RADIOGRAPHY COURSE > Module 5 > Flashcards

Module 5 Flashcards

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1
Q

Intra Oral techniques - Bitewing:

A

Modern:
- holder with aiming ring
Original:
- Wing or tab

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2
Q

Taking a bitewing radiograph:

A

1) is it an adult or child?
The normal size is 31x41mm - small is 22 x 35mm
- film
- solid state sensor
- photostimulable phosphor plate
2) position patient
head supported with the occlusal plane horizontal
3) position film/holder
lingual sulcus
distal of lower canine to the mesial aspect of lower third molar
receptor and teeth as close as possible
4) patient to close teeth on bite platform

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3
Q

Beam angulation (BW):

A
  • beam indicating device should be used
  • centre this on receptor
  • beam meets teeth and receptor at right angles (90 degrees)
  • beam passes through all contact points
  • beam aimed downward approximately 5-8 degrees
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4
Q

Choose settings (BW):

A
  • think about cross infection
  • patient preparation:
    • Explain procedure
    • Check ID
    • Check radiographic views required
    • Remove dentures, appliances etc
  • expose:
    • Patient in full view, ensuring they don’t move throughout the exposure
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5
Q

Advantages and Disadvantages for BW:

A

Advantages:

  • Simple and straightforward
  • Difficult for tongue to displace the receptor
  • Beam aiming device determines angulation
  • Cone cutting avoided
  • Autoclavable/disposable holders

Disadvantages:

  • Not 100% reproducible
  • Uncomfortable for patients
  • Expensive holders
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6
Q

Radiographic Features (Bw):

A
  • Crowns
  • Enamel
  • Dentine
  • Pulp chamber
  • Coronal part of root
  • Alveolar crests
  • Lamina dura
  • Periodontal ligament space
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7
Q

Additional features (Bw):

A
  • Floor of antrum
  • Carious cavity
  • Calculus
  • Unerupted/developing teeth
  • Restorations
  • Pulp stones
  • Airspaces
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8
Q

Ideal Quality criteria (BW)

A
  • no distortion or blurring
  • no coning
  • no overlap of approximal surfaces
  • include mesial surface of first premolar to distal surface of second molar
  • geometrically comparable to previous bitewing
  • occlusal plane in the middle of the image
  • buccal and lingual cusps superimposed
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9
Q

Ideal quality criteria - density and contrast (Bw)

A

Caries and restoration assessment:

  • well exposed
  • good contrast
  • differentiation between enamel and dentine
  • ADJ will be seen

Periodontal status

  • under exposed
  • avoid burn out
  • vertical bitewing
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10
Q

Technique errors (Bw)

A
  • Receptor positioned too far posterior =
    no premolars
  • Receptor incorrectly placed =
    displacement of receptor by tongue, distortion
  • Incorrect beam alignment in horizontal plane =
    too far posterior or anterior - coned off
    not aimed through contact areas - overlapping
  • Incorrect beam alignment in vertical plane =
    no superimposition of buccal and lingual cusps
  • incorrect exposure settings =
    overexposed - burn out - poor contrast - dark image
    underexposed - poor contrast - pale image
  • movement of patient or BID
    blurring
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11
Q

Quality assessment - technique (Bw)

A

assess the following:

  • Are all required teeth shown?
  • Are the crowns of upper and lower teeth shown?
  • Are the contact areas overlapped?
  • Are the buccal and lingual cusps superimposed?
  • Has there been any cone cutting?
  • Is the occlusal plane horizontal?
  • Is it geometrically comparable to previous films?
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12
Q

Quality - exposure factors (Bw)

A
  • Is the image too dark?
  • Is the image too pale?
  • is the amelodentinal junction apparent?
  • what effect has exposure had on the structures shown?
  • is any cervical burn-out noticeable?
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13
Q

Periapical Radiography (PA)

A

Includes:
Paralleling or bisecting angle techniques
Coverage 2-4 teeth
Individual teeth:
- apical areas
- detailed view of tooth and alveolar bones

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14
Q

Clinical indication (PA)

A
  • Apical infection/inflammation
  • Assess periodontal status
  • After trauma - check teeth and bone
  • Presence and position of unerupted teeth
  • Root morphology prior to extraction
  • Endodontic progression
  • Evaluate apical cysts or other alveolar bone lesions
  • Post operative evaluation of implants
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15
Q

Geometric requirements (PA)

A
  • Tooth and film in contact or as close as possible
  • Tooth and film packet parallel
  • Beam meets tooth film at right angles, beam should be at right angles in both planes (horizontal and vertical)
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16
Q

