RADIOLOGY Part 1: Radiation Physics Matter -radiation occurs at the subatomic level 1) lectrons: e!

ist in orbitals around the nucleus and carry an electrical char"e o# -1 $) %ucleus: contains &rotons and neutrons a) Protons: carry char"e o# '1 and mass 1()*! mass o# electron b) %eutrons: carry no char"e and are sli"htly heavier than &rotons )) Ioni+ation: occurs ,hen an electrically neutral atom loses an electron and becomes a &ositive ion and #ree electron becomes a ne"ative ion Electromagnetic Radiation -movement o# ener"y throu"h s&ace as a combination o# electric and ma"netic #ields -e!- Gamma rays. /-rays. 01 rays. visible li"ht. in#rared2heat. micro,aves. radio,aves -3uantum theory: considers electroma"netic radiation as small bundles o# ener"y 4photons) that travel at s&eed o# li"ht and contain a s&eci#ic amount o# ener"y Particulate Radiation -atomic nuclei2subatomic &articles movin" at hi"h velocity -e!- Al&ha2beta &articles. electrons 4cathode rays) X-Ray Tube 1) 5athode 4#ilament): source o# electrons in !-ray tube 4emits e- ,hen heated) -Molybdenum e- focusing cup electrostatically #ocuses electrons emitted by incandescent cathode into narro, beam directed at small area o# anode 4focal spot) $) Anode: consists o# tun"sten tar"et and co&&er stem a) 6un"sten tar"et: converts 7inetic ener"y o# e- "enerated #rom cathode into !-ray &hotons -#ocal s&ot: area o# anode on ,hich #ocusin" cu& o# cathode directs e-area #rom ,hich !-rays emanate -shar&ness o# radio"ra&hic ima"e increases as si+e o# #ocal s&ot decreases b) 5o&&er stem: houses anode to dissi&ate heat and reduces ris7 o# tar"et meltin" )) 1acuum: &rotects e3ui&ment #rom #ailure by &reventin" combustion by absorbin" heat "enerated by !ray &roduction 8) Glass envelo&e: surrounds !-ray tube and &revents lo,-"rade radiation #rom esca&in" 9) ner"y sources: a) one that &o,ers ener"y &otential bt, cathode and anode b) one that controls cathode #ilament 4on2o## s,itch #or !-ray unit)

Power Supply of X-Ray Tube 1) :eats !-ray tube #ilament 4cathode) -&rovides lo,-volta"e current by usin" ste&-do,n trans#ormer that reduces volta"e o# incomin" alternatin" current -controlled by milliam&s s,itch that re"ulates tem&- o# #ilament and thus number o# e- emitted -tube current: #lo, o# e- throu"h tube #rom cathode to anode and bac7 to cathode -3uantity o# radiation &roduced by an !-ray tube is directly &ro&ortional to tube current e!&osure time -controls number o# &hotons "enerated 4intensity o# beam) but not beam ener"y $) :i"h-volta"e trans#ormer "enerates hi"h &otential di##erence bt, anode and cathode -71& control selects volta"e #rom di##t- levels on autotrans#ormer and a&&lies it across &rimary ,indin" o# hi"h-volta"e trans#ormer -hi"h-volta"e trans#ormer increases volta"e si"ni#icantly and &rovides hi"h volta"e re3uired by !ray tube to accelerate e- #rom cathode to anode to "enerate !-rays -beam 3uality re#ers to mean ener"y o# !-ray beam. ,hich increases ,2 increasin" 71& -hi"h-ener"y &hotons have short ,avelen"ths 4hi"h #re3uency) -number o# &hotons 4beam intensity) also increases ,2 increasin" 71& )) 6ime e!&osure -timer controls len"th o# time hi"h volta"e is a&&lied to tube and there#ore the time the tube current #lo,s and !-rays are &roduced Target Film Distance -distance bt, tar"et 4#ocal s&ot) and #ilm -determines #ilm density. e!&osure. and dia"nostic 3uality -decreasin" this distance increases ma"ni#ication o# ob;ect -$ distances: 1) short cone: ( inches< e!&oses more tissue by &roducin" more diver"ent beam $) lon" cone: 1* inches< reduces amt o# e!&osed tissue by &roducin" less diver"ent beam and shar&er ima"e -best to use 1* inch tar"et #ilm distance to decrease ma"ni#ication Primary s Secondary Radiation 1) Primary radiation: main beam &roduced #rom anode at !-ray tube $) =econdary radiation 4scattered radiation): &roduced by collision o# main beam ,2 matter ,hich causes scatter -ma;or source o# ima"e de"radation in ima"in" !remsstrahlung Radiation -is sto&&in"2slo,in" o# hi"h-s&eed e- at the tar"et -e- is attracted to,ard &ositively char"ed nuclei and loses velocity -lost 7inetic ener"y is "iven o## in #orm o# ne, &hotons ->remsstrahlun" interactions "enerate !-ray &hotons ,2 continuous s&ectrum o# ener"y -is &rimary source o# !-ray &hotons #rom !-ray tube "haracteristic Radiation -results #rom e;ection o# an inner orbital e-. ,hich is re&laced by an outer orbital e- and subse3uent release o# &hoton o# s&eci#ic ener"y Factors "ontrolling the X-Ray !eam 1) ?iltration $) 5ollimation

