Lene RAD Summaries

RAD
DIAGNOSTIC IMAGING
CHAPTER 1
PHYSICS OF IONISING RADIATION
1.1 COMPOSITION OF MATTER

Matter: is something that occupies space, has mass, can exert force/be subjected to force.
May be gas, liquid, solid. Fundamental unit is an atom – electron, neutron, proton are the
sub-atoms. These play a role in generation, emission, absorption of radiation
Atom structure:
- Centre: nucleus
- In nucleus: protons(p) and neutrons(n)
- Surrounding nucleus: electrons(e) in electron orbits
- Innermost orbit: K and outside L, M…
- K is also 1 (is the principle quantum number or n in 𝟐𝒏𝟐 ) formula used to
determine # of e in orbit
- No atom has >7 orbits
- Thus K orbit: 2e
- L orbit: 8e…
- e has electrical charge of -1, proton +1 and neutron no charge
- Atom in ground state = electrically neutral thus p=e
- Atomic number(Z): # of p in nucleus and determine identity
- Electrostatic attraction between + nucleus and – e balance centrifugal force and

keep e in diff orbits
- Force keeping e in orbit: e binding energy/ionizing energy and is specific for specific
orbit
- e binding energy: highest in K orbit and decrease to lowest in Q orbit
- energy is needed to move e from orbit to further away orbit, energy needed = diff in
e binding energy between 2 orbits
- e to move to obit closer = energy lost as electromagnetic radiation
- e binding energy differ between diff orbits and diff atoms in same orbit (larger, high
Z#)) atom- higher e binding energy
- atom lose e: + ion and free e become – ion
- ionization: process during which a pair of ions are formed
- e loss occurs through heating, collision, x-rays
- inner orbit e loss requires high energy eg. x-rays
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1.2 NATURE OF RADIATION
Radiation: transmission of energy through space and matter.
This occur in 2 forms:
1. Particulate radiation eg radiation in cancer therapy
- Consist of atomic nuclei/subatomic particles moving at high speed
- Eg alpha, beta particles
- Ability to ionize atoms depend on mass, velocity, charge
- Beta particles are used in skin radiation
2. Electromagnetic (non-particulate) radiation eg dental x-rays

- Movement of energy through space as combination of electric and magnetic fields
- Eg gamma, UV rays
- Rays don’t require medium to be transmitted
- Different rays have different capabilities to ionize atoms
- Ionizing/non-ionizing radiation may occur
- If radiation have sufficient energy to move e from atom in radiated matter it is
ionizing radiation
- Characteristics are best explained by wave/quantum theory
 Wave theory:
Electromagnetic radiation occurs in form of waves
Waves travel at speed of light (not sound)(c) (3 x 108 𝑚𝑠 −1 ) in vacuum
All waves have wavelength (𝜆) and frequency(v)
Wavelength
- The distance between the crests of 2 adjacent waves
- Determines the energy/penetrating power of radiation
- Shorter wavelength, higher the energy and ability to penetrate tissue
Frequency (cycles/min)
- # of wavelengths that pass a particular point during certain period of time
- wavelength and frequency = inversely related
- F high = WL short
𝝀 x V = c = 3 x 𝟏𝟎𝟖 𝒎𝒔−𝟏
 Quantum theory
Electromagnetic radiation occurs in small, weightless bundles of energy called
photons. Each photon travel at c and has certain amount of energy
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1.3 COMPONENTS OF X-RAY MACHINE
Standard dental x-ray components:
1. Control panel, mounted behind protective shield/outside
2. Tube head, houses x-ray tube
3. Flexible extension arm, tube head is suspended from here
1. Control panel:
- Has switches, dials, gauges, lights
- Use operator manual
2. Tube head:
- Inside metal tube head housing is an x-ray tube
- Tube consist of evacuated, leaded glass envelope within which is a cathode(-) and
anode(+)
- Cathode consist of tungsten filament, focusing cup
Sketch: electron cloud

Filament made of coiled tungsten wire is mounted on 2 stiff wires which conduct
electric current
Electric current switched on - filament is heated to glow by the flow
Heated filament releases e at rate proportional to temp of filament
Filament is inside focusing cup constructed of neg charged molybdenum
Focusing cup focuses released e from glowing filament in narrow beam directed at
small rectangular area on anode (focal spot)
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e(-) are repelled from cathode(-) and accelerated toward anode(+)
Anode consists of small rectangular tungsten target (focal spot) embedded in copper
stem (disperse heat)
Focal spot: convert kinetic energy of e emitted from red-hot filament into x-ray
photons
Conversion is inefficient because >99% of e kinetic energy = converted to heat
Focal spot made from tungsten because:
 High melting point (resistance to melting damage)
 High atomic # (optimal x-ray production by focal spot)
 High thermal conductivity (dispersion of heat)
 Low vapour pressure (maintain vacuum)
Oil surrounding tube ensure heat in copper stem dispersed
- Sharpness of radiological imaging improve with decreased size of focal spot

- Heat generated at focal spot increase with decrease size
- Rectangular focal spot placed 20° to incoming central e beam to improve image
sharpness/heat dispersion
- Projection of focal spot perpendicular to e beam = effective focal spot(1x1) which is
smaller than actual focal spot(1x3) to gain both sharpness and heat dispersion
3. Flexible extension arm:

Tube head attached to metal extension arm by yoke that can revolve in all directions
1.4 ELECTRIC POWER SUPPLY TO X-RAY TUBE

When power supply to x-ray is on, electric current consisting of e moves along wire
Rate at which electric current flows = # of e moving past specific point in conductor/sec is
measured in amperes (A) or mA this depend on 2 factors:
1. Pressure (voltage) of electric current, (V)
2. Resistance of conductor to flow of electric current, (ohm)
Ohm’s law
V=IxR
V = electric potential measured in V
I = flow of electric current in A
R = resistance of conductor
Sketch: e colliding with anode produce x-ray beam of photons
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1.5 PRODUCTION OF X-RAYS
3 steps in x-ray production: (3 collision types of tungsten disc)
1. Thermionic emission (release of electrons in response to heat) a current running
through the filament causes it to become extremely hot so hot that the electrons
become dissociated from the metal and form an electric cloud around the
filament. e remains in cloud around tungsten filament until high V (70kV) pass across
tube
cathode anode
Tungsten focus tungsten filament
2. Acceleration of the electrons to give them extremely high kinetic energy. This can
be achieved by kilo voltage or kVp. The kVp creates a strong negative charge in the
filament that forces the electrons across the x ray tube. This make sense since the
negative charge electrons are attracted by the positively charge anode.
3. Last step is decelerating the electrons. The highly energetic electrons slam into the
anode of the x ray tube and in this process of decelerating they release their energy
as heat or more NB as X rays. The number of x rays are controlled by the mA (tube
current). Increase the mA= increase electrons= increase the x rays. Also increase in
the kVp (tube potential) =increase electron energy= increase x ray energy. kVp
controls the energy of the x rays
Bremsstrahlung Characteristic radiation
Kinetic energy of e = converted to x-rays during collision with focus area
Bremsstrahlung (breaking radiation) = produced by sudden stopping/slowing of high-speed

e when it reaches nucleus of tungsten atom in target
- Primary source of x-ray photons
- Produced in following ways:
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1. Stopping of high-speed e:
When it directly hits a tungsten nucleus
All its kinetic energy converted into high-energy x-ray photons
Energy of photon (keV) is numerically = to that of e = kV applied across tube
LOOK IN TEXTBOOK
Direct hit by high-energy electron on tungsten nucleus at focal spot

(high energy e – short wave – high energy photon)
2. Slowing of high-speed e:
When it doesn’t hit tungsten nucleus but pass the nucleus at a distance
e(-) is only attracted to nucleus(+) and loses some velocity
Diff amounts of energy is released from slowed e depending on distance with
which they miss nucleus.
Nearer nucleus they pass the greater attraction to nucleus, greater reduction in
velocity of e and more energy of resultant bremsstrahlung photons
Photon produced by slowing high-speed e have lower energy
Bremsstrahlung interactions produce photons with energy range
Form largest component of the beam
Near miss of tungsten nucleus at focal spot by high-energy e

(high energy e = low energy photon + slowed e)
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Characteristic radiation (unique to tungsten)
When high-energy e from filament ejects e from inner orbit of tungsten atom at focal spot
Particular tungsten atom is ionized
e from outer orbit of ionized atom will move from its orbit to replace missing e
Then high-energy photon is produced by replacing e during movement from orbit to other
Energy of photon = diff in 2 orbital energies (e binding energies)
Only small component of beam
(high energy e – ejected K e – L e replace = photon with energy L-K e binding energy)
1.6 FACTORS CONTROLLING X-RAY BEAM

1. Duration of exposure (DRBBBT)
2. Rate of exposure
3. Beam energy
4. Beam shape
5. Beam filtration
6. Target-patient distance
1. Exposure time
- When exposure time is doubled and keeping mA/kVp constant the # of photons in
beam is doubled and energy of photons remain constant
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2. Tube current (mA)
- More current flows to filament when mA is increased and kVp is constant
- Filament heats and e are released that are attracted to focus spot where they collide
to produce x-ray(photons)
- Quantity of radiation (# of photons) = directly proportional to tube current and
duration of exposure
- Quantity of radiation is expressed as product of tube current and time = mAs
- Quantity radiation remain constant regardless of variations in mA and time as long
as their product (mAs) remains constant
3. Tube voltage (kVp)

- Increasing kVp result in increased potential difference between cathode and anode
- e from cathode have increased energy when they collide with focal spot
- e energy is therefore more efficiently converted into photons because:
 more photons are produced
 photons have higher mean energy
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 photons have higher max energy like in 2nd figure
- low kVp = high contrast

