Radio Exam 5 (12-13) - Lecture notes 12-14 PDF

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Lecture 12 Objectives ● List the size of receptor used for an adult or child for occlusal radiographs. ○ Size 2 pedo, size 4 adult ● State how the patient’s occlusal plane should be positioned, angle of PID, receptor placement and point of entry for the following projections: ○ Parallel to the floor, with the exception of mandible cross section ● Discuss the purpose of the localization technique in radiography. ○ To help you find where an object is three dimensionally based on a two dimensional picture ● Explain how buccal and lingual objects will appear when applying the Buccal-object Rule. ○ SLOB-change in the direction of the PID. Same is Lingual, Opposite is Buccal ■ Take first image straight on ■ Move tubehead mesial, distal, or vertical, ■ If the object moves the same way its lingual ● Explain how the buccal object shifts in relation to the tube head. ○ It moves in the opposite direction of the tube head its buccal ● Discuss the technique to use with the Right-Angle technique. ○ Creating 3d info from two different 2d images (PA + Occlusal PA) Aim to Expose

POI

Occlusal Projection

Vertical Angulation (degrees)

Maxillary topographic

+65

Maxillary lateral (right or left)

+60

Roots of the molars, sinus

Outer canuts

Maxillary pediatric

+60

(most common) anteriors

Bridge of the nose

Mandibular topographic

−55

ID buccal or lingual expansion of lesions

Over chin

Mandibular cross- 90 sectional Mandibular pediatric

−55

Bridge of the nose

1” behind the tip of the chin Directly through tip of the chin

Lecture 12 guided notes Occlusal and Localization Techniques Chapter 21 Occlusal Technique Purpose – (p. 239, 240) ● used to examine large areas of the maxilla or the mandible on one image m/Receptor Size 4 (adult) or size 2 (child) –( p 240) Purpose and Use Usually used in conjunction with periapical or bitewing images List – (p 240) ● To locate retained roots of extracted teeth ● To locate supernumerary (extra), unerupted, or impacted teeth ● To locate foreign bodies in the maxilla or the mandible ● To locate salivary stones in the duct of the submandibular gland ● To locate and evaluate the extent of lesions (e.g., cysts, tumors, malignancies) in the maxilla or the mandible ● To evaluate the boundaries of the maxillary sinus ● To evaluate fractures of the maxilla or the mandible ● To aid in the examination of patients who cannot open their mouths more than a few millimeters ● To examine the area of a cleft palate ● To measure changes in the size and shape of the maxilla or the mandible Basic Patient Preparation for Occlusal Technique Procedure 21-1( p 240) ● 1. Briefly explain the imaging procedure to the patient. ● 2. Adjust the chair so that the patient is positioned upright and the level of the chair is at a comfortable working height. ● 3. Adjust the headrest to support the patient's head. ○ For maxillary occlusal exposures, the patient's head must be positioned with the maxillary arch parallel to the floor and the midsagittal (midline) plane perpendicular to the floor. ○ For some mandibular occlusal exposures, the patient's head must be reclined and positioned with the occlusal plane perpendicular to the floor. For others, the patient is positioned with the occlusal plane parallel to the floor. ● 4. Place and secure the lead apron with thyroid collar on the patient. ● 5. Request that the patient remove eyeglasses and any objects in the mouth (e.g., dentures, retainers, chewing gum) that may interfere with the procedure. Maxillary Occlusal Projections ● Maxillary topographic projection (figure 21-1) ○ Procedure 21-3 ■ Place the receptor as far posteriorly as the oral anatomy permits ○ Purpose p. 240

■ Topographic occlusal projection is used to examine the palate and the anterior teeth of the maxilla ○ Technique p. 241 (+65º) ■ +65 ■ Point of entry: top edge of the PID between the patient’s eyebrows on the bridge of the nose ● Pediatric maxillary projection – (figure 21-3) ○ Procedure 21-5 ○ Purpose p. 242 ■ The maxillary pediatric occlusal projection is used to examine the anterior teeth of the maxilla and is recommended for use in children 5 years or younger ○ Technique p. 244 (+60º) ■ +60 ■ Point of entry: bridge of the nose ● Lateral occlusal projection ○ Procedure ■ The long edge of the receptor should extend approximately ½ inch beyond the buccal surfaces of posterior teeth. ○ Purpose ■ The maxillary lateral occlusal projection is used to examine the palatal roots of molar teeth. ■ It may also be used to locate foreign bodies of lesions in the posterior maxilla ○ Technique ■ +60 ■ Point of entry: position the top edge of the PID above the corner of the patient’s eyebrow. (outer canthus of the eye)

