Major Topic Abbreviation: Radiology

RADIOLOGY
LEGEND
...,. ...
Major Topic Abbreviation
Image Characteristics
, -
1m Char
Miscellaneous Misc.
Normal Anatomy N Anat
Processing Proc
Radiation Biology R Bio
Radiation Characteristics R Char
Radiation Physics R Phys
Radiation Protection R Prot
Techiques Tech
X-rays X-rays
Copyright 2001 - DENTAL DECKS
RADIOLOGY
Which x-ray is designed for diagnosis of basilar skull fractures?
Water's
Submental-vertical
Towne's
Panorex
X-rays
Submental-vertical (also called submentovertex)
It also gives some diagnostic information about the zygoma, zygomatic arches and
mandible. This film is taken with the source below the mandible and the film above
the head.
X-rays
RADIOLOGY
Which of the following is the standard radiograph of choice for showing an anterior view
of the paranasal sinuses and of the mid-face and orbits?
Panorex
Towne's view
Water's view
Cephalogram
Water's view
This is a posterior-anterior projection with the patient's face lying against the film and
the x-ray source behind the patent's head. It is one of the best films for radiographic
diagnosis of mid-facial fractures. It is also used for diagnosing sinus infections .
X-rays
RADIOLOGY
Which of the following is the best film for visualizing the condyles and neck of the
mandible from an A-P projection?
Water's view
Caldwell's view
Towne's view
Panorex
Towne's view
The patient lies on his back with the film under his head. The x-ray source is from the front , but
rotated 30% from the Frankfort plane and is di rected right at the condyles.
The Towne view is often of value in assessing the
status of the condyles, condylar neck and rami ~
because superimposition of the mastoid and zygoma
over the condylar neck region in the straight postero-
anterior projection often makes interpretation diffi-
cull. The Towne view eliminates this superimposi-
tion, thus giving 990d visualization of the condy
lar area and rami. -
Note: The "Reverse Towne's View" is used to iden-
tify fractures of the condylar neck and ramus
area.
The following can be demonstrated on conventional _ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~
TMJ radiographs: t::tl:i:.
Position of the condyles in the glenoid fossa
The range of antero-posterior movement of the condyles
Areas of bone destruction on condylar heads
RADIOLOGY
Explain what is meant by the term "cervical burnout" on an x-ray.
X-rays
This term refers to diffuse radiolucent areas with ill-defined borders that may be
apparent radiographically on the mesial or distal aspects of teeth in the cervical
regions between the cervical edge of the enamel cap and the crest of the alveolar
ridge.
It is caused by the normal configuration of the affected teeth (the cementoenamel junc-
tion), which results in decreased x-ray absorption in those areas.
Important: These radiolucencies should be anticipated when viewing x-rays of almost
any tooth and should not be mistaken for a carious lesion.
RADIOLOGY
All of the following are advantages of a panoramic radiograph except:
It shows areas that may not be visible on a full mouth series
It shows both arches on the same film
It gives better detail and definition than periapical radiographs
It is more comfortable for the patient (eliminates gagging)
It requires less time than a full mouth series
X-rays
It gives better detail and definition than periapical radiographs
"'This is false; a panorex gives less detail and definition than periapi cal radiographs due to
intensifying screens, movement of the x-ray tube and film and increased object-film distance.
Indications for a panorex:
Diagnosis of oral pathology that may not be visible on periapical radiographs
Treatment planning (especially orthodontic cases)
Evaluation of anomalies
As one part of the follow-up evaluation in surgical and trauma cases
Edentulous patients (prior to constructing full dentures)
Patients that are unable to tolerate intra-oral x-rays
*"The drawback of a panorex is that there is a loss of image detail (it is hard to diagnose early
carious lesions). Bite-wing x-rays are required for the diagnosis of carious lesions.
Other disadvantages of a panorex:
Distortion of image due to increased object-f ilm distance
Inadequate for interproximal caries detection or for detecting periodontal breakdown (bone
loss)
Proximal overlapping (especially in premolar and molar areas)
Added exposure to a large area of body tissue, in addition to the oral tissues
RADIOLOGY
The screening x-ray for pathology of the jaws is:
A panorex
A cephalogram
A periapical x-ray
An occlusal x-ray
X-rays
A panorex
The panorex is excellent for third molar pathology as well as to observe the TMJ,
the sinuses and in sialography (which is a technique used in radiology in which a sali-
vary gland is filmed after an opaque substance is injected into its duct). A sialolith
which is located in Wharton's duct, however, can best be viewed by using a cross sec-
tional occlusal x-ray.
One inadequacy of the panorex is in the definition of interproximal caries. However,
by supplementing the panoramic film with posterior or anterior bite-wing films if indi-
cated, a more complete radiographic survey of the patient can be obtained.
X-rays
RADIOLOGY
Which of the following types of intra-oral radiographs are most useful in detecting inter-
proximal caries?
Periapical radiographs
Bitewing radiographs
Occlusal radiographs
Bitewing radiographs
"'Show crowns of both Max. and Mand. teeth; not root apices.
The primary reason for taking bitewing radiographs is to detect interproximal caries. They are
also useful in detecting periodontal disease. Bitewing films generally show the crowns of the
teeth, the alveolar crest, and the interproximal areas. In order for the film to be of use diagnosti-
cally, the quality of the following must be excellent: dimensional accuracy, image density, and
contrast and clarity of the image.
When taking bitewing radiographs, the film must be placed either horizontally or vertically.