Filtration -accom&lished by &lacin" an aluminum #ilter in &ath o# beam -reduces &atient dose by &re#erentially removin" less-&enetratin" &hotons #rom beam. thus chan"in" the number o# &hotons 4beam intensity) and mean ener"y -"ovt- re"ulations re3uire total in#iltration be e3ual to 1-9mm o# aluminum #or u& to @A 71& and $-9mm o# aluminum #or hi"her volta"es -half- alue layer: amt o# material 4thic7ness) re3uired to reduce intensity o# !-ray beam to hal# -hal#-value layer o# beam o# radiation #rom !-ray unit is #$mm of aluminum -t,o ty&es o# #iltration: 1) Inherent #iltration: absor&tion o# beam by &art o# !-ray tube 4"lass. &lastic cone. or aluminum) $) Added #iltration: additional aluminum dis7s &laced in cone to #ilter more lo,-"rade radiation "ollimation -use o# metal &lates to con#ine and direct radiation to s&eci#ic re"ion -collimator is metallic barrier ,2 an a&erture to reduce si+e o# !-ray beam and there#ore reduce volume o# irradiated &t tissue 4controls si+e2sha&e o# emitted beam throu"h sha&ed cones) -dental !-ray beams are usually collimated to a circle $%&' inches 4@ cm) in diameter -by la,. diameter o# beam must be no "reater than ) inches -rectan"ular collimators #urther limit si+e o# beam to ;ust lar"er than !-ray #ilm to reduce #urther &t e!&osure (ntensity of X-Ray !eam -is the total ener"y o# beam -e3ual to 4B !-ray &hotons) ! 4ener"y o# each &hoton) &er unit area o# e!&osure (n erse S)uare *aw -intensity o# !-ray beam at "iven &oint is inversely &ro&ortional to s3uare o# distance #rom source -IC 12d$ -chan"in" distance bt, !-ray tube and &t has mar7ed e##ect on beam intensity 4as you move tube #arther #rom ob;ect. ima"e becomes li"hter due to decreased intensity -increasin" distance by double causes the intensity to decrease by 8! 4or 128 as intense) (nteractions of X-Rays w+ Matter 1) 5oherent scatterin" 41AD o# interactions) $) Photoelectric absor&tion 4)AD o# interactions) )) 5om&ton scatterin" 4*AD o# interactions) "oherent Scattering -occurs ,hen lo,-ener"y &hoton &asses near an outer electron -the &hoton ceases to e!ist and e!cited e- returns to "round state. "eneratin" another &hoton ,2 same ener"y as incident beam Photoelectric ,bsorption -occurs ,hen a &hoton collides ,2 a bound e-. ,hich is e;ected #rom its shell and incident &hoton ceases to e!ist "ompton Scattering -occurs ,hen a &hoton interacts ,2 an outer orbital e-. ,hich recoils #rom im&act -incident &hoton is scattered in a ne, direction ,2 lo,er ener"y -ilo oltage -unit measure o# electrical &otential 4ener"y chan"e) bt, one &oint in electric circuit to another &oint -translates to how fast e- mo e bt, one &otential to another -e3ual to )uality o# &o,er o# !-ray -increasin" 71 reduces contrast 4lon"er scale o# contrast) and decreasin" 71 increases contrast 4shorter scale o# contrast)

Milliamperage -)uantity o# !-rays &roduced -determined by temperature of filament inside !-ray unit 4hotter #ilamentCmore e-) -ho, many &articles are &roduced determines density and amt o# e!&osure o# #ilm -increasin" mA increases density ,hich turns into dar7er ima"es on #ilm Density -overall dar7ness 4blac7ness) o# radio"ra&h -density increases ,2 increasin" mA. 71&. or e!&osure time -density decreases ,2 decreasin" mA. 71&. or e!&osure time "ontrast -re#ers to di##- in de"rees o# blac7ness bt, ad;acent areas on radio"ra&h 1) :i"h contrast: very dar7 and very li"ht areas $) Lo, contrast: many shades o# "ray 4&re#erred in dentistry) -71& is only #actor that a##ects contrast 4hi"her 71& causes more "ray and thus less contrast) Dosimetry 1) !&osure: measure o# 3uantity o# radiation received 4ener"y absorbed in air) -unit is Roentgen .R/ or "oulomb $) Absorbed dose: ener"y absorbed in tissue 4measure o# ioni+ed radiation absorbed by ob;ect) -unit is gray .0y/ or rad .radiation absorbed dose/ )) ##ective dose: ener"y absorbed in tissue times ,ei"htin" #actors -used to estimate ris7 in humans -measure in Sie ert .S / or Rem 8) 3uivalent dose: measure o# radiation 3uantity in tissue by a &articular ioni+in" radiation -meant to be com&ared ,2 other ioni+in" radiations to compare biological effects -measured by Rem or Sie ert 9) Radioactivity: decay rate o# radioactive materials -measured in "urie ."i/ or !ec)uerels 41 >3C I disinte"ration &er second) "on ersions -1 GrayC 1AA rads -1 radC -A1 "rays 41 cGy) -1 R EC 1AA =ieverts Part $: Radiation >iolo"y Phases of Radiation Damage 1) Latent &eriod: &eriod bt, radiation e!