- high kVp = lot of grey areas, better image, more bremsstrahlung, more high-energy e
collides with focal spot, high-energy photons penetrate deeper in tissue
- penetrating ability of beam can be determined by establishing half-value layer (HVL)

- HVL = thickness of any mat that cause 50% reduction in # of x-ray photons passing
through it (reduce beam intensity 50%)
- HVL will increase (thicker mat) as average energy of beam increase
- Beam quality = mean energy of beam controlled by V across tube
4. Collimation (nie dieselfde as n grid nie)

- # A collimator is a device that narrows a beam of particles or waves. To narrow can
mean either to cause the directions of motion to become more aligned in a specific
direction (i.e., make collimated light or parallel rays), or to cause the spatial cross
section of the beam to become smaller (beam limiting device).
- Is a metallic (lead) disc with round/rectangular opening in middle through which
beam emerges
- It reduces size of beam to size of film/digital sensor and reduces amount of
radiation and improve quality of image
- Many of absorbed photons cause scattered radiation in the radiated tissue through =
Compton scattering and reduce image quality
- Collimation also reduce Compton scattering
- Rectangular opening = preferred
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Apenture
Collimator
5. Filtration of low energy photons

- Only photons with sufficient energy (short wavelength) can penetrate through tissue
to reach film is useful
- Low-energy photons (long wavelength) don’t reach film = useless and add
unnecessary pt exposure because absorbed by tissue
- Low-energy photons can be removed by placing aluminum filter between focal spot
and pt
6. Inverse square law

- Beam spread out as it moves from focal spot
- Result in a decreased intensity of beam and is inversely proportional to the square of
distance from focal spot
- Thus 2x distance = ¼ intensity
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Reduced radiation intensity(I) with increased distance(D)
NB
𝑰𝟏 (𝑫𝟐)𝟐 𝒐𝒓𝒊𝒈𝒊𝒏𝒂𝒍 𝒊𝒏𝒕𝒆𝒏𝒔𝒊𝒕𝒚 𝒏𝒆𝒘 𝒅𝒊𝒔𝒕𝒂𝒏𝒄𝒆𝟐
= 𝒐𝒓 =
𝑰𝟐 (𝑫𝟏)𝟐 𝒏𝒆𝒘 𝒊𝒏𝒕𝒆𝒏𝒔𝒊𝒕𝒚 𝒐𝒓𝒊𝒈𝒊𝒏𝒂𝒍 𝒅𝒊𝒔𝒕𝒂𝒏𝒄𝒆𝟐
1.7 INTERACTION OF X-RAY WITH MATTER

When x-ray photon produced at focal spot arrive at pt this may happen:
1. Pass through pt without any interaction
2. Be completely absorbed by pt
3. Be scattered
A. Pass through pt without any interaction with atoms/particles thereof

- These photons are responsible for darker areas on x-ray
B. Be completely absorbed by pt (photoelectric effect)(30%)
- Total transfer of energy from photon to e and absorption depends on the energy of
beam and composition of tissue subjected to x-ray photon
- Photon collide with tightly bound inner orbit e, all the kinetic energy of photon
transferred to e ejecting it from orbit. Particular atom is ionized(+). Photon stop to
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exist and ejected e = photoelectron(-), little penetration power and absorbed by
surrounding tissue atoms
- = photoelectric effect (#The photoelectric effect is the emission of electrons or
other free carriers when light shines on a material. Electrons emitted in this
manner can be called photo electrons.)
D. Be scattered (Compton scattering)(62%)

- Photon may collide with loosely bound outer orbit e. During collision some kinetic
energy of photon transferred to e, which is ejected from orbit
- Photon cont in diff direction with reduced kinetic energy
- Photon undergone Compton scatter
- Ejected e = Compton e
- Involved atom has been ionized(+)
E. Low-energy photon may pass through atom and have its path changed by an outer
orbit e (coherent scatter)(8%)
- Atom remains unchanged and photon only change direction = coherent scatter
Factors that influence

transmission of x-ray through tissue:
1.8 X-RAY BEAM ATTENUATION

- As beam pass through tissue intensity reduces (attenuation)
- Beam attenuation is result of loss of photons mainly through absorption and
Compton scatter
- Attenuation of beam is predictable because depend on:
1. Characteristics of beam
2. Characteristics of tissue
- Low-energy photons are more likely absorbed than high-energy photons
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- Low-energy photons absorbed at surface of tissue and high-energy photons
penetrate deeper/pass through tissue depending on tissue density/thickness
PHOTON:
- Electrically neutral
- Move in straight lines
- Move at c in vacuum
- Polyenergetic
PATIENTS
- Release small amount of heat in tissue
- Ionize tissue by removing e
- Undergo scatter
INTRA-ORAL FILM
- Slow speed
- Better radiograph
- High exposure duration
CHAPTER 2
IMAGING PRINCIPLES AND TECHNIQUES
2.1 X-RAY FILM, INTENSIFYING SCREENS AND GRIDS

Tissue reduces intensity by absorption/scatter of photons
High-energy photons pass through tissue and take info on composition of tissue
and can be recorded on x-ray
2.1.1 X-ray film

3 types:
1. Intraoral film
2. Extraoral film
3. Duplicating film
1. Intraoral film
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- Placed inside mouth to examine teeth/supporting tissues
- 3 types/sizes
- films are packaged to project against moisture
- film and packaging = x-ray packet
- film packet 4 components:

1. x-ray film
- has small raised dot in 1 corner = identification dot
- dot is used for film orientation/distinguishes right and left side of pt, NB during film
mounting and interpretation
- film consist of: (FAEP)

1. film base
- backbone of film/support emulsion
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- made of polyester plastic 0.2mm thick
- must be sufficiently flexible to allow easy handling/translucent/mustn’t cast
pattern on x-ray/mustn’t be degraded or distorted by film processing
solutions, heat, moisture
2. adhesive layer
- thin layer of adhesive mat that attach emulsion to base
3. emulsion
- both sides of base
- consists of radiation sensitive silver halide crystals suspended in gelatin
- it absorbs processing solutions during film processing to allow reaction with
silver halide crystals
(#- halide = chemical compound that is sensitive to light/ionizing radiation
= consist of silver(metal), halogen(bromide/iodide)- AgBr, AgI (is the
2 silver halide crystals found in dental films))
4. protective layer
- thin/transparent coating over emulsion to protect it against mech and
processing damage
2. paper film wrapping

- black protective paper sheet that cover film/protect it against light
3. lead foil sheet

- piece of lead foil behind film
- protects film against back-scattered(secondary) radiation that cause film fog
- has carved pattern visible on processed film if wrong side of film packet was
exposed
4. outer plastic package wrapping

- consist: soft vinyl wrapping that hermetically seals film packet, protective black
paper wrapping, lead foil sheet
- protect film against moisture
- outer package wrapping has 2 sides:

1. tube side
- is white and has raised identification dot that corresponds with ID dot on
film
- placed in mouth tube(white) side must face x-ray tube
2. label side
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- has a flap used to open film packet to remove exposed film prior to
processing
- side is colour coded and show this info:
 ID dot
 Statement “opposite side towards tube”
 Manufacturer’s name
 Film speed
 # of films enclosed
- label side should face tongue
2.1.2 Intensifying screens (extraoral radiographic examination)

- Screen film = more sensitive to visible light than intraoral film
- Intensifying screen with screen film is 10-60 times more sensitive to x-ray than x-ray
film alone
- Intensifying screen used for certain Extraoral radiographic exams
- Intensifying screen transfer x-ray energy into visible light
- Visible light in turn exposes screen film
- Less radiation used
- Purpose is to reduce radiation exposure to pt during Extraoral radiographic exams
x-ray beam
(plastic)
(front)
Fluorescent
light from
screens (back)
(metal)
- Intensifying screens are used in pairs (1 in front of screen and 1

behind)
- Screen film and 2 intensifying screens are placed inside cassette that opens like a
book
- Cassette holds intensifying screens in contact with screen film to max sharpness of
image
2.1.3 Grids (nie collimator that narrows the beam nie)

- Is a device that reduces amount of scattered radiation that exists pt during Extraoral
radiographic exam
- Positioned between pt and film
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- Consist of numerous very thin lead strips alternating with radiolucent mat that are
arranged parallel to each other
- Lead strips absorb scattered radiation from pt which moves in all directions while
prim radiation (always moves in straight lines) penetrates radiolucent mat to create
radiographic image on film
- Non-imaging photons (scattered radiation) are removed and film contrast/image
definition are improved
(primary)
Lead strips (black)

Radiolucent mat (white)
Detector
2.2 PROJECTION GEOMETRY

Factors that influence the quality of x-ray image: (VIG)
1. Image characteristics
2. Visual characteristics
3. Geometric characteristics
2.2.1 Image characteristics

