Principles of radiographic interpretations

basics of interpretation principle of oral radiology

1. Seminar 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.

6. Image analysis INTRAORAL IMAGES IOPA before bitewing Rt. Maxilla lft . Maxilla lft . Mandible rt. Mandible Identify the anatomic structure, examine the bone & character of the trabecular bone. Compare the same area on adjacent and corresponding areas of other side.

7. 2 nd visual circuit Examining the ht. and cortication of alveolar bone relative to teeth. Examine alveolar bone for extent and severity of bone loss Areas of erosion; difference in trabeculae pattern

8. 3 rd visual circuit dentition and associated structures Each tooth in sequence, using all available images Examine PDL space & lamina dura of each tooth.

9. EXTRAORAL RADIOGRAPHY Analysis of Intraosseous Lesions picture matching, or "Aunt Minnie,"method step-by-step analysis

10. step-by-step analysis STEP 1: LOCALIZE THE ABNORMALITY

11. cherubism

12. Position in the jaws Soft tissue Within jaws

13. Specific epicenters

14. Single or multifocal periapical cementa ! dysplasia, odontogenic keratocysts , metastatic lesions, multiple myeloma, leukemic infiltrates Size- may aid in the differential diagnosis

15. STEP 2: ASSESS THE PERIPHERY AND SHAPE

16. Shape Circular/ hydraulic cyst Scalloped/ multilocular Cyst, cystlike lesions, tumors

17. STEP 3: ANALYZE THE INTERNAL STRUCTURE 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

18. STEP 4: ANALYZE THE EFFECTS OF THE LESION ON SURROUNDING STRUCTURES

19. 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

20. 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

21. STEP 5: FORMULATE A RADIOGRAPHIC INTERPRETATION

22. Decision 1 Decision 2 Decision 3

23. Systematic approach • The entire radiograph • Specific lesions

24. The entire radiograph

25. 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.

26. references White & Pharoh Oral Radiology,4 th Edition White & Pharoh Oral Radiology, 5 th Edition Eric Whaites ; Essentials Of Dental Radiography & Radiology, 3 rd Edition Karjodhkar ; Textbook Of Dental & Maxillofacial Radiology 2 nd Edition Dental Radiography Principles And Techniques; Haring & Howerton , 3 rd Edition