RADIOLOGY

I. HISTORY
- discovered by Wilhelm Conrad Roentgen 1895
- Gamma radiation has identical energy to diagnostic x-rays
II. PRODUCTION
- electrons originate at the cathode by heating a tungsten filament
- X-rays are produced when fast moving electrons are suddenly decelerated in
the tungsten target (anode) thus loosing much of their energy.
- electric field between the cathode and anode cause the electrons to accelerate
towards the anode
- < 1% of the energy formed at the anode is in the form of x-rays. Rest produces
heat .
- energy of electrons hitting the target varies because the voltage across the xray tube continually varies - the highest energy across the tube = peak kilovolt
(kVp)
- tube current (mA) controls the NUMBER of electrons produced at the cathode
- filters block low energy photons from leaving the tube resulting in fewer x-rays
leaving the tube but those that do have higher average energy
On striking the tungsten atoms, the electrons produce x-rays in two processes.
1. Characteristic radiation - where an electron is removed from the K shell and an
electron drops down from the L shell emitting exactly a 59 keV photon. This
amount of energy emitted is characteristic for tungsten.
2. Bremsstrahlung radiation - or general radiation - where an electron passes near
the positively charged nucleus and is deflected losing some of its energy. Here
the energy of the photon emitted depends on many factors; such as original
energy of the electron and how close it came to the nucleus of a tungsten atom.
Here the energy is not discrete like characteristic radiation but a whole series of
energy levels. Some low energy radiation such as heat is absorbed by the target.
Other low energy, long wavelength radiation is removed by filters in the x-ray
tube.
Intensity of the x-ray beam
1. Intensity = number of x-ray photons X energy of each photon
2. Depends on kilovoltage, tube current, target material, and filtration.
a. Kilovoltage (kVp) controls the energy field across the tube from cathode to
anode - thus, how much energy the electrons have when they strike the
anode.
b. Tube current (mA) controls the number of electron produced at the
cathode and thus the number available to strike the anode target.
c. Target material (tungsten) determines how much radiation will be produced
at a given kVp. High atomic number targets like tungsten are more efficient
in producing x-rays. The target determines the quality of x-rays produced
1

and the energy of the characteristic radiation produced.

d. Filters block low energy photons from leaving the x-ray tube resulting in
fewer x-rays leaving but those that do have a higher average energy level.
e. X-rays are produced by characteristic and bremsstrahlung effects and
have a continuous as well as a discrete component.
III. TERMINOLOGY
- quantity of exposure = Coulomb/kg (roentgen is old term)
C/kg = 3.88 x 103 roentgens
- absorbed dose = Gray (rad is old term, radiation absorbed dose)
1 Gray = 100 rads, 1 rad = 1 cGy
- dose equivalent = Sievert (rem is old term, radiation equivalent mammal)
1 Sv = 100rem, 1 rem = 1 cSv
- activity = Becqueral (Curie is old term)
- 1 rad = 1 rem
- 1 Sv = 1 Gray
- Quality of dose equivalent = equivalent effect of ionizing radiation on a biologic
system
- Different types of ionizing radiation are given a quality factor (QF). The QF for
x-ray, gamma rays and electrons is 1. The QF for alpha particles and protons
is 10. The QF for high energy alpha particles is 20.
- Old unit = radiation equivalent mammal (rem) = rad x QF
- Advantage of rem is that 100 rem of any type of ionizing radiation produces the
same biologic effect.
- Relative biologic effect (RBE) functions the same as QF but is used for the
study of specific biologic processes.
IV. PROPERTIES
- they are electromagnetic radiations of short wavelength high frequency and
high energy
- X-rays travel in straight lines in a vacuum
- X-rays propagate through space at the speed of light
- X-rays have no mass and no charge, only energy
- X-rays are capable of exposing photographic film
- electrons originate at tungsten element of cathode and accelerate towards anode,
x-rays are produced when the electrons are rapidly decelerated in the target
- most of the energy produced at the anode is in the form of heat
- less radiation to the patient if energy penetrates through the patient
V. INTENSITY
Intensity of the x-ray beam
1. Intensity = number of x-ray photons X energy of each photon
2. Depends on kilovoltage, tube current, target material, and filtration.
a. Kilovoltage (kVp) controls the energy field across the tube from cathode to
anode thus, how much energy the electrons have when they strike the

anode.
b. Tube current (mA) controls the number of electron produced at the
cathode and thus the number available to strike the anode target.
c. Target material (tungsten) determines how much radiation will be produced
at a given kVp. High atomic number targets like tungsten are more efficient
in producing x-rays. The target determines the quality of x-rays produced
and the energy of the characteristic radiation produced.
d. Filters block low energy photons from leaving the x-ray tube resulting in
fewer x-rays leaving but those that do have a higher average energy level.
e. X-rays are produced by characteristic and bremsstrahlung effects and have a
continuous as well as a discrete component.
f. Nearly all the scatter that fogs diagnostic x-rays is the result of the Compton
effect
QUALITY

EXPOSURE

RADIATION TYPE

ONLY X-RAYS OR
GAMMA RAYS

MEDIA

ABSORBED
DOSE

DOSE
EQUIVALENT

ACTIVITY

ALL IONIZING
RADIATION

ALL IONIZING
RADIATION

ALL

ONLY IN AIR

ANY

BIOLOGICAL
SYSTEMS

ALL

OBSERVED UNIT

IONIZATION

ENERGY
DEPOSITION

BIOLOGIC
EFFECT

NUCLEAR
TRANSFORMATION

OLD UNIT

ROENTGEN (R)

RAD

REM
REM=RAD X

CURIE (CI)

OF
NEW UNIT

COULOMB/KG
(C/KG)

GRAY (GY)

SIEVERT (SV)

BECQUEREL (BQ)