&osure and onset o# sym&toms $) Period o# cell in;ury: may be cell death. chan"es in cell #!n. or abnormal mitosis )) Recovery &eriod: some cells can recover #rom in;ury i# radiation ,as lo, level -e##ects o# radiation are additive and dama"e that is unre&aired accumulates in tissues Deterministic Effects -chan"es resultin" #rom 7illin" o# many cells #ollo,in" moderate-to-hi"h doses o# radiation -severity o# res&onse is &ro&ortional to dose 4Dose-de&endent) -there is threshold belo, ,hich no res&onse is seen -e!- Oral chan"es a#ter radiation thera&y Stochastic Effects -chan"es resultin" #rom dama"e to D%A o# sin"le cells -severity not dose-de&endent. but &robability o# res&onse is dose-de&endent -e!- Radiation-induced cancer and heritable e##ects

Radiation "hemistry 1) Direct e##ects: direct alteration o# biolo"ic molecules by ioni+in" radiation -12) o# biolo"ic e##ects o# !-ray e!&osure result #rom direct e##ects $) Indirect e##ects: radiation e##ects mediated throu"h ,ater -radiation converts ,ater to :' and O:- #ree radicals by radiolysis ,hich alter biolo"ical molecules -$2) o# radiation-induced biolo"ical dama"e caused by indirect e##ects )) 5han"es in biolo"ical molecules: dama"e to D%A molecule is &rimary mechanism #or radiation-induced cell death. mutation. and carcino"enesis "ellular Radiation Effects 1) Intracellular structures -nucleus is #ar more radiosensitive than cyto&lasm. es&ecially in dividin" cells -sensitive site in nucleus is D%A -chromosome chan"es serve as use#ul mar7ers #or radiation in;ury $) ##ects on 5ell Finetics a) Eitotic delay: mitotic delay occurs a#ter irradiation o# a &o&ulation o# dividin" cells -severity is dose-de&endent b) 5ell death: caused lar"ely by dama"e to chromosomes. &reventin" success#ul mitosis -radiation also causes cell death by the bystander e##ect and a&o&tosis c) 5ell Recovery: involves en+ymatic re&air o# sin"le-strand brea7s o# D%A -dama"e to both strands o# D%A at same site is usually lethal to cell )) Radiosensitivity and cell ty&e -cells that are more radiosensitive are: a) mitotically active b) undi##erentiated c) have lon" mitotic #utures -e!- Oral mucous membrane basal cells. re&roductive cells. bone marro,. lym&hocytes -cells that no lon"er divide are radioresistant 4e!- %eurons. muscle cells. mature bone cells) Radiation Effects at Tissue and 1rgan *e el 1) =hort-term e##ects: continuously &roli#eratin" tissues 4bone marro,. oral mucous membrane) are lost &rimarily by mitosis-lin7ed death $) Lon"-term e##ects: de&end &rimarily on mitotic activity o# the &arenchymal cells as ,ell as e!tent o# dama"e to #ine vasculature Rationale of Radiotherapy -radiation used to treat radiosensitive oral mali"nant tumors 4usually =55) -#ractionation o# total !-ray dose into multi&le small doses &rovides "reater tumor destruction than a sin"le lar"e dose Radiation Effects on 1ral Mucous Membrane -near end o# second ,ee7 o# thera&y. as basal e&ithelial cells die. mucous membrane be"ins to sho, areas o# redness and in#lammation 4mucositis) -as mucous membrane brea7s do,n. it #orms a ,hite-yello, &seudomembrane 4des3uamated e&ithelial layer) -at end o# thera&y. mucositis is most severe ,2 discom#ort at ma!imum and #ood inta7e di##icult -secondary yeast in#ection by 5andida albicans is common com&lication -a#ter irradiation is com&leted. mucosa be"ins to heal ra&idly and com&lete by $ months -at later intervals 4months to years). mucous membrane becomes atro&hic. thin. and relatively avascular ,hich com&licates denture ,earin" Radiation Effects on Taste !uds -radiation thera&y causes e!tensive de"eneration o# normal histolo"ical architecture o# taste buds and loss o# taste acuity durin" $nd or )rd ,ee7

