Suggested Study Notes & Topics in Radiology What adjustments would change the x-ray density = Kvp, time, Mamp, object to film distance, spot-size, collimation What « radiation protection = rectangular c limation, e-speed film, thyroid collar ° > Sues 2.‘The following pages represent a compilation of Oral and Maxillofacial Radiology-related questions from. previously released National Board Examinations. ‘Additional questions have been added to supplement the material. Al questions are arranged by topic and topics are arranged to parallel the Oral and Maxillofacial Radiology Course presented during your second year at Tuffs. At the end of each group of the questions, ‘you may find a brief explanation of the appropriate answers. Other questions are fact-based and will not require explanation. You will find that certain questions appear over and over again, but are simply reworded. Many other Oral and Maxillofacial Radiology- related questions from released dental boards may be found under other categories such as Oral Pathology, Endodontics, Oral Surgi Onhodontics, Periodontics, Pedodontics or they may fall into the Case-Based Questions section of the examination. It is impossible to separate these topics, so it would be in your best interest to use your other review packets to assist in your preparation for these upcoming exams In no way can this review provide you with all of the information possible regarding this topic. An ‘excellent review book that will assist you in studying for the board exam is “Exercises in Oral Radiographic Interpretation" by Langlais and Kasle, 3rd edition, Saunders, 1992. This text ‘contains a wealth of information and images, and itis ‘organized in test question format. The text is an ‘excellent resource for learning about normal anatomy and landmarks, variations from normal, and pathology as seen on intraoral, panoramic and other extraoral radiographs. Also, there are valuable sections on common panoramic and periapical technicaliprocessing errors. All of this will show up somewhere on the board examination. Another excellent review book is Review of Diagnosis, Oral Medicine, Radiology and Treatment Planning by Wood, 4° edition, Mosby, 1999. The radiology sections are very helpful and there are hundreds of miscellaneous questions with radiographic Components scattered throughout the text. You will bbe well prepared for the radiology-related questions if you can master this review packet and the suggested texts Good luck! Dr, Furkart = luwvell RADIATION TYPES 3. gamma rays Ae a ath Sabot 2 eye rors o yerne oF a @ @ e f ce ta ni answer: b pont ar Which of the following are examples of electromagnetic radiation? 1. radiowaves ~~ / ~ cathode rays alpha rays light waves‘ gamma rays beta rays co oar@ eae) answer: 8 ‘ (eorays, gam oth x and gamma rays) até produced By dental generators. answer: (“x-rays There are two types of radiation: electromagnetic and corpuscular or particulate. Electromagnetic radiatc refers to the propagation of wa space or mater. Examples o “FARMS, X-ays, adiowaves, Tight waves and cosmic rays. EM radiation types are grouped according to their wavelength in what i called the electromagnetic spectrum. All ty ‘no mass and travel i motion atthe speed of light. Their properties change with changing Wavelengths. The relationship ¢ speed of light) = wavelength x frequency halds true for EM radiation. a '‘X-rays and gamma rays are both members of the electromagnetic spectrum, identical as to their properties, but differing as to origins. X- produced by dental x-ray generators, while gamma raysate products of radioisotope breakdown] Fes esr fon ht ss and charge that travel in sraight ines at ‘speed. They are found in nuclear fallout from atomic bomb sites, in naturally occurring decay of radioactive isotopes and are generated by man for use inthe treatment of canes. Examples include alpha pate, beta prieles, eathode rays, protons and eawons ae = Ath aaa yas Soke XRAYGENERATION 2,44 1+ 1. X-rays ate generated when a steam of lect taveling from one side ofthe x-ray tube is suddenly stopped by its impact onthe filament cup tungsten target of the anode tungsten target of the cathode copper of the negative side of the anode none of the above a aeQ a answer: b 104 x19 plots oer Sas 2. Inradiology, mA priarly conmols. = 2°77" EE. othe) + rtd a. exposure time b. electron speed CH _ tumber of electrons produced “A. penetrating power of radiation answer: ¢ 3. Theheat of the filament determines the ‘quantity of electrons produced. The number of electrons, in tur, determines: @® the quantity of x-rays produced bo the quality of x-rays produced both quality and quantity of xrays produced answer: a ode A € soley CA 4, The speed with which electrons travel from the filament of the cathode to the target of the anode depends upon the: size ofthe electron cloud voltage in the filament circuit angle between the filament and the target number of milliamperes in the tube circuit potential difference between the two electrodes © answer: € 5. Amincrease in(&vp) mA) wi increase the speed with whittrthe bombarding electrons hit the target. JIL SE answer: kVp = SP °2 6. The penetrability ofthe primarily by the (mA, answer KVP = panes \ty of berm 1. (kVp(3) primarily affects the quantity of the phon in an x-ray bear answer, mA = Quanity of € 8, (V9) mA) primarily affects the quality of the fons in an x-ray beam. answer: kVp * y= 9. An increase in (kVp, mA) results in a hotter cathode filament and the production of more electrons. , hotter Ctl de, answers MAL = 10. Which of the following is an indicator ofthe quality of an x-ray beam? _-%~ milliamperage —b, exposure time Hand Deurve 4. machine output fe. half-value layer (HVL) answer: € A / folly ob Foti Sine, ball L fool i Since, tol 7Ph the bpt Hye 11. Ap.xcay beam with a higher HVL is of ei Tower) quality. 