EQUIVALENCIES

1 C/KG=3.88 X
103R

1 GRAY=100

1 SIEVERT = 100

RADS

REM

1 BEQUEREL = 3.7
X 10-10

1 RAD=1 CGY

1 REM=1 CSV

OF UNITS

COMPTON EFFECT
- MORE LIKELY WITH HIGHER ENERGY INCIDENT X-RAY PHOTONS
- ONLY PART OF ITS ENERGY IS TRANSMITTED TO OUTER ELECTRON BUT STILL CAUSING

IONIZATION
- THE RESULTANT X-RAY PHOTON (SCATTER PHOTON) HAS LESS ENERGY AND DIFFERENT
DIRECTION THAN THE INCIDENT PHOTON.
- THE EJECTED ELECTRON (COMPTON ELECTRON) PRODUCES SECONDARY IONIZATION
- THIS TYPE OF INTERACTION IS COMMON AT INTERMEDIATE DIAGNOSTIC X-RAY LEVELS AND
INTERMEDIATE TO LOW-WEIGHT ABSORBERS
- NEARLY ALL THE SCATTER RADIATION THAT FOGS DIAGNOSTIC X-RAYS IS THE RESULT OF
THE COMPTON EFFECT
- THE LITTLE X-RAY ENERGY THAT IS ABSORBED BY SOFT TISSUE IS PRIMARILY COMPTON
EFFECT. THIS IS WHY THE IMAGES OF SOFT TISSUES ARE USUALLY MORE BLURRY THAN
DENSE OBJECTS.

ATTENUATION
- IS THE REDUCTION IN INTENSITY OF THE X-RAY BEAM AS IT TRAVERSES MATTER BY EITHER
ABSORPTION (PHOTOELECTRIC EFFECT) OR DEFLECTION (COMPTON EFFECT) OF PHOTONS
IN THE BEAM

- DEGREE OF ATTENUATION DEPENDS ON SEVERAL FACTORS:

1) ENERGY OF INCOMING BEAM = > ENERGY > DEGREE OF PENETRATION
2) THICKNESS OF OBJECT = > THICKNESS > X-RAY PHOTONS ABSORBED
3) ATOMIC NUMBER OF THE OBJECT = > # >Z-RAY PHOTONS ABSORBED
4) DENSITY OF THE OBJECT = > COMPACT OF MATERIAL > X-RAY PHOTONS ABSORBED
VI. BACKGROUND RADIATION
- AVERAGE AMERICAN EXPOSURE TO ENVIRONMENTAL RADIATION IS 3.0 MSV/YR
- AVERAGE EQUIVALENT DOSE FOR 21 FILM SERIES 0.019-0.184 MSV (EQUALS 16
DAYS ENVIRONMENTAL EXPOSURE)
- AVERAGE EQUIVALENT DOSE FOR A PANORAMIC RADIOGRAPH 0.008-0.024 MSV
(EQUALS 1 WEEK OF ENVIRONMENTAL EXPOSURE)
- AVERAGE EQUIVALENT DOSE FOR A FOUR BITEWING SERIES 0.004-0.033 MSV
(EQUALS 3 DAYS OF ENVIRONMENTAL EXPOSURE)
- AVERAGE BONE MARROW DOSE FROM DENTAL X-RAYS IS 0.014 MSV/YR.
- FROM SUN/COSMIC IS 0.28 MSV/YR (WHOLE BODY DOSE)
- FROM SOIL, ROCKS AND BUILDINGS IS .26MSV/YR (WHOLE BODY DOSE)
- DIFFERENCES IN RADIATION EXPOSURE BETWEEN DIFFERENT TYPES OF DENTAL
RADIOGRAPHS ARE VERY SMALL. CLINICAL NEED RATHER THAN PATIENT DOSE IS THE
DETERMINING FACTOR IN WHICH RADIOGRAPHS TO SELECT.
- THE PANORAMIC RADIOGRAPH RESULTS IN AN AVERAGE PATIENT DOSE OF THE BONE

MARROW APPROXIMATE EQUIVALENT TO THAT RECEIVED FROM FOUR BITEWING FILMS. THIS
LOW DOSE RESULTS LARGELY FROM THE USE OF INTENSIFYING SCREENS. THE PATIENT
DOSE IS RELATIVELY HIGH IN THE REGION OF THE CENTERS OF ROTATION
YOUR RESPONSIBILITY IS TO KEEP RADIATION DOSES AS LOW AS REASONABLY
ACHIEVABLE (ALARA CONCEPT), DESPITE THE RELATIVE SAFETY OF DENTAL X-RAYS.
THERE IS NO ABSOLUTELY SAFE LEVEL OF X-RADIATION. ALL IONIZING RADIATION MAY
CAUSE SOME DAMAGE.