Paralleling technique (PA) practical technique

A
  • Receptor positioned in holder, placed with the long axis
    - vertical for incisors and canines
    - horizontal for molars and premolars
  • Ensure enough film beyond the apex to record the tissue in this area
  • Holder needs to be positioned so that the tooth to be x-rayed is touch bite block, may need to use a cotton wool roll
  • Patient to bite together
  • Locate ring should be just touching the patients face
  • Align the spacer cone with the ring
  • Ensure patient is still and make the exposure
  • This should be a reproducible position
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17
Q

Image positioning variations (PA)

A 
Maxillary incisors and canines =
    -Accommodate height of palate
    -Posterior position
Mandibular incisors and canines =
    -In floor of mouth
    -In line with lower canines or premolars
Maxillary premolars and molars =
    -In midline 
    -Accommodate height 
Mandibular premolars and molars 
    -Lingual sulcus 
    -Next to appropriate teeth
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18
Q

Patient care(PA)

A
  • Justification
  • Patient identification
  • Explain procedure
  • Remove appliance/dentures
  • Set exposure parameters
  • Patient positioning
    • Head support
    • Occlusal plane horizontal
  • Check required view
  • Position receptor
  • Align beam
  • Make exposure

Cross infection control =

  • PPE
  • Barriers
    • surfaces
    • receptors
  • Disinfection
  • Hand washing
  • Clinical waste
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19
Q

Radiographic features of the MAXILLA

A

CENTRAL INCISORS:

  • shadow of top of nose
  • trabecular bone pattern
  • lamina dura
  • median suture
  • gingival soft tissue
  • periodontal ligament space
  • pulp canal
  • restorations if present

CANINES:

  • trabecular bone pattern
  • lamina dura
  • periodontal ligament space
  • pulp canal
  • overlapping crowns
  • superimposed roots of first premolars
  • restorations if present

PREMOLARS:

  • trabecular bone pattern
  • lamina dura
  • periodontal ligament space
  • intercrestal bone
  • pulp canal
  • restorations if present
  • floor of antrum
  • maxillary antrum

MOLARS:

  • trabecular bone pattern
  • lamina dura
  • periodontal ligament space
  • intercrestal bone
  • pulp canal
  • restorations if present
  • floor of antrum
  • maxillary antrum
  • zygoma
  • unerupted 3rd molar
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20
Q

Radiographic features of the MANDIBLE

A

INCISORS:

  • enamel
  • periodontal ligament space
  • upper margin of the lower lip
  • lamina dura
  • trabecular bone pattern

CANINES:

  • enamel
  • pulp canals
  • periodontal ligament space
  • orientation dot
  • lamina dura
  • bone pattern
  • burn out

PREMOLARS:

  • lamina dura
  • bone pattern
  • pulp canals
  • mental foramen

MOLARS:

  • interdental bone
  • varying bone patterns
  • inferior dental canal
  • developing third molar
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21
Q

Ideal quality criteria(PA):

A
  • no distortion or blurring
  • include correct anatomical area with apices and 3-4mm of surrounding bone
  • no overlap of approximal surfaces
  • no coning off
  • geometrically comparable with previous periapical images

DENSITY AND CONTRAST:
caries, restorations, periapical assessment:
- well exposed
- good contrast
- differentiation between enamel and dentine
- differentiation between periodontal ligament space
periodontal status:
- under exposed
- avoid burn out

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22
Q

Preparation, positioning and technique errors: (PA)

A 
Dentures and appliances not removed
   - superimpositions
Incorrect position of receptor 
   - not over the area of interest - no apicies or periapical tissues 
   - bending - distortion 
Incorrect orientation
   - no image (back to front)
Poor alignment of BID
   - horizontal - cone cutting, overlapping contact areas 
   - vertical - cone cut, foreshortening, elongation 
Poor communication 
   - movement, blurring 
Incorrect settings 
   - poor contrast 
Double exposure 
   - receptor used twice
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23
Q

Considerations for PA:

A
  • children and disabled
  • anatomical difficulties
  • neurological difficulties
  • radiographic investigations appropriate to the limitations
  • appropriate film size
  • modify technique
  • assistance
  • under GA
  • avoid OPG
  • paralleling technique preferred
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24
Q

Positioning when doing Bisected angle technique:

A

PATIENT:

  • seated
  • head supported
  • occlusal plane parallel to floor
  • bite gently or slight support with thumb or index finger

