Unit 5

Imaging as an Examination Tool

 Clinical examination
 Signs
 Symptoms
 Ordering the right type of imaging
examination
 Ordering the right number of imaging
examination
 Necessary vs unnecessary examinations
 Benefit to the patient
Viewing condition
 Viewbox
 Monitor
 Prints
 Ambient light reduced
 Quiet room
 Intraoral films mounted on a opaque holder
 Equal intensity of light on the view box
 Monitors: calibration
 Magnification
 Software limitations
Systematic Approach
 Intraoral images
 Teeth, periodontium, bone, adjacent structures
 Tooth #1 to #16, and then #17 to #32

 Extraoral images;
 Panoramic, other extraoral plain radiographs

 Cross sectional images

 CT, MRI
Localize the abnormality
 How many lesions?
 Where is the lesion?
 Localized vs generalized
 Single arch or both the arches
 Inside the bone or outside
 Relation to the crown
 Relation to the root
 Superior to the mandibular canal
Periphery
 Well defined or ill defined?
 Sharp margins
 Corticated margins
 Sclerotic margins
 Radiolucent band
 Blends into adjacent area
 Irregular margins
Shape
 Circular
 Oval
 Scalloped
 Multilocular
Internal structures
 Radiolucent
 Mixed
 Radiopaque
 Trabeculation
 Septa
 Calcifications
 Tooth or similar entities
Adjacent structures
 Teeth
 Lamina dura
 Crestal bone
 Periodontal spaces
 Alveolar bone
 Nerve canals
 Maxillary sinuses
 Cortical bones
Description, description,
description
 Speak out loudly
 List it down
 Compare findings in different images
 Clinical information
 Radiographic
findings

Abnormal Normal

Developmental Acquired

Tumors
Cysts Inflammatory Bone dysplasia Vascular Metabolic Trauma
(benign/malig)
Vindicate your D/D
 Vascular
 Infection
 Neoplasm
 Drugs
 Idiopathic/inflammatory
 Congenital
 Autoimmune
 Trauma
 Endocrine/metabolic
In the Land of 10,000 lakes,…
…we see the fish!
Liar, Liar!! Do Our Eyes Lie?
Dirty words!
 Sun-ray appearance
 Ground glass
 Cotton wool
 Onion skin
 Driven snow
 Etc, etc
When not to order imaging
 You have not clinically / radiographically
evaluated the patient
 No benefit to the patient
 Additional images may not provide extra
information
 No ‘routine’ radiograph
What goes on the report
 Patient, doctor, clinic identification
 Date, type and number of examination
 Reasons for the examination
 Clinical information
 Relevant observation
 Radiographic Impressions
 Any further tests, examinations