- The black/white appearance and shades of grey of x-ray when viewed on light box
- Black areas = radiolucent areas (eg oral cavity lacks density and permit passage of
photons with little/no resistance)
- White areas = radiopaque areas (eg enamel/AM high density and absorb photons)
- Soft tissues in head/neck don’t produce pure radiolucent/opaque areas but shade of
grey
2.2.2 Visual characteristics
- Influenced by radiographic density/contrast
A.) Radiographic density = overall radiolucency(blackness) of radiograph (indication of
amount of x-rays that reached film)
- Density of film is to high = x-ray to dark
- 4 factors that determine density of x-ray:
1. tissue thickness and density and 3 exposure factors:
2. mA
3. duration of exposure (s)
4. kilovoltage (kVp)
1. Increased tissue thickness and density
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- in pt with large amounts of soft tissue/thick dense bone = fewer x-rays
reach film
- image will have less radiographic density = radiopaque
2. Increased mA
- produce more photons that reach film
- film = darker/higher density
3. Increased exposure time (s)
- increases total # photons reaching film
4. Increased kVp
- produces photons with higher energy/increased ability to penetrate
tissue
B.) Radiographic contrast = the range of densities(diff degrees of blackness) seen on

radiograph
- Radiograph with dark/white areas = high contrast (striking diff) = short grey scale of
contrast
- Radiograph that don’t have very dark/very white areas but many shades of grey =
low contrast = long grey scale of contrast
C.) Film contrast = characteristics of film that influence contrast that include inherent
qualities of film/film processing
- Film qualities determined by manufacturer and can’t be manipulated
- Contrast improved with longer processing time/using chemicals with higher temp
D.) Subject contrast = determined by thickness, density, composition (atomic #) of

tissue
- Can be altered by adjusting kVp
- High kVp (>90) produces more penetrating beams that give x-ray low subject
contrast – many shades of grey/no white areas
- Intermediate kVp – high subject contrast
- Low kVp produce x-ray consisting of white areas/shades of grey/no black areas – low
subject contrast
E.) Scattered radiation = result from Compton/coherent interactions of photons with

tissue
- Interactions result in emission of photons in all directions other than direction of
main beam
- This cause fogging (overall darkening) = loss in contrast
- Fogging (scattered radiation) can be reduced by using:
1. Relatively low kVp (Decrease kVp = increased contrast)
2. Collimation of beam to size of film to prevent scatter from outside region of
interest
3. Grids
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2.2.3 Geometric characteristics
- 3 geometric characteristics that influence diagnostic quality of x-ray
1. image sharpness
2. magnification
3. distortion
- these characteristics should be optimized to produce accurate/high quality x-rays
1. Image sharpness (detail, resolution, definition)
- Capability of film to reproduce distinct outlines of object/how well smallest detail of
object is reproduced on film
- All images have fuzzy/blurring margin = penumbra (object closer- increase
penumbra, decrease focal spot- decrease penumbra)
- Sharpness of image influenced by 5 factors: (neem shap fotos)
1. effective focal spot size (small)
2. focal spot-object distance (long)
3. object-film distance (short)
4. film composition (small crystals)
5. movement (don’t move)
2. Magnification
- Image that is larger than actual size of object
- Occur because photons radiate in all directions as they leave focal spot – diverging
beam
- Min magnification by using long focal spot-object distance
- Short tube give divergent beam/more enlargement
- Subject closer to film = image smaller
3. Distortion
- Image that doesn’t have same size/shape as actual object
- May be too long/short/partially distorted
- Result from improper object-detector alignment and beam angulation
- Can min by ensuring that:
1. X-ray detector is parallel to object
2. Beam is perpendicular to object and detector
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2.3 PROCESSING X-RAY FILMS
2.3.1 Latent image formation
D-speed/ultra speed = lot of radiation, smaller crystals, sharper image
E-speed
F-speed(we use) = larger silver halide crystals, 60% less radiation than D-speed
A: - Film emulsion contain Ag ions and Br ions in crystal arrangement

- Crystal contain free Ag ions/trace chemicals – form sensitivity sites
B: - Exposure of film to x-ray result in interaction of photon with Br ions in crystal
- e is ejected from Br ion with formation of Br atom
- Ejected e has energy gained from photon and move around in crystal
C: - When e reach sensitivity site it communicates neg charge to site
D: - Nearest free Ag ion is attracted to neg charged sensitivity site
- When it reaches site Ag ion gains e from site and is converted to neutral Ag atom
- Neutral Ag atom now creates part of latent site
- All latent image sites in film emulsion form radiographic latent image
- During film processing developer solution cause neutral Ag atom at sensitivity site
to initiate conversion of other Ag ions in other areas of crystal into 1 large grain of
metallic Ag.
A: Film emulsion before exposure

B: Film emulsion after x-ray exposure
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2.3.2 Processing solutions
Film processing steps:
1. Development
2. Rinse
3. Fixation
4. Rinse
5. Drying
1. Development
- Developer solution consist of H2O in which developer(reducer), activator,
preservative, restrainer is dissolved
- Developer consist of phenidone/hydroquinone that serve as e donor that selectively
reduces exposed Ag halide crystals converting them into black metallic Ag which
appear dark on x-ray
- Reduction is restricted to crystals containing latent image sites
- Ag atoms act as bridge by which e from reducer reach Ag atoms in crystal and
convert them into solid grains of metallic Ag
- Areas of film with many exposed crystals = dark (black) due to high concentration of
black metallic Ag after development
- When exposed film is developed, developer initially has no visible effect
- Then density(blackness) increases rapidly then slow until all exposed crystals are
developed
- If film remains in developer too long, unexposed Ag halide crystals without latent
image are slowly reduced result in overdeveloped (chemical fogging) of film
- Activator consist of Na hydroxide/potassium hydroxide that ensure alkalinity (pH

10) to activate developer
- Activator cause gelatin of emulsion to become soft/swollen so that developer can
diffuse into emulsion and reach all Ag halide crystals
- Preservative is Na sulphate, an antioxidant to protect developer against oxidation by
atmosphere and extend life of developer
- Oxidized developer = brown/may stain film
- Restrainer is potassium Br and prevents development of unexposed Ag halide
crystals = antifog agent/improve contrast
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Film emulsion after x-ray exposure Film emulsion after development
2. Rinse
- Developed film is rinsed in H2O for 30s using gentle agitation to remove all
developer solution from saturated/swollen film emulsion
- This is to prevent further development of image
3. Fixation (caph)
- Consist of H2O in which a clearing agent, acidifier, preservatives, hardener is
dissolved
- Cleaning agent(triosulphate) binds to unexposed Ag halide crystals to make them
more soluble/remove from emulsion
Film emulsion after development Film emulsion after fixation

- Hardener is Al sulphate
- It reduces swelling of emulsion/drying time
- Hardens emulsion – resistant to mech damage
4. Rinse
- In luke-warm water bath to remove all triosulphate/Ag triosulphate complexes
- If not done properly triosulphate will react with Ag to form brown Ag sulphide
- This will result in stained x-ray/compromise interpretation
5. Drying
- At room temp/dust-free environment OR film placed in heated drying cabinet
- Dry film prior to handling to facilitate hardening of emulsion/prevent scratching film
NB – process in dark
Know process and times
2.3.3 Common causes of faulty radiographs

Common radiographic problems and causes
1. Fish bone image (lead foil image)
 Cause – wrong side of film exposed, beam reduced by lead foil backing in film
packet
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 Action – ensure white side with button of film directed towards beam
2. Partial image
 Cause – dropped film corner seen when edge of film not placed parallel to
incisal/occlusal surface of teeth
 Action – make sure that edge of film is parallel to I/O surface of teeth
3. Bent film
 Cause – dark line represent area where film emulsion was cracked due to
excessive creasing of film prior to exposure
 Action – don’t bend film excessively prior to exposure
4. No image
 Cause – film wasn’t exposed
- unexposed film was developed
- machine was off
- electrical failure
 Action – ensure exposed film is developed
- ensure machine is on and functional
5. White image (decrease density because increased contrast)

 Cause: incomplete exposure
- failure to depress exposure switch for entire time
- not enough exposure (mA, kVp, time)
- film-source distance too large
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: processing error
- under development (temp too low, time too short, inaccurate
thermometer)
- depleted developer solution
- diluted developer
- excessive fixation
 Action – check abovementioned exposure/processing factors and correct
6. Dark image (over exposed light, increased kVp/exposure to light = darker)

 Cause: over exposure
- excessive mA, kVp, exposure time
- film-source distance too short
: processing error
- over development (temp too high, time too long)
- developer concentration too high
- accidental light exposure
- inadequate fixation
- improper safe-lighting
 Action - check abovementioned exposure/processing factors and correct
7. Film fog (DICOL)

 Cause – improper safe lighting
- light leaks
- over development
- contaminated solutions
- deteriorated film (outdated, too humid/warm)
 Action
8. Blurred image
 Cause – pt moved during exposure
 Action – pt instructed to remain still during procedure
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9. Distorted image
 Cause – distorted lower portion due to film bending
 Action – check film placement/pt finger pressure and instruct pt to stabilize film
gently
10. Double image

 Cause – double exposure/film movement during exposure
 Action – organize workspace/after each exposure place film in container to
avoid mixing exposed/unexposed film
11. White spots

 Cause – fixer solution was in contact with film before processing
 Action – use clean working area in dark room/ place paper towel on work
area before unwrapping film packet
12. Dark spots

 Cause – developer spots seen when developer solution come in contact with
film before processing
 Action - use clean working area in dark room/ place paper towel on work
area before unwrapping film packet
13. Brown stains

 Cause – due to oxidized/old developer, insufficient fixation/rinsing
 Action – replace chemicals, check processing procedure, use adequate fixation
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time/rinsing time
14. Scratched film

 Cause – white lines on film when soft film emulsion is damaged by sharp object
prior to fixation/drying
 Action – be careful when placing film rack in processing solutions
- avoid contact with other film hangers/sharp objects like finger nails
15. Finger print

 Cause – due to moist hands touching film before processing/ finger
contaminated developer solution
 Action – wash/dry hands before processing film
- handle film by edge only
2.4 RADIOGRAPHIC QUALITY ASSURANCE

For high quality x-rays the machine, film processor, films, viewer need to be subjected to
regular quality assurance programs – professionalism
2.5 INFECTION CONTROL

Infections like h. simplex virus, hep B, HIV, TB
- Routes of infection transmission:
1. Direct contact with microorganism in saliva, blood, respiratory secretions, lesions
2. Contact with contaminated objects/instruments
3. Contact with airborne microorganisms from respiratory fluids
2.6 INTRAORAL RADIOGRAPHIC EXAMINATIONS