1. Inradiotogy, a collimating device is used to conto: answer: higher | ae a. film detail | = “The xray tube within a dental x-ray generator isan b. iim density evacuated glass tube, Within the glass tube there is 2 film contrast ; te | _— Basal sated saad onde ot ngsen @ size ofthe ay beam ~ <= - —~ilament) and a postvely charged anode (made af wavelength ofthe x-ray beam tungsten and embedded ina copper red). answer: d When the current (m4) passing through the tungsten filament is increased, the flament becomes hotter ‘X-ray beams should be collimated to: and an electron cloud is generated. The hortershe ‘filament. the more electrons are generated and a AC reduce exposure time - 7 _steater quantity of x-rays photons are produced at the. 2. prevent overexposure to patients anode. 7 ey) 3. redugethe area of patient exposure “ Ome Aly 004 ws fot 44 reduce secondary radiation ib she film “7 poe ‘When a potential difference (kVp) is created between 5. reduce secondary radiation tothe patient . the cathode and the anode, the electrons are attracted — by the anode and they are accelerated toward the a 234 a anode ata speed close to thespeed of light. X-rays boas ag then generated atthe anode. The greater the — & 1235 potential difference between the cathode and the @® 23,45 “anode [ihe Hier The RV) We greater the speed of €. allofthe above “Wie EIecHrOAS aS They Havel from cathode to anode | ‘cross the xray tube and the greater the penetrability answer: d ofthe resulting x-rays, 3. The primary purpose of the lead diaphragm Ie follows that mA primarily controls the quanti of Within the PID ofan cray ubehead ito: x-ray emission and kVp primarily the quality of x-ray a ens 2. reduce or eliminate tubchead leak — b. eliminate tong wavelength x-ray photons _The QUALITY of the x-ray beam isa measure ofthe ¢. increase penetrating qualities ofthe beam penetrating ability ofthe beam. A hard beam is of © ttc sie and shape ofthe beam of - high quality and shorter wavelength photons radiation Predominate nthe b beam. A weak beam is of lower ialicandTonger wavelengths predominate in the answer: team. 4A (rinse filter) is used to restrict the size As kVp increases, quality increases of Beam that hits the patient's fce——~ as filtration increases, quality increases answer: collimator “The half-value layer of the beam is a reotthe. quality ofthe Beam. The HVL of the beam is defined . ‘As Goins), te) can ashat 1D which tissbebeing inadated, reduce the eater the answer: collimator Edie volume of “The x-ray beam leaves the tbe housing through a |. rere Position fidietog Device (PID). FILTRATION AND COLLIMATION OF THE A collimator restricts the size of a beam. Usually, the DENTAL X-RAY BEAM collimator i a leadwasher witha hole Inthe mile CE 3215 a Dien O and is placed at the tube housing end of the PID. The collimator resiricts the siz CCollimation restricts the size and shape ofthe beam, thus preventing overexposure to patients by reducing the area of patient exposure and also redi scatter Im, to the patient and @ coceupaisnaly ivolved personnel 6. The principal reason for placing an aluminum filter in the primary beam of radiation i 0: a. reduce exposure time b. decrease development time of the films g reduce radiation to the skin of the patient obtain greater teeth answer: ¢ 7. The aluminum filter in the x-ray tubehead functions to: @ reduce exposure to patients’ skin @) absorb longewavelenth photons / preferentially absorb short-wavelength photons preferentially increase penetrability of the beam @ LAC decease peneablty of te beam g b. e 4 £ s used to preferentially fength photons from the 8. A (collimator remove long: xray beam. answer: filter fesse answer. lower, higher The x-ray beam is filtered with discs of aluminum, This hardens the beam, increasing the quality of the beam, by preferentially eemoving Tong-wavelength photons from the beam. A filter removes photons of every wavelength, but preferentially the longer wavelengths. intensity ofthe Beam, but wil increase the mean every ofthe bean, ae Because long-wavelength photons are preferentially removed from the beam, these long-wavelength photons will never reach the patient. This reduces DENSITY, CONTRAST AND SHARPNESS 1. A decrease in which of the following causes an as tip thier distance CD sourceotjctcitane — Bene answer: d = 2. To increase radiographic film density, one should increase mA increase kVp increase time decrease source to object distance increase source to object distance 0 