BIOLOGIC EFFECTS OF IONIZING RADIATION

4

- THE LETHAL DOSE FOR 50% OF HUMANS IN 30 DAYS (LD50/30) IS APPROX 450 RADS OR 4.5
GRAYS TOTAL BODY DOSE
- CELLS THAT DIVIDE RAPIDLY AND CELLS THAT ARE RELATIVELY UNDIFFERENTIATED ARE MOST
RADIATION SENSITIVE = LAW OF BERGONIE AND TRIBONDEAU
- BIOLOGIC EFFECT OF RADIATION ARE 1) SOMATIC, EFFECTS ON ANY OF THE CELLS OF THE
INDIVIDUAL HIMSELF, OR 2) GENETIC, MUTATIONS WHICH ARE NOT EVIDENT IN THE
INDIVIDUAL BUT WHICH ARE EFFECTS ON THE GERM PLASMA THAT ARE PASSED ON TO
FUTURE GENERATIONS.
- A LISTING OF CELLS FROM THE MOST RADIOSENSITIVE TO THE LEAST RADIOSENSITIVE MIGHT
INCLUDE: 1) LYMPHOID CELLS, 2) GONADS, 3) PROLIFERATING CELLS OF THE BONE
MARROW, 4) EPITHELIAL CELLS OF THE BOWEL, 5) EPIDERMIS, 6) HEPATIC CELLS, 7)
EPITHELIUM OF THE LUNG ALVEOLI AND BILIARY PASSAGES, 8) KIDNEY EPITHELIAL CELLS, 9)
ENDOTHELIAL CELLS (PLEURA AND PERITONEUM), 10) NERVE TISSUE, 11) BONE CELLS, 12)
MUSCLE AND CONNECTIVE TISSUE. GENERALLY, THE MORE RAPID THE TURNOVER OF THE
CELL, THE GREATER THE RADIATION SENSITIVITY.
- LOW DOSES WOULD EFFECT = RADIOSENSITIVE CELLS (PLATELETS, WBC OF LYMPH AND
BONE MARROW). YOU SEE FEVER, INFECTION, HEMORRHAGE = HEMATOPOIETIC SYNDROME
- DOSES OVER 600 RADS (6 GY) = GASTROINTESTINAL SYNDROME (FLUID LOSS, DIARRHEA,
AND GI INFECTION)
- DOSES > 10,000 RADS (100 GY) = CEREBRAL SYNDROME (RAPID DISORIENTATION AND
SHOCK IN ADDITION TO SYMPTOMS OF THE OTHER SYNDROMES)
- A TOTAL DOSE THAT WOULD BE LETHAL IF GIVEN IN A SHORT TIME, SUCH AS A FEW DAYS,
MAY RESULT IN NO DETECTABLE EFFECT IF GIVEN IN SMALL DAILY INCREMENTS OVER A
PERIOD OF SEVERAL YEARS. THIS IS DUE TO THE ABILITY OF LIVING TISSUE TO REPAIR SOME
OF THE DAMAGE DONE TO IT

ORAL EFFECTS OF RADIATION

- FIBROSIS OF SALIVARY GLANDS LEADS TO XEROSTOMIA AND INCREASED CANDIDIASIS AND
CARIES (TX NYSTATIN, CLOTRIMAZOLE, OR KETOCONAZOLE (IF RESISTANT)
- TEETH ARE AFFECTED ONLY SECONDARY TO THE XEROSTOMIA
- OSTEORADIONECROSIS - ONE OF THE MOST SERIOUS SIDE EFFECTS OF HEAD AND NECK
RADIOTHERAPY
A. RADIATION OF THE BONE RESULTS IN DAMAGE TO THE MICROVASCULATURE CAUSING THE
ALTERED BONE TO BECOME HYPOXIC, HYPOVASCULAR, AND HYPOCELLULAR
B. INFECTION IS NOT NECESSARILY PRESENT
C. RESULTS OF NON-HEALING, NECROTIC BONE. IT IS CONSIDERED A PROBLEM OF WOUND
HEALING RATHER THAN INFECTION.
D. RADIATION DOSE IS THE MAIN FACTOR ASSOCIATED WITH BONE NECROSIS
E. CLINICAL FEATURES INCLUDE PAIN AND EVIDENCE OF EXPOSED BONE OF MORE THAN
THREE MONTHS DURATION WITHOUT HEALING.
F. NEVER GETS BETTER AS FAR AS RISK IS CONCERNED, ONLY WORSE.
- ACUTE INFLAMMATION OF THE ORAL MUCOSA (MUCOSITIS) STARTING THE SECOND WEEK OF
RADIATION (TOPICALS LIKE BENEDRYL OR LIDO)
- IMPAIRMENT OR LOSS OF TASTE STARTING THE THIRD WEEK OF RADIATION AND RECOVERY
USUALLY IN SIX MONTHS (ZINC SULFATE PILLS WITH MEALS)
- TRISMUS DUE TO FIBROSIS OF THE MUSCLES OF MASTICATION

VII. DENSITY
- IS THE DEGREE OF "BLACKNESS" OF THE FILM
- MA IS THE MOST IMPORTANT FACTOR CONTROLLING DENSITY
- THE DENSITY VARIES DIRECTLY WITH MA AND TIME
- MA AND EXPOSURE TIME ARE INTERCHANGEABLE AND CONSIDERED AS A SINGLE
FACTOR (MAS)
- INCREASING MAS INCREASES THE NUMBER OF X-RAYS
- INCREASED KVP ALSO INCREASES THE DENSITY
- DISTANCE IS ALSO A FACTOR IN DENSITY ( IF YOU 2X THE DISTANCE, YOU MUST 4X THE
TIME )
VIII. CONTRAST
- HIGH CONTRAST FROM LOW KVP (SHORT SCALE)
- LOW CONTRAST FROM HIGH KVP (LONG SCALE)
- HIGH KVP TECHNIQUES ALLOW A WIDER RANGE OF MA SETTINGS BUT RESULT IN LESS
CONTRAST THAN LOW KVP TECHNIQUES
REMEMBER:
KVP INFLUENCES SUBJECT CONTRAST (EXPOSURE DIFFERENCES) AND EXPOSURE LATITUDE; MA
CONTROLS FILM BLACKENING (DENSITY)
- WHEN THE KVP IS INCREASED, THE MAS MUST BE DECREASED IN ORDER TO KEEP THE
SAME RADIOGRAPHIC IMAGE

IX. LIGHT RADIOGRAPHS

UNDER EXPOSURE:
- TOO SHORT OF AN EXPOSURE
- TOO LONG OF A FILM DISTANCE
- KVP TOO LOW
- MA TOO LOW
- REVERSED FILM PACKET
- DROP IN THE LINE VOLTAGE
UNDER DEVELOPMENT:
- DEVELOPING TIME TOO SHORT
- LOW TEMP
- CONTAMINATED/EXHAUSTED SOLUTIONS
- OLD FILM
X. DARK RADIOGRAPHS
OVER EXPOSURE:
- TIME TOO LONG
- DISTANCE TOO SHORT
- KVP TOO HIGH
- MA TOO HIGH
OVER DEVELOPMENT:
6