Terms:
- Parallel: lying in same plane
- Intersecting: 1 line cutting across other
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- Perpendicular: 2 lines intersect at 90°
- Right angle: 90° angle between 2 perpendicular lines
- Long axis of tooth: imaginary line that divide tooth longitudinally in 2 halves
- Central x-ray: central portion of beam
- Vertical angulation: positioning of aiming cylinder in vertical plane
- Horizontal angulation: positioning of aiming cylinder in horizontal plane
- Bisect: divide in 2 equal halves
- Interproximal: between 2 adjacent teeth
2.6.1 Periapical (paralleling) tech

Indications: apex of tooth/periapical tissue examined
Tech: - Image detector placement
Ensure appropriate area will be examined/all areas of image detector will be
exposed
- Image detector
Should be parallel to long axis of tooth
- Vertical angulation
Central x-ray must be perpendicular to image detector/long axis to avoid image
distortion
- Horizontal angulation
Central x-ray beam must be perpendicular to film/directed through contact
areas between teeth to avoid image overlapping
Advantages: simple – film holder facilitate proper horizontal/vertical angulation of beam

image is accurate – free of distortion/max detail/definition
easy to standardize – easily repeated and compared later
Disadvantages: difficult to place film in child/adult with small mouth/shallow palate –
discomfort and modification is required
2.6.2 Bisecting tech (based on isometry rule – 2 triangles are equal when they share
1 side and have 2 equal angles)
Indications: periapical x-ray in pt with shallow palate/shallow floor of mouth
Ensure appropriate area will be examined/all areas of film exposed
- Image detector
as close as possible to lingual surface of teeth resting on palate/floor of mouth
pt uses finger to keep detector in position
plane of detector/long axis of teeth form triangle(ABC) with its apex at point
where detector contacts teeth
2 triangles(ADB, CDB) formed by bisecting line(BD) share common side and 2
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equal angles
central beam directed perpendicular to imaginary line(BD) that bisect triangle
ABC
incorrect vert angulation – image that isn’t same length as tooth
shortened image of tooth – excessive vert angulation when beam is directed
perpendicular to detector
elongated image of tooth – insufficient vert angulation when beam directed
perpendicular to long axis of tooth
central beam must be perpendicular to image detector/directed through contact
Advantages: taken without film holder in pt with shallow palate/floor
less expensive
Disadvantages: difficult tech – detector holder not used
image distortion may occur – film bending if pt applies excessive
pressure with finger that hold detector
incomplete image detector exposure – improper film placement
faulty tech – unnecessary pt exposure because x-rays repeated
2.6.3 Bite-wing tech

Indications: evaluate teeth for interproximal caries
evaluate interproximal surfaces of restorations
evaluate health of crestal bone
Ensure appropriate area will be examined/all areas of image detector will be
exposed
- Image detector
as close as possible to lingual surface of md/mx teeth
plane of detector/long axis of mx/md teeth must be parallel
tube side of detector will be directed slightly upward due to anatomical position
of mx/md teeth resulting in curve of Monson
central x-ray must have vert angulation of 10° to ensure that beam is directed
perpendicular to plane of detector
central beam must be perpendicular to image detector/directed through contact
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Advantages: tech relatively easy – can be repeated and compared later

Disadvantages: difficult to place film in child/adult with small mouth/shallow palate –
discomfort and modification is required
2.6.4 Object localization

- Can use buccal object rule to locate object
- Object furthest away from x-ray tube will “move” in the same direction as tube
(lingual side is furthest away from beam in periapical x-rays)
2.6.5 Occlusal tech

- Used when areas larger than those shown by periapical x-rays need to be examined
- Uses:
1. locate supernumerary/retained teeth
2. locate foreign bodies
3. locate salivary gland calculi in floor of mouth
- Tech involves these basic principles:
1. film used is larger than periapical films
2. film is positioned with white side facing dental arch to be examined
3. film placed between O surfaces of mx/md teeth
4. film stabilized by pt gently biting film
2.6.5.1 Mx occlusal projections

 Mx topographical occlusal projection
Indication: to examine ant mx/teeth
Tech: Film placement
Film position
Against mx O surface parallel to floor
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Film placed as far post in mouth as pt anatomy permit
Pt stabilize film by gently biting it
Vertical angulation
Central x-ray must be directed through midline of dental arch with vert
angulation of +65° toward center of film
Top edge of x-ray aiming cylinder gently placed between eyebrows on bridge
of nose
Exposure
Set exposure factors according to manufacturer’s recommendations using
dials on control panel
 Mx lat (left/right) occlusal projection

1. Indication: examine post mx/teeth
Tech:
2. Film placement
3. Film position
Against mx O surface parallel to floor
Film shifted to side to be examined/long edge of film should extend 1cm
beyond B aspect of post mx teeth
4. Vertical angulation
Central x-ray must have vert angulation of +60° toward center of film
Top edge of x-ray aiming cylinder is gently placed above corner of the eye
5. Exposure
 Paediatric mx occlusal projection

Indication: examine ant mx/teeth of child
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Film position
Place post periapical film against mx O surface parallel to floor
Vertical angulation
Central x-ray is directed through midline of dental arch with vert angulation of
+60° toward center of film
Top edge of x-ray aiming cylinder is gently placed between the eyebrows on
bridge of nose
Exposure
2.6.5.2 Md occlusal projections

 Md topographical occlusal projection
Indication: to examine ant md/teeth
Film position
Against md O surface parallel to floor
Vertical angulation
Central x-ray must be directed through midline of dental arch with vert
angulation of -55° toward center of film
X-ray aiming cylinder gently placed over the chin
Exposure
 Md cross-sectional occlusal projection

Indication: examine B/lingual aspects of md/locate salivary gland stones on floor of
mouth
Film position
Recline pt/position md arch perpendicular to floor
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Film against md O surface parallel to floor
Pt stabilize film by gently biting it (film must be perpendicular to floor)
Vertical angulation
Central x-ray must be directed through midline of dental arch/perpendicular
toward center of film
X-ray aiming cylinder gently positioned 2cm post of chin
Exposure
2.7 NORMAL RADIOGRAPHIC ANATOMY – INTRAORAL FILMS

- X-ray = 2D representation of 3D structure/always show superimposition of
anatomical structures
- Angle of beam may affect location of anatomical structures
- Character of x-ray image depends on energy of beam/density of tissue examined
- Dense tissues like enamel/cortical bone absorb almost all photons – little/no black
metallic Ag is formed in film emulsion behind tissues – radiopaque
- Air in mx sinus/soft tissue – absorb little photons – large amounts of black metallic
Ag form in film emulsion behind areas – radiolucent
Most radiolucent to radiopaque areas:
RADIOLUCENT
Air, gas
Fluid
Soft tissue (fact, collagen)
Bone marrow
Trabecular bone
Cortical bone, dentine, cementum
Tooth enamel
Metal (AM, gold)
RADIOPAQUE
- Crown of sound
tooth is covered by enamel – most radiopaque tissue in body
- Dentin and cementum have similar radiodensity – less than enamel (can’t
distinguish between dentine/cementum on x-ray)
- Soft tissue of dental pulp – radiolucent/tapers toward root apex in adult teeth
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- Apical foramen of developing teeth – distinct radiolucent apical area
- All unerupted teeth are surrounded by tooth follicle – well demarcated radiolucent
zone
- Supporting structures that can be seen on x-ray – pdl (thin radiolucent zone between
root surface and lamina dura – radiopaque), lamina dura, alveolar crest
- Trabecular bone pattern of mx is generally finer in composition to md which is
coarser
- Nutrient canals visible in trabecular bone – radiolucent
- Zygoma appear U-shaped radiopaque structure superimposed in mx 1st/2nd molars.
Size, width, definition depend on angle at which beam passes through zygoma
- Mx tuberositas is convex mx bone D of mx 8’s
- Hamulus of medial pterygoid plate may be seen just D to mx tuberositas
- Median mx fissure is thin radiolucent line between mx central incisors that originate
from alveolar crest/extend post for variable distance
- Incisive (nasopalatine) foramen is oval radiolucent area between roots of mx central
incisors
- O x-ray of md may show genial tubercles lingual of ant md – radiopaque
Apical foramen
Tooth follicle
Nutrient canals
in trabecular bone Zygoma
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Mx tuberositas Incisive canal
Median mx fissure
Incisive foramen
Hamulus
Genial tubercles
2.8 RADIOGRAPHIC INTERPRETATION OF DENTAL CARIES

- Caries = localized destruction of tooth substance by microorganisms
- 1st caries is demin of hard tooth substance, degradation of protein matrix, form
cavity
- demin result in decreased density of hard tissues – radiolucent
- correlate x-ray and clinical findings
- caries are classified according to surface, substance, severity they affect
- bitewing is best choice
2.8.1 Interproximal caries

- Between teeth at/below contact area
- Can’t be examined clinically
- Appearance determined by anatomy of tooth
- As caries progress inward through enamel it assumes a triangular shape due to
enamel prism orientation
- Apex of triangle is at DEJ
- As caries reach DEJ spread lat/advance into dentine as triangular lesion due to
dentine tubule orientation
- Can be classified according to depth of penetration of lesion through
enamel/dentine:
1. Incipient interproximal caries: less than halfway into enamel
2. Moderate interproximal caries: more than halfway into enamel, but not into
dentine
3. Advanced interproximal caries: through enamel and less than halfway into
dentine
4. Severe interproximal caries: through enamel and more than halfway into
dentine
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2.8.2 Occlusal caries
- Caries that involve O surface
- Originate in O fissures
- Because of superimposition of cusps on bite-wing O caries can’t be seen when only
enamel is involved only when dentine is involved
- Clinical exam is better
- Classified:
1. Incipient occlusal caries: can’t be seen on x-ray – small amount of demin
2. Moderate occlusal caries: into dentin as a thin radiolucent line at DEJ. Enamel
show little radiological change
3. Severe occlusal caries: into dentin as large radiolucent area, cavity seen during
clinical exam
Stages Illustration Radiographs
Incipient
Moderate
Severe
2.8.3 Buccal/Lingual caries

- On B/L aspect
- Because of superimposition of densities of normal tooth structure they are difficult
to detect on bite-wings
- Clinical exam is better
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Illustration Radiographs
Buccal/lingual
2.8.4 Root surface caries

- In dentin/cementum of root, no enamel involved
- Preceded by perio with alveolar crest bone loss/gingival recession – root surface
exposed/vulnerable
- Easily detected clinically
- Crater-shaped radiolucency on root, apical of CEJ
Root surface
NB distinguish root caries from cervical burnout!