IMAGE RECEPTOR:

  • orientate
  • as close to tooth as possible
  • do not bend
  • tube head placed dependent on tooth for investigation
  • assess vertical angle
  • beam 90° to bisected angle
  • horizontal angle through interproximal areas
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25
Vertical angulation (PA):
``` Maxilla - downwards angulation: INCISORS - 45° to bridge of nose CANINES - 50° PREMOLARS - 40° MOLARS - 30° ``` ``` Mandible - upwards angulation: INCISORS - 25° CANINES - 20° PREMOLARS - 15° MOLARS - 5° ```
26
ADVANTAGES - Bisected angle technique:
- comfortable positioning for patient - positioning is relatively simple and quick - dependent on correct angulation, image is same length as tooth - adequate for most diagnostic purposes
27
DISADVANTAGES - Bisected angle technique:
- distortion due to many variables - elongation/ foreshortening - vertical angulation wrong - periodontal bone levels not seen - zygomatic shadow overlies roots of upper teeth - skill required for angulation assessment - not reproducible - cone cutting - roots and crowns overlap - horizontal angulation wrong - distortion of crowns common - foreshortened buccal roots of maxillary posterior teeth
28
EXPOSURE FAULTS (PA):
Elongation - Angulation to shallow, long image Foreshortening - Angulation too steep, short image Coning - Angulation not central to film, partial exposure Blurred image - Movement of patient or collimator Transparent film - Film inserted the wrong way round Fogged film - Exposure to light before x-ray beam Blank film - Machine not switched on
29
Occlusal radiography:
Maxillary occlusal projections - upper standard occlusal (standard occlusal) - upper oblique occlusal (oblique occlusal) - vertex occlusal Mandibular occlusal projections - lower 90° occlusal (true occlusal) - lower 45° occlusal (standard occlusal) - lower oblique occlusal (oblique occlusal)
30
Upper standard occlusal
ANTERIOR OF MAXILLA Clinical indication: - presence of unerupted canines, supernumeraries, odontomes - Position of unerupted canines - Lesion evaluation - Anterior teeth and alveolar bone fractures ``` PATIENT •Seated •Occlusal plane horizontal •Head supported •Bites together gently ``` ``` IMAGE RECEPTOR •Flat in mouth •On occlusal surfaces of lower teeth •Orientated •Centrally •Long axis crossways (adult) •Antero-posteriorly (child) ``` ``` TUBEHEAD: • Above patient • In midline • Downwards through bridge of nose • 65° - 70° to film packet ```
31
Upper oblique occlusal:
POSTERIOR OF MAXILLA AND UPPER POSTERIOR TEETH ON ONE SIDE clinical indications: - lesion evaluation - cysts tumors etc - antral floor assessment including the position of displaced roots - posterior teeth and alveolar bone fracture ``` PATIENT •Seated •Occlusal plane horizontal •Head supported •Bites together gently ``` ``` IMAGE RECEPTOR •Flat in mouth •On occlusal surfaces of lower teeth •Orientated •Long axis Antero-posteriorly •on side of investigation ``` TUBEHEAD: • side of patients face • Downwards through cheek 65° - 70° to film • centred to region of interest
32
LOWER 90° OCCLUSAL:
TOOTH BEARING PORTION OF THE FLOOR OF THE MOUTH CLINICAL INDICATIONS: - presence and position of calculi in salivary ducts - position of unerupted teeth - lesion evaluation - horizontal plane assessment of fracture of body of the mandible PATIENT: - head tipped back - head supported - bites together gently IMAGE RECEPTOR: - orientate so that it is centrally placed - onto occlusal surfaces of lower teeth - long axis cross ways TUBEHEAD: - circular collimator - below chin - in midline - centred to interproximal of the first and second molars
33
LOWER 45° OCCLUSAL:
ANTERIOR OF MANDIBLE AND ANTERIOR TEETH clinical indications: - periapical assessment if patients are unable to tolerate periapical radiography - lesion evaluation - vertical plane assessment of fractures PATIENT: - head supported with the occlusal plane horizonal - bites gently together on the film IMAGE RECEPTOR: - orientate - centrally in mouth - to occlusal surfaces of lower teeth - long axis antero-posteriorly TUBEHEAD: - in midline - centered through chin point - 45° to film
34
LOWER OBLIQUE OCCLUSAL:
UNILATERAL VIEW OF MANDIBLE AND/OR SUBMANDIBULAR SALIVARY GLAND clinical indications: - detect calculi in submandibular salivary gland - position of unerupted third molars - lesion evaluation, posterior of body of mandible PATIENT: - head supported, facing away - chin raised - bite together gently IMAGE RECEPTOR: - orientate to the side of the investigation - place on the occlusal surfaces of lower teeth - long axis anterior posterior TUBEHEAD: - using a circular collimator - position it upwards and forwards, below and behind the angle of the mandible - parallel to lingual surface