Radiation Effects on Sali ary 0lands -there is a dose-de&endent and &ro"ressive loss o# salivary secretion seen in #irst #e, ,ee7s a#ter initiatin" thera&y -mouth becomes dry 4!erostomia). tender. and s,allo,in" becomes di##icult and &ain#ul -reduced salivary #lo, &ersistin" beyond 1 year is unli7ely to sho, si"ni#icant recovery -salivary chan"es have &ro#ound in#luence on oral micro#lora. leadin" to radiation caries Radiation Effects on De eloping Dentition -irradiation o# teeth durin" develo&ment severely retards "ro,th Radiation "aries -caries results #rom chan"es in salivary "lands. includin": 1) reduced #lo, )) decreased bu##erin" ca&acity $) decreased &: 8) increased viscosity -best restorative results obtained #rom combo o# restorative &rocedures. e!cellent oral hy"iene. and to&ical sodium #luoride Radiation Effects of !one -&rimary dama"e to mature bone results #rom dama"e to vasculature o# &eriosteum and cortical bone -normal marro, may be re&laced ,2 #atty marro, and #ibrous 56 that becomes hy&ovascular. hy&o!ic. and hy&ocellular -endosteum becomes atro&hic ,2 lac7 o# osteoblasts and osteoclast activity ,2 em&ty lacunae 4necrosis) -,hen chan"es are so severe that bone death results. it is termed osteoradionecrosis 4most serious com&lication #rom radiation to bone) -decreased vascularity o# mandible renders it easily in#ected by microor"anisms #rom oral cavity -OR% more common in mandible than ma!illa b2c o# richer vascular su&&ly to ma!illa and mandible bein" more #re3uently irradiated Part ): :ealth Physics Sources of Radiation E2posure 1) %atural radiation: lar"est contributor 4(AD) to radiation e!&osure in 0= a) !ternal sources 419D): results #rom cosmic and terrestrial sources 4radioactive nuclides in soil) b) Internal sources 4*9D): inhaled radon 4most radiation o# all sources) and in"ested radionuclides $) Arti#icial radiation: contributes $AD o# e!&osure a) Eedical dia"nosis and t!t 4dental !-rays account #or only $-9D o# av" annual e!&osure) b) %uclear medicine c) 5onsumer2industrial sources 4smo7in". ,ater. combustible #uels. 61. &oc7et ,atches. smo7e alarms. nuclear &o,er. etc-) E2posure and Dose in Radiography -"oal o# health &hysics is to &revent occurrence o# deterministic e##ects and minimi+e li7elihood o# stochastic e##ects by minimi+in" e!&osure o# o##ice &ersonnel and &ts durin" radio"ra&hic e!ams -"oal accom&lished by &hiloso&hy o# ALARA 4as lo, as reasonably achievable) -dose limits: a) occu&ational e!&osure limit is 9A m=v o# ,hole body radiation in 1 year -occu&ational e!&osure o# dental &ersonnel #rom !-ray e3ui&ment av" annual rate is A-$m=v b) there are no dose limits #or &ts e!&osed in course o# dental and medical t!t -&rimary ris7 #rom dental radio"ra&hy is radiation-induced cancer -much lo,er ris7 #rom dental radio"ra&hy than #rom smo7in" or eatin" #atty #oods. but not +ero ris7

Methods of Reducing Radiation Dose 1) Patient selection 4only on &ts that need !-rays ta7en< only done a#ter clinical e!am) $) 0se 2?-s&eed #ilms #or >Gs and PAs - 7ta-s&eed #ilm is most e##icient ,ay to reduce &t radiation e!&osure )) 0se rare-earth intensi#yin" screens #or PA% and 5e&hs 8) 0se e!tended source-to-&t distance 41* inch) to reduce &t e!&osure and im&rove ima"e clarity 9) 0se rectan"ular collimator to remove more than hal# o# &t e!&osure com&ared to round collimators *) 0se leaded a&rons ,2 thyroid collars @) ?ilm holders that &osition rece&tor to collimator should be used () Filovolta"e ran"e o# @A-HA 71& is suitable H) !&osure time: set mA to hi"hest &ossible value and ad;ust e!&osure time to balance out 1A) O&erator should stand at least 3 feet #rom &t and not in &ath o# beam 4&re#erably out o# room or behind barrier) -o&erator should never hold #ilm in &ts mouth or hold radio"ra&hic tube durin" e!&osure 11) Process #ilm under &ro&er time and tem&erature conditions Part 8: /-Ray ?ilm. =creens. and Grids "omposition of X-Ray Film 1) mulsion: silver halide "rains 4mostly silver bromide) are sensitive to !-rays and visible li"ht -are #lat. tabular crystals attached to base ,2 colla"enous vehicle -smaller the crystals. the better the ima"e resolution $) >ase: #le!ible. &lastic #ilm base su&&orts the emulsion )) Identi#ication dot: raised dot im&ression in corner o# #ilm used #or #ilm orientation 8) =creen #ilm: #ilm sensitive to visible li"ht so it is &laced bt, t,o intensi#yin" screens ,hen e!