2.6. In radiography, a longer g 3. Arradiograph of a 1/2" thick dise of pure aluminum will be (less, hore)radiodense than aradiograph of I” thick QtsCof pure, aluminum. —_— answer; more poor fifo vf Learery 4. Anincresse in (fiyabon(@a) wil resakina Aaa info answer mA frmb£ Ocal th) a Radiodensity, or blackness of a radiograph car-be~ creased by: jocreasing (re xrays per unit time) fisreasng kVp (tore penetrating x5) increasing exposure time (more x-ray hit film) V, decreasing source to film distance decreasing amount of added filtration jncreasing film speed ‘extending processing (within certain limits) 5. How should proper subject contrast be ‘maintained when taking a radiograph of 2 patient with thick, heavy bones? increase mA — increase kVp — Contvest use a high contrast film increase exposure time increase development time oao@s answer: b scale of contrast can be achieved by: a, decreasing the filtration (BD increasing the kilovoltage © iereasing the miliamperage 4. decreasing the miliampere seconds increasing the focal spocskin distance answer: b 7. Aradiograph of a billiard ball will exhibit image contrast, with the most opaque art of the image being the (center) periphery) ofthe ball. This is due to the (deereased increased) thickness of the center relative to th ery, answer: center, increased quality and penetrability ofthe beam and will resultin (fesse) increased) image contrast. answer: kVp, decreased = fo7-“ 777 Image contrast is affected by (1) the anatomical structures being pictured (their thickness, density, and atomic number, (Z); (2) the beam energy. The higher the beam energy (higher kVp) andi [higher the filtration, the greater the penerability of “Whe beam The anatomic structures being penetrated ‘Willdifferentially absorb energy from the beam, leading to many shades of gay (low eontas ot long scale conta) A low energy beam (low kVp) will penetrate soft tissue (producing a black image) but be totally absorbed by hard tissue (producing a white image). ‘This is high contrast or short scale contrast demonstrating few shades of gray. High contrast is Sood forcaries dewction = SS 9. The size of the x-ray tube focal spot influences radiographic: _B)_efinition 3. eontrast density distortion answer: a 10. Image sharpness ona radiograph is increased by: a. increasing film speed > sing a smal for pt sie using a large focal spot size 4. "increasing object-film distance €. decreasing target-skin distance answer: -b jet » 11. A Clnges) shorter) PID will result ina Slap radiograph of incre answer: longer 12. A faster film, having a lg size lead to a radiograph of (decrease sharpness, answer: decreased GIT ss? ES “The size ofthe focal spot influences radiographi sharpness. The larger the focal spo, the worse isthe penumbral unsharpness. ‘This is because xerayScan_ bbe generated at any point in a large focal spot (many sources of x-ray photons), while from a very small focal 's emanate from what is “essentially a poi ~ Other factors influenci image sharpness are: Grain size of film increases/sharpness decreases Thickness of acetate base increases/sharpness decreases i Source to object di incceases Object to film distance inereasestsharpness decreases increases/sharpness Aaa BEAM INTENSITY/NVERSE SQUARE LAW 1. Ifthe intensity of bese of radiation is.42 ata point 12 inches from the target, the intensity + oF the beam at 24 inches is 6 é : answer: © ‘At90KVp and 15 mA and ata source-film distance of 8 inches, the exposure time for a film is 25 second. Using the same kVp and mA, the exposure time at 16 inches is 2 second 4 seconds a. Usecond youre 7 @) I second \Sm Be 7 © 1 W2seconds Bib 1 4 ; answer: b 3. Anexposure of 2 Roentgens is recorded ata point & inches from the target of an x-ray ‘machine. With the same beam, the exposure at ee te 88) c« 8R ° a 16R Because the x-ray beam diverges from the source ‘outward, the inverse square law applies ie, the intensity ofthe beam willbe inversely proportional ‘othe square ofthe Aistance Wrom the source. Tithe PID length is doubled, the intensity ofthe beam at the end ofthe PID will be quartered. = Mf he RADIATION BIOLOGY PRINCIPLES (Dohee 1. Which of the following statements accurately describe variances among cells and tissues in sensitivity to x-radiation? V/A. the greater the rate of, or potential for, mitosis, the greater the sensitiv J 2. hemor marie the els and ss, the greater the sensitivity the more differentiated the cells and tiscues, the greater the sensitivity J 4, lymphoid and immature blood celts are aniong the most sensitive tissues and cells muscle is more sensitive than epithelium ofthe gastrointestinal tact 4 @ € 4 1, 1, 1, answer: b 2. Which of the following cells are the MOST radioresistant? a. lymphocytes b. granulocytes erythroblasts epithelial cells usc eel answer: e, muscle cells are highly differentiated and non-dividing3. Which two of the following tissues are the most, radiosensitive? squamous epithelium endothelium hematopoietic tissue ‘central nervous systems gastrointestinal lining where a b. d answer: these cell types undergo a high rate of tumover and hematopoietic tissue contains stem cells that are nt well = c. reduced total filtration © increased development time a increased source-film distance. answer: 4, increased developmeatsime will ake the film darker ~ 4, Use of which ofthe following does NOT reduce somatic exposure ofa patent during dental radiography? a. Ektaspeed Plus film b. lead apron a rectangular eoiman? 