Mandibular Occlusal Projections ● Mandibular topographic projection (Procedure 21-6) ○ Procedure ■ Insert the receptor into the patient’s mouth, placing it as far posteriorly as the oral anatomy permits ○ Purpose – p 242 ■ The mandibular topographic occlusal projection is used to examine the anterior teeth of the mandible ● ○ Technique p 245 ■ (-55º) ■ Point of entry: over the patient’s chin ○ Figure 21-4, p. 245 ● Cross sectional projection (Procedure 21-7)

○ Procedure ■ Receptor as far back as possible ○ Purpose – p 242 ■ The mandibular cross-sectional occlusal projection is used to examine the buccal and lingual aspects of the mandible. ■ Used to located foreign bodies or salivary stones in the region of the floor of the mouth ○ Technique – p 246 ■ (Mand arch perpendicular to the floor) ■ 90 degrees toward the center of the receptor ■ Point of entry: 1 inch below patient’s chin ○ Fig 21-5, p 246 ● Pediatric projection ○ Purpose ■ The mandibular pediatric occlusal projection is used to examine the anterior teeth of the mandible and is recommended for use in children 5 years or younger ○ Technique ■ -55 ■ Point of entry: directly through the chin Helpful hints ● White side (film) faces arch being exposed ● Black side (receptor) faces arch being exposed ● Minimal film edge extends beyond teeth ● Center over area of interest ● Consider where “a” is, not in diagnostic are

Localization techniques Pg. 242, 248-251; Fig 21-7 and 21-8 ● Purpose and use p 242 ○ Locate ■ Foreign bodies ■ Impacted teeth ■ Unerupted teeth ■ Retained roots ■ Toot positions ■ Salivary stones ■ Jaw fractures ■ Broken needles and instruments ■ Dental restorative materials Types: Buccal object rule fig 21-11 Uses horizontal or vertical angle to locate an object on the buccal or lingual Two ways to determine object on buccal: ■ Buccal object moves in the same direction of the x-ray beam

■ Lingual object moves in the opposite direction of the x-ray beam Or a different way to say it….. Clark’s rule or tubehead shift method (SLOB- same on the lingual- opposite on the buccal) § Buccal object moves in the opposite direction of the tubehead § Lingual object moves in the same direction of the tubehead ★ In relation to the beam, it is the opposite of slob Right angle technique; fig 21-12 for example · Expose a regular PA of the tooth and then an occlusal to see if the location of the object on buccal or lingual

Lecture 13 panoramics objectives ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ● ●

Explain what quality assurance means. List 8 items that would be quality control duties. List the 6 steps to perform the coin test to check the safe-light. Explain what a reference film is and how to create one. Discuss the legal issue of patient refusing dental images from the aspect of negligence. Give examples of methods to educate the patient to accept having dental images exposed. Discuss ways to gain cooperation from a child when exposing radiographs Explain how a parent can help when a child may be uncooperative State examples for the use of panoramic imaging and the disadvantages. State the other name used for a panoramic imaging. Explain how the collimation of the x-ray beam differs in panoramic equipment from intraoral equipment. Explain what the “focal-trough” is and how it relates to patient positioning and image definition Explain how the Frankfort plane is used in positioning the patient and its location. List and demonstrate the steps in proper positioning of the patient and teeth for a panoramic image. Recognize the reason for patient positioning errors and the resulting appearance on the image. Define what a ghost image is. List reasons for exposing radiographs on an edentulous patient. Explain how to position a receptor holder and the use of cotton rolls when taking periapicals on an edentulous or partially edentulous patient. Explain how the exposure setting would be adjusted for an edentulous patient. Define a minor patient and relate to informed consent. Explain ownership of dental images.

Lecture 13 guided notes

1.