&osure is made (ntensifying Screens -made o# a base su&&ortin" material and a &hos&hor layer 4lanthanum and "adolinium) -&hos&hors incor&orated into intensi#yin" screens #luoresce in &ro&ortion to !-ray ener"y absorbed -convert !-ray ener"y into visible li"ht ,hich e!&oses screen #ilm -use o# intensi#yin" screens results in substantial reduction in &t dose but decrease ima"e resolution b2c o# dis&ersion o# li"ht #rom &hos&hors -used only in e!traoral radio"ra&hy Magnification -caused by !-rays that are not &arallel to ob;ect or #ilm -caused by decreasin" tar"et #ilm distance or increasin" ob;ect-to-#ilm distance -PA%s have $9D ma"ni#ication Radiographic Density -overall de"ree o# dar7enin" -measured as o&tical density o# area o# !-ray #ilm -o&tical densityC lo"1AI4Io2It) ,here Io is intensity o# incident li"ht and It is intensity o# li"ht transmitted throu"h the #ilm -o&tical density o# enamel is A-8. dentin 1-Am so#t tissue $-A -increasin" mA. 71&. or e!&osure time increases density -reducin" distance #rom #ocal s&ot to #ilm also increases density -the thic7er the sub;ect or "reater its density. the li"hter it ,ill a&&ear on radio"ra&h Radiographic "ontrast -ran"e and number o# densities on a radio"ra&h a) =ub;ect contrast: ran"e o# characteristics o# the sub;ect that in#luences radio"ra&hic contrast b) ?ilm contrast: ca&acity o# radio"ra&hic #ilms to dis&lay di##erences in sub;ect contrast

Radiographic Speed -amount o# radiation re3uired to &roduce an ima"e o# standard density -#astest dental #ilm has s&eed ratin" o# ? 4&re#erred) -only #ilms ,2 s&eed ratin" o# D or hi"her as a&&ro&riate #or intraoral radio"ra&hy Film *atitude -measure o# ran"e o# e!&osures that can be recorded on #ilm -#ilm o&timi+ed ,2 ,ide latitude can record a sub;ect ,2 ,ide ran"e o# contrast -#ilm o&timi+ed ,2 a narro, latitude can distin"uish ob;ects ,2 similar contrasts Radiographic 4oise -a&&earance o# uneven density o# a uni#ormly e!&osed #ilm -radiographic mottle is uneven density resultin" #rom &hysical structure o# #ilm or intensi#yin" screens Radiographic ,rtifacts -de#ects caused by errors in #ilm handlin" 4#in"er&rints) or errors in #ilm &rocessin" 4s&lashin" develo&er). or mar7s2scratches #rom rou"h handlin" Radiographic !lurring 1) =har&ness: ability o# radio"ra&h to de#ine an ed"e &recisely $) Resolution2resolvin" &o,er: ability o# radio"ra&h to record se&arate structures that are close to"ether )) Radio"ra&hic blur caused by: a) increased si+e2decreased number o# silver "rains in emulsion b) intensi#yin" screens c) movement o# #ilm. sub;ect. or !-ray source durin" e!&osure d) lar"e #ocal s&ot or short source-to-ob;ect distance Radiopacity s Radiolucency 1) Radio&acity: ob;ects that inhibit or absorb &assa"e o# !-rays onto #ilm cause them to a&&ear ,hiter on #ilm -bone. enamel. dentin. and metals $) Radiolucency: ob;ects that allo, !-ray &articles to &ass throu"h a&&ear dar7er on #ilm 0rids -com&osed o# alternatin" stri&s o# radio&a3ue material 4lead) and stri&s o# radiolucent material 4&lastic) -#!n is to reduce amt o# scattered radiation e!itin" a sub;ect that reaches the #ilm Part 9: Pro;ection Geometry 5ertical s 6ori7ontal ,ngulation 1) 1ertical an"ulation: re#ers to direction !-rays ,ill &ass throu"h ob;ect in vertical &lane 4su&eriorly. in#eriorly) $) :ori+ontal an"ulation: re#ers to direction !-rays ,ill &ass throu"h ob;ect in hori+ontal &lane 4anterior. &osterior) such that central ray is at A de"rees to ob;ect and HA de"rees to anterior-&osterior &lane o# ob;ect "entral Ray -ima"inary line that runs directly throu"h center o# !-ray cone Positi e s 4egati e ,ngulation 1) Positive an"ulation: ,hen tube is directed to,ard the ceilin" $) %e"ative An"ulation: ,hen tube is directed to,ard the #loor 6ow to (mpro e (mage Sharpness 1) 0se small e##ective #ocal s&ot as &ossible $) Increase distance bt, #ocal s&ot and ob;ect -use lon". o&en-ended cylinder )) Einimi+e distance bt, ob;ect and #ilm

