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A comparison of paralleling and bisecting

radiographic techniques as experienced


by dental students
Parouk Mowshed, B.D.S., M.S’c.,* and A. Lorenzo McKinney, D.D.X.,*”
Washington, D. C.
HOWARD CNIVERSITY COLLEGE 0~ DENTISTRY

Evaluation of 8,726 periapieal radiographs made by 158 dental students revealed


9 per cent less technical errors when the students applied the paralleling technique
and used the XCP and the Precision x-ray instruments than when they applied
the bisecting-angle technique and used the Snap-A-Ray film holder. In applying the
bisecting-angle technique, the most frequent errors noted were improper film
positioning, incorrect vertical angulation, cone-cutting, and incorrect horizontal
angulation. In applying the paralleling technique, the most frequent errors were
improper film positioning and faulty horizontal angulation.

T he major challenge of teaching periapical radiography


student to learn to make radiographs
is in helping the
wit,h a minimum of technical errors and
with the least possible x-ray exposure and discomfort to the patient. A previous
study1 surveyed the types and frequency of intraoral technical errors made by
junior and senior dental students using the bisecting-angle technique and the
Snap-A-Ray film holder. The study revealed that the average number of errors
was 7.8 per full-mouth examination. Obviously, the number of errors is far from
satisfactory ; therefore, we decided to explore other techniques designed to re-
duce the number of technical errors made by studenbs.
The two major methods of periapical radiography are the bisecting-angle
technique and the paralleling technique. Each technique has its advantages and
disadvantages, and an experienced person using either can produce radiographs
of reasonable quality. The problem in teaching periapical radiography is ob-

Presented at the 1971 meeting of the Oral Radiology Section of the American Associa-
tion of Dental Schools, Chicago, Ill.
*Associate Professor, Division of Oral Radiology; Active Member of the American
Academy of Dental Radrology.
**Assistant Professor, Division of Oral Radiology.

284
Volume 33 Comparison of radiographic techniques 285
Number 2

taining the same good results from the average student in a learning situation.
The objective of this study was to determine the merits and effects of two
different instruments (the Xtension Cone Paralleling instrument (XCP) * and
the Precision x-ray instrumentt ) in the teaching of the paralleling technique.

METHODS AND MATERIALS


The dental students in the College of Dentistry of Howard University are
exposed to both the bisecting-angle and the paralleling principles of periapical
radiography. Radiographic technique is presented as a lecture course in the
second semester of the sophomore year, followed by demonstrations and clinical
training for two half-days of block assignment (four or five students each) the
following summer. Junior and senior dental students are assigned to the radiol-
ogy clinic in blocks of four or five students for four half-day sessions each se-
mester. The junior students, in addition, are assigned to the radiology clinic for
two half-day sessions in the summer prior to the senior year.
This investigation was carried out in the fall semester of the school year.
The junior class (85 students) and the senior class (73 students) were divided
into three groups. The first, group, consisting of 54 students (29 juniors and 25
seniors), used the bisecting-angle technique and Snap-A-Ray film holder. The
second group, consisting of 5.3 students (27 juniors and 26 seniors), used the
paralleling technique and the XCP instrument. The third group, consisting of
51 students (29 juniors and 22 seniors), used the paralleling technique and the
Precision x-ray instrument.
The junior class was divided into eighteen blocks and the senior class was
divided into seventeen blocks. The assignment was on an alternating basis for
the first twelve blocks of each class which used either the Snap-A-Ray film holder
or the XCP instrument. The last six blocks of juniors and five blocks of seniors
were assigned to use the Precision x-ray instrument.
Although the students who used the bisecting-angle technique had the ad-
vantage of previous exposure to this technique, it was decided to consider their
performance in periapical radiography as a control for comparison with the
other techniques.
A booklet2 describing the XCP technique was given to each student required
to use the XCP instrument prior to the time of this assignment. Similarly,
when the Precision instrument was required, each student was given a reprint
of a paper3 which described the use of this instrument. The students were asked
to read the required material carefully prior to their clinic assignments.
The first session of clinic assignment for each block of students consisted of
a one-hour demonstration and practice on manikin DEXTER,+ using the re-
quired instrument. In addition, the instructor, while demonstrating the tech-
nique, presented additional material which was pertinent to the technique.4-7
The demonstration was followed by patient assignment for training.
At the beginning of subsequent clinic assignments an instructor discussed
“Rinn Manufacturing Co., Elgin, Ill.
tprecision Manufacturing Co., Nashville, Tenn.
$Alderson Research Laboratories, Inc., Stamford, Conn.
Oral Surg.
E’ebrulrv c*> 197‘2
.I