6 a shor, epen ended, endstined cone Gio) ansies 5. _Incensifying sreens are used with exroral radiographic increase kVp increase exposure time improve image quality (decrease radiation tothe patient (answer: 4, intensifying screens contain phosphors which emit ight in response to x- ays. Intensifying sercens amplify the action of X-ray photons, Thiele use ects TT OERPESSET— TEEPE patient because the exponae O can Be reduced, However, their use also imaging such as panoramic radiography or cephalometric radiography, this loss of definition is tolerated, 6. Which of the following reduce the amount of radiation toa patient? using low kVp & C using an aluminum fer 3.) using a high speed film ~~ J 4) increasing source-film distance ‘5: decreasing source-film distance ‘Which of the following patients is likely to suffer the greatest overall biologic damage from exposure to radiation? QQ astgear ot sett vo recived 400 rad (4.Gy) whole body dose over a span of {minutes during a nuclear accident therapy toa small portion of his thorax, which therapy totaled 6,000 rads (60 Gy.) (6 Se year oldman who bad dation \ vera 6wetk period © an adult who has lived ina certin region of India for 34 years, which region receives about 1,300 millirads (13 mGy.) of background radiation per year. 4, a 13-year old girl who had a panoramic radiograph and 2 dental full mouth series of radiographs that gave about 5 rads (05 j Gy,) to the skin ofthe face over a 45- minute period answer: a, low doses of ionizing radiation to radiography. High doses to the “Hiroshima, Nagasaki, Chernobyl High doses to wel-ocalized areas over an extended pefiod of time are tolerated for thelr beneficial effects. For example: patents receiving therapeutic radiation for head and neck tumors. Mh Jor A ahh J 10“=—The Gal hivation (sui of herent Hliration 8. Which of the following statements is correct? _--& a fall mouth series of x-rays should be taken for all patents at their frst decal appointment. b, Dental x-rays should not be taken ona pregnant patient under any circumstances. Dental x-rays films should only be exposed following a comprehensive ‘medical and dental history and a complete intraoral and extraoal exam. 4. all patents should have a full mouth survey taken every two years answer: ¢ 9. The fastest available flm should be used on a patient, Currently, the fastest available Kodak films: Ektaspeed Cb) Bitaspeed Plus Ultraspeed bit yes files answer: b ‘A dentist should understand the hazards of using ionizing radiation to expose radiographic films. ‘There is no threshold below which there i damage to the cells and tissues. overnmment does not legislate the amount of radiation a patients exposed 1. Therefore, isthe responsibility ofthe dentist to insure thatthe risks of radiation exposure be balanced by the nee for the radiation exposure, The patent is exposed 10 radiation for only one reason: to acquire information to assist in making a diagnosis. 1. Films shoutd be exposed when the information is needed, and not because some arbitrary time has elapsed since the last exposure The x-ray beam should be of proper quality 35 determined by kVp or aluminum filtration and added aluminum filtration should be “2.SamEAtuntinuny equivalent for this amount of filtration insures thatthe longer wave lengths are removed fromthe beam, These longer waveTengihs would be absorbed by the tissue in front of the film and would not be of any diagnostic value. 3, Tee xia beam soul be almated io sno more than 2.75" in diameter at e iD, where the PID touches the patents fc, _This reduces the volume of tissue being exposed to radiation, and reduces scatter radiation fo the patest, the operator and the film. ~ 4. The fastest available film should be used. Currently the fastest film available is Ek speed Plus. — 5. A lead apron and 2 lead collar should be used to protect the trunk and the thyroid from scatter radiation, — 6. Proper radiograph techniques should be used to protect the trunk and the thyroid from scatter sadiation, 7. Dark room procedures should follow ‘manufacturer's recommendations as tothe time and temperature of processing. awe RADIATION PROTECTION FOR OCCUPATIONALLY INVOLVED PERSONNEL 1. When planning a dental office, considerations related to structural shielding including which of the following: workload (mAs/week) istance from the source of radiation type of material of which walls are constructed 4. whether shielding is for full or partial ‘occupancy 5. whether occupationally or non- ‘occupationally exposed personnel are involved a 1,23 b 1235 «24,5 & 1,345 423,45 /B ) allot the above Lb. eae tet Flor, he Ge(Dp ertan{ oe f Conf god” ~ 7 2. The effective dose equivalent limit for occupationally exposed individuals is: CE 100 mremiveek b. I mrem/week . Lmrem/year OQ Stems year Evens /yod R= 5 rems!year ‘The maximum permissible dose equivalent of radiation per week to an occupationally exposed person is: ZZ 0.1 rem (0.001 Sv.) Trem (0.002 Sv.) (04 rem (0.004 Sv.) (04 rem (0.004 Sv.) e. OS rem (0.005 Sv) answer a 4, In performing normal dental diagnostic procedures, the operator receives the greatest hazard from whick type of radiation? direct primary-beam secondary and scatter gamma answer: b 3. Innormal dental diagnostic procedures, the principal hazard to the operator is produced by what type of radiation? a. gamma b. primary @ seonday none of te above 6. When a dental film needs to be held in the mouth ofa child, the operator should 1. hold the film "2. usea film holder —3. ask a dental auxiliary to hold the film 4. aska parent or guardian to hold the film a Lor? b. Lor3 ©. 