6ow to Minimi7e (mage Si7e Distortion+Magnification 1) Increase #ocal s&ot-to-#ilm distance $) Decrease ob;ect-to-#ilm distance 6ow to Minimi7e (mage Shape Distortion 1) Position #ilm &arallel to lon" a!is o# ob;ect a) =hortenin" results ,hen e!cessive vertical an"ulation b) lon"ation results ,hen !-ray beam oriented at ri"ht an"els to ob;ect but not #ilm $) Orient central ray &er&endicular to ob;ect and #ilm !isecting ,ngle s Paralleling Techni)ue 1) >isectin" an"le: #ilm &laced as close to teeth as &ossible and central ray is directed &er&endicular to ima"inary &lane that bisects an"le bt, teeth and #ilm -disadvanta"es: causes increased distortion. ima"e is not true re&roduction o# ob;ect -advanta"e: decreases e!&osure time $) Parallelin": #ilm &laced &arallel ,2 lon" a!is o# tooth and central ray directed &er&endicular to lon" a!is o# teeth and #ilm -&re#erred method #or intraoral radio"ra&hs -must use /5P to 7ee& #ilm &arallel to lon" a!is o# tooth -disadvanta"e: re3uires increased e!&osure time due to use o# lon" cone 4increased ob;ect-#ilm and source-#ilm distances) Tube Shift+ 8S*1!9 Techni)ue -i# tube is shi#ted and directed at a re#erence ob;ect #rom a more mesial an"ulation and ob;ect in 3uestion also moves mesially 4same direction). ob;ect lies LI%G0AL to re#erence ob;ect -i# tube moved mesially and ob;ect in 3uestion moves distally. ob;ect lies 1055AL to re#erence ob;ect Egg Shell Effect -cortical borders are more o&a3ue than contents b2c o# lon"er &hoton &ath throu"h ed"e o# bone Part *: Processin" /-Ray ?ilm E2posing X-Rays -,hen a beam o# &hotons e!&oses an !-ray #ilm. it chemically chan"es the &hotosensitive silver halide crystal in the emulsion -e!&osed areas become radiolucent. and none!&osed areas become radio&a3ue -latent ima"e #ormed as silver halide crystals contain sensitivity sites that tra& e- "enerated ,hen emulsion is irradiated to &roduce crystals containin" neutral silver atoms

Processing Solutions 1) Develo&er: converts e!&osed silver halide crystals into metallic silver "rains that are seen as radiolucent a) Phenidone: serves as #irst e- donor that reduces silver ions to metallic silver at latent ima"e site b) :ydro3uinone 4develo&in" a"ent): &rovides e- to reduce o!idi+ed &henidone bac7 to its ori"inal active state so that it can continue to reduce silver halide "rains to metallic silver -"ives detail to !-ray ima"e c) Accelerator: al7ali salt 4sodium carbonate) ,hich maintains al7aline &: o# solution #or r!ns to occur d) Restrainer: &otassium bromide solution ,hich controls actions o# develo&er so that une!&osed silver salts arenJt removed #rom emulsion e) Antio!idant &reservative 4sodium sul#ite): &revents develo&er #rom o!idi+in" in &resence o# air $) Rinsin": dilutes the develo&er to slo, develo&ment &rocess -also removes al7ali activator to &revent neutrali+ation o# acid #i!er )) ?i!er: dissolves and removes undevelo&ed silver halide crystals #rom emulsion a) 5learin" a"ent: sodium2ammonium thiosul#ate dissolves undevelo&ed silver halide "rains b) :ardener: aluminum sul#ate com&le!es ,2 "elatin in emulsion to &revent dama"e to "elatin durin" handlin" c) Antio!idant &reservative: serves to &reserve #i!er #rom s&ontaneous o!idative &rocesses -sodium sul#ite d) Acidi#ier: acetic acid serves to neutrali+e any al7aline develo&er carried over 8) Gashin": a#ter #i!in". &rocessed #ilm is ,ashed in ,ater to ensure removal o# all thiosul#ate ions and silver thiosul#ate com&le!es that ,ould stain the #ilm Manual Processing Procedures 1) Re&lenish develo&er and #i!er solutions and stir them $) Let set in develo&er #or 9 mins at *( de"rees ? -as room tem&erature increases. develo&ment time decreases )) Rinse in runnin" ,ater #or )A secs 8) Place #ilm in #i!er #or 1A mins 9) Place in runnin" ,ater #or 1A mins ,utomatic Film Processing -chemical com&osition o# develo&er and #i!er are modi#ied to o&erate at hi"her tem&s than those used #or manual &rocessin" and to meet re3uirements o# ra&id develo&in". #i!in". ,ashin". and dryin" Mounting Radiographs -&ro&er method has bum& #acin" vie,er Film "ontamination 1) Dar7 s&ots: contamination ,2 develo&er be#ore &rocessin" $) Li"ht s&ots: #ilm contaminated ,2 #i!er be#ore &rocessin" Part @: Di"ital Ima"in" Digital Detectors 1) 55D 45har"e-cou&led devices) and 5EO= 45om&lementary metal o!ide semiconductors) -silicon sensor ca&tures !-ray ener"y #rom e!&osure as a volta"e &otential2electric char"e that is stored -silicon chi& reads out volta"e o# each &i!el to dis&lay ima"e -used #or intraoral. PA%. and 5e&h ima"in" -55D is most common sensor used $) P=P 4Photostimulable &hos&hor &lates) -&lates made o# barium #luorohalide ,2 traces o# euro&ium 4>a?>r: 0'$) -&lates ca&ture and store !-ray ener"y #rom e!&osure -&lates &laced into reader ,here stored ener"y is released as &hos&horescence by laser -reader measures released li"ht #rom &late and #orms ima"e