- Cervical burnout = radiological artefact that appears as radiolucent area on root
between CEJ/alveolar bone crest
- Ill-defined margin while root caries is well defined, saucer-shaped lesion on root
surface exposed by gingival recession/alveolar bone loss
- Cervical burnout usually doesn’t occur on teeth with perio
- Cervical burnout is caused by decreased x-ray absorption in cervical region of root
compared to increased x-ray absorption by crown on 1 side and root/alveolar bone
on other side
- If present cervical burnout occurs on all teeth of pt
Cervical burnout
2.8.5 Secondary caries

- Adjacent to restorations because of inadequate cavity prep/defective restoration
margin/incomplete caries removal prior to placement of restoration
- Radiolucent below dental restoration
Secondary caries
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2.9 RADIOGRAPHIC INTERPRETATION OF PERIODONTAL DISEASE
- Periodontium = tissue that support teeth (alveolar crest, lamina dura, pdl, medullary
bone)
- Alveolar crest:
located 1.5-2mm apical of CEJ
shape is pointed/radiopaque between ant teeth
between post teeth is flat/less radiopaque/parallel to imaginary line between CEJ
- Lamina dura:
Thin/radiopaque line around roots of teeth
- Pdl:
Thin radiolucent line of uniform thickness around root/between lamina dura and
root surface
Varies in thickness between individuals/diff teeth in individual/diff areas around root
of specific tooth
Tends to be slightly wider at root apex near alveolar crest – fulcrum of physiological
movement is where pdl is thinnest
Shape of root may create appearance of double pdl
- Medullary bone: (cancellous/trabecular/sponge bone)
Between cortical plates of md/mx
Visible on intraoral x-ray as thin radiopaque lines called bone trabeculae surrounding
numerous radiolucent marrow spaces
Pattern of bone trabeculae varies with age/diff individuals/diff areas in jaw
Trabeculae in ant mx are thin/numerous surrounding small marrow spaces
In post mx marrow spaces are slightly larger
In ant md are trabeculae are slightly thicker/marrow spaces larger than ant mx
resulting in coarser (rough) trabecular pattern
Marrow spaces in post md are similar/slightly larger than ant md
If bone trabeculae are absent/have suspicious appearance on intraoral x-ray it is
useful to compare trabecular pattern with opposite side of jaw/with previous x-ray
Alveolar crest
Pdl
Lamina dura
Medullary bone
- Periodontal disease = group of diseases that affect supporting tissue of teeth

- Range from gingivitis (clinically detectable with no radiological changes to alveolar
bone) to severe destruction of alveolar bone/pdl
- Can’t see soft tissue/early B/L alveolar bone changes on x-ray
- Use x-ray and clinical exam!
- Use bite-wing/periapical x-ray parallel tech for perio disease – most accurately show
amount of bone loss
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- Bite-wing doesn’t show overview of all perio bone
- Periapical is used to estimate amount of alveolar bone loss = difference between

physiological bone level (1.5-2mm apical to CEJ) and height of remaining alveolar
bone
- Bone loss described according to pattern/distribution/severity
- Classification:
 Pattern of bone loss is determined using CEJ as reference point
1. Horizontal bone loss = occur in plane parallel to CEJ
2. Vertical bone loss = occur in plane not parallel to CEJ
Horizontal bone loss Vertical bone loss
Physiological bone height

Horizontal bone loss
Height of remaining bone
 Distribution of bone loss

 Localized: restricted to isolated area
 Generalized: involve several teeth
 Severity/degree of bone loss

1. Mild
2. Moderate
3. Severe
- Perio develop due to a number of etiological/predisposing factors which must be

eliminated to successfully manage perio
- Certain predisposing factors like calculus/defective restorations can be recognized
on x-rays
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- Calculus may have variety of appearances but most commonly pointed radiopaque
projections that extend from interproximal root surfaces
- Restorations may be defective due to open contacts/uneven interproximal
margins/overhangs/inadequate margins
- This act as food traps/bact reservoir – perio
calculus overhang
Limitations of radiographs
 X-ray provides 2D view of 3D tissue.
- Bone defects that are overlapped by higher bony walls may not be visible
- Tooth structure is superimposed on B/L bone on intraoral x-ray
- Only interproximal bone can be seen clearly
 X-ray show less severe bone destruction than actually present
- Early perio lesions with mild bone destruction don’t cause sufficient change visible
- 30% demin of bone has to occur before detected on x-ray
 X-ray don’t show soft-tissue-to-hard-tissue relationship
- No info regarding depth of soft tissue pockets provided
- NB use x-ray and clinical exam to evaluate perio
 Bone level measured from CEJ
- This reference point isn’t valid in situations of tooth overeruption because of opposing
tooth loss/passive eruption due to severe attrition
- In this situation distance between level of crestal bone and CEJ will be increased due
to tooth/CEJ moving away from alveolar crest and not because of alveolar bone
destruction
Intraoral x-rays are useful to evaluate:

- Amount of bone loss
- Condition of alveolar crest
- Bone loss in furcation area
- Width of pdl
- Presence of predisposing factors for perio
- Crown-to-root ratio
- Anatomical considerations
- Relation of mx sinus to perio defect
- Absent/supernumerary/impacted teeth
- Path considerations
- Caries
- Periapical lesions
- Root resorption
*look at condensing periodontitis
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2.10 DIGITAL RADIOLOGY
2.10.1 Terminology
 Charged-coupled device (CCD): image receptor found in intraoral sensor
 Digital radiology: imaging system that captures radiographic image produced by x-
rays on sensor converting it into pixels/presenting image on computer
 Pixel: discrete unit of digital info
 Sensor: sensor placed intraorally to capture image
 Storage phosphor imaging: image is recorded on phosphor-coated plates which is
placed into electronic processor which scans plate using laser/produce image on
computer
2.10.2 Fundamental aspects

- 3 basic types of digital imaging systems based on how image is generated:
1. direct digital radiography
2. semi-direct digital radiography (storage phosphor)
3. indirect (optically scanned) digital radiography
- sensor is placed in pt mouth and is exposed to x-rays similar to conventional
radiography
- image is transferred from sensor to computer which displays/stores image
- digital systems are also available for Extraoral radiography
2.10.3 Radiographic equipment

- Basic elements:
1. Machine
2. Digital sensor (receptor)
3. Computer
1. Machine
- of conventional type is used in most digital imaging systems
- timer in control panel has to be adjusted to allow exposures in 0.01s because
much shorter exposure times – less radiation
2. Digital sensor (receptor)
 Direct digital radiography:
- uses small/reusable sensors which are placed inside mouth to capture image
- direct refers to digital image is directly produced without delay
- no steps in developing a phosphor plate like with semi-direct/scan a film like
indirect
- sensor may be wired/unwired
- wired sensors are linked to fibre optic cable that transmit image to computer
- wireless sensors aren’t linked to computer but have phosphor-coated plates
that record image
- types of sensors:
1. Charged-coupled devices (CCD)/complementary metal oxide
semiconductor (CMOS)
2. Photostimulable phosphor plates (PSP)
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Charged-coupled devices (CCD)
- direct digital system

- rigid/non-flexible sensor and most common
- wired/unwired
- consist of thin silicon chip(wafer) in which an electronic circuit is embedded
to record image
- covered by scintillation layer to convert photons into electrical signals
- silicon chip contain thousands light-sensitive elements arranged in
rectangular array that convert photons into electrical signals through
photoelectric effect
- Electronic charge in light-sensitive element is proportional to # of e
released
- Each element has diff electronic charge after exposure depending on # of
photons absorbed/# of e set free
- electronic latent image consist of millions of electrical charges is created in
light-sensitive elements
Complementary metal oxide semiconductor (CMOS)
- contain silicon-based semiconductors but differ from CCD in way pixel
charges are read
- instant image/less expensive/less fragile – last longer
- more radiographic noise/less info
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 Semi-direct digital radiography
Uses Photostimulable phosphor plates (PSP) as intraoral sensor
- Image scanned to digitize and erased before reuse
- More flexible/thinner than CCD
- Handle film with care/less user friendly because may damage/increased
radiation due to retakes
- It absorb/store energy from x-rays/release stored energy as light
(phosphorescence) when stimulated by red light of 600nm
- When PSP exposed to x-ray energy from photons absorbed and electronic
latent image formed by displaced e
- Red light converted to green light converted to electric energy
- Expose plates to bright light to erase latent image before exposure
- New exposed plates handled in dark room
 Indirect (optically scanned) digital radiography

