Producing Quality Radiographs

1. 4 Producing Quality Radiographs

2. Objectives • Define the key words. • Evaluate a radiographic image identifying the basic requirements of acceptability. • Differentiate between radiolucent and radiopaque areas on a dental radiograph. • Define radiographic density and contrast. • Differentiate between subject contrast and film contrast.

3. Objectives • List the factors that influence magnification and distortion. • List the geometric factors that affect image sharpness. • Summarize the factors affecting the radiographic image. • Describe how mA, kVp, and exposure time affect image density.

4. Objectives • Discuss how kVp affects image contrast. • Explain target-surface, object-image receptor, and target-image receptor distances. • Demonstrate the practical use of the inverse square law.

5. Key Words • Contrast • Crystal • Definition • Density • Distortion • Exposure chart • Exposure factors • Exposure time

6. Key Words • Extraoral radiography • Film contrast • Focal spot • Geometric factors • Grid • Intensifying screen • Intraoral radiography • Inverse square law

7. Key Words • Kilovoltage peak (kVp) • Long-scale contrast • Magnification • Milliampere (mA) • Motion • Object-image receptor distance • Penumbra

8. Key Words • Position indicating device (PID) • Radiographic contrast • Radiolucent • Radiopaque • Sharpness • Short-scale contrast

9. Key Words • Subject contrast • Target-image receptor distance • Target-object distance • Target-surface distance

10. Introduction • Each patient presents with a unique set of characteristics for which a customized approach to exposure settings is needed. • The dental radiographer has an ethical responsibility to produce the highest diagnostic quality radiographs for patients who agree to be exposed to ionizing radiation.

11. Introduction • To consistently produce diagnostic quality radiographs at the lowest possible radiation dose, the dental radiographer needs to understand the inter-relationships of the components of the dental x-ray machine.

12. Introduction • Three basic requirements for an acceptable diagnostic radiograph: • All parts of the structures recorded must be imaged as close to their natural shapes and sizes as the patient’s oral anatomy will permit. Distortion and superimposition of structures should be at a minimum.

13. Introduction • Three basic requirements for an acceptable diagnostic radiograph: • The area examined must be imaged completely, with enough surrounding tissue to distinguish between the structures. • The radiograph should be free of errors and show proper density, contrast, and definition.

14. Figure 4-1 An acceptable diagnostic radiograph.

15. Terminology • Radiolucent • Radiopaque • Density • Contrast • Short-scale contrast • Long-scale contrast • Sharpness

16. Figure 4-2 Radiographic density. Radiograph (A) is underexposed and appears too light (less dense). Radiograph (B) is overexposed and appears too dark (more dense).

17. Figure 4-3 Penetrometer tests demonstrate radiographically that a longer contrast scale results from the use of 100 kilovolt exposures. Dental radiographs exposed at 100 kVp have long-scale contrast. Radiographs exposed at 60 kVp have short-scale contrast.

18. Figure 4-4 Radiographic contrast. Radiograph (A) exposed at 60 kVp, has high contrast. Radiograph (B) exposed at 90 kVp, has low contrast.

19. Shadow Casting • A radiograph is a two-dimensional image of three-dimensional objects. Therefore, it is necessary to apply the rules for creating a shadow image to produce a quality radiographic image.

20. Rules for Shadow Casting • Small focal spot — toreduce the size of the penumbra (partial shadow around the objects of interest) resulting in a sharper image and slightly less magnification • Long target-object distance — to reduce the penumbra and magnification • Short object-film distance — to reduce penumbra and magnification

21. Rules for Shadow Casting • Parallel relationship between object and film — to prevent distortion of the image • Perpendicular relationship between central ray of x-ray beam and the object and film — to prevent distortion of the image

22. Factors Affecting the Radiographic Image • Radiographic contrast • Subject • kVp • Scatter radiation • Film/digital sensor type • Exposure • Processing

23. Table 4-1 Summary of Factors Influencing Radiographic Image Contrast

24. Factors Affecting the Radiographic Image • Sharpness/Definition • Focal spot size • Target-image receptor distance • Object-image receptor distance • Motion • Screen thickness • Screen-film contact • Crystal/pixel size of intraoral image receptors

25. Table 4-2 Summary of Factors Influencing Radiographic Image Sharpness

26. Figure 4-5 Using a small focal spot on the target a long target-image receptor distance, and a short object-image receptor distance will result in a sharp image.