Vertical bitewings will provide more periodontal information, such as boney defects and furcation
involvement. Remember: A loss of crestal bone is often associated with early periodontitis.The
periapical film is used (pedo or adult) with either cardboard tabs, sticky tabs, or a bitewing hold-
er. Two bitewings are usually taken on a child and four (molar and premolar views) are usually
taken on an adult (or two long films-size 3).
Notes :
1. The vertical angulati on for bitewing radiographs should be between +8 and +10 degrees.
2. Adjust horizontal angulation to direct the central ray toward the center of the film.
3. Alveolar bone resorption is best demonstrated on bitewing x-rays,
4. Vertical bitewing x-rays will show more alveolar bone than traditional horizontal bitewings.
RADIOLOGY
Which of the following are uses for cephalometries in orthodontics?
Diagnosis
Analysis of treatment results
Longitudinal study of growth
All of the above
X-rays
All of the above
The lateral head radiograph (cephalometric x-ray) must be compared with "normal"
lateral radiographs from an accepted norm. Linear and angular measurements are
obtained utilizing known anatomical landmarks in the lateral head radiography of the
patient. These measurements are then compared with those considered within normal
limits and in that way enable the orthodontist to assess aberrations in the dentition and
jaw structures which result in malocclusion.
Analysis of cephalometric radiographs is not limited to the hard structures such as
bone and teeth, but also includes measurements of soft tissue structures such as the
nose, lips, and soft tissue chin.
Superimposition in longitudinal cephalometric studies is generally on a reference
plane and a registration point. This will best demonstrate the growth of structures far-
thest from the plane and the point. The most stable area from which to evaluate
craniofacial growth is the anterior cranial base because of its early cessation of
growth.
Cephalometries are useful in assessing tooth-to-tooth, bone-to-bone, and tooth- to-
bone relationships. Serial cephalometric films can show the amount and direction of
growth.
RADIOLOGY
Foreshortening and elongation are produced by:
Incorrect horizontal angulation
Incorrect vertical angulat ion
Either of the above
Tech
Incorrect vertical angulation
Important: Foreshortening refers to a shortened image and elongation refers to an
elongated image. Both are produced by an incorrect vertical angulation. Excessive
vertical angulation causes foreshortened images. while insufficient vertical angulation
causes elongated images.
Vertical angulation is directing x-rays so that they pass vert ically through the part
being examined. This is accomplished by positioning the tubehead and direction of the
central ray in an up-and-down (vertical) plane.
Horizontal angulation is maintaining the central ray at 0 degrees as the tube is moved
around the head. This is accomplished by positioning the tubehead and direction of the
central ray in a side-to-side (horizontal) plane. Note: The general rule for horizontal
angulation is that the central ray should be perpendicular to the mean anteroposteri-
or plane of the teeth being x-rayed.
The central ray is said to be at 0 degrees when the x-ray tube is adjusted so that the
central ray is parallel to the floor. If the tubehead is directed at the floor, it is called plus
angulation; if it is directed toward the ceiling, it is called minus angulation.
Important: Incorrect horizontal tube angulation causes overlapping (teeth images are
superimposed on each other).
Tech
RADIOLOGY
Which of the following errors in radiographic technique is the most likely reason that an
image on a radiograph would appear elongated?
Too much vert ical angulation
Too little vertical angulation
Incorrect horizontal angulat ion
Beam not aimed at center of film
Too little vertical angulation
Some errors often made when taking dental radiographs:
Elongation (most common error): teeth appear too long - may be caused by too
little vertical angulation, the occlusal plane not being parallel to the floor, or poor film
placement
Foreshortening: teeth appear too short - may be caused by too much vertical
angulation or poor chair position
Cone cutting: portion of film will appear clear with a curved line - the beam was
not aimed at the center of the film
Herringbone effect: zigzagged pattern appears on the film - the film was placed
backwards in the mouth
Poor film placement: the film was not placed far enough back or not forward
enough in the mouth
Overlapping: interproximal areas are overlapped, reduces diagnostic quality
of film - due to incorrect horizontal angulation (the central x-ray was not perpendi-
cular to the center of the film)
Tech
RADIOLOGY
The herringbone markings that appear on the film below were caused by what tech-
nical error?
The film was exposed with the film packet in reverse position
Other artifacts:
See picture # 30 in booklet See picture #31 in booklet
Tech
RADIOLOGY
One of the films in a full mouth series of dental radiographs has crescent-shaped
marks on it. What is the most likely cause of these marks?
Overbent films
Patient had glasses on
Exposure to secondary radiation
Cone cutting
X-ray arm drifted
Overbent films (cracked emulsion)
Some other common errors made when taking dental radiographs/cause:
Light films (underexposed, image NOT dense enough) / Incorrect milliamperage
(too low) or time (too short); incorrect focal film distance; cone too far from patient's
face
Dark films (overexposed, image too dense) / Incorrect milliamperage (too high) or
time (too long)
Double exposure / film was used twice
Fogged films / exposed to radiation other than primary beam
Artifacts / patient didn't remove eyeglasses, earrings, or removable prosthetic appli-
ances
Poor contrast / incor rect kVp (too high)
Blurred image / patient movement or drifting of x-ray arm
Clear films / were not exposed to radiation
Tech
RADIOLOGY
The two radiographs below were taken with the buccal object rule in mind. In film #2,
the x-ray tube was directed from a mesial angulation. What is the spacial position of
the circular object in these radiographs?
The object lies lingual to the first molar
The object lies buccal to the first molar
The object lies between the second premolar and the first molar
The object lies directly apical to the first molar
FILM II
FILM '2
Copyright @) 2001 - DENTAL DECKS
The object lies lingual to the first molar
The buccal object rule (also called the tube shift technique) is used to determine an
object's spacial position within the jaws. This technique utilizes two radiographs of an
object exposed with slightly different tube angulations. It then compares the object's
position on the radiograph with respect to a reference point (e.g., the root of a tooth).
