount the X-ray beam is stopped (attenuated) by an object determines the radio density of the shadows. So we have radiopaque, radiolucent and gray shadows, The white or radiopaque shadows on a film represent the various dense structures within the object which have totally stopped the X-ray beam.
3|Page

 The black or radiolucent shadows represent areas where the X-ray beam has passed through the object and has not been stopped at all. The grey shadows represent areas where the X-ray beam has been stopped to a varying degree. when you want to describe a lesion you say radiopaque lesion or radiolucent lesion.

The final image depends on many factors

1. The material itself. The specific type of material of which the
object is made. The image of your hand will not be the same as the image of microphone. Soft tissues is not like image of metal 2. The thickness or density of the material. If you take a radiograph for a kid. It is not like a radiograph for an adult. 3. The shape of the object. 4. The intensity of the X-ray beam used. If you increase the dose. You will have different radiographs. When you increase the dose the image will be darker. Finally you will burn you image. So sometimes when you want to see small things like stones in salivary glands we usually decrease the dose up to 50%. We also decrease the dose when we want to make an image for a kid.

5. The position of the object in relation to the X-ray beam and film. If there is superimposition with other objects or not. 6. The sensitivity of the film. The higher the sensitivity of the film
is the faster the film.

4|Page

 This picture shows us that different materials give different shadows

Here we have the same material with different densities.

Here we have different shapes and we have different final images

5|Page

 Here we have different shapes and different levels of X-rays (dose). Look here we are increasing the intensity so the maximum intensity of X-ray will result in burning the object, we dont see the object (a) any more unless the object is big like (d) in the figure so we can see part of it.

6|Page

In the intraoral films the basic films like the periapical films you can see 1- The main parts of the tooth( enamel, dentin , pulp) 2- You can see the lamina Dura which is the cortical bone surrounding the tooth 3- You can see PDL (periodontal ligament) space which is between lamina Dura and the tooth. 4- You can see trabecular bone

7|Page

If you take cross sections you can see buccal and lingual cortical bone surrounding the tooth. In the intraoral films we can only see the 2D of the object we cant see the whole tooth, if you want to see the whole tooth you have to take another image like 3D image.

Limitations of 2D images
1. Superimposition. We cant see the whole object, so we have to imagine. Look at this house, different views gave different images

So this is the problem, that you see part of the object. So on your picture you may capture the caries but if you take it from another angle you may miss it.
8|Page

Look here we detect radiopaque object in the nose but due to super imposition we couldnt know the exact location.

So we took another image from lateral view. And now we can see that this radiopaque object is a clip in the brain. And the arrows show the true location for the clip.

Look at this example. An object is in the middle of the head. The X-ray is coming from behind of the patient and the final image was the same. Although the object was in different places and in (d) was a different object. However the final image was the same.
9|Page

Look here when we take lateral view now we have different images for the different places and for different shapes.

So side view can overcome the problem of superimposition sometimes. When we have fracture in the jaw one image is not enough so we have to take 2 images perpendicular to each other or we need advanced imaging modalities. Like CT or MRI. 3D images or advanced images will solve these problems. Look here I took side view image however I had similar images why? Because I have superimposition with another object. So not always I can solve the superimposition problem by taking another image.
10 | P a g e

Sometimes I have to go to advanced imaging and this is the best. For example a patient having trauma, go for advanced imaging dont hesitate to take advanced imaging modalities for the patient because it is very important to know the exact extension of the fracture, I dont know if this fracture only in the nose, only in the jaw or is it extending into the brain I have to know everything. If I have a periapical image for an impacted tooth I cannot know where this tooth is located? Lingual or buccal? I have to take another image perpendicular to it like an occlusal radiograph. Now we will be able to see the canines location. Or I can take 3D image.

Quality of the image (later on we will have lectures about the quality)
General over view for now>> We have something called contrast and spatial resolution and sharpness. If you want to buy new TV , flat one you have to take care about resolution and contrast What is contrast? It is the ability to differentiate between shades of grades of colors. Saturation of the colors. Do you want to have your TV saturated with colors or you want it to be sharper. What is resolution or spatial resolution specifically? It is the ability to separate two objects from the back ground.
11 | P a g e

 Which is better or more important? In fact no one can answer this question because both can affect each other. And we are in need for both. What is sharpness? It is the ability to define an edge. Image geometry. ~~ To make an ideal radio graph we have to be sure of three things ~~ 1. The object and the film should be in contact or as close together as possible. So to take a radiograph image you have to put the film as close as possible to the tooth lingually. 2. The object and the film should be parallel to one another. Why? To overcome problems of elongation or shortening 3. The X-ray tubehead should be positioned so that the beam meets both the object and the film at right angles. These are the ideal characteristics to have an ideal radiograph. However in daily practice we cannot give the ideal image. So we have to do some modification to overcome these problems. Later on we will know them.

