DHY 161 - Oral Radiology

1. Discuss historic contributions associated with the discovery and growth of x-radiation
   1. Summarize the importance of dental radiographs
   2. List the uses of dental radiographs
   3. Summarize the discovery of x-radiation
   4. Recognize the pioneers in dental x-radiation and their contributions and discoveries
   5. List the highlights in the history of x-ray equipment, film, and techniques
2. Understand the fundamental concepts of atomic and molecular structure
   1. List the three states of matter and the properties of each
   2. Identify the structure of the atom
   3. Define molecule and discuss how molecules are formed
   4. Describe the process of ionization
3. Discuss the nature of radiation
   1. Indicate the various types of radiation in the electromagnetic spectrum
   2. Describe the nature of electromagnetic wave forms
   3. Write definitions for crest, wavelength and frequency
   4. List ten properties of x-rays
4. Recognize the components of the x-ray machine, their functions, and their controlling factors
   1. Describe the main components of an x-ray tube and their functions
   2. Identify the electric currents of an x-ray tube and their functions
   3. Understand the types of x-rays that are produced
   4. Explain interactions of x-radiation and matter
5. Understand the characteristics of dentally used radiation and how these affect radiographic image production
   1. List the three characteristics of a radiation beam
   2. Describe how kilovoltage, milliamperage, time, and distance can alter an x-ray beam
   3. Understand the Inverse Square Law
6. Obtain a working knowledge of Radiation Biology to understand the harmful effects of ionizing radiation on human tissues
