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Rad Summary
Rad Summary
DIAGNOSTIC IMAGING
CHAPTER 1
PHYSICS OF IONISING 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
Quantum theory
Electromagnetic radiation occurs in small, weightless bundles of energy called
photons. Each photon travel at c and has certain amount of energy
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
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
LOOK IN TEXTBOOK
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
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
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. label side
- 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
(plastic)
(front)
Fluorescent
light from
screens (back)
(metal)
(primary)
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
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
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
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
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
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. 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
8. Blurred image
Cause – pt moved during exposure
Action – pt instructed to remain still during procedure
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
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
Tech: - Image detector placement
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
equal angles
- Vertical angulation
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
- Horizontal angulation
central beam must be perpendicular to image detector/directed through contact
areas between teeth to avoid image overlapping
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
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
- 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
Mx tuberositas Incisive canal
Median mx fissure
Incisive foramen
Hamulus
Genial tubercles
Severe
Alveolar crest
Pdl
Lamina dura
Medullary bone
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
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
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)
Charged-coupled devices (CCD)
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
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
center of rotation
x-ray beam
x-ray sensor
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.
- 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
- 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
A B C
D E F
Sketch DEF
D grey zone: structures between sensor and moving centre of rotation – real single image
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
Pt positioning:
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
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
- 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
- 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
2. Supramentale (B) deepest point in the bony outline between the infradentale
and pogonion
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
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
5. Maxillary Plane (MP) The plane represented by a joining of the anterior and
posterior nasal spines
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
Z
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
Exposure factors: exposure must occur according to instructions of manufacturers of
x-ray film, intensifying screens and x-ray equipment
EXTRA NOTES
- BEAM IS AT THE BACK
- FACE CLOSER TO THE SENSOR/FILM TO REDUCE MAGNIFICATION
- CAN’T USE TO EVALUATE CONDYLES
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
Beam alignment: central x-ray beam is directed through the centre of the head and
perpendicular to the cassette
Exposure factors: exposure must occur according to instructions of manufacturers of
x-ray film, intensifying screens and x-ray equipment
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
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
- 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)
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
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