35
EXTRA ORAL RADIOGRAPH - oblique lateral:
Radiographs of the head and jaw
36
TRUE LATERAL:
Sagittal plane and film parallel X-ray beam perpendicular to both Taken using a cephlostat unit
37
OBLIQUE LATERAL:
Film and sagittal plane not parallel X-ray beam perpendicular to film Differing projections possible
38
CLINICAL INDICATIONS FOR OBLIQUE LATERAL:
- Assessment of unerupted teeth - Detect fractures of the mandible - Evaluate lesions, cysts etc - Alternative to intra oral view if patient unable to open mouth or cannot tolerate intra oral radiographs - Specific views of anatomy required i.e. salivary glands
39
EQUIPMENT FOR OBLIQUE LATERA:
- Standard dental x-ray set | - Extra oral cassette containing film and intensifying screens or digital phosphor plate - 13 x 18cm in size
40
Positioning - OBLIQUE LATERAL:
CASSETTE: - held by patient over the area of interest PATIENT: - seated/upright with head rotated to the side of interest - raise chin this increases the triangular space between the back of the ramus and the cervical spine through which the x-ray beam will pass (radiographic keyhole) TUBEHEAD: - opposite side to film - behind ramus through radiographic keyhole - beneath lower border of the mandible
41
BIMOLAR TECHNIQUE
- same radiograph used twice - right and left side of jaws - lead screen to protect film not being exposed - turn patient and film around - lead screen used to shield part of film already exposed - make second exposure
42
DENTAL PANORAMIC TOMOGRAPHY (DPT) - image production:
- narrow beam rotational tomography - 2 centers of rotation - focal trough - 3 dimensional - image created in sections which are built up during rotations
43
Equipment (DPT):
- tube head - cassete and carriage assembly - positioning apparatus
44
Taking a DPT:
• Patient considerations • Ensure correct identification • Procedure explained to the patient giving reassurance regarding the equipment
45
Selection Criteria for DPT:
* Orthodontic assessment * Assessment of bony lesions or unerupted teeth * Prior to hospital admission * Periodontal assessment * Assessment of third molars * Fracture of the mandible * Antral disease * TMJ assessment * Implant planning
46
Preparation (DPT)
* Cassette or phosphor plate inserted * Collimate field * Select exposure settings – 70 – 100kV; 4 – 12 mA * Place bite peg – barrier cover
47
Patient Considerations (DPT)
``` • Confirm the patient's identity • Check their current medical history • Confirm the radiographic request • Explain the procedure • Reassure the patient • Remove spectacles, dentures, orthodontic appliances and any metal objects ```
48
Positioning of the Patient (DPT)
* Ensure they have a straight spine and to hold the supports * Bite edge-edge on bite peg * Immobilise their head using temple supports * Use light markers to indicate * Vertical mid sagittal plane, * Frankfort plane horizontal * Canine light between upper lateral incisor and canine * Ask them to close their lips and keep their tongue to roof of the mouth * Tell them not to move throughout the exposure
49
Anatomy Markers
* Mid sagittal plane * Frankfort plane * Canine light
50
Panoramic Anatomy
* Real or actual shadows * Air shadows * Ghost or artefactual shadows
51
Additional points (DPT)
* Not an alternative for intra oral techniques * Less operator technique required * Technique sensitive * Digital improves resolution
52
Occlusal Radiographs
Intra oral technique with image receptor (5.7 x 7.6 cm) placed in the occlusal plane, at present there are no suitable sized solid-state digital sensors Maxillary Occlusal Projections Upper Standard Occlusal Upper Oblique Occlusal Vertex Occlusal - no longer used Mandibular Occlusal Projections Lower 90° occlusal Lower 45° occlusal Lower oblique occlusal
53
Clinical Indications (occlusal rads)
• Evaluate size and extent of lesions in anterior maxilla • Assessment of anterior periapical regions where periapical techniques cannot be tolerated • Detection of unerupted canines, supernumeraries and odontomes for orthodontic assessment • Dento-alveolar trauma to anterior maxilla
54
Technique (occlusal)
• Patient seated, head supported, horizontal occlusal plane • Image receptor inserted with long axis cross ways for adults • Antero-posteriorly for children • Patient gently bites together • Tube head positioned in the midline above the patient, downwards angle of 65° - 70° to image receptor • Periapical film for small children, place flat in occlusal plane, tube head at 50°