   1. Describe the mechanisms, theories and sequence of radiation injury
   2. Describe the factors that determine radiation injury
   3. Discuss short term and long-term effects as well as the somatic and genetic effects of radiation exposure
   4. Describe the effects of radiation exposure on cells, tissues, and organs
   5. Identify the relative sensitivity of a given tissue to x-radiation
   6. Define the units of measurement used in radiation exposure
   7. Describe sources of radiation exposure
   8. Define and estimate risk exposure in dental radiography
7. Understand the concepts associated with radiation protection
   1. Define methods for reducing patient exposure
   2. Describe methods for protecting the operator
   3. State what ALARA stands for
8. Become familiar with image receptors and accessories
   1. Identify the various types of image receptors available for use in dental radiography
   2. Identify various positioning devices
   3. Explain the composition of film packets and describe each component material and its use
   4. Define latent image formation
   5. Identify various film sizes, speeds, and their uses
   6. Discuss the function and composition of grids
   7. Describe proper film storage and protection
9. Discuss categories of radiographic image characteristics and the factors that influence them
   1. Differentiate between radiolucent and radiopaque areas on a radiographic image
   2. Describe a diagnostic dental radiograph
   3. List two visual characteristics of a radiographic image
   4. List factors that influence density and contrast
   5. Discuss the differences between contrast variations
   6. Describe a step-wedge
   7. List three geometric characteristics of a radiographic image and the factors that influence them
   8. Define focal spot, penumbra, resolution, target-film distance, and object film distance
10. Relate proper processing of a x-ray film
    1. List important features of a darkroom
    2. Identify darkroom equipment.
    3. List and indicate the purpose of each chemical in the developer solution
    4. List and indicate the purpose of each chemical in the rinse and the fixer
    5. List steps in preparation for processing films
    6. List the steps for proper automatic processing of films
    7. Describe procedures to follow at end of the day
    8. Label processed film according to the recommended procedure
11. Interpret common processing errors
    1. Explain common darkroom errors
    2. Identify errors on actual radiographs
    3. Describe methods to prevent errors
12. Explain the normal anatomic landmarks of the mandible and maxilla in periapical images.
    1. Describe the normal anatomic structures shown in mandibular periapical radiographs
    2. Describe the normal anatomic structures shown in a maxillary periapical radiograph
    3. Point out on a radiograph the image of any normal structure named
    4. List some radiopaque and radiolucent substances.
    5. Describe the anatomy of the tooth and its surroundings on drawings and radiographs.
    6. Identify restorative materials on the radiograph as radiolucent or radiopaque.
    7. Describe variations in the radiographic appearance of normal landmarks and suggest reasons for such variations.
13. Mount a series of dental films in correct sequence
    1. Place all films with identifying embossed dot dome up or convex
    2. Separate anterior films from posterior films
    3. separate bitewing films from posterior films
    4. Mount bitewing films first and then use them to aid placement of remaining films
    5. Separate maxillary from mandibular posterior films and mount
    6. Separate maxillary from mandibular anterior films and mount
14. Summarize the steps used to produce diagnostically useful images
    1. Explain the purpose of the various types of bitewing radiographs
    2. Identify the various positioning devices used for bitewing radiographs
    3. Describe basic positioning of the patient, film, and x-ray tube for posterior bitewings
    4. Explain the paralleling technique.
    5. Identify and assemble the parts of the anterior and posterior Rinn XCP instruments.
    6. Identify basic film, instrument, and cone positions for anterior placements.
    7. Identify basic film, instrument, and cone positions for posterior placements.
    8. Indicate when cotton rolls are appropriately used.
    9. Identify film positioning errors.
    10. Summarize the basic principles of the bisecting technique.
    11. Explain how to load and position holders used for the bisecting technique.
    12. Describe common errors which can occur when using the bisecting technique.
    13. Compare the paralleling and bisecting techniques.
    14. Identify usual changes in the control panel using any of the described techniques.
15. Discuss the importance of communication in the operator-patient relationship
    1. Describe the influence of the operator’s attitude and appearance on patient treatment
    2. Relate procedures indicated for special need’s patients
    3. Recall answers to common questions concerning x-rays asked by patients
16. Practice all principles of radiation safety applicable to actual exposure of radiographs
    1. Activate control panel to select correct impulse selection
    2. Place lead apron on patient
    3. Use properly stored film of fastest speed available or digital receptors.
    4. Use film holder - do not hold film
    5. Expose minimum number of films which will provide a diagnostic survey, requiring no more than four retakes in a F.M.S. of 16 P.A.’s and 4 B.W.’s
    6. Stand in the most protected area available during exposure, and ensure that others are clear of exposure area
    7. Wear personal monitor at all times when working with radiation emitting equipment
    8. Use antiseptic techniques according to criteria established in sterilization and disinfection procedures
17. Recognize and produce radiographic exposures which meet identified criteria.
    1. Assemble properly the armamentarium required for the chosen exposure technique which minimizes patient discomfort and anxiety
    2. Select receptor size appropriate to the size of patient’s mouth
    3. Expose radiographs according to established criteria.
    4. Process and mount films correctly
    5. Label films properly with the date, patient’s full name or identification number, and the operator’s name
18. Evaluate the exposed radiographs to determine that they meet the identified criteria
    1. Produce radiographs that meet the following general criteria
    2. Produce interproximal surveys that meet the following criteria
19. Describe methods to improve or modify the procedure or final product if the identified criteria is not met
    1. Identify the most likely technical error(s) responsible for producing the discrepancies observed and
    2. Indicate modifications of technique required in order to eliminate or to reduce the severity of the following discrepancies
20. On a panoramic exposure, identify the commonly found radiolucent and radiopaque landmarks of the maxilla and mandible including:
    1. Maxillary landmarks-maxillary sinus, ppterygomaxillary fissure, lateral pterygoid plate, hamulus, zygomatic arch, glenoid fossa, articular eminence, zygomatico-temporal suture, zygomatic bone, malar process, middle cranial fossa, orbit of eye, infraorabital ridge, infraorbital foramen, infraorbital canal, nasal fossa and its borders, nasal septum, nasal turbinates, incisive foramen, incisive canal, nasopalatine canal, hard palate and the maxillary tuberosity.
    2. Mandibular landmarks-condyle, coroniod process of the mandible, mandibular notch, ramus, angle of the mandible, external auditory meatus, mastoid process, styloid process, cervical vertebrae of the spine, inferior border of the mandible, external oblique ridge, mental foramen, mandibular canal, mandibular foramen, submandibular fossa, mental ridges, genial tubercles, hyoid bone, mandibular alveolar processes and dentition, nasopharyngeal air space, palatoglossal air space, soft tissue shadow of the ear, soft tissue shadows of the nose and lips, opening of the lips, shadow of the opposite mandible and “negative” shadows-optical illusions caused bye ht absence of superimposed structures.