If the tube is shifted and directed from a more mesial direction, and the object in ques-
tion appears to have moved mesially with respect to the reference point, then the
object lies lingual to that reference point. Conversely, if the tube is shifted mesially and
the object in question moves distally , it lies on the buccal aspect of the reference
object.
Remember the acronym SLOB:
***If the object in question appears to move in the same direction as the x-ray tube, it
is on the lingual aspect. If it appears to move in the opposite direction as the x-ray
tube, it is on the buccal aspect.
Tech
RADIOLOGY
Which of the following positioning errors is the most likely cause of a reverse occlusal
plane curve on a panorex (panoramic radioradiograph)?
Chin tilted too far upward
Chin tilted too far downward
Head turned slightly
Chin tilted too far upward
' **Mandibular structures look narrower and maxillary structures look wider (looks like a
"frown")
Chin tilted too far downward:
1. Occlusal plane shows an excessive upward curve (looks like a "big smile")
2. Severe interproximal overlapping, anterior teeth appear very distorted
Note: Although this is an extra-oral radiograph, there is a bite piece which is held
between the patient's front teeth. This bite piece should either be sterilized after each
use or covered with a disposable plastic slipcover.
RADIOLOGY
Image magnification may be minimized by:
Using a short cone
Placing the film as far from the tooth as possible
Using a long cone
Shortening the exposure time
Tech
Using a long cone
Five rules for accurate image formation when taking x-rays:
1. Use the smallest focal spot that is practical.
Note: The size of the focal spot influences radiographic definition or sharpness.
They are inversely proportional.
2. Use the longest focus-film distance that is practical in the particular situation.
3. Place the film as close as possible to the structure being radiographed.
4. Direct the central ray at as close to a right angle to the film as anatomical struc-
tures will allow.
5. As far as is practical, keep the film parallel to the structure being radiographed.
Tech
RADIOLOGY
Name some of the advantages and disadvantages of the paralleling technique.
Advantages
1. Little or no root superimposition on a maxillary molar view
2. Accurate diagnosis of periodontal bone height (given minimal distortion)
3. Image formed is dimensionally accurate
Disadvantages
1. Film placement may be difficult in some areas (i.e., low palatal vaults)
2. Increased exposure time due to long cone
3. XCP holders can be cumbersome to work with and may cause patient discomfort
Tech
RADIOLOGY
Which of the following is not a disadvantage of the bisecting technique?
Image on x-ray film may be dimensionally distorted (amount may vary)
Increased exposure time
Due to the use of a short cone (which results in divergent rays), the image is not a
true reproduction of the object
May not be able to judge the correct alveolar bone height
Increased exposure time
'''The exposure time is actually decreased
The bisecting angle technique is based on the geometric principal known as the rule
of isometry. The rule states that two triangles are equal if they have two equal angles
and share a common side. The following best describes the bisecting technique:
The dental x-ray film is placed along the lingual surface of the tooth.
At the point where the film contacts the tooth, an angle is formed by the plane of the
film and the long axis of the tooth.
The person taking the x-ray needs to visualize a plane that bisects this angle. This
plane is called the imaginary bisector (this creates two equal angles and provides a
common side for the two imaginary equal triangles).
The central ray is positioned perpendicular to the imaginary bisector.
Important: When this technique is followed strictly, the image of the tooth pro-
duced is accurate.
Tech
RADIOLOGY
Which of the following is a major disadvantage of the paralleling technique?
The image formed on the film will not have dimensional accuracy
Due to the amount of distortion, periodontal bone height cannot be accurately diag-
nosed
An increase in exposure time is necessary due to the use of a long cone
An increase in exposure time is necessary due to the use of a short cone
An increase in exposure time is necessary due to the use of a long cone
The paralleling technique is based on the concept of parallelism. Other names for this
technique include XCP (extension cone paralleling technique), right-angle technique,
and long-cone technique.
Basic Principles:
Film is placed parallel to the long axis of the tooth being x-rayed.
Central x-ray is directed perpendicular to both the film and the long axis of the tooth.
A film holder (XGP) must be used to keep the film parallel to the long axis of the
tooth.
The object -film distance ml lst be incl"4il i sed tg kQQjJ thQfilm parallel This results_
in image magnification and loss of definition
The target-film distance must also be Increased ,10 compensate for the image
magnification and to make sure that only the most parallel rays will be aimed at the
tooth and the film. Using a long cone (16 inch target-film distance) results in greater
definition and less image magni fication.
Tech
RADIOLOGY
Name the two x-ray techniques that are utilized in dentistry for taking periapical films.
1. Bisecting technique (see Figure 1)
2. Paralleling technique (see Figure 2)
PID
Long axis
of tooth
F i l m ~ ~ ~
Filmholder ~
Figure 2
Positions of the film. teeth, and central ray of
the x-ray beam in the paralleling technique.
Film and long axis of the tooth are parallel. The
central ray is perpendicular to the tooth and
film. An increased target-film distance (16
inches) is required.
Central
ray
Imaginary
bisector "'\
Film ".
~ ~ " . ~
Figure 1
The image on the film is equal to the length of
the tooth when the central ray is directed at 90
degrees to the imaginary bisector. A tooth and
the radiographic image will be equal in length
when two equal triangles are formed that share
a common side (imaginary bisector) .
Reproduced with permission from Haring, Joen Janucci and Laura Jansen Lind, Dental radiography
Principles and Techniques. WB. Saunders Company, Philadelphia, Pennsylvania, 1996.