55
Upper Oblique Occlusal
Clinical indications • Evaluate size and extent of lesions in posterior maxilla • Assessment of posterior regions where periapical techniques cannot be tolerated • Antral floor assessment • Cleft palate assessment • To assess fractures of posterior teeth or alveolar bone
56
Technique (Upper Oblique Occlusal)
• Patient seated, head supported, horizontal occlusal plane • Use protective thyroid shield • Image receptor inserted with long axis antero posteriorly to side of mouth under investigation • Patient gently bites together • Tube head positioned to the side of the patient, downwards angle of 65° - 70°to image receptor through the cheek
57
Lower 90°/ True Occlusal
Clinical indications • Detection of calculi in submandibular duct • Assessment of mandible affected by lesions causing bucco - lingual expansion • Torus mandibularus assessment • Assessment of unerupted tooth position, bucco – lingual • Assessment of fractures for horizontal displacement • Implant assessment Technique • Image receptor centrally placed – crossways or antero- posteriorly • Patient gently bites together • Head tilted backwards as far as comfortable • Tube head placed in midline below the patient's chin 90° to image receptor • Tube head placed below body of mandible on side of investigation 90° to image receptor
58
Lower 45° Occlusal
Clinical indications • Assess dento-alveolar trauma (in conjunction with periapicals) • Assess anterior mandible for lesions – size and extent • Alternative for patients who cannot tolerate periapicals • Assess mandibular fractures for vertical displacement Technique • Patient seated with head supported and with the occlusal plane horizontal and parallel to the floor • Image receptor facing downwards centrally placed onto the occlusal surfaces of the lower teeth with the long axis Antero-posteriorly • Patient gently bites together • Tube head placed in midline below the patient’s chin 45° to image receptor • Tube head placed below body of mandible on side of investigation 90° to image receptor
59
Lower Oblique Occlusal
Lower Oblique Occlusal Clinical indications • Detection of calculi in sub mandibular salivary gland • Assessment of the bucco lingual position of unerupted lower wisdom teeth • Evaluation of the extent and expansion of cysts etc in the posterior part of the body and angle of the mandible Technique • Patient seated with head supported and rotated away from the side of investigation • Image receptor facing downwards centrally placed onto the occlusal surfaces of the lower teeth with the long axis antero posteriorly • Patient gently bites together • Tube head is aimed upwards and forwards from below and behind the angle of the mandible and parallel to the lingual surfaces of the mandible
60
Cephalometric Radiography
``` Clinical Indications Orthodontic Treatment • Initial diagnosis – skeletal/soft tissue abnormalities • Treatment planning • Treatment progression • Appraisal of treatment Orthognathic Surgery ``` * Preoperative evaluation * Treatment planning * Postoperative appraisal Equipment Cephalostat: • Head positioning and stabilising apparatus • Anti scatter grid • Cassette holder Cassette -usually 18 x 24 cm • Aluminium wedge filter – attenuates the x-ray beam selectively in the region of the soft tissues to enable the soft tissue profile to be seen on the final radiograph ``` Beam Characteristics • Fixed position • Sufficiently penetrating • Parallel • Collimated ```
61
True Cephalometric Lateral Skull
* Sagittal plane of head vertical * Frankfort plane horizontal * Teeth in full occlusion * Immobilise the head * Film parallel to sagittal plane * Beam perpendicular to film * Position aluminum wedge
62
Cephalometric Postero-Antero of the Jaws
* Rotate head stabilising apparatus 90° * Position patient head tipped forward * Radiographic baseline horizontal and perpendicular to film * Forehead to nose position * Immobilise the head * Beam horizontal, central ray through cervical spine
63
Cephalometric Points
* Sella S * Orbitale r * Nasion N * Anterior nasal spine ANS * Subspinale or Ponit A * Prosthion Pr * Infradentale Id * Supramentale or point B * Pognion Pog * Gnathion Gn * Menton Me * Gonion Go * Posterior nasal spine PNS * Articulare Ar * Porion Po
64
Planes and Angles:
* Frankfort plane * Mandibular plane * Maxillary plane * SN plane * SNA * SNB * ANB * Maxillary incisal inclination * Mandibular incisal inclination
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