20r3 @ 204 Bord answer: d 7. A dentist uses a film badge service to measure the radiation exposure. The service reports that the badge was exposed to 500 millirems in the previous month. The dentist should: a, _ stop exposing x-ray films immediately b. report to a physician for a blood count snore the report because the reading is ifcant “evaluate his x-ray procedures and take steps to reduce unnecessary radiation cil used. / Glows aban answer: thermoluminescent dosimeters (TLDs) 9. With the use of higher vp, (mons Jess) searer radiation is generated. answer: more 10. Wn taeda open-end PID, more seater Is ganar. answer: closed-end 11. To avoid exposure to radiation when taking radiograplis, the dentistshoutd stand: a. inback of the patient b. next to the patient cc, atleast three feet from the patient at least six feet from the source of scatter answer: d ‘The design of a new radiographic facility requires careful planning. By standing behind an ordinary wall made of two panels of sheet rack, separated by a stud, the average operator, with an average work load, can 12 Selfeel he or she is not receiving any scatter radiation, In such an average practice, the walls of an operatory need not be leaded. Film badges and TLDs are an inexpensive means of estiiating the ariount of exposure to ionizing radiation that a worker has received. They help to ingure thatthe occupational dose for an individual has not been exceeded. Film badges are used only once, while TLDs can be re-used. Wien heated, ht proportional to the amount of vidual. To protect occupationally exposed individuals from ionizing radiation, the rules of position and distance should be followed. If possible, the dentist or staff ‘member exposing radiographs should stand behind ‘an appropriate barrier or at least 6 feet from the source of scatter radiation. The safest position to stand, if you cannot stand behind a barrier is at an angle of between 90 and 135 denrees to the primary beam aaa PROCESSING OF RADIOGRAPHIC FILMS 1. Fixing solution functions to: a. accelerate the film processing remove the atomie silver move undeveloped silver salts silver ions to metallic silver 2. Developer solutions function to a. accelerate the film processing b. remove the atomic silver remove undeveloped silver salts reduce silver ions to metallic silver lot my petlie sile answer d 3. Ifa drop of fixer were to inadvertently fll upon afl before processing, dagulting ‘diowaph would sows Gu ia answer, tight 4. Ifyou claim to be manually processing films using the time-temperature method, you must have the following two items in your darkroom. @® secure themomeerand ine © fim ayer and cpt © theometer and avtomatcpocesir nove of he above 5. Developing and fix changed, in the averas practice (daily, aver monty 6. Desens stn sols spe Gal) moni) sever daly \renan iy team spas ous ed Covccnpi ster oson reed 2 be The beam leaving the head has been changed. Itis less intense. itis of higher quality, But most porsntly for diagnostic purposes, the beam contains diagnostic information duc to the differential absorptions of energy occurring by the ‘beam’s passage through the head hits a radiographic film, the formation to the silver The latent imas processing._Proper darkroom procedures must be followed to insure consistently high quality radiographs. The best x-ray, generator, the best radiographic technique will be of no worth if processing isnot good, It has been stated that 95% becomes visible only upon. _of radiographic pitfalls are traceable to feulty darkroom procedures. Some causes of film fogging include over- nent, faulty safelights, darkroom lightleaks, ated processing solutions, use of old or dradiographic film, or careless film storage. ‘The fixing solution, or clearing agent, selectively _Temoves from the exposed film thase silver salis which were not exposed tothe beam and consequently were not reduced to fie silver bythe developing solution. QL. “pall Ly 5 lea 117a aa RADIOGRAPHIC TECHNIQUES AND RADIOGRAPHIC INTERPRETATION 4. s. Each of the following represents an appropriate rationale for obtaining a dental radiographic examination EXCEPT one. Which one if the EXCEPTION? & —apatient experiences intermittent pain in tooth a patient's tooth is mobile € apatient’s maxillary canine has not erupted B) a patient has presented fora siemonth , periodic examination answer: d The Food and Drug Administration Guidelines for dental radiographic