Tech
RADIOLOGY
Name the two x-ray techniques that are utilized in denti stry for taking periapical films.
1. Bisecting technique (see Figure 1)
2. Paralleling technique (see Figure 2)
Film holder
Long axis
of tooth
Figure 2
Positions of the film. teeth, and central ray of
[he x-ray beam in the paralleling technique.
Film and long axis of the tooth are parallel. The
central ray is perpendicular to the tooth and
film. An increased targetf ilm distance (16
inches) is required.
Central
ray
Imaginary
bisector .... ...
Film " .
' ' " . " . ~
Figure 1
The image on the liIm is equal to the length of
the tooth when the central ray is directed at 90
degrees to the imaginary bisector. A tooth and
the radiographic image will be equal in length
when two equal triangles are formed that share
a common side (imaginary bisector) .
Reproduced with permission from Haring, Joen lanucci and Laura Jansen Lind, Dental radiography
Principles and Techniques. W.B. Saunders Company, Philadelphia, Pennsylvania, 1996.
R Prot
RADIOLOGY
The most effective means in reducing the time of exposure, the amount of radiation
reaching the patient and the amount of radiation scattered to the dentist is:
A lead apron
Ultra-speed film
Lead diaphragms
Increasing target-film distance
Ultra-speed film
All of the following reduce the amount of radiation to the patient:
A lead apron
Increased filtration using an aluminum disk
Ultra-speed film
Lead diaphragms placed within the cone of an x-ray tubehead
Collimating an x-ray beam
Increasing target-film distance
Intensifying screens (used for all extraoral radiography, i.e. panorex, cephs.)
Note: The committee on Radiation Protection of the National Bureau of Standards rec-
ommends that a person who works near radiation be exposed in one year to a maxi-
mum dose of 5 REM (0.1 REM per week). S con ary and scatter radi ati on pose tfie
grea est hazard to the dental team.
Important: Carcinogenesis and genetic mutation are important and serious effects
of repeated exposure to low doses of x-radiation. The mechanisms involved may be
frameshift mutations, synergism with chemical carcinogens and altered DNA repair
enzyme functions.
RADIOLOGY
All of the following are true concerning collimation except
It prevents overexposure to patients
It increases the area of patient exposure
It reduces secondary radiation to the film
It reduces secondary radiation to the patient
R Prot
It increases the area of patient exposure
"'This is false; collimation reduces the area of patient exposure
Collimatio efers to the control 01 the size and shape of x-ray beam.
It is a basic rule of radiation hygiene that the radiation beam be as small as practical. For intra-
oral radiography, by state law, the diameter of a circular beam of radiation at the patient's skin
can be no greater than 3 inches. One can use a diaphragm or metal cylinders, cones or tubes
to collimate the beam.
These devices do not reduce the amount of radiation received by the exposed tissues, but
reduce the radiation to surrounding tissues due to x-ray beam divergence.
Aluminum disc filtration:
The x-ray beam consists of many different wavelengths. The short wavelength (high energy)
rays have great penetrating power; long wavelength (low energy) rays have low penetrating
power and do not reach the film in reasonable quantities since they are attenuated by the soft
tissues. Low energy rays add only to the total amount of radiation the patient receives.
Aluminum discs are used to filter out the useless long wave x-rays, Increasing the overall
quality of the beam.
Important: Filtration reduces patient dose, decreases contrast and decreases the density of
the film.
R Prot
RADIOLOGY
Explain how filtration is an important element in the control of the emerging radiation
from an x-ray beam.
Copyright @ 2001 - DENTAL DECKS
Filtration absorbs the longer, less penetrating rays, which would otherwise be
absorbed by the patient's skin or scattered and absorbed by both patient and oper-
ator. It also i reases the penetrating qualities of the beam (bY' absorbing the
longer.. wavelengt h x-rays).
There are two types of filtration:
1. Inherent filtration - is caused by absorption of the beam by the glass window of the x-ray
tube, the oil surrounding the tube, the alll miRum filter iR the x ray head aAd IAe "Iasti c canfl....
2. Added filtration - is obtained by placing thin sheets of aluminum in the cone to filter the use-
ful beam further.
"'lotal filtration is the sum of inherent and added filtration. Recommended tptal: equivalent
of 0.5 mm (below 50 kVp) and 2.5 mm (over 70 kVpJof alumiiiU01.
Notes:
1. Longer wavelength x-rays (those produced at lower kilovo/tages) are easily absorbed.
2. Shorter wavelength x-rays (produced at higher kilovoltages) penetrate objects more read-
ily (they form image on the film).
Remember: The x-ray beam is composed 01 rays of different wavelengths and penetrating power
(the term used for this is polychromatic) because the potential across the tube changes con-
stantly as the voltage varies.
RADIOLOGY
What is meant by the term "half-value layer"?
; 4 i
A Phys
When an x-ray beam encounters a mass of material, not all the x-rays are
absorbed. If a certain thickness of this material reduces a monochromatic beam by
50%, the x-ray beam is said to have a half-value layer of the thickness used, meas-
ured in terms of the absorbing material - most often aluminum. The greater the
half-value layer of aluminum, the more penetrating the radiation wavelengths.
In oral diagnostic radiography, the half-value layer of the beam of radiation is approxi-
mately 2 mm of aluminum. This means that half of the x-rays exiting the vacuum tube
are absorbed by 2 mm of aluminum. It should be noted that doubling the thickness of
aluminum will not absorb all of the x-rays, but only half of the remaining x-rays.
2x ",,\l -!t llf'
Important point to remember: The half-value layer is an indicator of .
x-ray beam.
Note: X-rays and gamma rays are examples of non-particulate radiation energy.