Table I. Number of pcriapical radiographic snrvcys maclc by XT,junior ant1


73 senior dental students
P,PCiSiOTl
Group instrument Totals
Juniors 92 299
Seniors 81 286
Totals iz x5

with the students the technical errors shown in the radiographs taken in the
previous session and explained how these errors could be corrected or avoided.
In addition, instructors were available in the clinic to supervise the training
of the students. Special assistance was given when requested by a student in
case of difficulty encountered in some technical procedure.
The number of periapical radiographic surveys made by the students is
shown in Table I. A total of 585 periapical surveys were made exclusively by
junior and senior students on regu1a.r clinic patients. Students using the Snap-
A-Ray film holder made 198 surveys, those using the XCP instrument made 214
surveys, and students using the Precision instrument made 173 surveys.
The average number of surveys made by a student was 3.7 when the Snap-
A-Ray film holder was used, 4 when the XCP instrument was used, and 3.4
when the Precision x-ray instrument was used. Variations in the number of sur-
veys performed by a student were due mostly to variations in patient avail-
ability.
Periapical surveys for adult, dentulous patients were used and consisted of
fourteen standard-sized films (No. 2) when the Snap-A-Ray film holder was
used. Sixteen films were used with either of the paralleling instruments; stan-
dard-sized films (No. 2) were used for examining premolar-molar areas, and
No. 1 films were used for examining anterior teeth. The two additional films
were used in examining the maxillary lateral incisors.
The total number of periapical films taken for this study was 3,726. Ttvo
hundred thirty-eight films (2.6 per cent) were missing at time of film evaluation.
A total of 2,721 films were ta.ken by the Snap-A-Ray film holder group (51 films
were missing) ; 3,330 were taken by the XCP group (94 films were missing), and
2,675 films were taken with the Precision instrument (93 films were missing).
Three different brands of x-ray unit were used. One machine had an ex-
ternally short built-in “long cone” (an open-ended opaque lead-lined cone) ,*
another was equipped with a long open-ended opaque lead-lined cone,t and the
third machine had a long open-ended transparent plastic cone-$ The beam di-
ameter at the cone tips of the x-ray units was 2.75 inches except for the built-in
“long cone,” which had a beam diameter of 2.5 inches.
Errors counted in this study were technical errors made by the students.
Errors due to incorrect x-ray exposure or improper film processing were not

“S.S. White Technical Dial Super 75 Model 75R.


iWeber Ultron 90.
$General Electric SO-II.
Volume 33 Comparison of radiographic techniques 287
Number 2

Table II. Type and frequency of periapical radiographic errors


Snap-A-Ray XCP Precision
Type jilm holder indrzmment instwment
of
Group errors No. 1 Per cent No. ) Per cent No. ) Per cent
Juniors P 273 19.0 439 27.3 458 32.7
V 178 12.4 18 1.1 41 2.9
H 131 9.1 188 11.7 108 7.7

Ii 125
29 Ki :i 1.2
0.9 16
25 1.8
1.1
T 736 51.2 679 42.2 648 46.2
Seniors
F 232
143 18.1
11.1 414 24.0 302
30 23.7
2.4
H 86 6.7 2:: 1i.i 97 7.6

iti 154 12.0


0.6 19
17 1:o 123 0.9
0.2
T 62: 48.5 686 444 34.8
Totals P 505 18.5 853 25.6 760 28.4

