The ability to see and understand what is revealed by a radiographic image.

Importance of recognizing normal anatomy The independence of radiographic signs to imaging modalities The principle of symmetry Radiographic signs: terminology and description Categorization of disease and/or abnormalities

Saggital

Axial Maxilla

Coronal

Axial Mandible

Axial

posterior

right

left

left

anterior

Saggital

superior

Coronal

superior

posterior

anterior

right

left

left

inferior

inferior

lingual buccal/facial buccal/facial

facial

Global

Assess symmetry of form and density Follow cortical boundaries Count teeth

Local

Assess periodontal ligament space and lamina dura Evaluate root form and canal structure Assess crowns for caries or abnormality

Patient information

Age, sex, race

History Symptoms Clinical examination Existing diagnostic radiographs Image selection Initial examination of images

Just as we use signs in interpreting art we can use signs to interpret radiographs

Diagnostic Radiograph Normal Developmental Congenital Abnormal Acquired Trauma Inflammation Tumor: Benign vs Malignant Cyst Fibro-osseous Vascular And lesions of bone

IMPRESSION

Systemic - Metabolic

Language of Interpretation

Terminology : Radiolucent Lesions

Unilocular Radiolucent Lesion with Non-Corticated Borders

Multilocular Radiolucent Lesion (cont.)

Terminology : Radiopaque Lesions

Focal Opacity

Target Lesion

Irregular and ill-defined radiopaque pattern

Ground-Glass Radiopacity

Ground-Glass Radiopacity (cont.)

Mixed Density Lesion

Mixed Density lesion: Mostly cystic with flecks of calcification

Mixed Lucent-Opaque Lesion in the Pericoronal Location

Mixed Lucent-Opaque Lesion in the Pericoronal Location (cont.)

Soft Tissue Opacity

Calcified lymph nodes Sialoliths Tonsilloliths Phleboliths (calcified blood clots) Calcified carotid atheromas Calcified laryngeal cartilage and triticeous cartilage

Dome shaped opacity in the sinus

52 year old female with hypertension Stroke in 1987

1. 2. 3. 4. 5. 6. 7.

Radiographic density Margin characteristics Shape Location and distribution Size Internal architecture Effect on surrounding tissue

Benign

Malignant

Radiolucent Mixed radiolucent-radiopaque Septations, loculations Radiopaque

Always radiolucent, except:

Metastases
Breast cancer Prostate cancer

Osteogenic sarcoma

Benign Well-defined

Malignant " Ill-defined:

"
" "

narrow zone of transition

wide zone of transition

Smooth, regular Corticated

Ragged Moth-eaten

Round Oval Undulated Unilocular Multilocular Soap bubble

Benign Round or oval

Malignant Irregular

unilocular

multilocular

Benign Expansion Thinning Aggressive benign may erode

Malignant " Erosion " Destruction

Malignant Erosion Destruction Benign Displacement

Benign Displacement mandibular canal No neuro-sensory deficits

Malignant Invasion and destruction of canal Anesthesia, paresthesia

Benign Displacement May prevent eruption

Malignant Floating teeth

Benign Horizontal or near horizontal

Malignant More variable Sometimes no root resorption Spiked roots

B cell lymphoma