- TOO LONG
- TEMP TOO HIGH
- SOLUTION TOO STRONG
HIGH CONTRAST FILM (DARKS TOO DARK AND LIGHTS TOO LIGHT) = LOW PENETRATION (KVP TOO
LOW), OR OVER DEVELOPMENT, TOO LONG EXPOSURE
LOW CONTRAST (ALL GRAY TONES) = EXCESSIVE PENETRATION (KVP TOO HIGH), UNDER
DEVELOPMENT, EXCESSIVE SCATTER FOG, UNDER EXPOSURE
XI. GEOMETRIC FACTORS
- THE SOURCE OF THE RADIATION SHOULD BE AS SMALL AS POSSIBLE
- DISTANCE FROM THE SOURCE OF THE RADIATION TO THE OBJECT SHOULD BE AS LONG
AS POSSIBLE

- THE DISTANCE FROM THE OBJECT TO THE RECORDING SURFACE SHOULD BE AS SHORT
AS POSSIBLE

- OBJECT AND FILM SHOULD BE PARALLEL

- BEAM SHOULD STRIKE OBJECT AND FILM AT RIGHT ANGLE
NOTE: PLEASE REFER TO NDS/ORAL RADIOLOGY COURSE HANDOUT "COMMON
RADIOGRAPHIC ERRORS" FOR AN EXCELLENT SUMMARY OF ERRORS IN RADIOGRAPHIC
TECHNIQUE AND PROCESSING. SOME OF THESE INCLUDE :
- PROJECTION AND TECHNIQUE ERRORS
- EXPOSURE AND PROCESSING ERRORS
- PANORAMIC TECHNICAL ERRORS
- PANORAMIC POSITIONAL ERRORS
XII. EXTRAORAL RADIOGRAPHS
- MID-FACE SERIES: - TRAUMA TO MAXILLA OR MIDFACE OR A LESION IN MAXILLARY SINUS
OR
MAXILLA
1. WATERS VIEW (POSTERIOR-ANTERIOR OBLIQUE VIEW)
2. POSTERIOR-ANTERIOR VIEW
3. SUBMENTAL VERTEX VIEW (JUGHANDLE VIEW)
4. TRUE LATERAL VIEW (CEPHALOMETRIC OR STRAIGHT LATERAL)

- FOR TRAUMA OR LESIONS IN THE MANDIBLE, YOU SHOULD ORDER ONE OR MORE OF THE
FOLLOWING: LOWER FACE SERIES: - TRAUMA TO MANDIBLE
1. POSTERIOR-ANTERIOR VIEW
2. LATERAL OBLIQUE
3. MODIFIED TOWNES VIEW (RAMUS AND NECK OF CONDYLE)
4. MANDIBULAR OCCLUSAL VIEW
- TMJ FILMS:
- TRANSCRANIAL VIEW (LINDBLOM VIEW)
- TRANSPHARYNGEAL VIEW (MCQUEEN VIEW)
- TRANSORBITAL VIEW (ZIMMER VIEW)

TRUE LATERAL VIEW (CEPHALOMETRIC)

- ASIDE FROM ORTHODONTIC NEEDS, THIS PROJECTION HAS VERY LIMITED VALUE IN DENTISTRY
DUE TO SUPERIMPOSITION OF THE RIGHT AND LEFT SIDES WHICH MAY MASK UNILATERAL
LESIONS
- DIAGNOSTIC FOR THE FOLLOWING:
1. ORTHODONTIC EVALUATION
2. FRACTURE OF THE MAXILLA WITH POSTERIOR DISPLACEMENT
3. FRACTURE OF THE CERVICAL SPINE
4. FRACTURE OF THE MAXILLARY SINUSES
5. FOREIGN BODIES
6. SELLA TURCICA ENLARGEMENT DUE TO PITUITARY ADENOMA OR A CRANIOPHARYNGIOMA

LATERAL OBLIQUE VIEW

- AN EXCELLENT LATERAL VIEW OF MANDIBLE
- CAN SEE CONDYLES, ASCENDING RAMUS, ANTERIOR NASAL SPINE, HYOID BONE, CORONOID
PROCESS, ANGLE OF THE MANDIBLE
- DIAGNOSTIC FOR THE FOLLOWING:
1. FRACTURES OF THE CONDYLES, CORONOID PROCESS, RAMUS, BODY OF THE MANDIBLE,
AND ALVEOLAR BONE

2. FOREIGN BODY
MODIFIED TOWNES VIEW
- CAN SEE SPHENOID SINUS, CONDYLAR PROCESS, NASAL SEPTUM AND VOMER, RAMUS AND
STYLOID PROCESS

- DIAGNOSTIC FOR THE FOLLOWING:

1. NASAL SEPTUM
2. CONDYLAR NECK
POSTERIOR ANTERIOR VIEW
- DESIGNED TO DEFINE BONY STRUCTURE OF THE LOWER 1/3 OF THE FACE
- CAN SEE FRONTAL AND MAXILLARY SINUSES, THE NASAL SEPTUM, AND THE FLOOR OF THE
NASAL CAVITY
- MAJOR PORTION OF THE MIDDLE 1/3 OF THE FACE IS OBSTRUCTED BY THE PETROUS PORTION
OF THE TEMPORAL BONE AND THE MASTOID PROCESS
- THE SPINAL COLUMN TENDS TO OBSTRUCT A CLEAR VIEW OF THE ANTERIOR MANDIBLE
- DIAGNOSTIC FOR THE FOLLOWING:
1. GENERAL SURVEY OF THE MANDIBLE
2. LATERAL WALL OF THE MAXILLARY SINUS
3. NASAL SEPTUM
4. SUPRA AND INFRAORBITAL RIDGES