Digital Detector "haracteristics 1) 5ontrast resolution: Ability to distin"uish shades o# "ray $) =&atial resolution: ability to detect ed"es2se&arate t,o close &oints -intraoral: normal #ilm better than 55D25EO= ,hich are better than P=P -PA%25e&h: 55D and P=P e3uivalent )) Detector latitude: ran"e o# structures o# varyin" density sho,n on ima"e -P=PK55DKnormal #ilm 8) Detector sensitivity: dose re3uired to achieve standard "ray level -doses #or di"ital ima"in" about L that needed #or normal #ilm ,d antages of Digital (maging 1) Immediate dis&lay o# ima"es $) nhancement o# ima"es 4contrast. "ray scale. bri"htness) )) Radiation dose reduction u& to *AD 4b2c sensor is more sensitive to !-rays) -ma;or disadvanta"e is cost ,2 other disadvanta"es bein" decreased resolution and contrast and bul7iness o# sensors Part (: %ormal Radio"ra&hic Anatomy Tooth "omposition 1) namel: a&&ears more radio&a3ue than other tissues b2c it is most hi"hly minerali+ed2dense substance in body $) Dentin: about @9D minerali+ed so a&&ears more lucent than enamel and rou"hly the same as bone )) 5ementum: about 9A D minerali+ed< not usually a&&arent b2c lo, contrast bt, it and dentin and b2c cementum layer is so thin 8) Pul&: a&&ears radiolucent Supporting Structures 1) Lamina dura: thin radio&a3ue layer o# dense bone surroundin" tooth soc7et -continuous ,2 cortical bone -small disru&tions in lamina dura may re&resent nutrient canals &assin" #rom mand- bone to PDL $) Alveolar crest: level o# crest is considered normal ,hen it is no more than $mm #rom 5 M )) PDL s&ace: radiolucent s&ace bt, tooth root and lamina dura 8) 5ancellous bone: lies bt, cortical &lates Ma2illary Structures 1) Interma!illary suture: thin radiolucent line in midline ma!illa $) Anterior nasal s&ine: radio&a3ue area located $cm above alveolar crest above ma!- central incisors )) %asal #ossa: radio&a3ue line e!tendin" bilaterally a,ay #rom base o# anterior nasal s&ine re&resents in#erior border o# #ossa< #ossa itsel# a&&ears radiolucent 8) Incisive #oramen 4naso&alatine #oramen): radiolucent area located bt, roots o# ma!- central incisors in middle to a&ical thirds o# roots -&resence o# incisive canal cyst &resumed i# ,idth o# #oramen e!ceeds 1 cm 9) Lateral #ossa 4incisive #ossa): radiolucent de&ression in ma!- near a&e! o# lateral incisor *) Ea!illary sinus: borders o# sinus a&&ear as thin radio&a3ue line that usually e!tends #rom distal o# canine to ma!- tuberosity @) Ny"omatic &rocess o# ma!illa: a&&ears as 0-sha&ed radio&a3ue line ,2 o&en end directed su&eriorly in area o# roots o# ma!- 1st molar in area o# ma!- sinus () Ny"oma: in#erior &ortion o# +y"omatic bone can be seen as uni#orm radio&acity over a&ices o# molars H) Ptery"oid &lates: sin"le. radio&a3ue shado, around area o# ma!- tuberosity

Mandibular Structures 1) Genial tubercles: located on lin"ual sur#ace o# mand- sli"htly above in#erior border in midline -,ell seen on mand- occlusal radio"ra&hs -on Pas. a&&ear as radio&a3ue mass in midline belo, incisor roots $) Eental &rotuberance: t,o radio&a3ue lines s,ee&in" bilaterally #or,ard and u&,ard to,ard midline around "enial tubercles )) Eental #ossa: radiolucent de&ression on labial as&ect o# mandible e!tendin" laterally #rom midline and above mental rid"e 8) Eental #oramen: radiolucent area located belo, mand- $nd &remolar 9) Eandibular canal: dar7. linear shado, ,2 radio&a3ue su&erior2in#erior borders runnin" belo, roots on mand- teeth *) %utrient canals: radiolucent lines runnin" vertically #rom bone to tooth roots @) Eylohyoid rid"e: crest o# bone on lin"ual sur#ace o# mand- body -seen as radio&a3ue area runnin" do,n and #or,ard #rom area o# )rd molars to &remolar re"ion at a&ices o# &osterior teeth () =ubmandibular "land #ossa: de&ression in bone on lin"ual sur#ace belo, mylohyoid rid"e in molar area that accommodates submand- "land H) !ternal obli3ue rid"e: radio&a3ue areas runnin" do,n #rom anterior body o# ramus onto body o# mandPart H: Radio"ra&hic A&&earance o# 5aries Pro2imal Surface "aries -sha&e o# early lesion in enamel is classic trian"le ,2 broad base at tooth sur#ace and a&e! to,ard D M -,hen reaches D M. s&reads laterally lon" ;!n ,2 base o# $nd trian"le #orms ,2 a&e! to,ards &ul& -dentin trian"le has broader base than enamel trian"le and &ro"resses to,ard &ul& in direction o# dentin tubules -located ;ust "in"ival to contact &oint -around 9AD o# all &ro!imal lesions in enamel canJt be detected by !