Quality Assurance Plan Refers to special procedures used to assure the production of high quality diagnostic images Includes both: (Box 10-1) pg 105 a. quality control tests B. quality administration procedures 2. Quality Control Tests Test used to monitor: ● Dental x-ray machines ● Dental x-ray film ● Screens and cassettes ● Viewing equipment ● Darkroom lighting ● Processing equipment ● Processing solutions ● Digital imaging x-ray machines: ● Monitored and inspected periodically ● State health dept. inspects in Okla. ● Calibrate and adjust machines by technician x-ray film: 1.propperly stored 2. Test for fog 3. Check expiration date Screens and cassettes: fig 10-1 · Examine for dirt and scratches · Clean monthly with screen cleaner; Replace scratched screens · Check cassette holders for light leaks, tears, worn closures · Test screen for film-screen contact Viewing equipment: · May be used to clear images from exposed sensors · Periodically examine for dirt and discoloration · Surface should be wiped clean every week · Discolored Plexiglas should be replaced · Blackened fluorescent light bulbs must be replaced Film processing: · Most critical area of quality control and requires daily monitoring Darkroom lighting: · Darkroom checked for light leaks every month; close door with all lights off Processing equipment: · Perform safelight test using coin test; 4 ft – 4 min fig 10-3 Steps for Coin Test(light tightness of darkroom) 1. Turn off all lights in darkroom; including safelight 2. Unwrap one unexposed film four feet from safelight with coin on top of film

3. Turn on safelight for four minutes 4. Remov coin and process film ● If no visible image, safelight is correct ● If outline of coin appears, improper safelighting Check timer and thermometer for accuracy; maintain equipment Processing solutions: · Replenish solutions daily and change every 3-4 weeks · Evaluate processing solutions each day before films are processed · Developer strength: (fresh solutions and fresh film) ● What is a Reference radiograph – p 107 ○ A film processed under ideal conditions; demonstrates optimal film contrast and density ○ Used to compare against film density of quality control radiographs processed daily How is quality control film made?? ● Reference radiograph ○ Film processed under ideal conditions ■ Used to compare against film density or radiographs processed daily ● Step Wedge radiography- p.108 ○ Expose a film using step wedge device on top ○ Process film ○ View film side by side with reference radiograph to match densities ○ Matched densities, solution strength is adequate ● Normalizing device ○ A commercially available device to monitor film density ■ What we did use at RSC -pg 108 Digital Imaging: ● Annual tests for calibration of imaging equipment, receptors ● Direct digital imaging - inspect wired connections ● Update and maintenance of computers and laser scanning devices, adhering to manufacturing instructions ● Commercial kits available 3. Quality Administration ● Refers to the management of the quality assurance plan ● Dentist is ultimately responsible but usually delegates to assistant or hygienist ● Elements: (pg. 117) ○ Description of the plan ○ Assignment of duties ○ Monitoring schedule ○ Maintenance schedule ○ Record keeping log ○ Plan for evaluation and revision ○ In-service training

Chapter 13 – Patient Education and the Dental Radiographer

You will encounter patients resistant to having dental images and x-ray exposure... Patients do not understand the value of dental images. The dental radiographer must take time to educate the patient. 1.

Methods of Education · Brochures or written literature – ADA or your own to explain the need for dental images · Visuals – examples of images showing normal and abnormal conditions. Digital images showing caries, calculus, periodontal conditions, or oral diseases.

Chapter 14: Legal Issues and the Dental Radiographer 1.

Licensure requirements ● Obtaining certification in dental imaging ● Performing dental imaging procedures only under direct supervision of the dentist 2. Informed consent ● Consent given by patient following complete disclosure (informing the patient about particulars of dental imaging) ● Must have at RSC! 3. Minor patients ■ Under 18 years ■ Must have informed consent from legal guardian ■ Do not expose an RSC patient w/o this! 4. Liability ● Legal accountability (liability) is presumed to lie with both the supervising dentist and the dental auxiliary ● The dentist and the dental auxiliary may both be sued for the actions of the dental auxiliary ● Dental malpractice result when the dental practitioner is negligent in delivery of dental care; ● Negligence occurs when dental treatment delivered falls below the standard of care; ○ Negligent care is either an action or lack of action ● Standard of care defined as the quality of care that is provided by dental practitioners in a similar locality under the same or similar conditions. 5. 6. ● ● ● ● 7. ●

Confidentiality

Ownership and retention of Dental Images Legally, dental images are the property of the dentist even though paid by pt or insurance ○ because radiographs are indispensable as part of the patient’s record Patients have right to reasonable access Must request in writing Dental records and images should be retained indefinitely Patients who refuse exposure of dental images The standard of care requires that the dentist decline to treat a patient who refuses necessary x-ray images

○ DDS should decline treatment ○ X-rays are the standard of care ● Treatment without necessary images is considered negligent. ● No document can be signed to release the dentist from liability ○ Legally, the patient cannot consent to negligent care; such consent is invalid ● Patient essentially asking dentist to treat negligently ○ because dentist is treating without all diagnostic information