WATERS VIEW (POSTERIOR-ANTERIOR OBLIQUE VIEW)

- TIPPING OF THE FACE RESULTS IN THE PETROUS PORTION OF THE TEMPORAL BONE AND THE
MASTOID PROCESS BEING DISPLACED INFERIORLY. THIS ALLOWS A CLEAR VIEW OF THE
UPPER 2/3 OF THE FACIAL BONES.
- DIAGNOSTIC FOR THE FOLLOWING:
1. MAXILLARY SINUSITUS
2. FRACTURES OF THE MAXILLA, ORBIT, ZYGOMA, ZYGOMATIC ARCH, AND NASAL SPINE
8

SUBMENTAL VERTEX VIEW

- CAN SEE ZYGOMATIC ARCHES, FOREIGN BODIES (AIDS IN DETERMINING THE MEDIAL OR
LATERAL POSITION), AND THE FORAMINA AT THE BASE OF THE SKULL
- DIAGNOSTIC FOR THE FOLLOWING:
1. FRACTURE OF THE ZYGOMATIC ARCHES
2. DEPRESSION OF THE ZYGOMATIC ARCHES
MANDIBULAR OCCLUSAL VIEW
- CAN SEE MANDIBULAR CORTICAL PLATES, GENIAL TUBERCLES, AND OCCLUSAL VIEW OF MAND
TEETH

- DIAGNOSTIC FOR THE FOLLOWING:

1. EXPANSION OF THE CORTICAL PLATES
2. OCCLUSAL VIEW OF MANDIBULAR LESIONS
3. POSITION OF IMPACTED TEETH
4. SIALOLITHS IN THE SUBMANDIBULAR DUCT
XIII. PANORAMIC RADIOGRAPHS
- USES TOMOGRAPHIC-LIKE PRINCIPLES
- X-RAY SOURCE AND FILM ROTATE IN OPPOSITE DIRECTIONS
- THE RELATIVE FOCAL SPOT IS INSIDE THE PATIENT'S MOUTH
- AS TUBE AND FILM MOVE, ALL IS BLURRED EXCEPT FOR A FOCAL PLANE OR TROUGH
- "GHOST IMAGES" ARE FORMED WHEN THE OBJECT IS LOCATED BETWEEN THE X-RAY
SOURCE AND THE CENTER OF ROTATION. SINCE THE DISTANCE FROM THE CENTER OF THE
IMAGE LAYER IS ALWAYS GREAT, GHOSTS ALWAYS APPEAR WITH SIGNIFICANT DISTORTION
MAGNIFICATION AND UNSHARPNESS. SINCE THE BEAM IS PROJECTED FROM BELOW,
GHOSTS ALWAYS APPEAR HIGHER ON THE FILM. THEY ARE REAL IMAGES AND THEY APPEAR
ON THE CONTRALATERAL SIDE OF THE FILM
- IF OBJECT IS PLACED TO FAR TOWARD THE ROTATION CENTER THE IMAGE OBTAINED WILL BE
DISTORTED WIDER (TOO WIDE)
- IF OBJECT IS PLACED TO CLOSE TO THE FILM THE IMAGE OBTAINED WILL BE DISTORTED
VERTICALLY (TOO NARROW)

XIV. SPECIAL IMAGING TECHNIQUES

- TOMOGRAPHY - A PROCESS WHEREBY AN IMAGE OF A LAYER WITHIN THE BODY IS PRODUCED
-

WHILE IMAGES OF STRUCTURES ABOVE AND BELOW THAT LAYER ARE MADE
INVISIBLE BY BLURRING
TMJ ARTHROGRAPHY - THE RADIOGRAPHIC EXAMINATION OF A JOINT FOLLOWING THE
INJECTION OF RADIOPAQUE MEDIA INTO THE JOINT SPACE. IN TMJ
ARTHROGRAPHY, INJECTION OF THE LOWER JOINT IS MORE DIAGNOSTIC.
SIALOGRAPHY - RADIOGRAPHIC VISUALIZATION OF THE DUCTAL TREE AND PARENCHYMA OF
THE MAJOR SALIVARY GLANDS BY MEANS OF INTRADUCTAL INJECTION OF A
RADIOPAQUE CONTRAST MEDIUM.
CT SCAN - OR COMPUTED TOMOGRAPHY (ALSO KNOWN A CAT - COMPUTED AXIAL
TOMOGRAPHY) PRODUCES DIGITAL DATA MEASURING THE X-RAY

TRANSMISSION THROUGH AN OBJECT IN THREE DIMENSIONS. THE DIGITAL

DATA CAN BE MATCHED TO A DENSITY SCALE AND A PREDETERMINED
IMAGE
LAYER IS DISPLAYED ON A TV MONITOR
- SPECIFIC IMAGE LAYERS CAN BE DISPLAYED.
ADVANTAGES
- IT IS MORE SENSITIVE THAN NORMAL X-RAYS IN DIFFERENTIATING SOFT TISSUE
DENSITIES.
- MORE INFORMATION IS AVAILABLE WITH LESS RADIATION THAN NORMAL X-RAYS
WOULD NEED FOR THE SAME DETAIL.
- THE IMAGE CAN BE ROTATED AT ANY ANGLE AND ENHANCED TO SHOW SPECIFIC
TISSUES EVEN AFTER THE PATIENT HAS LEFT.