RADIOLOGY
Explain the difference between primary and secondary radiation.
R Phys
Primary radiation is referred to as the main beam of x-ray energy that is produced
from within the x-ray tubehead.
Secondary radiation occurs when the primary beam of radiation collides with mat-
ter. Secondary radiation that trayels out in all directions is referred to as "scattered
radiation. "
Notes:
1. lead is most effective in stopping x-rays (patients should always wear a lead
apron and thyroid collar)
2. X-rays have more energy than light
3. The following belong to a group of radiations known as electromagnetic radia-
tions: microwaves, x-radiation, visible light, and gamma radiation
4. Approximately 1% of the energy released in the x-ray tube is released as x-rays
5. MPD stands for maximum permissible dose of radiation exposuje
6. The yearly MPD for a non-occupationally exposed person ' 0.5 RE compared
someone who works near radiation
7. cone (PIO) that best reduces the amount of scatter radiation that the
patient receives is a leaded, rectangular one since this greatly reduces the size of
the beam (PID should always be open-ended)
RADIOLOGY
Identify the following parts of an x-ray tube.
R Phys
2 3 4
7 6 5
1. Glass envelope
2. Anode
3. Filament
4. Cathode
5. Focusing cup
6. Tungsten target
7. Window
X-rays are generated when a stream of electrons (which are produced by the filament)
travels from the cathode to the anode and is suddenly stopped by its impact on the
tungsten target. The filament located in the cathode is made of tungsten wire. The small
area the target that the electrons strike is called the focal spot. It is the source of x-
rays.
Note: The size of the focal spot directly influences the x-ray definition (the larger the
focal spot, the greater the loss of definition and sharpness of image).
R Char
RADIOLOGY
Suppose that in a periapical examination of the mandibular incisor region, an exposure
time of 1/4 second and focus-film distance of 8 inches were used. If you increase the
focus-film distance to 16 inches, what would be the new exposure time required to pro-
duce the same density in the radiograph?
1/2 second
1 second
2 seconds
4 seconds
1 second
Explanation:
The time required for a given exposure is directly proportional to the square of the
focus-film distance. The formula is:
Original Time = Original Distances
New Time New Distances
Hence,
1/4 = 8
2
= 1/4 X 16
2
= 1/4 x 256 = 64 = 1 = x (in seconds)
x = 16
2
= 8
2
64 64
Important: The above formula holds true only if the rnAand kVp are constant.
Remember: The inverse square law formula is:
Original Intensity = Original Distancee
New Intensity New Distances
Important: The intensity of radiation is inversely proportional to the square of the dis-
tance.
RADIOLOGY
Kllovoltage controls the speed of:
Photons
Electrons
Anodes
Cathodes
R Char
Electrons
The speed with which electrons travel from the filament of the cathode to the target of
the anode depends upon the potential difference between the two electrodes (kilovolt-
age). This, in turn, has a very important effect on the x-rays produced at the focal
spot.
The kilovoltage has nothing to do with the number of electrons that compose the
stream flowing from cathode to anode. The umber of electrons (which determines
the quantity of x-rays produced) is controlled by the temperature of the cathode fila-
ment (milliamperage setting). The hotter the filament , the more electrodes are emitted
and available to form the electron stream (the x-ray tube current). In the x-ray tube the
number of electrons flowing per second is measured in millamperes. The intensity of
x-rays produced at a particular kilovoltage depends on that number.
Note: Setting the x-ray machine for a specific milliamperage actually means adjusting
the filament temperature to yield the current flow indicated.
To increase film density, you should increase mA, kVp and time. Also, you should
decrease the source-object distance.
RADIOLOGY
Increasing the kilovoltage (kVp) causes the resultant x-ray to have :
Decreased density
More latitude
A shorter scale of contrast
A longer scale of contrast
R Char
A longer scale of contrast
Remember: K ovoltage controls
One effect of a change in kilovoltage is a change in the penetrating power of the x-
rays. In,creasing kilovoltage reduces subject contrast (and the longer the scale of con-
trast); decreasing kilovoltage increases subject contrast (and the shorter the scale of
contrast). A second effect of an increase in kilovoltage is that not only are new, more
penetrating x-rays produced, but more of the less penetrating rays which were also pro-
duced at the lower kilovoltage are emitted.
Conclusion:
Kilovoltage influences the x-ray beam and radiograph by:
Altering contrast quality (for patients with thick jaws, increase kilovoltage)
Determining the quality of the x-rays produced
Determining the velocity of the electrons to the anode
RADIOLOGY
The number of x-rays produced is controlled by:
Kilovoltage (kVp)
Milliamperage (rnA)
Exposure time
R Char
Milliamperage (rnA)
The operator of an x-ray unit is in control of three factors:
1. KiloYoltage - the quality or penetrating power of the x-ray beam
2. Milliamperage - the quantity or number of x-rays produced
3. Exposure time - the length of time x-rays are produced and patient is exposed to
them
Suitable ranges of dental x-rays are 50-100 kVp and 5-15 mA
Some x-ray machines are calibrated in "impulses" (there are 60 impulses in 1second)
Density refers to the overall darkness (blackness) of a radiograph
Density will increase as mA, kVp, or exposure time is increased
Density will decrease as mA, kVp, or exposure time is decreased
Contrast refers to the difference in degrees of blackness between areas on a radi-
ograph
High - very dark and very light areas
Low - many shades of gray - preferred in dentistry
0 I ~ one exposure factor affects contra t=kiloYoltage (kVp) Note: filtration
plays a role here also.
R Bio
RADIOLOGY
Which of the following is a measure of the energy imparted by any type of ionizing
radiation to a mass of any type of matter?