- Finished conventional film radiograph is scanned/digitized like scanned
document
- New digitized image can be manipulated same as direct/indirect
#Direct-conversion detectors have an X-ray
photoconductor, such as amorphous selenium,
that directly converts X-ray photons into an
electric charge.
#Indirect-conversion detectors, on the other
hand, have a scintillator that first converts X-
rays into visible light. That light is then
converted into an electric charge by means of
photodetectors such as amorphous silicon
photodiode arrays or CCDs. Thin-film transistor
(TFT) arrays may be used in both direct- and
indirect-conversion detectors.
3. Computer
- to receive/store signals from digital sensor
- convert electronic signals to shades of grey that are viewed on screen
- digital x-ray composed of shades of grey – continuous tone image
- to convert data from sensor into digital each element of image is converted
to individual piece of info (pixel-picture element) by analogue to digital (A-D)
converter
- this info describes the light brightness/location as a whole
- higher # of pixels/more closely placed – better image
- pixel grey-scale resolution = pi-range of pixels
2.10.4 Principles of digital image display and image enlargement

2.10.4.1 Digital image display
- Image is displayed on computer monitor
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- Display may vary by bright background lighting/light reflected off monitor
- Best view where light is subdued/indirect
2.10.4.2 Image enhancement

- This mean that the adjusted image is an improved version of original image
- It largely depends on viewer preference and often performed in attempt to make
image visually acceptable
- We can do this by adjusting brightness/increasing contrast/increasing image
sharpness/reducing radiographic noise
- Sometimes image enhancement might reduce image quality eg. improving contrast
between enamel/dentine to max caries detection make it difficult to identify alveolar
crest – subjective image enhancement (change according to what viewer wants)
 Brightness and contrast
- Image might be too dark/light/too much/little contrast
- We can adjust this by using the image histogram in the editing software
- This adjustment value is controversial
- Selectively enhance specific areas
 Sharpening and smoothening

- Purpose is to remove blur/noise – speckling(high-frequency) or gradual intensity
change (low-frequency noise)
- Different filters are available to selectively reduce low/high-frequency noise
- Be familiar with the effects of filters
- This will make image visually more appealing
2.10.5 Radiation exposure

- Digital require 50-80% less x-radiation than conventional because sensor more
sensitive to x-rays
- Eg exposure time for digital (0.05s) and conventional (0.2s)
2.10.6 Step by step procedure for use of intraoral digital sensors

- Refer to manufacturer’s instructions for info regarding equipment prep/pt
prep/exposure settings
- General guidelines:
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- Place sensor in pt mouth same as conventional
- Ensure sensor is centered over area of interest
- Sensor held in position by bite-block attachment that indicate proper alignment of
beam
- Use paralleling tech
2.10.7 Advantages and disadvantages of digital radiography NB SERRIINN

 Advantages:
- Superior grey-scale resolution
Digital 256 diff shades of grey, conventional 16-25 – NB for diagnosis based on
contrast
- Reduced radiation exposure
Digital require 50-80% less x-radiation than conventional because CCD sensor more
sensitive to x-rays
- Reduced imaging costs

Digital doesn’t require films/processing solution/darkroom/processor
- No processing errors
Filmless sensor
- No environmental pollution
No lead foil-containing films/processing solutions
- Image enhancement
Can be used by colourisation/zoom functions
Zoom allows detection of small tooth decay/perio
Can also use digital subtraction which reverse grey scale – radiolucent areas in image
appear radiopaque and visa versa
- Increased speed of image viewing
Viewed immediately because no film processing
- Effective pt education
On computer image is 32cm and on film 5cm
 Disadvantages: SSL
- Set-up costs
May be high depending on manufacturer/level of computer equipment in
practice/aux features like intraoral digital camera
- Sensor size
Sensors are thicker than film – pt complain of bulkiness/gag
Infection control – can’t be sterilized so cover with infection control barrier
- Legal issues
Can be manipulated so always save original as well
Problems associated with use of rigid intraoral digital receptors:

1. placement errors (in premolar/molar areas)
2. vert angulation (in ant regions) result in incisal edge cut-offs
3. horizontal overlapping due to incorrect horizontal beam angulation
4. cone-cutting
5. difficulties with bite-wing placement (in premolar areas)
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6. pt discomfort
- to avoid these pay attention to details of sensor placement at precise location/vert
and horizontal angulation of beam/film parallelism to tooth of interest
- to reduce pt discomfort rigid receptors should be placed closer to midline of oral
cavity/palate (increase sensor-object distance). This will min image distortion
because it will ensure sensor is parallel to long axis of object to be examined.
- Cotton roll may be placed on bite-block to facilitate placement/allow crowns to be
fully in x-ray
2.11 EXTRAORAL RADIOGRAPHIC EXAMINATIONS
2.11.1 Panoramic radiography

Principles of image formation
- Pan shows panoramic view of tissues in both jaws
- Sensor is outside pt mouth and together with tube rotate around pt head
- X-ray produced through process called tomography = radiographic tech that allows
imaging of 1 layer of tissue while blurring image of tissues in other planes
- Plane of tomography (focal trough) in pan corresponds to shape of dental arches
- #collimator: a device for producing a parallel beam of rays or radiation.
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x-ray tube
center of rotation
x-ray beam
x-ray sensor
*beam goes behind and source in front of pt
Focal trough;. A three-dimensional area within which structures are accurately reproduced
on a panoramic radiograph. Positioning the patient within the focal trough is critical to
producing a panoramic radiograph that clearly reproduces oral structures.
- Plane of tomography: It is a theoretical concept used to determine where the dental

arches should be positioned to achieve clearest image
- It is defined as 3D curved zone in which structures are clearly demonstrated in a pan
- Tissues in the focal trough will be well defined
- Structures inside/outside will be blurred in a pan
- Most pan machines have a focal trough that is narrow in ant region and wider
towards post region
- In pan focal trough corresponds to layer/slice of tissue – it is a tomogram of the jaws
- During a pan the sensor and x-ray head rotate around pt head at same speed
- Beam cont changes direction as it rotates around pt head
- Pan machine design is such that it cont change in direction of beam occur around an
imaginary centre (axis) of rotation
- Centre of rotation is located on L aspect of md dental arch away from objects being
imaged
- Centre of rotation is initially located near L surface of right body of md when left TMJ
is exposed
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- Rotation centre moves ant along an arc that ends just L of symphysis when md
midline/ant teeth are being imaged
- This arc is reversed when opposite side is imaged
- Structures near x-ray head are distorted/out of focus because x-ray beam sweeps
through them in opposite direction in which sensor is moving
- Structures near x-ray head are so magnified/blurred that they aren’t seen as discrete
images but as ghost images
Real, double and ghost images

- During rotation, some anatomical structures are imaged twice during 1 exposure
cycle. Depending on their location they may present these different images:
1. Real image
2. Double image
3. Ghost image
A B C
Sketch ABC: Formation of real single, real double, ghost image

Exposure begin with x-ray head on pt right, cont behind pt head and end left
Dotted line indicates imaginary inverted V-shaped path of moving centre of rotation of
beam during exposure
D E F
Sketch DEF
D grey zone: structures between sensor and moving centre of rotation – real single image
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E grey zone: structures between moving centre of rotation and sensor that are exposed
twice – real double image
F grey zone: structures between moving centre of rotation and x-ray head – ghost images
1. Real image:
- Objects that are located between centre of rotation and sensor
- If they are located within this zone and also within the focal trough their images will
be sharp
- Objects located within this zone but outside focal trough will have blurred images
2. Double image:
- Structures such as the epiglottis/hyoid bone/cervical spine are located post of centre
of rotation
- They are imaged twice during an exposure cycle/form double images 1 on each side
of resultant pan
3. Ghost image:
- Some anatomic structures like left or right md ramus/hyoid bone/cervical
spine/metal accessories like earrings, necklace, hairpins are located between x-ray
head and centre of rotation
- Such structures/foreign objects produce ghost images on pan
- Ghost image will be located on opposite side of its true location/at higher level
because of upward inclination of beam
- They are also blurred/magnified because objects/structures are located outside
focal trough and close to x-ray head
* head rotation to left (left images magnified – closer to beam)

* bite to far forward – ant md teeth small/thin
backward – ant md teeth wide
* chin down – smiley
* chin up – flat
Pt positioning:
Indications for pan use:

- Evaluate impacted teeth
- Evaluate eruption patterns, growth, development of jaw
- Detect lesions and conditions of jaw
- Examine extent of large lesions
- Evaluate trauma of jaw
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Pan image isn’t as sharp as intraoral radiograph so shouldn’t be used to detect caries/perio
Tech:
Equipment prep:
- load 1 extraoral film/2 intensifying screens in pan cassette.
- Ensure that bite block is sterile.
- Set exposure factors
Pt prep:
- 1. Explain procedure to pt
- 2. Place lead apron on pt
- 3. Remove glasses, earrings, necklace, studs, hairpins, hearing aids, dentures
- 4. Instruct pt to sit with straight spine, to bite in groove in bite block, close lips on
bite block for duration of exposure
- 5. Pt head must be stabilized by forehead support machine
- 6. Ensure pt midsagittal plane is perpendicular to floor
- 7. Ensure pt Frankfort plane (imaginary line that connect sup border of external
auditory canal and infraorbital rim) is parallel to floor
- 8. Instruct pt to position tongue against roof of palate during duration of exposure
- 9. Instruct pt to remain still during exposure
- 10. Expose film and process film
Advantages:
- Entire mx/md can be viewed on x-ray
Disadvantages:
- Image not as sharp because of effect of intensifying screens
- Can’t be used to assess caries/perio
- Tissue outside focal trough can’t be evaluated
- Certain amount of magnification, distortion, overlapping occur even when proper
tech is applied
- Pan machine is expensive
- Several errors may occur during pan and they are:
1. Pt prep errors
Ghost images will be visible on pan if foreign objects aren’t removed
prior to exposure
2. Pt positioning errors
o If pt lips aren’t closed on bite block a dark shadow will obscure
ant teeth
o If tongue isn’t against palate a dark shadow will obscure
apices of mx teeth
o If pt chin is too high the Frankfort plane will be angled upward
and reverse smile will be apparent, hard palate and floor of
nasal cavity will be superimposed on apices of mx teeth, mx
incisors will be blurred/enlarged
o If pt chin too low the Frankfort plane will be angled downward
and exaggerated smile will be obtained, md incisors will blur,
detail in ant apical region will be lost, condyles won’t be visible
o If pt ant teeth are in front of groove in bite block teeth will be
too narrow/blurred because they won’t be in focal trough
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o Pt ant teeth behind groove in bite block teeth will be too
wide/blurred not in focal trough
o Pt not centred, md ramus/post teeth closest to film will
appear smaller than other side where tissues are enlarged
o If pt doesn’t sit upright with vert spine the cervical spine will
appear as vert radiopaque area in centre of x-ray which will
obscure detail in this region
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- The inferior border of the orbital cavity can often be seen in the upper 1/3 of the mx
paranasal sinus
- The nasal septum is the vertical radiopaque structure between the 2 nasal cavities
- The nasal turbinates are on the lateral wall of the nasal cavity
- The mx paranasal sinuses should be symmetrical, radiolucent areas above root
apices of mx premolars/molars
- Radiopaque bone septae can be detected in sinuses, if this occur the mx paranasal
sinuses assumes a ‘multilocular’ appearance
- The roots of above mentioned are often in close association with sinuses/protrude
into sinuses
- Mx paranasal sinus often enlarge when mx posterior teeth are extracted =
pneumatisation
- The Fronto-zygomatic process of the maxilla forms the lateral wall of the orbit
- The zygomatic arch arises over 1st and 2nd molar area and extend posteriorly to the
articular eminence
- Just posterior to articulating eminence is the glenoid fossa into which the head of
the md condyle articulates
- The styloid process is a radiopaque structure posterior of ramus/angle of md and
may be superimposed on the ear lobe
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- The head of the md condyle is separated from coronoid process by coronoid notch
- The inferior alveolar canal which contain the inferior alveolar neurovascular bundle,
originates at approximately the upper 1/3 of the ramus
- It extends antero-inferiorly and follows the curve of corpus of md to 2nd premolar
where it terminates in mental foramen
- Submd gland fossae are poorly demarcated, radiolucent areas with reduced bone
trabeculae which are located periapically of the md molars (bilateral symmetry) also
above radiopaque line which form superior margin of fossa
- This is the mylohyoid line which extend antero-inferiorly from 3rd md molar to md
premolars
- The hyoid bone often can be seen as horizontal radiopaque structure that is
bilaterally superimposed on md angle and extend distally to end of film
- Md symphysis is an area of increased radiodensity in md midline
- The convex, vaguely radiopaque posterior dorsum of the tongue can often be seen
superimposed on md ramus. It is separated from the vaguely radiopaque soft palate
by radiolucent airspaces in posterior oral cavity
- The radiolucent nasopharyngeal airspace is posterior of the soft palate
- It inferiorly communicates with the airspace of the oropharynx and airspace of the
laryngopharynx respectively
- Good x-ray may show the radiopaque epiglottis in the radiolucent airspace of
laryngopharynx
- The pterygomx fissure (located superior of mx 8’s) is a well-demarcated, tear drop-

shaped, radiolucent area adjacent to the posterior surface of mx paranasal sinus
- The mx tuberositas is the convex mx bone distal of mx 8’s (show bone trabeculae on
a good x-ray)
- Cancellous/trabecular bone forms bulk of both jaw bones

- In health, it is covered by cortical bone that is more radiopaque than cancellous
bone
- Radiodensity of medullary and cortical bone/trabecular bone pattern show variation
between pt’s
2.11.2 Skull radiology

- used in MFOS/Ortho (treatment plan, treatment and maintenance)
- they are difficult to interpret because of superimposition of several anatomical structures
(sometimes require multiple x-rays of 1 area)
- most common used skull radiographs are:
1. Lateral ramus projection
2. Lateral cephalogram
3. Posterior-anterior projection
4. Water’s projection
5. Submenton-vertex projection
6. Reverse Towne’s projection
Transorbital/transpharyngeal projections are occasionally used to evaluate the TMJ
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2.11.2.1 Lateral ramus projection
 Indications: this projection shows md ramus from angle of md to the condyle and is
mostly used to view wisdom teeth in pt that can’t undergo panoramic x-ray due to
trismus
 Film placement: head is centred over the cassette, which is placed against the pt
cheek and parallel to the ramus of interest. Pt supports the cassette in appropriate
position with thumb on inferior aspect of cassette and palm of hand on outside of
the cassette
 Head position: head is tilted 15’ towards the side to be investigated and chin
extended and slightly elevated
 Beam alignment: central x-ray beam is directed slightly upward (-15’ to -20’) to a
point distally of 3rd molar area of interest. The beam must be directed perpendicular
to horizontal plane of cassette
 Exposure factors: exposure must occur according to instructions of manufacturers of
x-ray film, intensifying screens and x-ray equipment
2.11.2.2 Lateral cephalogram

 Indications: the purpose is to evaluate facial growth and trauma. It demonstrates
the bones of the face/skull as well as soft tissue of the face. Soft tissue is more
readily seen when a filter Is placed between pt and film. It filters some of the x-rays
that pass through the facial soft tissue, thus enhancing the image of pt’s facial soft
tissue
 Film placement: receptor/cassette is placed perpendicular to floor in a cassette-
holding device. The long axis of cassette is positioned horizontally
 NB Head position: left side of pt face is positioned against cassette. The head is
centred over the cassette. The midsagittal plane must be parallel to the cassette
and perpendicular to the floor. The Frankfort plane must be parallel to the floor
 Beam alignment: central x-ray is directed perpendicular to centre of cassette
 Exposure factors: exposure must occur according to instructions of manufacturer of
 Anatomical landmarks: main anatomical landmarks on a lateral ceph is NB because
they are often used to determine planes/angles in ceph analysis for Ortho and
MFOS
NB REFER TO TEXTBOOK FOR PICTURES AS WELL
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ANATOMICAL LANDMARKS:
1. Subspinale (A) deepest midline point between the anterior nasal spine and
prosthion
2. Supramentale (B) deepest point in the bony outline between the infradentale
and pogonion
3. Sella (S) The centre of the sella turcica
4. Nasion (N) The most anterior point on the fronto-nasal suture
5. Orbitale (Or) The most anterior point on the infraorbital margin
6. Porion (Po) The upper most point of the bony external auditory meatus, usually
regarded as coincidental with the uppermost point of the ear rods of the
cephalostat
7. Anterior Nasal Spine (ANS) The tip of the anterior nasal spine
8. Posterior Nasal Spine (PNS) The tip of the posterior spine of the palatine bone
in the hard palate
9. Gonion (Go) The lateral external point at the junction of the horizontal and
ascending rami of the md (gonion is identified by bisecting the angle formed by
tangents to the posterior and inferior borders of the md)
10. Gnathion (Gn) The most anterior, inferior point on the bony outline of the chin,
situated equidistant from pogonion and menton
11. Menton (Me) The lowest point on the bony outline of the md symphysis
12. Pogonion (Pg) The most anterior point of the bony chin
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13. Bolton point (Bo) highest point of the curvature between the occipital condyle
and basilar part of occipital bone, located behind occipital condyle. The point is
a substitute for the posterior basion when it isn’t visible on a ceph
PLANES:
1. SN line the plane represented by a line joining the nasion and sella
2. BP (Bolton plane) a plane represented by the line joining Bolton point and
nasion
3. Frankfort Plane The plane represented by the line joining the orbitale and
porion
4. Mandibular Plane (Man P) The plane representing the lower border of md

corpus
5. Maxillary Plane (MP) The plane represented by a joining of the anterior and
posterior nasal spines
6. OP: a plane represented by the line indicating the mx occlusal surface
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ANGLES:
1. SNA relates anterioposterior position of the maxilla (point A in book) to the
cranial base
2. SNB relates anterioposterior position of the mandible (point B) to the cranial

base
3. ANB relates anterioposterior position of the maxilla to the mandible, indicates

the anteroposterior skeletal pattern (Class I, II, III)
4. Maxillary Incisal Inclination (X) The angle between the long axis of the mx
incisors and mx plane
5. Mandibular Incisal Inclination (Y) The angle between the long axis of the md
incisors and the md plane
6. Z the angle between the Frankfort plane and md plane
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2.11.2.3 Posterior-anterior projection (for trauma in middle 1/3)
 Indications: the purpose is to evaluate facial growth, trauma and disease as well as
frontal/ethmoidal, paranasal sinuses, orbits, nasal cavities
 Film placement: cassette is positioned perpendicular to the floor with long axis
vertically
 Head position: pt faces cassette with forehead/nose touching cassette. The head is
centred over the cassette. The midsagittal plane is perpendicular to the floor and
the canthomeatal line (imaginary line connecting the central point of external
auditory meatus with lateral canthus of eye) is parallel to the floor
 Beam alignment: central x-ray beam is directed through the centre of the head and
perpendicular to the cassette
EXTRA NOTES
- BEAM IS AT THE BACK
- FACE CLOSER TO THE SENSOR/FILM TO REDUCE MAGNIFICATION
- CAN’T USE TO EVALUATE CONDYLES
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2.11.2.4 Water’s projection (trauma in upper 1/3)
 Indications: purpose is primarily to evaluate the mx sinus, but the frontal and
ethmoidal sinuses, orbits and nasal cavity can also be viewed clearly
 Film placement: cassette is perpendicular to the floor with the long axis vertically
 Head position: pt faces the cassette and head is centred over it. The chin must touch
cassette, but should be elevated in such a manner that the canthomeatal line is at
45’/37’ with cassette. Midsagittal plane is perpendicular to the floor
2.11.2.5 Submenton-vertex projection (canthomeatal line paralle to the cassette)
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2.11.2.6 Reverse Towne’s projection (TMJ problems)
 Indications: purpose is to evaluate the condylar neck and md ramus for the
presence of fractures
 Film placement: cassette perpendicular to the floor with long axis vertically
 Head position: pt centres head over cassette and faces it with the head tilted
downwards and forehead touching the cassette in such a manner that the
canthomeatal line is at -30’ angle with cassette. The mouth must be as wide open as
possible and chin touching the chest. The midsagittal plane must be perpendicular to
the floor
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CHAPTER 3: BIOLOGICAL EFFECTS OF IONISING RADIATION
3.1 Radiation injury