DISADVANTAGES
- THE RESULTANT IMAGE IS NOT AS SHARP AS WITH ORDINARY X-RAYS
- THE RADIATION DOSE IS HIGH (FROM 2.2 TO 6.8 RADS IN A NORMAL HEAD SERIES)
- BONY LESIONS ARE BETTER VISUALIZED ON NORMAL X-RAYS
- GREAT DIFFICULTY IN IMAGING METALLIC OBJECTS
- EXPENSIVE
- ACCORDING TO LAST WRITTEN BOARD - MAJOR DISADVANTAGE IS INABILITY OF
THE PATIENT TO REMAIN STILL.
- MRI - USES THE RESONANCE OF HYDROGEN NUCLEI FOLLOWING EXCITATION BY A
RADIOWAVE TO PRODUCE A COMPUTER DERIVED PICTURE OF THE TISSUE. NO
X-RAYS ARE USED. THE TECHNIQUE IS VERY EFFECTIVE IN DETECTING
NECROTIC TISSUE, ISCHEMIA, MALIGNANCY AND DEGENERATIVE DISEASE IN
SOFT TISSUE. BUT TEETH AND BONES ARE NOT WELL IMAGED. CAN BE USED
TO EXAMINE TMJ DISK DISPLACEMENTS

REMEMBER THE ALARA CONCEPT KEEP RADIATION DOSES AS LOW AS REASONABLY ACHIEVABLE
THERE IS NO ABSOLUTELY SAFE LEVEL OF X-RADIATION.
XV. X-RAY PROTECTION
- CURRENT FEDERAL AND STATE LAWS ARE BASED ON NATIONAL COUNCIL ON RADIATION
PROTECTION (NCRP) REPORT #35.
- THE POPULATION AT LARGE (AVERAGE OF WHOLE POPULATION) - MAXIMUM PERMISSIBLE
DOSE (MPD) = 1.7 MSV/YR (0.17 REM/YR)
- DESPITE DOSE LIMITS, ALL RADIATION MAY BE DAMAGING, SO BEYOND MEETING THE MPD WE
MUST REDUCE RADIATION AS MUCH AS POSSIBLE (ALARA)
METHODS TO REDUCE RADIATION EXPOSURE
- TIME = < AND YOU WILL < EXPOSURE
- DISTANCE - INTENSITY OF THE X-RAY BEAM DECREASES AS THE SQUARE OF THE DISTANCE.
STAY AS FAR FROM THE X-RAY SOURCE AS POSSIBLE
- BARRIERS - EVEN NORMAL BUILDING MATERIALS ARE OFTEN EFFECTIVE BARRIERS
- LEAD LINED WALLS ARE EXPENSIVE AND SELDOM NEEDED WITH DENTAL X-RAY
10

UNITS

OTHER METHODS TO REDUCE OCCUPATIONAL EXPOSURE

- X-RAY TECHNICIAN SHOULD STAND AT LEAST 6 FEET FROM THE X-RAY TUBE AND AT AN ANGLE
OF 90 TO 135 DEGREES TO THE CENTRAL BEAM OR BE BEHIND A BARRIER
- THE TECHNICIAN SHOULD NEVER HOLD THE FILM OR THE X-RAY TUBE WHILE THE TUBE IS ON
- ALL X-RAY EQUIPMENT SHOULD BE CHECKED BY A RADIATION PHYSICIST AT LEAST EVERY 3
YEARS

- OTHER PROCEDURES THAT DONT REDUCE OCCUPATIONAL EXPOSURE BUT MONITOR IT, SUCH
AS THE USE OF PERSONAL AND ENVIRONMENTAL RADIATION DOSIMETERS, ARE OF LIMITED
VALUE IN FACILITIES USING LOW DOSE RADIATION AND ARE NO LONGER REQUIRED IN NAVY
DENTISTRY.
- THERE IS NO MPD FOR THE PATIENT
- SINCE THE X-RAY IS PRIMARILY FOR THE PATIENTS BENEFIT, IT IS ASSUMED THAT THE
ADVANTAGES OF THE INFORMATION GAINED OUTWEIGH THE POTENTIAL RISKS

- NO MATTER HOW MUCH PREVIOUS EXPOSURE THE PATIENT HAS HAD, IF YOU DECIDE THAT A
DIAGNOSTIC X-RAY IS NEEDED - THEN TAKE IT
- DIAGNOSTIC X-RAYS DO NOT COUNT AGAINST THE MPD DOSE.
- HOWEVER, DO NOT TAKE UNNECESSARY Z-RAYS
- EACH X-RAY SHOULD BE ORDERED ON AN INDIVIDUAL BASIS - NO ADMINISTRATIVELY
REQUIRED X-RAYS ARE NOW PERMITTED
- GENERALLY, IT IS RECOMMENDED THAT A FULL SERIES BE TAKEN ON THE INITIAL EXAM, THEN
FOLLOWED UP WITH BITEWINGS EVERY 24 TO 36 MONTHS IN AN ADULT AND EVERY 12 TO 24
MONTHS IN CHILDREN

- IN PATIENTS WITH HIGH CARIES, FOLLOWING BITEWINGS ARE RECOMMENDED EVERY 12 TO 18

MONTHS IN ADULTS AND EVERY 6 MONTHS IN CHILDREN (HHS PUBLICATION FDA 88-8273 OF
OCT 1987)
- USE OF LONG CONE TECHNIQUE WITH RECTANGULAR COLLIMATOR REDUCES EXPOSURE UP
TO 80%
- HIGH SPEED FILM < EXPOSURE 30 TO 50%
- ALWAYS USE LEAD APRON AND THYROID COLLAR ALSO WHEN NOT TAKING A PANORAMIC
RADIOGRAPH

- AVOID NEED FOR RETAKES

XVI. PHYSICAL CHARACTERISTICS OF X-RAY FILM AND FILM PROCESSING
AFTER INTERACTION OF THE X-RAY BEAM WITH THE ANATOMIC STRUCTURES OF THE PATIENT,
THE EXIT BEAM OR BEAM OF REMNANT X-RAYS CONSISTS OF A PATTERN IN WHICH DIFFERENT
AREAS HAVE DIFFERENT NUMBERS OF PHOTONS CORRESPONDING TO THE PATTERN OF THICKNESS,
ATOMIC NUMBERS, AND DENSITIES THROUGH WHICH THE BEAM HAS PASSED.