H” 217
321 11.8
8.0 404
38 12.2
1.1 205
71 7.7
2.6

iz 279 10.2
1.4 :8” 1.0 37
19 1.4
0.7
T 1,3% 49.9 1,365 4::: 1,092 40.8
P = Improper film positioning.
V = Incorrect vertical angulation.
H = Horizontal overlap.
C = Cone-cutting.
M = Miscellaneous errors.
T = Total.

included. In counting radiographic errors, two types of information were re-


corded. One type was obtained by evaluating each radiograph individually and
counting the most obvious technical error, whether or not the error was over-
come in adjacent radiographs. The other type of information collected was ob-
tained by evaluating each full-mouth survey as one unit and recording the
number of necessary retakes for that survey. Only those errors which were
demonstrated in the original radiographs were counted. Errors demonstrated
in the retakes were not included. In radiographs which showed more than one
error, only the most flagrant error was counted. All of the radiographs were
evaluated by the same investigator.

RESULTS AND DISCUSSION


The distribution of technical errors by students using the bisecting-angle
technique and the Snap-A-Ray film holder is seen in Table II. Almost one half
(49.9 per cent) of the periapical radiographs demonstrated one or more techni-
cal errors when the radiographs were evaluated individually. The frequency of
radiographic errors made by the senior students (48.5 per cent) was slightly
less than that made by the junior students (51.2 per cent). The most frequent
error noted was improper film positioning (18.5 per cent), followed by incorrect
vertical angulation (11.8 per cent), cone-cutting (10.2 per cent), and horizontal
overlap (8 per cent). Miscellaneous errors, such as film bending, film fuzziness,
L
etc., constituted 1.4 per cent of the errors.
Pig. I. Regional distribution of 1,,359 periapienl radiographic W~OTS made by 54 junior
and senior dental students in 198 permpicnl surveys whtln the students uwd the Snap-A-Ray
film holder.

Technical faults made by junior students were similar t,o those made by
senior students, with minor exceptions. The junior students demonstrated al-
most equal distribution of cone-cutting (8.7 per cent) and horizontal overlap
(9.1 per cent), while the senior students showed more cone-cutting (12 per cent)
and less horizontal overlap (6.7 per cent).
Regional distribution of the technical errors is shown in Fig. 1. It was noted
that improper film positioning occurred with higher frequency in the premolar-
molar regions of both jaws but to a lesser degree in the maxillary premolar-
molar regions. Horizontal overlap was noted most often in relation to the maxil-
lary cuspid area. Incorrect vertical angulation was more frequently noted in
the maxillary premolar-molar areas and the cuspid areas of both jaws. Cone-
cutting was seen most often in the molar areas and, to a lesser degree, in the
premolar areas in both jaws. The students made 7.8 per cent more technical
errors in the films taken in the maxilla than in those taken in the mandible.
When the junior and senior students used the Snap-A-Ray film holder with
the bisecting-angle technique, their performance was nearly equal in the type
Volume 33 Comparison of radiographic techniques 289
Number 2

Fig. 8’. Distribution of periapieal radiographic errors made by 158 junior and senior dental
students.