Chapter 24: Radiography of Patients with Special Needs – pg. 278-281 1. Pediatric patient Why expose? To locate caries, conditions of teeth and bones, trauma, evaluating growth and development When to do? · Based on individual needs of patient; depends on the individual needs of child including number of teeth present, the age of the child, and child’s ability to cooperate during procedures · Age 6 – first deciduous teeth shed and first permanent molar Table 24-1 Technique: pg 278 · Bisection and paralleling techniques · Bite-wing and occlusal techniques · Digital sensor-PSP sensors preferred and more comfortable for pediatric patients over bulky, wired sensors Patient and equipment preparations: ● Be confident. Show authority. ● Show and tell ● Reassure the patient ● Demonstrate behavior ● Request assistance ● Postpone examination. Don’t force 2. Edentulous Survey – p 282-283 Purpose: what are we looking for? ● Root tips, ● impacted teeth ● Lesions (cysts, tumors) ● Identify objects in bone ● Quantity and quality of bone Panoramic is a common way to exam. Fig 24-10 Can supplement with PAs or occlusals as needed. Technique: ● Panoramic survey most common

● Periapical examination ○ Paralleling technique ■ Use cotton rolls to simulate missing teeth must be placed on both sides of the bite-block in place of missing teeth. ● No teeth ● No mandibular teeth ● No maxillary teeth ○ Bisecting technique ● Decrease exposure setting ○ Less mass to absorb x-rays

Chapter 22:

Panoramic Imaging

Panoramic imaging-extraoral technique that is used to examine the maxilla and mandible on a single projection It is a good survey image but can’t replace periapicals 1.

Purpose and Use · Dentition and supporting structures · Impacted teeth · Evaluate eruption patterns, growth and development · Detect diseases, lesions and condition of jaw · Examine the extent of large lesions · Evaluate trauma Can also view calcifications on the carotid artery

3.

Fundamentals · Receptor and tubehead are moving around the patient · Patient sits or stands stationary F22-3 · Produces an image through process known as tomography; tomo= section; gets an image of one layer and blurs everything around it; “tomogram” · Image conforms to the shape of dental arches ● Focal trough ○ Image layer ○ 3-D curved zoned where structures are clearly defined How does it work? · The receptor and x-ray tubehead rotate simultaneously around patient during exposure · The pivotal point, or axis, around which the receptor and x-ray tubehead rotate is the rotation center. · The focal trough is where the dental arches must be positioned to obtain the sharpest image. Fig 22-5 · The structures positioned outside of the focal trough appear blurred and are not readily visible. The quality of the resulting image depends on the positioning of the patient’s teeth within the focal trough. · Structures found within the focal trough appear sharp while structures outside of

4.

the focal trough appear blurred.

5.

6.

7.

· Tubehead does not have a round collimation but a narrow______________________ · The receptor also has a vertical slit in it that allows the x-ray beam to expose different sections of receptor as it rotates · ___________________ second exposure; keep eyes on the patient for ____________ Equipment: ● Whether digital or film-based, all panoramic machines have similar components ○ X-ray tubehead ○ Head positioner ○ Exposure controls ● Each has a filament used to generate electrons and a target used to produce x-rays ● The collimator used in panoramic x-ray machine is a lead plate with an opening in the shape of a narrow vertical slit ● The x-ray beam emerges through the collimator as a narrow band ○ Receptor has a vertical opening ■ Exposes different sections as it rotates ○ 10-30 second long exposure ■ Keep an eye on the patient! ● The beam passes through the patient and then exposes the receptor through another vertical slit in the receptor holder ● The tubehead of the panoramic unit rotates behind the patient’s head, while the receptor rotates in front of the patient ● Each unit has a head positioner, which is used to align the patient’s teeth in the focal trough. ● Exposure time varies depending on the x-ray unit but typically ranges from 10-30 seconds ● Exposure settings variable based on size of patient (fig 22-9) Image receptors ● Digital or film ● Digital imaging software downloads within seconds and transmit image to computer ● Whether digital sensor or film receptor is used, the image must clearly indicate the patient’s right and/or left sides ● Extraoral screen film is used in film-based panoramic imaging; this film is sensitive to the light emitted from intensifying screens ■ Cassettes for film-based imaging vary from hard to flexible, curved or straight. ■ Must be “light-tight” Equipment preparation ● Prepare receptor ● prepare bite-block

● Choose exposure settings ● Adjust machine height 8. ● ● ● ●

9.

Patient preparation Explain imaging procedure Remove all glasses, hair ornaments, earrings, piercings, removable prosthetics, hearing aids, nec...