THIS INFORMATION IS DECODED BY MEANS OF A PHOTOGRAPHIC FILM

THE FILM MAY BE EXPOSED BY THE DIRECT ACTION OF THE X-RAYS AS IS DONE IN INTRAORAL
RADIOGRAPHY IN DENTISTRY, OR THE ENERGY OF THE X-RAY BEAM MAY BE CONVERTED INTO

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LIGHT BY INTENSIFYING SCREENS, AND THIS LIGHT IN TURN USED TO EXPOSE THE FILM.
THE METHOD USED IN EXTRAORAL RADIOGRAPHY.

THIS IS

DENTAL INTRAORAL X-RAY FILM

- FILM INDIVIDUALLY WRAPPED IN MOISTURE RESISTANT PAPER
- WITHIN, THE FILM IS FURTHER PROTECTED BY BLACK INTERLEAVING PAPER
- BACKED BY LEAD FOIL, THAT PROTECTS FILM FROM RADIATION THAT MAY BE BACK SCATTERED
BY THE TISSUES OF THE ORAL CAVITY DURING EXPOSURE. IT ALSO CONTRIBUTES TO THE
RIGIDITY OF THE FILM PACKET.
FILM
- X-RAY FILM IS PHOTOGRAPHIC FILM CONSISTING OF PHOTOGRAPHICALLY ACTIVE, OR
RADIATION-SENSITIVE, EMULSION WHICH IS USUALLY COATED ON BOTH SIDES OF A
TRANSPARENT SHEET OF PLASTIC CALLED THE BASE.
- FIRM ATTACHMENT BETWEEN THE EMULSION LAYER AND THE FILM BASE IS ACHIEVED BY A
THIN LAYER OF ADHESIVE

- THE DELICATE EMULSION IS PROTECTED FROM MECHANICAL DAMAGE BY A THIN LAYER KNOWN
AS THE SUPERCOATING.
FILM BASE
- BASICALLY PROVIDES SUPPORT FOR THE FRAGILE EMULSION
- USED TO BE CELLULOSE TRIACETATE
- NOW POLYESTER IS 1ST CHOICE BECAUSE IT IS MORE RESISTANT TO WARPING WITH AGE, IT IS
STRONGER AND HAS GREATER DIMENSIONAL STABILITY

- BOTH ARE CLEAR AND COLORLESS

- BLUE WAS ADDED IN 1933 TO PROVIDE EASIER VIEWING BY PREVENTING EYESTRAIN
EMULSION
- HOMOGENEOUS MIXTURE OF GELATIN AND SILVER HALIDE
- GELATIN IS CLEAR SO THAT IT WILL TRANSMIT LIGHT, BUT SUFFICIENTLY POROUS FOR
-

THE
PROCESSING CHEMICALS TO PENETRATE IT TO GAIN ACCESS TO SILVER HALIDE CRYSTALS
RAPIDLY WITHOUT DESTROYING ITS STRENGTH OR PERFORMANCE.
GELATIN IS MADE FROM BONE
FILMS HAVE PHOTOSENSITIVE EMULSIONS COATED ON BOTH SIDES OF THE FILM BASE FOR:
1. THE FILM WOULD MOST LIKELY CURL IF THE EMULSION WAS APPLIED TO ONLY ONE SIDE,
BECAUSE, AFTER APPLICATION THE EMULSION DRIES AND SHRINKS TO 1/10TH ITS ORIGINAL
VOLUME.
2. LIGHT PHOTONS ARE ABSORBED ONLY IN THE OUTER LAYERS OF THE EMULSION,
THEREFORE, IT IS IMPORTANT TO HAVE TWO THIN LAYERS INSTEAD OF ONE THICK LAYER.

SILVER HALIDE: THE LIGHT SENSITIVE MATERIAL IN THE EMULSION

- THE HALIDE IN MEDICAL X-RAY FILM IS ABOUT 90-99% SILVER BROMIDE AND 1-10% SILVER
IODIDE.
- THE PRESENCE OF SILVER IODIDE PRODUCES AN EMULSION OF MUCH HIGHER SENSITIVITY
-

THAN A PURE SILVER BROMIDE EMULSION

THE SILVER HALIDE IN AN EMULSION IS IN THE FORM OF SMALL CRYSTALS SUSPENDED IN THE
GELATIN
THE CRYSTAL ID FORMED FROM IONS OF SILVER, IONS OF BROMIDE, AND IONS OF IODIDE

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ARRANGED IN A CUBIC LATTICE.

- THE IODIDE ATOMS CAUSE A PHYSICAL DISTORTION OF THE CRYSTAL LATTICE AND MAKES IT
PHOTO SENSITIVE
- CHEMICAL SENSITIZATION OF THE CRYSTAL MAY BE PRODUCED BY ADDING SULFURCONTAINING COMPOUND TO THE EMULSION WHICH REACTS WITH THE SILVER HALIDE TO FORM
A SILVER SULFIDE ON THE SURFACE = SENSITIVITY SPECK

LATENT IMAGE
- THE LATENT IMAGE IS DEFINED AS THE INVISIBLE IMAGE PRODUCED IN THE FILM EMULSION BY
LIGHT OR X-RAYS THAT IS CONVERTED TO A VISIBLE IMAGE UPON DEVELOPING.
- AN X-RAY OR LIGHT PHOTON INTERACTS WITH AN AGIBR CRYSTAL TO ALLOW AN ELECTRON
TO ESCAPE FROM A BR- OR I- ION
- THE BR-, OR I- ION, WHICH BECOMES NEUTRAL BY LOSS OF AN ELECTRON, MIGRATES FROM
THE CRYSTAL AND IS TAKEN UP BY THE GELATIN OF THE EMULSION.
- THE FREE ELECTRON IS CAPTURED AND TEMPORARILY HELD AT THE SENSITIVITY SPECK IN THE
CRYSTAL