and number of radiographic errors. Improper film positioning was the most fre-
quent error. All other errors occurred with nearly equal frequency (Fig. 2).
The performance of students using the bisecting-angle technique is almost
identical to the performance seen in another study and with a similar pattern
of radiographic err0rs.l This finding may be indicative of an inherent short-
coming in the bisecting-angle technique.
Students using the XCP instrument demonstrated a drastic reduction in
both cone-cutting and vertical angulation errors. The occurrence of these two
errors was 1 per cent and 1.1 per cent, respectively (Table II). The performance
of junior students closely paralleled that of senior students. However, there was
a significant increase in errors caused by improper film positioning (25.6 per
cent), and horizontal overlap was more frequent (12.2 per cent) than when the
Snap-A-Ray film holder was used. Both the junior and senior students experi-
enced equal degrees of difficulty in film positioning as well as in the frequency
of horizontal overlapping (Table II).
When the ra,diographs were evaluated individually, the frequency of errors
was 41 per cent with the XCP instrument. Senior students showed a 2.4 per cent
improvement over junior students (Table II). In contrast, senior students using
the Snap-A-Ray film holder did not show much improvement over juniors (2.7
per cent difference only), although each senior student had made, on the aver-
age, eight to ten periapical surveys the previous year.
Regional distribution of errors made by the junior and senior students who
Fiy. 8. R,egional distrikmtion of 1,365 periapic’al radiographic errors madr- by 53 junior and
senior dental students in 214 periapical surveys when the students uwd thcx XCI’ instrument.

used the XCP instrument is shown in &‘ig. 3 .* Most of the improper film posi-
tioning occurred, in descending frequency, in the molar areas, the maxillary
central incisor area, and the premolar areas. The difficulty faced by students
using the XCP instrument in the positioning of films might be attributed to
the fact that the XCP instrument, in comparison to the Snap-A-Ray film holder,
is somewhat more voluminous. Film-positioning difficulty increased when the
students were confronted with the far distal loca.tion of the molars and with
interference by the floor of the mouth and/or the tongue during premolar-molar
film positioning. Improper film positioning in the maxillary central incisor area
was caused by the failure of some students to put the film in a central position
in relation to the cenOra1 incisor teeth. The narrow films used (Size 1) may have
contributed to the frequency of this error.
It was noted that most of the horizontal overlapping associated with the use
of the XCP instrument occurred in the maxillary cuspid areas and, to a far
lesser degree, the maxillary premolar areas (Fig. 3). This suggests that employ-
ment of the XCP instrument, as with the Snap-A-Ray film holder, is associated
with a high frequency of overlapping in the maxillary cuspid regions (44.6 per
*Since cone-cutting and incorrect vertical angulation errors were minimal when the XCP
instrument was used, both of these errors were added to the category of miscellaneous errors.
Volume 33 Comparison of radiographic techniques 291
Number 2

cent and 33.7 per cent, respectively). Over-all, 13 per cent more errors were
made in films taken in the maxilla than in those taken in the mandible when
the XCP instrument was used.
Although students using the XCP instrument showed more improper film
positioning and horizontal overlapping than students using the Snap-A-Ray film
holder, there was a 9 per cent over-all improvement of films made with the XCP
instrument over those made with the Snap-A-Ray film holder (Fig. 2). In our
opinion, the two problems of improper film positioning and horizontal overlap-
ping constitute a challenge for both teachers and students when the XCP in-
strument is used as the method of choice. Hopefully, the frequency of these two
errors can be reduced to a more acceptable level.
The students who used the Precision x-ray instrument also demonstrated a
substantial reduction in cone-cutting and incorrect vertical angulation errors
(Table II) when their films were compared to films made with the Snap-A-Ray.
The occurrence of these two errors was 0.7 per cent and 2.6 per cent, respec-
tively. These data are comparable with those seen when the XCP instrument
was compared to the Snap-A-Ray film holder. However, films taken with the
Precision instrument showed the highest frequency of improper film positioning
(28.4 per cent) of any device used (Table II). This frequency is 2.8 per cent
higher than when the XCP instrument was used, and it is 9.9 per cent higher
than when the Snap-A-Ray film holder was used. It may well be that the size
and volume of the Precision instrument, as well as its weight, are drawbacks
in the learning situation in positioning films in the patients’ mouths. Radio-
graphs made with this instrument showed 7.7 per cent frequency of horizontal
overlapping, which is comparable to that produced with the Snap-A-Ray film
holder (8 per cent) and 4.5 per cent less than that which resulted from using
the XCP instrument (12.2 per cent) (Fig. 2).
The total frequency of errors with the Precision instrument was 40.8 per
cent. However, the performance of the senior students was better (34.8 per
cent) than the performance of the junior students (46.2 per cent). A possible
reason for improvement may be that the senior students, using the Precision
instrument for the first time, had the benefit of previous radiographic training
which provided them with more skill in positioning the films. The frequency
of improper film positioning among the radiographs which were made by the
senior group was 23.7 per cent; however, the frequency was 32.7 per cent for
the junior group, a 9 per cent difference. Other than that, the errors made by
the juniors were comparable to those made by the seniors in relation to incorrect
vertical angulation, horizontal overlap, cone-cutting, and miscellaneous errors.
Regional distribution of technical errors made by the students using the
Precision instrument is shown in Fig. 4.+ The dominating error was improper
film positioning which occurred with the highest frequency in the mandibular
molar-premolar regions and the maxillary central incisor region and, to a
lesser degree, in the maxillary molar regions and the cuspid regions of both
*Since cone-cutting and incorrect vertical angulat.ion errors were minimal when the Pre-
cision instrument was used, both of these errors were added to the category of miscellaneous
errors.
Pig. 4. Regional distribution of 1,092 periapical radiographic errors made by 51 junior
and senior dental students in 173 periapical surveys when the students used the Precision
x-ray instrument.