Absorbed dose
Exposure
Equivalent dose
Effective dose
Absorbed dose
mThe traditional unit of absorbed dose is the rad (radiation absorbed dose).
Exposure is a measure of radiation quantity, the capacity of the radiation to ionize air.
The roentgen (R) is the traditional unit of radiation exposure measured in air. The roent-
gen applies only to x-rays and gamma rays.
dose is used to compare the biologic effects of different types of radiation
to a tissue or organ.
Effective dose is used to estimate the risk in humans.
RADIOLOGY
All of the following are radioresistant cells except
Muscle
NeNe
Mature bone
Lymphocytes
R Sio
Lymphocytes
Cells in the body have different sensitivities to radiation than others (see chart
below).
Radiosensitive Cells Radioresistant Cells
Reproductive cells (sperm and ova) Muscle
Lymphocytes (immature blood cells) Nerve
Bone Marrow Mature Bone
Immature bone cells
In general, the greater the rate or potential for mitosis and the more immature the
cells and tissues are, the greater the sensitivity or susceptibility to radiation.
R Sio
RADIOLOGY
It is recommended that the operator stand at least how many feet away from the
patient when taking radiographs?
Two feet
Four feet
Six feet
Eight feet
Six feet
Radiation exposure to the operator can be reduced by standin at least six fee
way, behind a lead shield, or both when exposing radiographs. The operator should
never remain in the room holding the x-ray packet in place for the patient. If a film must
be held in place by someone else (for a child), drape the parent and have him or her
hold the film. All dental personnel should wear film badges that monitor exposure
dosages.
Note: Regarding the taking and processing of dental radiographs, always remem-
ber to maintain proper infection control at all times!!!
R Bio
RADIOLOGY
The period between radiation exposure and the onset of symptoms is called the:
Latent period
Period of cell injury
Recovery period
Latent period
The-latent period is the period of time between radiation exposure and the onset of
symptoms. It may be short or long, depending on the total dose of radiation received
and the amount of time it took to receive the dose.
The period of cell injury follows the latent period. Cellular injury may result in cell
death, changes in cell function or abnormal mitosis of cells.
The r covery period is the last event in the sequence of radiation injury. Some cells
recover from radiation injury, especially if the radiation is "low level".
Note: The effects of radiation exposure are additive and the damage that remains
unrepaired accumulates in the tissues. The cumulative effects of repeated radiation
exposure can lead to various serious health problems (e.g. carcinogenesis, which
leads to various carcinomas, genetic mutations which cause birth defects, different
kinds of leukemia and cataracts).
Proc
RADIOLOGY
Marilyn has taken three panoramic x-ray films today. During the day as she developed
each film, she noticed the films getting lighter and lighter. What needs to be done so
that this problem can be corrected?
Decrease the temperature of the developing solution
Increase the temperature of the developing solution
Replenish the developing solution
Increase the mA setting
Increase the kVp setting
Replenish the developing solution
As the developing solution gets weaker, the films will get lighter. Both the develop-
ing and fixing solutions should be replenished on a daily basis. These solutions also
need to be changed on a regular basis, and the tanks need to be scrubbed and cleaned
as well.
The following factors affect the life of a developing solution: the cleanliness of the
tanks, the size of the films processed, the number of films processed, and the temper-
ature of the solution.
Notes:
1. Yellowish-brown film will result from insufficient fixing or rinsing.
2. Fogged film may also result from the improper film storage or outdated films.
3. Low solution levels will appear as: developer cut-off (straight clear border) or fixer
cut-off (straight black border) .
RADIOLOGY
X-ray fixer contains all of the following except :
A clearing agent
An antioxidant preservative
An accelerator
An acidifier
A hardener
Proc
An accelerator
X-ray fixing solution contains the following:
clearIng agent , such as sodlum or. ammoni thiosulfate, commonly called hypo, dis-
solves and removes the underdeveloped silver salts from the emulsion (Note: This is one of
the main functions of fixing solutions.) The chemical "clears" the film so that the black
silver image produced by the developer becomes distinctly perceptible. When the film is
improperly cleared, the remaining unexposed crystals darken upon exposure to light and
obscure the image.
An anti oxidant preservative, for example sodium sulfite prevents the decomposition of the
fixer chemical.
An acidifi er such as aceti c acid that is necessary for the correct action of the other
chemicals and also neutralizes any alkaline developer that may be carried over by the film or
hanger.
A hardenel" such as pot assium alum that shrinks and hardens the gelatin in the emulsion. It
shortens drying time and protects the emulsion from abrasion.
Notes:
1. If a dried radiograph were processed a second time, there would be no change in contrast
or density.
2. Fixing time i always at least twice as long as the developing time.
RADIOLOGY
X-ray developer contains all of the following except:
A developing agent
An antioxidant preservative
A clearing agent
An accelerator
A restrainer
Proc
A clearing agent
X- ay dev loping solution contains the following:
A developing agent, uch as hydroquinone, which is a chemical compound that is
capable of changing the exposed grains of silver salts to metallic silver. At the same
time, it produces no appreciable effect on the unexposed grains of the emulsion.
Gives detail to the x-ray image.
An antioxidant preservative, for example, sodium sulfite, prevents the developer
solution from oxidizing in the presence of air.
An accelerator - an alkali (sodium carbonate) - activates the developing agents
and maintains the alkalinity of the developer at the correct value.
A restrainer, such as potassium bromide, is added to developers to control the
action of the developing agent so that it does not develop the unexposed silver salts
to produce fog.
Remember: Developer is a chemical solution that converts the invisible image on a
film into a visible one composed of minute masses of black metallic silver.