examinations suggest that radiographs should NOT be taken simply to screen for occult lesions, but that every radiograph taken should be evaluated for these lesions. Occult lesions are lesions that; are painful cause the jaw to swell present with confusi 3 or symptoms as b. @ have no signs or symptoms answer: d A S-year old boy presents for his first dental appointment. His primary dentition is complete; al teeth are in proximal contact. There is no clinical evidence of caries or other pathology. For this child, the dentist should recommend which of the following radiographs? ovo biteswings 5 two bite-wings and one panoramic film c. two bite-wings, four periapicals, and two occlusal films| answer a ‘The decision on whether to order dental radiographs for an adult patient should be based on which of the following? 1 age tim since lst dental radiographs ies activity clinical findings previous dental treatment a 13,4 bys) © 445 d 23,4 e. 2,3,4,5 fa arr! 34,5 answer: g. When is the appropriate time to take the first bite-wing radiographs of a clinically caries-free child? when spaces between the posterior teth have closed b. when the entire primary dentition is completely erupted when the permanent first molars have erupted d. atthe first dental examination The extension-cone paralleling technique fulfills which of the following basic principles of shadow casting? AC the source of radiation should be as large as possible the distance from the radiation source to the object shouldbe as long as possible 3. the object andthe recording surface should’be parallel ation should strike both the object and the recording surface at right angles a 1,23 b. 124 © 2%3anda “E.allofthe above answer: € High quality radiographs involve positioning films nearly parallel withthe long axes of teeth. This generally places the films some distance from the teeth and causes distortion. to compensate, one should: 14decrease kVp to below 60 increase kVp to above 60 process films at 85 degrees F. decrease target-film distance i Im distance 9. Although a dentist wishes to use the long-PID paralleling technique (40 em source-object distance), the x-ray machine is equipped with ‘only a short PID (20 em source-object distance). As a result, the dentist moves the machine away from the patient's face so that the source-object distance is 40 em and adjusts the exposure time appropriately. Compared to the amount of tissue exposed by an actual long : cone, this “extended” short cone exposes what amount of tissue? @) , more i. the same c. less 10. The periapical film is the film of choice in 5 evaluating: root surfaces,/ L . LAD occlusal caries "3 proximal caries A. Stpponing bone Yo 5. the periodontal ligament space a 125 34 © Las a 24s @.allofthe above answer: ¢ II. The best method for detecting incipient carious lesions on the proximal surfaces of posterior teeth is by: 2. transllumination (8) bite-wing radiograph © periapical radiograph 4. mircorand explore examination positions of condyles inthe glenoid fossae C3}. the ange of anteroposcir movement of ~, condyle On S heads _Z% ‘lationships between hard and soft tissue structures in the joint 16To determi buccally ols film is necessa ifan impacted upper euspid is ually impacted, an occlusal T oF answer: False, two films taken at ferent ‘angles can be Compaced and the buccaleabject of the source, (Same Lingual Opposite Buccal - SLOB) In a panoramic survey, ifthe incisors look small too far backward). answer: too farfonvard 2, +0 In the following illustration of a radiograph, facial and lingual objects (« and *) are superimnnced ‘When the cet posterior, th ral ray is directed from farther idiograph appears as follows. Which of the following statements about the location of the two objects are true? the * objects located lingually the + objects located facially the * object is located lingually the * object is located facially a tand3 (&D Lands 2and3 a ands answers b 28. A practitioner takes a radiograph ofa patient's mandibular molar at O° vertical angulation. It shows the superior border ofthe mandibular canal in apparent contact with the apices. Tae practitioner takes a second radiograph Vertical angulation; it shows the man anal separated from the apices by several rillimeters. These radiographs confirm that the anatomic location ofthe mandibular canal, in relation tothe root apices ofthe molar is: CD) interior and inal b. inferior and facial superior and lingual @. superior and fail injustaposiion answer: a, lingual structures move withthe source of radiation/buccal objects move away from the source?by the principle ofthe Buccal Object Rule. (Same Lingual Opposite Buccal - SLOB) 29. Inaperiapical of the lower second bicuspid, there are 2 bony crests crossing the tooth, The sharper level of bone is the (oyccal and it is sharper because itis closer fiom) tefl XQ | sve lag lt Lingual sractures are closer othe : tures closer tothe film appa sharper and : than structures fied the “/ ”30. Qree 33, 34, Radiographically, a benign neoplasm in bone may be differentiated from a malignant neoplasm because in the benign lesion: 1. margins are iregular and fade imperceptibly into surrounding bone. the cortex tends to remain intact but may be thined and the part involved expanded 3. margins are usually defined and demarcated from surrounding bone. 4, there often is a perforation of the periosteum. 