jaws. Horizontal overlapping in the maxillary cuspid region remained as a


problem when the Precision instrument was used (Fig. 4).
The errors were evenly distributed between the films made for the maxillary
regions (40.3 per cent) and those made for the mandibular regions (41.1 per
cent). This equal site distribution of errors was not found when either the
Snap-A-Ray film holder or the XCP instrument was used.
From this study, it appears that the Precision instrument calls for more
skill than that required for use of the other two devices. Radiographs made
by juniors showed more improper film positioning with the Precision instru-
ment than when the XCP instrument was used, while seniors performed with
comparable frequency (Table II 1.
It was noted that the students using the Precision instrument made sig-
nificantly fewer errors in positioning the films in the maxillary molar regions
than students using the XCP instrument (Figs. 3 and 4). However, students
using the Precision instrument made more errors in film positioning in the
maxillary cuspid and central incisor regions and in the mandibular premolar
and cuspid regions than students using the XCP instrument. Films taken with
Volume 33 Comparison of radiographic techniques 293
Number 2

Table III. Comparison of average number of retakes per periapical survey


Snap-A-Ray XCP instru- Precisiolz
film holder* mentt inutrzlmentt
Group No. 1 Per cent No. Per cent No. ) Per cent
Juniors 4.2 30 4 25 4.1 25.6
Seniors 3.5 25 3.4 21.2 3.2 20
Average 3.5 27.5 3.7 23.1 3.6 22.8
*Periapical survey consisted of fourteen films.
tPeriapica1 survey consisted of sixteen films.