Important: The function of developing sol ution is to reduce silver. halides to crystal s
of pure silver, while the function of fixing solution is to stop aevelopment and dis-
solve remaining pure silver cry tals.
Proc
RADIOLOGY
After processing a film, you notice that it appears brown in color. What is the most like-
ly cause of this?
Solutions are too strong
Solutions are too weak
Fixing time was not long enough
Fixing time was too long
Film was under-developed
Fixing time was not long enough
***A film will appear brown when it is not completely fixed
Some common errors made in the darkroom/cause:
Mounted films are improperly labeled (wrong patient name) / racks not labeled properly
Fogged film (gray/lack ot.conu. sty / faulty safelight in darkroom;-,white light leaking into dar!<
room
Lost films / films not secured properly on rack
Stat ic marks (multiple black lines) / friction when opening film packets causes static elec-
tricity
Overdeveloped film (dark) / incorrect time (too long) and temperature (too hot)
Underdeveloped film (light) / incorrect time (too short) and temperature (too cold); weak
solutions (too old or diluted)
Torn emulsion / films were allowed to touch or overlap while they were drying
Stained film (dark/white spots) / dirty work surfaces; person developing film was sloppy
Scratched films (white lines) / film emulsion removed by sharp object (fingernails/racks
touching)
Clear films (emulsion washed away) / films left in water (wash) for over 24 hours
Air bubbles (white spots) / air trapped on film surface while being placed in processing solu-
tions
NAnat
RADIOLOGY
Which of the following is the name of the bony projection that arises from the sphe-
noid bone and extends downward and slightly posteriorly?
The lingula
The hamular process
Sella turcica
Pubic symphysis
Copyright @ 2001 - DENTAL DECKS
The hamular process
On the x-ray tube its image is seen in proximity to the posterior surface of the tuberos-
ity of the maxilla. It varies greatly in length. width and shape from patient to patient. It
usually exhibits a bulbous point, but somet imes the point is tapered.
See pictures # 18, 19 and 20 in booklet
N Anat
RADIOLOGY
The image of the coronoid process of the mandible often appears in periapical x-rays
of:
The incisor region of the mandible
The molar region of the mandible
The incisor region of the maxilla
The molar region of the maxilla
The molar region of the maxilla
As the mouth is opened, the process moves forward, and therefore it comes into view
most often when the mouth is opened to its fullest extent at the time the exposure is
made. It is evidenced by a tapered or triangular radiopacity, which may be seen
below, or in some instances, superimposed on the molar teeth and maxilla.
See picture #16 in booklet
N Anat
RADIOLOGY
Identify the normal anatomy of the maxillary molar region.
.-::lP' ';''....."..",=,"__f
B
:>-.
H
G
o
E
Reproduced with permission from Kasle, Myron J . An Alias of Dental Radiographic Anatomy, Fourth Edition.
Philadelphia, Pennsylvania, W.B. Saunders Company, 1994.
Radiographic anatomy of the maxillary molar region:
A. Maxillary sinus depression
B. The zygomatic process
C. The lateral pterygoid plate
D. The maxillary tuberosity
E. The hamulus (part of the medial pterygoid plate)
F. The coronoid process of the mandible
G. Film identification dot
H. The floor of the maxillary sinus
N Anal
RADIOLOGY
What is the most likely interpretation of the radiolucency seen in the x-ray below
between the maxillary central incisors? Note: The teeth are vital.
The incisive foramen (also called the anterior palatine foramen)
As seen on x-rays, it's image may vary in relation to the roots of the incisor teeth and
ranges from a position near the crest of the alveolar ridge to one that may be at the
level of the apex of the roots. In some instances, its image may be superimposed on
the apex of the root of the central incisor when x-rays of the adjacent teeth are made.
and it may then be mistaken for a periapical lesion.
Notes:
1. It is almost always elliptical in shape and variable in size.
2. A cyst of the incisive canal with which it may be confused has a well-defined bor-
der and tends to be round.
N Anat
RADIOLOGY
Identify the anatomic structures labeled 1-5 of the anterior and premolar regions of the
maxilla.
2
{.
1. The nasal septum
2. The nasal fossae
3. The floor of the nasal fossa as it extends posteriorly
4. The anterior wall of the maxillary sinus
5. The nasal spine
N Anat
RADIOLOGY
Identify the normal radiographic anatomy of the maxillary incisor region.
E
c
Reproduced with permission from Kasle, Myron J. An Atlas of Dental Radiographic Anatomy. Fourth Edition.
Philadelphia . Pennsylvania. W.B. Saunders Company, 1994.
Radiographic anatomy of the maxillary incisor region:
A. The nasal conchae in the nasal fossae
B. Nasal fossae
C. The anterior nasal spine
D. A shadow of the lip line
E. The nasal septum
N Anat
RADIOLOGY
Identify the normal radiographic anatomy of the mandibular incisor region.
ABC
G F [
D
Reproduced with permission from Kasle. Myron J . An Atlas of Dental Radiographic Anatomy. Fourth Edition.
Philadelphia. Pennsylvania. W.B. Saunders Company. 1994.
Radiographic anatomy of the mandibular incisor region:
A. The permanent lateral incisor
B. The permanent central incisor
C. Overlapping contacts
D. The permanent canine
E. The genial tubercle
F. The lingual foramen
G. The inferior cortical plate of the border of the mandible
N Anat
RADIOLOGY
Identify the normal radiographic anatomy of the mandibular molar region.
A B
F
E D
c
Reproduced with permission from Kasle, Myron J. An Atlas of Dental Radiographic Anatomy. Fourth Edition.