-ray 1cclusal Surfaces -most carious lesions o# children and adolescent occur on occlusal sur#aces -classic a&&earance is broad based radiolucent +one into dentin ,2 little or no chan"es in enamel !uccal+*ingual Surfaces -usually a&&ear round and as they enlar"e become elli&tical2semilunar Root Surfaces -detected by absence o# intact root sur#ace -&it#all in detection is cervical burnout &henomenon Part 1A: Radio"ra&hic A&&earance o# Perio Disease 4ormal ,natomy -normal alveolar bone crest lies at level 1-1-9mm belo, 5 M Mild Periodontitis -early lesions a&&ear as areas o# locali+ed erosion o# inter&ro!imal alveolar crest -anterior re"ions sho, bluntin" o# crests and sli"ht loss o# bone hei"ht -&osterior re"ions may sho, loss o# normal shar& an"le bt, lamina dura and alveolar crest Moderate Periodontitis 1) :ori+ontal bone loss: loss in hei"ht o# bone around multi&le teeth -crest still hori+ontal but more a&ically #rom line o# 5 Ms $) 1ertical bone loss: most o#ten locali+ed to one or t,o teeth

Multirooted Teeth -,idenin" o# PDL at a&e! o# interradicular bony crest o# #urcation is stron" evidence that &erio d! involves #urcation -most common route #or #urcation involvement o# ma!- 1st molar is #rom mesial side Part 11: Radio"ra&hic rrors 6erringbone Effect+Tire Trac: Pattern -characteri+ed by +i"-+a" &attern on !-ray #ilm a#ter develo&ment -indicates #ilm ,as &laced incorrectly 4bac7,ards) ,2 e!&osed #ilm #acin" a,ay #rom cone and lead #acin" the cone Foreshortening and Elongation 1) ?oreshortenin": characteri+ed by #ilm ima"e a&&earin" s3uashed or shortened in vertical dimension -caused by too much vertical angulation o# cone in relation to #ilm $) lon"ation: ima"e a&&ears stretched in vertical dimension -caused by too little vertical angulation o# cone to ob;ect 1 erlapping -inter&ro!imal areas overla&&ed -due to incorrect horizontal angulation ,rtifacts -ima"e on #ilm introduced by &t not removin" ob;ects in #ield that ,ould sho, radio&a3ue 1 erbent Films -bendin" #ilm crac7s emulsion -a&&ear as blac7 semilunar radiolucencies or crac7s in #ilm -is result o# bendin" #ilm as ,hen &t bites directly on #ilm *ight Films -caused by: 1) increased tar"et #ilm distance $) lo, mA )) lo, develo&er solution Dar: Films -caused mainly by too much mA Double E2posure Eulti&le ima"es on same #ilm -caused by usin" #ilm more than once Fogged Films -result o# e!&osure #rom other sources o# !-rays other than main beam Poor "ontrast -result o# 71 settin" too hi"h !lurred (mage -&t or cone movement durin" e!&osure "lear Films -#ilm ,as not e!&osed to !-ray beam

P,4 Errors 1) Reverse occlusal &lane 4O?ro,nP): chin tilted too #ar u&,ard -mand- structures loo7 narro,er and ma!- structures loo7 ,ider $) Occlusal &lane has e!cessive u&,ard curve 4O>i" smileP): shin tilted too #ar do,n,ard Part 1$: Radio"ra&hic 1ie,s Submento-5erte2 Techni)ue -occlusal #ilm &laced on occlusal &lane ,2 emulsion #acin" chin -central ray &laced &er&endicular to #ilm -&rovides in#o on +y"oma. +y"omatic arches. and mandible -&rovides best dia"nostic in#o on basilar s7ull #ractures -O;u"-handle vie,P is modi#ication ,here e!&osure reduced to a third so +y"omatic bones stand out to vie, +y"oma #ractures and rest o# s7ull is undere!&osed ;ater<s 5iew .Paranasal Sinus 5iew/ -&t &laced #acin" #or,ard to #ilm and chin an"led su&eriorly a"ainst #ilm -central ray directed &er&endicular to #ilm -o##ers dia"nostic vie, o# ma!illary and &aranasal sinuses 4also "ood #or mid-#acial #!s) Towne<s 5iew -central ray directed )A de"rees su&erior #rom ?ran7#ort &lane ,2 #ilm behind &ts head -o##ers vie,s o# condylar head and ramus -Reverse 6o,neJs vie,: "ives dia"nostic vie,s o# condylar nec7 and ramus #ractures *ateral 6ead Radiograph -#ilm &laced to side o# &tJs head ,hile central ray &laced on o&&osite side and directed &er&endicular to #ilm -used in ce&halometric analysis and cranio#acial "ro,th in orthodontics