27. Figure 4-6 Large focal spot on the target and long object-film distance results in more penumbra and therefore loss of image sharpness.

28. Figure 4-7 Movement of the tube head. Motion, even slight, of the tube head will effectively create a larger surface area of the focal spot, resulting in penumbra.

29. Figure 4-8 Large focal spot on the target and short target-image receptor distance results in more penumbra and loss of image sharpness.

30. Figure 4-9 Blurry, unsharp image caused by movement of the patient, the film, or the tube head.

31. Figure 4-10 Screen thickness. X-ray A strikes a crystal far from the film and the divergent light exposes a wide area of the film resulting in unsharpness. X-ray B strikes a crystal close to the film, resulting in less divergence of the light that exposes the film and therefore a sharper image. The thicker the screen, the less sharp the image.

32. Factors Affecting the Radiographic Image • Magnification/enlargement is mostly influenced by the target-object distance and the object-image receptor distance. The target-object distance is determined by the length of the PID.

33. Factors Affecting the Radiographic Image • Distortion is the result of unequal magnification of different parts of the same object. Distortion results when the image receptor is not parallel to the object (Figure 4-13) and/or when the central ray of the x-ray beam is not perpendicular to the object and the plane of the image receptor (Figure 4-14)

34. Figure 4-11 Magnification. Comparison of 8-in. (20.5-cm) and 16-in. (41-cm) target-object and target-image receptor distances. The image is magnified (enlarged) when these distances are shortened. (Courtesy of Dentsply Rinn)

35. Figure 4-13 Object and film are not parallel, resulting in distortion.

36. Figure 4-14 Central ray of x-ray beam is not perpendicular to the objects and image receptor, resulting in distortion and over-lapping of object A and object B. Note that object A is magnified larger than object B because object A is a greater distance from the image receptor than object B.

37. Table 4-3 Effect of Varying Exposure Factors on Image Density

38. Effects of Varying the Exposure Factors • Variations in milliamperage (mA) • Variations in exposure time • Milliampere-seconds (mAs) • Variations in kilovoltage (kVp)

39. Effects of Variations in Distances • The operator must take into account several distances to produce the ideal diagnostic quality image: • The distance between the x-ray source (at the focal spot on the target) and the surface of the patient’s skin • The distance between the object to be x-rayed (usually the teeth) and the image receptor

40. Effects of Variations in Distances • The operator must take into account several distances to produce the ideal diagnostic quality image: • The distance between the x-ray source and the recording plane of the image receptor • the terms target-surface distance, object-image receptor distance, target-object distance, and target-image receptor distance are used.

41. Figure 4-15 Distances. Relationship among target, skin surface, object (tooth), and image receptor distance

42. Effects of Variations in Distances • Target-surface distance • Object-image receptor distance • Target-image receptor distance

43. Figure 4-16 Object-image receptor distance. This placement of the image receptor places the crown of the tooth closer to the receptor than the root.

44. Figure 4-17 Inverse square law. Relationship of distance (D) to the area covered by x-rays emitted from the x-ray tube. X-rays emerging from the tube travel in straight lines and diverge from each other. The areas covered by the x-rays at any two points are proportional to each other as the square of the distances measured from the source of radiation.

45. Inverse Square Law • Inverse square law states that the intensity of radiation varies inversely as the square of the distance from its source. • Inverse square law may be written as:

46. Inverse Square Law • Where: • I1 is the original intensity • I2 is the new intensity • D1 is the original distance • D2 is the new distance

47. Exposure Charts • Exposure charts, available commercially or custom made by the practice, should be posted at the x-ray unit control panel for easy reference. • These charts show at a glance how much exposure time is required for a film of any given speed or a digital sensor when used with all possible combinations of exposure time, milliamperage, and peak kilovoltage.

48. Review: Chapter Summary • An acceptable diagnostic radiograph must show the areas of interest completely and with minimum distortion and maximum sharpness. • When evaluating a radiographic image the oral health care professional should utilize appropriate scientific terminology.

49. Review: Chapter Summary • The dental radiographer must have a working knowledge of the factors that affect the radiographic image.

50. Recall: Study Questions • General • Chapter Review