During radiography not all photons pass through tissue to reach x-ray film. Low-energy
photons are absorbed by tissue during which photon energy is transferred to tissue.
Transferred energy causes chemical changes in tissue that may be harmful.
2 specific mech of radiation injury may occur:
- Ionization- Compton scatter
- Free radical formation
Ionization:
Occur through Compton scatter or photoelectric effect when photons interact with
atoms and eject e from their orbits. E high-speed e in turn interacts with other atoms in
tissue, resulting in further ionization and breaking of molecular bonds, all of which cause
chem changes in cells that result in biological damage. Ionization may have little effect
on cells if chem changes don’t alter sensitive molecules. Such changes may however
have profound effect on important structures like DNA
Free radical formation:

Occurs in tissue when x-ray photons ionize water molecules, which is the largest component
of all cells. Ionization of water results in formation of hydrogen and hydroxyl free radicals
Radiosensitivity: relative susceptibility of cells, tissues, organs or organisms to the harmful

effect of ionizing radiation
Most sensitive: spermatoginia, rbc, epidermis, mucosal cells
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These are undifferentiated, well nourished, quick dividing, high metabolic activity
Lowest sensitivity: nerve, muscle fibres
A free radical is a neutral molecule/atom with an unpaired e in its outer orbit. Free radicals
are very unstable and have a lifetime of approximately 10−10 sec
In order to achieve stability, free radicals may undergo the following reactions:
- Recombination without any changes to water molecules
- Combinations with other free radicals and cause cell damage
- Combination with ordinary molecules to form toxins such as hydrogen peroxide that
cause cell damage
Cell damage by free radicals is considered the indirect effect of ionizing radiation because it
isn’t directly caused by an indirect x-ray photon that ejects e from orbit. Indirect injuries due
to free radical formation from ionizing radiation occurs frequently due to high water
content in all tissues
To determine which levels of radiation exposure are acceptable use the resultant dose-
response curve
A: Linear relationship
Indicate that tissue response is directly proportional to the dose of radiation received and
that there is no threshold from tissue
B: a non-linear no threshold curve:
Indicates that tissue response isn’t proportional to the dose of radiation received
Little tissue damage is therefore seen at low doses of radiation
C: non-linear threshold curve:
Indicates that tissue has a threshold to the radiated dose although molecular changes occur
prior to the point of threshold, the extent thereof is too small to result in clinically
detectable tissue damage
Clinical signs of radiation damage will only occur in the specific tissue of radiation dose
exceeds threshold dose
Radiation effects are either stochastic/non-stochastic

#stochastic: having a random probability distribution or pattern that may be analysed
statistically but may not be predicted precisely.
- Non-stochastic effects (deterministic effects) – of more concern

Occur in somatic cells (all cells except germ cells) and have a threshold above which the
effects will occur. This means that at relative low radiation doses no clinical signs will be
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observed (below threshold) but once clinical signs occur its severity increases with increased
absorption of radiation.
They require a much larger radiation dose to occur compared to stochastic.
Eg: erythema of skin/oral mucosa, hair loss, decreased fertility
Effects are temporary because DNA isn’t affected and undamaged cells can replace
damaged ones
Dose determines damage
Sensitive cells reach threshold quick
Acute effect within hours (short term)
- Stochastic effects
Direct effect of radiation dose and have no threshold. The probability of stochastic effects
occurring is directly proportional to the absorbed radiation dose. The severity of tissue
damage is however not proportional to absorbed dose.
Eg: mutations which occur in DNA of cells in reproductive system and can cause birth
defects/ DNA of cells in bone marrow may be affected and cause leukemia
They are all or nothing effects because an individual develops a birth defect/not…
They are permanent because DNA in primitive, rapidly developing cells are affected
Small dose may be a hazard
Longterm genetic damage
Chemical reactions occur on molecular level and becomes clinically evident over a period
called the latent period
Latent period can be short/long dependent on:
- Radiation dose absorbed
- Time span during which radiation exposure occurred
- Tissue sensitivity to radiation
Effects of radiation exposure are cumulative (repeated may cause cancer, birth defects)
Determining factors for radiation injury: (not the mechanism of radiation injury)
1. Total radiation dose
more tissue damage when large quantities of radiation are absorbed by tissues
2. Dose rate
rate at which radiation exposure occur. More tissue damage with high doses delivered at
short intervals because tissue can’t recover
3. Amount of tissue irradiated
total area of body irradiated eg with an atomic bomb – cause extensive damage to
haemopoietic system that result in systemic adverse effects
4. Tissue sensitivity
to ionizing radiation differs between tissue types. Cells with high mitotic activity are more
sensitive
5. Age
children are more susceptible
Radiation effects
- Short term and long term effects
Short: is effects occur after latent period of days/weeks (non-stochastic)
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Occur after exposure of high dose of radiation over short period
Effects are: erythema, ulceration, vomiting, diarrhea, hair loss
Not relevant in dentistry
Long: (stochastic)
Develop years after repeated exposure to low doses x-rays
Cumulative effect
Effects: cancer, birth defects
- Somatic and genetic effects

Somatic:
All cells except reproductive
Effects present as poor health and have signs and symptoms
Genetic:
Reproductive cells
Can be repaired
Don’t effect pt health and no signs and symptoms
Effect in future generations as developmental abnormality
- Radiation effects on cells
Nucleus is more sensitive than cytoplasm
Nuclear damage occur in chromosomal DNA and result in cell death, unequal cell
division, cell immortality, neoplasms
Some cells are more sensitive – radiosensitive cells
Less sensitive cells – radioresistant cells
These factors determine the response of cells:

 Mitotic ability – high mitotic activity cells are radiosensitive
 Cell differentiation – undiff like stem cells are more radiosensitive than diff cells like
nerve cells
 Cell metabolism – high metabolic demand more radiosensitive
- Radiation effects on tissue and organs

Radiosensitive organs consist of radiosensitive cells and radioresistant is the liver, kidney
and nervous system
Protect these organs during radiation:

1. Skin
2. Thyroid gland
3. Lens of eye
4. Bone marrow
5. Reproductive
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McGrigor Campbell Fracture lines
These lines are a set of lines

that you will draw in a water
projection that will help you
determine and look at the
projection in segments so that
you are able to look for
fracture lines especially along
the anatomy of the actual
patient.
Draw 4 lines that will pass through the various anatomical structures
1. Frontal zygomatic suture from the left of the patient
over the superior border of the orbit to the other
fronto zygomatic suture
2. Zygomatic bone through to the zygomatic arch to
inferior border of the orbit and the to the other side
zygomatic bone and arch
3. Over the condyle head of the mandible through the
coronoid process to the superior border of the
maxillary sinus and then again to the other side
4. From the ramus of the mandible on the one side to
occlusal surface of the teeth though the ramus of the
mandible
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RAD

1.1 COMPOSITION OF MATTER

- Electrostatic attraction between + nucleus and – e balance centrifugal force and

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2. Electromagnetic (non-particulate) radiation eg dental x-rays

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Sketch: electron cloud

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- Sharpness of radiological imaging improve with decreased size of focal spot

3. Flexible extension arm:

1.4 ELECTRIC POWER SUPPLY TO X-RAY TUBE

Sketch: e colliding with anode produce x-ray beam of photons

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Bremsstrahlung Characteristic radiation

Kinetic energy of e = converted to x-rays during collision with focus area

Bremsstrahlung (breaking radiation) = produced by sudden stopping/slowing of high-speed

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Direct hit by high-energy electron on tungsten nucleus at focal spot

Near miss of tungsten nucleus at focal spot by high-energy e

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1.6 FACTORS CONTROLLING X-RAY BEAM

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3. Tube voltage (kVp)

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- low kVp = high contrast

- penetrating ability of beam can be determined by establishing half-value layer (HVL)

4. Collimation (nie dieselfde as n grid nie)

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5. Filtration of low energy photons

6. Inverse square law

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1.7 INTERACTION OF X-RAY WITH MATTER

A. Pass through pt without any interaction with atoms/particles thereof

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D. Be scattered (Compton scattering)(62%)

Factors that influence

1.8 X-RAY BEAM ATTENUATION

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2.1 X-RAY FILM, INTENSIFYING SCREENS AND GRIDS

2.1.1 X-ray film

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- film packet 4 components:

- film consist of: (FAEP)

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2. paper film wrapping

3. lead foil sheet

4. outer plastic package wrapping

- outer package wrapping has 2 sides:

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2.1.2 Intensifying screens (extraoral radiographic examination)

- Intensifying screens are used in pairs (1 in front of screen and 1

2.1.3 Grids (nie collimator that narrows the beam nie)

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Lead strips (black)

2.2 PROJECTION GEOMETRY

2.2.1 Image characteristics

1. Increased tissue thickness and density

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B.) Radiographic contrast = the range of densities(diff degrees of blackness) seen on

D.) Subject contrast = determined by thickness, density, composition (atomic #) of

E.) Scattered radiation = result from Compton/coherent interactions of photons with

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Lene Merbold 2017