- THE TRAPPED ELECTRON ATTRACTS A MOBILE INTERSTITIAL AG+ ION TO THE SENSITIVITY
SPECK, FORMING A NEUTRAL AG ATOM.
- THE REPEATED ATTRACTION AND NEUTRALIZATION OF INTERSTITIAL SILVER IONS BUILDS UP A
CLUMP OF SILVER ATOMS, CALLED THE LATENT IMAGE CENTER IN THE CRYSTAL, WHICH MUST
-

BE PRESENT BEFORE THE DEVELOPING PROCESS WILL CAUSE VISUAL AMOUNTS OF METALLIC
AG TO BE DEPOSITED.
THE MORE SILVER ATOMS WHICH EXIST AT A LATENT IMAGE CENTER, THE GREATER IS THE
PROBABILITY THAT THE CRYSTAL WILL BE DEVELOPED

FILM PROCESSING
- THE PRIMARY ACTIONS OF THE PROCESSING SOLUTIONS ARE TO CONVERT THE CRYSTALS
WITH LATENT IMAGES INTO BLACK METALLIC SILVER GRAINS THAT CAN BE VISUALIZED AND TO
REMOVE THE UNEXPOSED SILVER BROMIDE CRYSTALS.

DEVELOPMENT
- A CHEMICAL PROCESS WHICH AMPLIFIES THE LATENT IMAGE BY A FACTOR OF 100,000,000
TO FORM A VISIBLE PATTERN OF METALLIC SILVER

- VARIATIONS OF DENSITIES ON THE PROCESSED RADIOGRAPHS ARE CAUSED BY VARIATION IN

THE PROPORTION OF UNDEVELOPED TO DEVELOPED CRYSTALS IN AN AREA

- IF THE DEVELOPER IS PERMITTED TO REMAIN IN PROLONGED WITH SILVER BROMIDE CRYSTALS

THAT DO NOT CONTAIN A LATENT IMAGE, IT WILL SLOWLY REDUCE THEM ALSO AND THEREBY
OVERDEVELOP THE IMAGE.
- DARK FILM ARE USUALLY THE RESULT OF OVEREXPOSURE NOT OVERDEVELOPMENT
- THE DEVELOPER CONTAINS TWO REDUCING AGENT WHICH WORK SYNERGISTICALLY
1. HYDROQUINONE - (BRINGS OUT SHARP CONTRAST)
2. ELON (METAL) - BRINGS OUT GRAY SHADES
- HYDROQUINONE IS INACTIVE AT LOW TEMPS (DEVELOPING LOW CONTRAST)
- HYDROQUINONE IS VERY ACTIVE AT HIGH TEMPS (DEVELOPING HIGH CONTRAST)
- IN ADDITION, THE DEVELOPER CONTAINS
1. AN ACTIVATOR (ALKALI - USUALLY SODIUM CARBONATE)
- DEVELOPERS ARE ONLY ACTIVE AT HIGH PH VALUES >PH 11
- SOFTENS AND SWELLS THE GELATIN OF THE EMULSION TO LET DEVELOPER DEFUSE INTO
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EMULSION
2. A PRESERVATIVE (SODIUM SULFITE) HAS A NATURAL AFFINITY FOR O2
- EXTENDS THE USEFUL LIFE OF THE DEVELOPER BY PROTECTING IT FROM ATMOSPHERIC
OXIDATION
- COMBINES WITH BROWN, OXIDIZED DEVELOPER TO PRODUCE A COLORLESS, SOLUBLE
COMPOUND
3. A RESTRAINER (POTASSIUM BROMIDE) ANTIFOG AGENT
- DECREASES THE RATE OF DEVELOPMENT OF UNEXPOSED CRYSTALS (FOG)

RINSING
- ELIMINATES ALKALI (ACTIVATOR) WHICH WOULD CONTAMINATE THE FIXER
- DILUTES THE DEVELOPER IN THE EMULSION AND STOPS THE DEVELOPMENT PROCESS
FIXING SOLUTIONS
- REMOVES THE UNDERDEVELOPED SILVER HALIDE CRYSTALS FROM THE EMULSION
- HARDENS THE GELATIN EMULSION
- CONTAINS FOUR COMPONENTS
1. CLEARING AGENT (SODIUM OR AMMONIA THIOSULFATE)
- REMOVES UNDEVELOPED SILVER IONS FROM SOLUTION BY FORMING STABLE, WATER
SOLUBLE COMPLEXES
2. ACIDIFIER (ACETIC ACID)
- NEUTRALIZES DEVELOPER, THEREBY, STOPS DEVELOPMENT THUS REDUCES POTENTIAL
FOR FOG
- PREVENTS CONTAMINATION OF THE FIXER
3. PRESERVATIVE (SODIUM SULFITE)
- PREVENTS OXIDATION OF ANY DEVELOPER WHICH MAY HAVE CONTAMINATED THE FIXER
- COMPLEXED WITH THE COLORED OXIDIZED DEVELOPER AND REMOVES IT FROM THE FIXER
BEFORE IT CAN STAIN THE FILM.
- INHIBITS THE DECOMPOSITION OF THE THIOSULFATE CLEARING AGENT
4. HARDENER (POTASSIUM ALUM)
- INCORPORATES WITH THE GELATIN TO BECOME MORE RESISTANT TO ABRASION
- DECREASES THE SWELLING OF THE GELATIN

FINAL RINSE (WATER)

- ELIMINATES SULFURIZING OF THE IMAGE
- ELIMINATES THIOSULFATE FROM REACTING WITH THE SILVER TO FORM BROWN SILVER
SULFIDE

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