Look here this is the ideal image, if you can put a film in contact to a tooth both are parallel to each other and the beam is perpendicular to both this is the perfect image.

What will happen if your film is not parallel making an angle with the tooth? In this case we will have an elongated image.
12 | P a g e

These are mistakes and the students make these mistakes in the clinic and asking why? Why my image is foreshorted ? because the beam is perpendicular to film but not to the tooth.

Why the image distorted, elongated and fake? Because the beam is not perpendicular to both like( c )this is distorted image

So elongation can result from incorrect placement of the film, the film is not parallel to the tooth, elongation also results from insufficient vertical angulations (later on you will know). Just to have an idea when we increase a dose (kilo voltage) this the kilo voltage peck (in the slide), this is the dose that we give it to the patient (in the slide),, of course we also concern about Milliampere and the time, all of these factors will result in the final dose. lets concern now on the kilo voltage ,when we increase kilo voltage we increase the number (shades of grays) this is called SCALE OF CONTRAST ; long scale of contrast many shade of grays , however the
13 | P a g e

contrast will be this(in the slide) if we have only black and white this will be the highest contrast the(CT machine)which used in the medical field they used a high kilo voltage for this reason they can see a soft tissue, however in dental field we use( CO beam(not sure)) only give 80 kilo voltage so we are not able to see the soft tissue . Any increase in the Milliampere or time or kilo voltage will result in darker image. In the clinic the student sometimes plays with these factors so as a result the image and the density will be affected. What is density? Density: it is the degree of darkness of the film What are the ideal characteristics of the x-ray beam? 1. Sufficiently penetrates we have a kid and we want to make an image to the kid. and I only used 10 kilo voltage ,this will not make an image because it will not penetrate through the body, so I have to increase it . 2. The x-ray must be parallel not divergent; because the divergent of the beam will result in magnification, in fact X-rays usually travel in divergent pathway, so how we can overcome this problem? By using a device called collimator to make it parallel then we can make the image. 3. Produced from a point source, to reduce blurring of the edges of the image, a phenomenon known as the penumbra effect. Penumbra effect it mean the blurring of edges, why we have blurring edges? Because the x-ray source is not a point it is from tungsten plate so the penumbra effect will result by using this plate. So how we can overcome this penumbra? By tilting the target (of course you cant imagine what do we mean by target next lectures you will know)

Now this the final point in this lecture which is: Contrast, context and partial images. When you have a radiograph and you have a pathology in this radiograph the interpretation will be different among different observers.
14 | P a g e

For example: I will say this is caries but if I give you the radiograph you will say this is normal, why? 1) The power of eye. 2) Surrounding environment will effect. 3) Perception (Experience), because I have an trained eye I can see things in this radiograph that you cant see it, and also I have a background that the caries will appear radiolucent and it appears in this area, so I have knowledge that makes it easy to detect caries. So this is the perception depends on experience. For example if I want to make a research in radiology and I want to send it a journal to accept it. They will not accept it if I am the only observer, why? Because at least they will need two observer, why? Because this is the problem of perception I can see there is an abnormality and another observer will say no there is no abnormality so it depends. 4) Context: look here if u see this image you will say this small square is radiopaque is white ,however in the last image is radiolucant is black so it depend on environment

what about this, here you will say this is B but when you looking here you will say this is number 13 why ?

Because in the first line was between letters so I consider it B While in the second line it is between numbers so I consider it 13.
15 | P a g e

So in the mouth there is cortical bone, cancellous bone, vessels, so this is normal anatomy any structure will be one of these. But in case you are looking on the maxillary sinus you will never say this is a tooth unless there is a problem. If there is something radiopaque most probably it is not a tooth because maxillary sinus is full of air, sometimes fluid, sometimes mucosal thickening but it will not be a tooth.

THE END Done by: Yousef Nasrawi & Sawsan Jwaied

Inspiration is one thing and you can't control it, but hard work is what keeps the ship moving. Good luck means, work hard. Keep up the good work Kevin Eubanks

16 | P a g e