1 and 2 only 12and 4 2and 3 only 2,3.and4 Sand 4 only na@er ¥ In radiographs, which of the following regions of the tooth crown is MOST often mistaken fora caricus lesion? pul om cis alum cementoenamel junction answer: d Cervical burmpyt occurs more often in teth that arg (round bquare) in cros-scton ae A soswer: (rand) In radiographs of a incipient cariout lesion limited to the enamel on proximal surfaces of 8 posterior tooth, the lesion appears: a asaradiopaque area . asa triangle with the apex at the tooth surface larger in the radiograph than actually exists clinically all ofthe above Ce). none of the above answer: tthe Characteristic features of proximal caries fon premolars and molars are that they: 1. spread cone-shaped into the enamel, the base of the cone being the deepest par. 2. spread cone-shaped into the enamel, g the deepest ‘pat. 3. spread in the dentin in a conical form, the apex pointing toward the pulp. 4. spread in the dentin in a conical form, the base pointing toward the pulp. a Yand3 b Landa @ ands SG ana answer: ¢ When observing properly exposed and mounted radiographs, if th -d dot faces the observer the patents thas sas) seen on the left portion of the x-ray mount answer: right side, during film placement the raised dot on the film packet faces the source st radiation {tis almost inevitable that a dentist will order radiographs to be taken on a patient's first visit. Before scheduling radiographs to be taken, there are many considerations: + Anatomic variations (ype and thickness of patients tissues). ‘+ Anatomic Limitations (degree of jaw opening possible) + kVpseting + mA setting Exposure times available Most commen films tobe used are ‘© Periapical radiographs + Bitewing radiographs + Occlusal radiographs + Extraoral radiographs sone around the apices of the ome of aking eipieal 18“Tor ths mandible Gacin i the teeth, as parallel as ‘Then, using a long PID, the central ray is made tobe perpendicular to the film, 2. Bisecting the Angle Technique “The film contacts the crowns ofthe testh being Tadiographied, The cental ay of We xray bbeam is made to be perpendicular to the plane bisecting the angle berveen the tooth andthe film. Bitewing Radiographs. The bitewing film is placed behind both the mandibular and maxillary crowns and the central ray is aimed so as to open the interproximal contact. Because of the favorable vertical angulation, bitewings are of value in viewing incerpe coimal decay, real tal bone, calculus, mari Occlusal Radiographs. The occlusal film is placed inthe mouth withthe emulsion Ss Tins Te Roar ng.up for maxilla): Occlusal ht angles to periapicals and sluable in buccolingual extension of pathologic Conditions or the location of inerupted Te ira Buco manner. Also, Mey are wetil for finding Subriandibular calculi films, being at Lateral Jaw Radiographs, The film is held against the side of the jaw to be radiographed and centered fon the area of interest. The head is tipped toward the Im (to move the mandible on the tube side above ‘the mandible of the film side). The chin is extended (to separate the jaws from the spinal column), Lateral jaw radiographs can be used to view broken needles, foreign bodies or salivary duct calculi which ‘would be impossibie t9 radiograph intraorally—~ Pathology which extends beyond the areas covered by intraoral radiographs can be seen in their entirety using lateral jaw radiographs, Other Radiographic Examinations Include: Panoramic Radiographs which for coverage and continuity surpass an intraoral survey. The entire mandible and maxilla are covered on one film. In the usual case, the patient's head is stationary and the film and the tubehead revolve around the head. While superior toa full mouth intraoral survey in lity and coverage, a panoramic survev is in detail and definition to an intraoral survev. A are SLE Coane c Ceplclomettic Radiographs ae erat nd estan films ken whe len’ head is stabilized. aA wa ANATOMIC LANDMARKS 1. Which of the following landmarks can be seen in periapical radiographs of the mandible? extemaLobliue ridge myahyoid ride 4. mental foramen pb a 123 ED hye, Ai @ u3a Wythe team 3, + O48 cata GUaGe tem a 2s e245 £ allofthe above answer: b Which of the following structures appear radiolucent in a periapical radiograph? maxillary tuberosity >” genial tubercles 2» mandibular canal anterior nasal spine > median patatal suture |-7 Oy = 9 © a Land? bd Land3 ©. 