Principles of radiographic interpretations
- 2. Introduction • Interpretation: an explanations • Radiographic interpretation is an explanation of what is viewed on dental radiograph • Diagnosis: the identification of a disease by examination or analysis.
- 3. Aim: • systematic method of image analysis ACQUIRING APPROPRIATE DIAGNOSTIC IMAGES • Quality of the Diagnostic Image • Number and Type of Available Images
- 4. • VIEWING CONDITIONS: .Ambient light in the viewing room should be reduced. .Intraoral radiographs should be mounted in a film holder. .Light from the view box should be of equal intensity across the viewing surface. .The size of the view box should accommodate the size of the film. If the viewing area is larger than the film, an opaque mask should be used to eliminate all light from around the periphery of the film. This mask can be fabricated from a sheet of opaque material cut to fit the entire view box, leaving an opening for one film. .An intense light source is essential for evaluating dark regions of the film. .A magnifying glass allows detailed examination of small regions of the film.
- 5. A. Wardray viewing box incorporating an additional central bright-light source for viewing over-exposed dark films. B. The SDI X-ray reader — an extraneous light excluding intraoral film viewer with built-in magnification.
- 7. Image analysis • INTRAORAL IMAGES 1. IOPA before bitewing 2. Rt. Maxilla lft. Maxilla lft. Mandible rt. Mandible 3. Identify the anatomic structure, examine the bone & character of the trabecular bone. 4. Compare the same area on adjacent and corresponding areas of other side.
- 8. • 2nd visual circuit 1. Examining the ht. and cortication of alveolar bone relative to teeth. 2. Examine alveolar bone for extent and severity of bone loss 3. Areas of erosion; difference in trabeculae pattern
- 9. • 3rd visual circuit 1. dentition and associated structures 2. Each tooth in sequence, using all available images 3. Examine PDL space & lamina dura of each tooth.
- 10. EXTRAORAL RADIOGRAPHY • Analysis of Intraosseous Lesions 1. picture matching, or "Aunt Minnie,"method 2. step-by-step analysis
- 11. step-by-step analysis STEP 1: LOCALIZE THE ABNORMALITY
- 12. cherubism
- 13. • Position in the jaws Soft tissue Within jaws • Odontogenic origin Coronal to tooth • Odontogenic origin Above IAC • Neural or vascular origin Within IAC • Not of odontogenic origin Below IAC • Cartilagenous or osteochondromas Condylar region
- 15. Specific epicenters CGCG • Mandible- anterior to 1st molar • Maxilla- anterior to cuspid Osteomyeli tis • Mandible more common Periapical cemental dysplasia • Periapical region of teeth
- 16. • Single or multifocal periapical cementa! dysplasia, odontogenic keratocysts, metastatic lesions, multiple myeloma, leukemic infiltrates • Size- may aid in the differential diagnosis
- 17. STEP 2: ASSESS THE PERIPHERY AND SHAPE Well defined borders Punched out sclerotic margin radiopaque lesion with radiolucent margins corticated margin Ill defined borders blending border invasive border/ p ermeative
- 20. • Shape Circular/ hydraulic cyst Scalloped/ multilocular Cyst, cystlike lesions, tumors
- 22. STEP 3: ANALYZE THE INTERNAL STRUCTURE radiolucent mixed radiopaque Radiolucent lesions: Unilocular- eriapical cyst, granuloma,, abscess, PA cemental dysplasia. Multilocular- OKC, CGCG, botryoid odntogenic cyst, aneursymal bone cyst,cherubism Moth eaten - osteomyelitis, osteosarcoma, lymphoma,multiple myeloma radiopaque lesions: Focal opacity- PA cemental dysplasia, condensing osteitis,sclerotic bone Target lesions- benign cementoblastoma, complex odontome Multifocal confluent- osteitis deformans, florid osseous dysplasia Mixed- AOT, CEOT, compound odontome, KCOT, ossifying fibroma Irregular- osteosarcoma, chondrosarcoma Ground glass- FD, ostetis deformans, osteopetrosis, hyperthyroidism
- 25. STEP 4: ANALYZE THE EFFECTS OF THE LESION ON SURROUNDING STRUCTURES • stimulate bone resorption or formation. Inflammatory lesion • slowly creates its own space by displacing teeth and other surrounding structures space- occupying
- 27. Epicentre above the crown Apical displacement of tooth eg; follicular cyst, odontomas Epicentre in ramus push teeth in an anterior direction eg; cherubism Papilla of developing teeth push the developing tooth in a coronal direction eg; lymphoma, leukemia, Langerhans‘ cell histiocytosis Widening of the periodontal membrane space Malignant lesions; an irregular widening and destruction of the lamina dura Resorption of teeth chronic or slowly growing process; more commonly related to benign processes
- 28. Presence of reactive bone at periphery slow, benign growth and possibly the ability to stimulate osteoblastic activity in the surrounding bone IAN canal superior displacement Fibrous dysplasia IAN canal widening with cortical boundary benign lesion of vascular or neural origin IAN canal widening with cortical destruction malignant neoplasm growing down the length of the canal
- 29. • Periosteal new bone formation Slow growing lesion • Missing of cortical plate Rapidly growing lesions • Lift the periosteum • Recurrence cause onion skin pattern Inflammatory lesion with exudation
- 31. STEP 5: FORMULATE A RADIOGRAPHIC INTERPRETATION
- 33. Systematic approach • The entire radiograph • Specific lesions
- 35. Specific lesions A systematic description of a lesion should include its: • Site or anatomical position • Size • Shape • Outline/edge or periphery • Relative radiodensity and internal structure • Effect on adjacent surrounding structures • Time present, if known.
- 36. references • White & Pharoh Oral Radiology,4th Edition • White & Pharoh Oral Radiology, 5th Edition • Eric Whaites ; Essentials Of Dental Radiography & Radiology, 3rd Edition • Karjodhkar; Textbook Of Dental & Maxillofacial Radiology 2nd Edition • Dental Radiography Principles And Techniques; Haring & Howerton, 3rd Edition