-
Radiographic anatomy of the mandibular molar region:
A. The external oblique ridge
B. An enamel pearl
C. Film identification dot
D. Cortical bone of the inferior border of the mandible
E. A healing extraction site
F. The mandibular canal
N Anat
RADIOLOGY
Identify the normal radiographic anatomy of the mandibular premolar region.
ABC
J
H
E
G
F
Reproduc ed with permissio n from Kasle, Myron J. An Atl as of Deni al Radiographic Anatomy, Fourth Edition.
Radiographic anatomy of the mandibular premolar region:
A. Tom film emulsion
B. The buccal cusp of the mandibular permanent first premolar
C. The lingual cusp of the mandibular permanent first premolar
D. A portion of the metal film holder
E. Metal restorations
F. The submandibular fossa
G. The internal oblique ridge
H. The mandibular canal
I. The mental foramen
J. Sclerotic bone
RADIOLOGY
It is best to retain dental radiographs for how many years?
2 years
4 years
6 years
Indefinitely
Misc.
Indefinitely
The dental record must include documentation of informed consent and the exposure
of radiographs (e.g. the number and type of films, the rationale for exposure and the
interpretation). Legally, dental radiographs are the property of the dentist. Patients
do, however, have a right to reasonable access to the dental radiographs, which
includes having a copy of the radiographs forwarded to another dentist.
Note: Patients may refuse dental x-rays, however, the dentist must decide whether
an accurate diagnosis can be provided and whether treatment can provided.
Remember: No document can be signed by the patient that releases the dentist from
liability.
RADIOLOGY
Osteoradionecrosis is more common :
In the mandible
In the maxilla
Misc.
In the mandible
Osteoradionecrosis is more common in the mandible than in the maxilla, probably
because of the richer vascular supply to the maxilla and the fact that the mandible is
more frequently irradiated.
Remember: Osteoradionecrosis is the necrosis of bone, produced by ionizing radia-
tion.
The most common factors precipitating osteoradionecrosis are pre- and post-irradia-
tion extractions and periodontal disease.
Note: Damage to the blood vessels (as opposed to nerves, muscle, etc.) predispos-
es a patient to the development of osteoradionecrosis.
Misc.
RADIOLOGY
Your dental hygienist has a patient that says she needs bite-wing x-rays because it has
been six months since the last films were taken. Your hygienist should respond in
which manner listed below?
Agree with the patient
Tell the patient that bite-wing x-rays should be taken once a year
Tell the patient that dental x-rays are taken only when needed as judged by each
patient's needs
None of the above
Tell the patient that dental x-rays are taken only when needed as judged by
each patient's needs
Decisions about the number, type and frequency of dental x-rays are determined by
the dentist based on each patient's needs. Every patient has a different dental condi-
tion and thus the frequency of x-rays is different as well. There are guidelines published
by the ADA that aid a dentist in prescribing the number, type and frequency of dental
x-rays. Note: Patients who have tooth decay, periodontal disease, tooth mobility, pain
in one or more teeth or possible impacted teeth need more frequent radiographic
examinations than patients without such problems. Remember: For a pediatric patient
who is caries free (and asymptomatic), the first bite-wing radiographs should not be
taken until the spaces between the posterior teeth have closed.
Note: Occult diseases (for example, smsll carious lesions, cysts and tumors) are
those presenting no clinical signs or symptoms. Because occult disease in the peri-
oral tissues is so rare (except for caries), a radiographic examination of the jaws
should not be undertaken solely to look for it in an individual with teeth when there are
no clinical signs or symptoms. However, every x-ray taken should be evaluated for
these lesions.
Remember: Caries is an exception to the above rule because of its much higher
prevalence as compared to occult cysts or tumors.
RADIOLOGY
Which type of structure inhibits the passage of x-rays?
Radiopaque
Radiolucent
1m Char
Radiopaque
Radiopaque structures/materials:
Less radiation penetrates the structure and reaches the film
Radiopaque structures appear white on the processed film
Dense materials such as metals, enamel, dentin, and bone
Radiolucent structures/materials:
Allow radiation to pass through, absorbing very little
More radiation penetrates the structure and reaches the film
Radiolucent structures appear gray to black on processed film
Less dense materials, including soft tissue and air space
Note: Radiographs show shading from black to white (most radiolucent to most
radiopaque). Example: Least to most radiopaque: periodontal ligament space,
dentin, enamel , ZOE, amalgam.
RADIOLOGY
The area from which x-rays emanate is cal led the:
Target
Focal spot
Intensifying screen
Cone
1m Char
Focal spot
The focal spot is the area of tungsten on the anode that receives the impact of the speeding
electrons.
The target (also called the tungsten target) is a wafer of tungsten embedded in the face of the
anode at the point of electron bombardment. Note: The focal spot is actually a small area of the
target.
Remember: Intensifying screens are devices used in extraoral radiography that convert x-ray
energy into visible light. The light, in turn, exposes the screen film. Therefore, the radiation that
a patient receives is decreased. A cassette holder is a light-tight device used in extraoral radi-
ography to hold film and intensifying screens.
Important: Target film distance (also called source-to-film distance) is the distance from the
source of x-rays (focal spot on the tungsten target) and the film. It is determined by the length of
the position-indicating device (also called PIO). Two standard target-film distances are used in
intraoral radiography:
1. 20 cm (8 inches) is called the short cone, exposes more tissue by producing a more divergent
beam.
2. 41 em (16 inches) is called the long cone, reduces the amount of exposed tissue by produc-
ing a less divergent beam. Also results in smaller focal spot and better sharpness of the x-ray.

Major Topic Abbreviation: Radiology

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RADIOLOGY

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