the Precision instrument showed more frequency of horizontal overlapping in


the maxillary molar regions than films taken with the XCP instrument. How-
ever, the latter showed more frequency of horizontal overlapping in the films
of the maxillary cuspid regions and, to a lesser degree, the maxillary premolar
and lateral incisor regions (Figs. 3 and 4).
In the final analysis, junior a,nd senior groups collectively showed a greater
frequency of improper film positioning and a lower frequency of horizontal
overlapping when they used the Precision instrument than when they used
the XCP instrument. Other errors were more or less the same (Fig. 2). The
XCP instrument and the Precision instrument, employing the paralleling
principle, are comparable and resulted in a lower frequency of errors (9 per
cent) than when the bisecting-angle principle employing the Snap-A-Ray film
holder was used (Fig. 2).
A factor of importance in selecting an instrument for periapical radiography
is t,hat of radiation protection. It has been reported that, with the Precision
instrument, there is less x-ray exposure to the patient.*-lo On the other hand,
it was the experience of the group of students who used the Precision instru-
ment, and our own observation, that, this instrument frequently was not well
tolerated by our patients. This is probably due to its inflexible metallic nature.
Reduction in radiation exposure in the process of obtaining diagnostic
radiographs is one of our major objectives. It is important, therefore, that the
number of retakes be at minimum levels.
The average number of retakes per periapical survey was 3.8 (27.5 per cent)
for all students using the Snap-A-Ray and the bisecting-angle technique (Table
III). The number of retakes per periapical survey (14 films) varied from 0 to
12 for the junior group and from 0 to 10 for the senior group. Students using
the XCP instrument averaged 3.7 (23.1 per cent) retakes per periapical survey
(16 films), and the range was from 0 to 10 retakes per periapical survey for
junior and senior groups. The average number of retakes when the Precision
instrument was used was 3.6 (22.8 per cent), which was comparable to that of
the XCP instrument. The range was from 0 to 12 retakes per periapical survey
for the junior group and from 0 to 9 retakes for the senior group.
The frequency of retakes for junior students using the XCP and the Pre-
cision instruments was higher (25 per cent and 25.6 per cent, respectively)
than that for senior students (21.2 per cent and 20 per cent, respectively).
Oral Hurg.
E’ehruary, 1972

The average numbers of retakes per periapical survey made with the XCP
and the Precision instruments were similar. Students using the XCP instrument
had 4.4 per cent fewer retakes than sbudents using the Snap-A-Ray film
holder, while the improvement was almost equal (4.7 per cent) for those students
using the Precision instrument (Table III).
It might be said that a 4.4 per cent or 4.7 per cent reduction in the fre-
quency of retakes is not a substantial improvement. However, the images pro-
duced with the XCP and the Precision instruments were of higher quality,
and with the Precision instrument the amount of radiation to the patient is
reduced.8-10 The problems of using these instruments constitute a challenge for
teachers and students.
In this study, the frequency of retakes with the bisecting-angle technique
(27.5 per cent) was comparable to that reported by BeanI (25 per cent). In
contrast, the frequency of retakes in this study when the XCP instrument
was used (23.1 per cent) was almost double that reported by Bean’l (11 per
cent). Furthermore, the frequency of retakes when the Precision instrument
was used (22.8 per cent) was also almost double that reported by Weissman
and LonghurstlZ (11 per cent).
Our data and the findings of the other two studies may be not comparable
because variations do exist between the three research designs. Moreover, the
judgment of the three observers of these studies as to what constitutes a
poor-quality radiograph and which radiographs need to be retaken will prob-
ably vary. The findings of the three studies, however, are in agreement in that
the most frequent error was improper film positioning when students used the
XCP or the Precision instruments.

CONCLUSIONS
This study was designed to explore periapical x-ray techniques for the
purpose of selecting one that reduced the number of technical errors made by
the dental students.
A total of 158 junior and senior dental students were divided into three
equal groups. Each group was assigned to use one of three devices-the XCP
instrument or the Precision instrument employing the paralleling principles
or the Snap-A-Ray film holder employing the bisecting-angle principles. The
students made 585 periapical surveys in one semester for this study.
Almost one half (49.9 per cent) of the periapical radiographs made by the
students who used the bisecting-angle technique and the Snap-A-Ray film
holder demonstrated one or more technical errors when each radiograph was
evaluated individually. The most frequent error noted was improper film
positioning (18.5 per cent). This was followed, in descending frequency, by
incorrect vertical angulation (11.8 per cent), cone-cutting (10.2 per cent),
and horizontal overlap (8 per cent). Miscellaneous errors, such as film bending,
film fuzziness, etc., constituted 1.4 per cent of the errors.
The two groups of students who used the XCP and the Precision instru-
ments demonstrated a drastic reduction in both cone-cutting (0.1 per cent and
Volume ,33 Comparison of radiographic techniques 295
Number 2