2and3 a. Qand4 e. Sand4 Band S ‘answer: f 3. dX represents the inverted “Y" as seen in the mil rine ar. itl he fa answer: left 4, Inthe inverted "Y" above, the curved line is the (tor ofthe nose, anterior Wal Of the maxillary sinus). Ss ‘answer: anterior wall of the maxillary sinus G33 195. Allof the following anatomic structures are usually recognized in periapical radiographs EXCEPT the: mental foramen ¢— mylohyoid ridges — coronoid process $-— pterygoid hamulus ¢— mandibular foramen median palatal suture¢— answer: —¢, this structure is located out of the range ofthe periapical film 6. Which of the following normal anatomic landmarks is/are radiolucent? coronoid process inferior border of mandible maxillary tuberosity b @. mena forrmen aotthe above answer: 7. Which of the following normal anatomic landmarks is/are radiopaque? a. incisive foramen &. maxillary sinus © genial tubercles nasal fossa e. allofthe above answer: ¢ Normal anatomic landmarks are like a road map. ‘They tell you where you are and provide a background upon which abnormal radiogrephic appearances stand out. Without a grasp of normal anatomic landmarks, deviations from normal appearances cannot be distinguished. TECHNICAL ERRORS 1, Identify the technical error that causes a radiograph to demonstrate a lighter than. ity and a regular patter of lines 8. use of low kVp b. use oflow mAs ®_ reversal of film d. use of outdated film €. films touching during development answer: _¢,a reversed film has the lead foi backing facing the tube, infront ofthe film. Consequently, the processed film will be slightly more fadiopagu because the lead foil has absorbed some energy from the beam. The pattern ofthe lead foil will also appear on the Processed film. A small, very round, very. qpaque dot, close by the mark of tie film clip is called an “air bell” and is due to a bubble of air adhering tothe film when itis being (developbd, fixed). answer: developed, the air bubble displaces the developer, the developer eannot perform its radiopaque dot. When the operator is ouilty of excessive distal ‘oblique angulation while radiographing upper molars, the resulting radiograph will exhibit lapped contact points and (decreased, fhcreased) radiopacity. This is due to the (decreased, increased) thickness of bone the ‘beam is traversing. answer: increased, inereased Excessive distal angulation will cause the beam fo traverse more bone, the beam will be atenuated more, and the image will appear more radiopaque Overlapped interproximal contacts in 2 premolar bitewing are due to: ,__ improper vertical angulation ofthe PID (©) improper horizontal angulation ofthe PID "film placement too far posterior 4. KVptoo high answer. , ifthe horizontal angulation ofthe x-ray beam does not coincide withthe buccal- torlingual angulation of the interproximal cofiat, the contacts will not appear “open” the film, 20 WWhite spots on 2 radiograph could be due to which ofthe following? 3, film contaminated with developer drops before processing b. static electricity Gags file bet noted with fixe before answer: d, developer drops before processing ‘would éause Black Spots/tatic electricity would eause black spots ranch type black markshilm bending would cause ablumred sph inte area of he bend Overan: cut off crowns; elongated teeth “eut off crowns, fSreshorened teeth cut off apices; elongated teeth 4. cutoff apices: foreshorened teeth answer: b, underangulation may cause cut off apices and\elongated teeth Radiographs with only partial im: es may be 1. ralsstignment of the PID (PID cut) 2. the thyroid collar being allowed to conie between the x-ray beam and film, 3. the film not completely immersed in the deviloper when being processed 2. Lonly b. Land? only all of the above & “hone of the above ‘answer: ¢, all of the above will cause areas ‘of the film to appear clear or white, either because x-rays did not strike the film (as in answers | er 2) or because the developer did not complete it's function (as in answer 3). ‘Chemical fogging of a radiograph can occur if room technician develops a film for (longer)shorter time thah the manuficrufr’s dations. PRG > Lope rr, answer: longer, chemical fog on a processed film results from development that has excesded the manufacturer's recommendations or when the radiographic film is old or has been carelessly stored close to other chemicals, 9. Iadeop of fixer were toi pu a film before processing radiograph Would show a (dar ivertently fall the resuliing Ee answer: light, the fixing solution, or clearing agent, seleively removes fom ie exposed film those silver salts which were not exposed TORE Ea nT SOIGUERT WOH vce to fee silver by the cevelping solution dry automatic processor rollers 2 cc. Static electricity ~ 4 Tight leak 7 IT oF the a bove answer: ease developer drops on fiz 11, A dark radiograph (excessive optical density) could be produced if A 3, RYpis too high answer: ealso if exposure time too high, left in developer too long. 12, Ona panoramic radiogreph, one side of the ‘mandibular body, ramus and associated teeth ‘appear much Jarger than the other side. The patient's chin i too far down down . patient did not place tongue to roof of mouth patient's is too far backward‘Smile line and the condylar heads could be projected off the top of the film. A “quarter moon” shaped radiolucency would be see: superimposed over the apices of the maxillary ‘teeth if the patient did not keep the tongue to the roof of the mouth, This space is known as the palatoglossal air space. The anterior teeth would appear magnified in width and blurry if tle patient was posisioned tao far backward in the unit. Also, the condylar heads and rami may be pushed off of the sides of the film in this case,