Unit 5

Imaging as an Examination
Tool

Clinical examination
Signs
Symptoms
Ordering the right type of imaging
examination
Ordering the right number of imaging
examination
Necessary vs unnecessary examinations
Benefit to the patient

Viewing condition

Viewbox
Monitor
Prints
Ambient light reduced
Quiet room
Intraoral films mounted on a opaque holder
Equal intensity of light on the view box
Monitors: calibration
Magnification
Software limitations

Systematic Approach

Intraoral images
Teeth, periodontium, bone, adjacent structures
Tooth #1 to #16, and then #17 to #32

Extraoral images;
Panoramic, other extraoral plain radiographs

Cross sectional images

CT, MRI

Localize the abnormality

How many lesions?

Where is the lesion?
Localized vs generalized
Single arch or both the arches
Inside the bone or outside
Relation to the crown
Relation to the root
Superior to the mandibular canal

Periphery

Well defined or ill defined?

Sharp margins
Corticated margins
Sclerotic margins
Radiolucent band
Blends into adjacent area
Irregular margins

Shape

Circular
Oval
Scalloped
Multilocular

Internal structures

Radiolucent
Mixed
Radiopaque
Trabeculation
Septa
Calcifications
Tooth or similar entities

Adjacent structures

Teeth
Lamina dura
Crestal bone
Periodontal spaces
Alveolar bone
Nerve canals
Maxillary sinuses
Cortical bones

Description, description,
description

Speak out loudly

List it down
Compare findings in different images
Clinical information

Vindicate your D/D

Vascular
Infection
Neoplasm
Drugs
Idiopathic/inflammatory
Congenital
Autoimmune
Trauma
Endocrine/metabolic

In the Land of 10,000 lakes,

we see the fish!

Liar, Liar!! Do Our Eyes

Lie?

Dirty words!

Sun-ray appearance
Ground glass
Cotton wool
Onion skin
Driven snow
Etc, etc

When not to order

imaging

You have not clinically / radiographically

evaluated the patient
No benefit to the patient
Additional images may not provide extra
information
No routine radiograph

What goes on the report

Patient, doctor, clinic identification

Date, type and number of examination
Reasons for the examination
Clinical information
Relevant observation
Radiographic Impressions
Any further tests, examinations