0.7 per cent, respectively) and incorrect vertical dimension of the image (1.1
per cent and 2.6 per cent, respectively). However, there was an increase in
improper film positioning (25.6 per cent and 28.4 per cent, respectively). Hori-
zontal overlapping was greater (12.2 per cent) in the group using the XCP
instrument ; horizontal overlapping was comparable (7.7 per cent) in the group
using the Precision instrument to that when the Snap-A-Ray film holder was used.
The total frequency of errors was 41 per cent for the XCP group and 40.8
per cent for the Precision group when each radiograph was evaluated indi-
vidually. This indicates that the two instruments were comparable in the
hands of the dental students and resulted in a lower frequency of errors (9
per cent) than when the Snap-A-Ray film holder was used.
When each periapical survey was evaluated as one unit, the average num-
ber of retakes per periapical survey (14 films) was 3.8 (27.5) for the group
of students who applied the bisecting-angle technique.
The average number of retakes per periapical survey (16 films) was 3.7
(23.1 per cent) when the XCP instrument was used and 3.6 (22.8 per cent)
when the Precision instrument was used. This, again, indicates that these two
instruments were comparable in the hands of the dental students, and there were
4.4 to 4.7 per cent fewer retakes than when the Snap-A-Ray film holder was used.
It has been reported that with the Precision instrument there was less x-ray
exposure to the patient.*-lo On the other hand, this instrument frequently was
not well tolerated by the patient, probably because of its inflexible metallic
nature.
It is our observation that the radiographs made with the XCP and the
Precision instruments were of higher quality. Accordingly, if either should be
the instrument of choice, the problems of their use, which are improper film
positioning and horizontal overlapping, constitute a challenge to both teachers
and students for future improvement. Hopefully, the frequency of these two
errors could be reduced to a more acceptable level.

REFERENCES
1. Mourshed, F.: A Study of Intraoral Radiographic Errors Made by Dental Students. Oral
Surg. 32: 824-828, 1971.
2. Updegrave, W. J.: New Horizons in Periapical and Interproximal Radiography, Elgin,
Ill., 1967, The Rinn Corporation, pp. 2-38.
3. Medwedeff, F. M., and Elcan, P. D.: A Precision Technic to Minimize Radiation, Dent.
Survey 43: 45-53,196i’.
4. Medwedeff, F. M., Knox, W. H., and Latimer, P.: A New Device to Reduce Patient
Irradiation and Improve Dental Film Quality, OR& Sm. 15: 1079-1088, 1962.
5. Weissman, D. D.: Manual of Rectangular Field Collimation for Intraoral Periapical
Radiography, Los Angeles, 1970, School of Dentistry, UCLA.
6. Updegrave, W. J.: Simplifying and Improving Intra-oral Roentgenography, ORBL SURQ.
12: 704-716, 1959.
7. Updegrave, W. J.: Higher Fidelity in Intraoral Roentgenography, J. Am. Dent. Assoc.
62: l-8, 1961.
a. Winkler, K. G.: Influence of Rectangular Collimation and Intraoral Shielding on Radia-
tion Dose in Dental Radiography! J. Am. Dent. Assoc. 77: 95-101, 1968.
9. Weissman, D. D., and Sobkowskl, F. J.: Comparative Thermoluminescent Dosimetry of
Intraoral Periapical Radiography, 0~ BURG. 29: 376-386, 1970.
10. Weissman, D. D., and Feinstein, R. B.: X-ray Beam Profiles and Oral Radiography,
OUL SURQ. 31: 546-555,197l.
296 Mourshed and McKinney Oral Surg.
February, 1972

11. Bean, L. R.: Comparison of Bisecting-Angle and Paralleling Methods of Intraoral


Radiology, J. Dent. Educ. 3.3: 441-445, 1969.
12. Weissman, D. I?., and Longhurst, G. E.: Clinical Evaluation of a Rectangular Field
Collimating Device for Periapical Radiography, J. Am. Dent. Assoc. 82: 580-582, 1971.

Reprint requests to:


Dr. Farouk Mourshed
Division of Oral Radiology
Howard University College of Dentistry
600 “W” St NW. .
Washington; D. C. 20001