21. Evaluate periapical, bitewing, occlusal, and extraoral images for presence of exposure, handling and processor errors including:
    1. exposure errors - receptor placement, downhill composition, horizontal overlappings, vertical distortion, cone-cut, blurred image, thin image, dark image, elongation, foreshortenings, unexposed film, artifacts (eyeglasses etc.).
    2. Handling errors - reversed images, bent film, black lines, static electricity, double exposure, rough handling, high temperature, fog, movement.
    3. Processing errors - underdeveloped, overdeveloped, partial image, incomplete immersion in deveooper, incomplete immersion in fixer, exposure to white light, films stuck to each other, chemical burn incomplete fixing, scratches.
22. Relate methods of prevention or correction of previously identified exposure, handling and processing errors.
23. Demonstrate proficiency in the fundamental use of digital radiography.
    1. Review advantages and disadvantages of digital imaging systems.
    2. Describe the two types of radiographic digital imaging.
    3. Discuss the advantages and disadvantages of the different types of receptors.
    4. Describe and demonstrate infection control procedures that should be used with digital receptors.
    5. Discuss legal issues that surround the use of digital imaging.
    6. Describe the application of the DICOM standard to imaging in Dentistry.
    7. Describe and utilize image processing techniques.
24. Describe proper patient positioning and head alignment and reationale for use for the following extra oral radiographic exposures including:
    1. Lateral oblique exposure
    2. Posteroanterior
    3. Water’s
    4. Reverse-Towne
    5. Submentovertex
    6. Lateral cephalometric
    7. Transcranial (TMJ)
25. Demonstrate steps in operation of the Orthoralix 8500 machine for exposing panoramic images.
    1. Recall the rationale for choosing screened or non-screened receptors.
    2. Relate steps in loading, cleaning and caring for the cassettes and screens.
    3. Check the readiness of the machine for the chosen exposure.
    4. Ready the patient.
    5. Position the patient. Adjustments for children and adjustments for edentulous patients.
    6. Demonstrate the ability to produce a diagnostically acceptable panoramic radiograph.
26. Explain the differences between tomography, computed tomography, and cone-beam computed tomography, and describe their roles in oral health care.
27. Recall radiographic manifestations of pathologic conditions of jaws including most common benign neoplasms and malignancies.
28. Employ a systematic approach in radiographic interpretation.
    1. Incorporate case history, clinical examination and any existing films.
    2. Use an appropriate viewing environment.
    3. Discriminate normal versus abnormal.
29. Identify dental caries on a radiograph.
    1. State the most accurate radiologic techniques for detecting caries on radiographs.
    2. Recognize the following types of caries on radiographs: interproximal, occlusal, buccal-lingual, root (cemental), recurrent, rampant, and pulp exposure.
    3. Detail the radiographic classificaitons of caries: incipient, moderate, severe, and advanced.
    4. Recall the manner in which any of the following affects caries interpretation: contrast scale, exposure time, film processing, angulation, restorative materials, cervical burnout and overlapping teeth.
30. Distinguish the radiographic features of periodontal disease.
    1. Discuss the importance of the clinical and radiographic examinations in the diagnosis of periodontal disease.
    2. Discuss the limitations of radiographs in the detection of periodontal disease.
    3. Describe the type of radiographs that should be used to document periodontal disease and the preferred exposure technique.
    4. State the differences among the bone loss classifications and recognize their radiographic appearances.
    5. Identify clear-cut radiographic evidence of bone loss.
    6. Determine if radiographic evidence is of diagnostic quality.
    7. Record radiographic findings on the examination chart.
31. Describe radiographic and clinical signs and symptoms of infections of periapical tissues.
32. List common dental anomalies and their distinctive clinical and radiographic features including:
    1. Supernumary teeth
    2. fusion
    3. gemination
    4. concrescence
    5. developmentally missing teeth
    6. enamel pearl
    7. microdontia
    8. macrodontia
    9. transposition
    10. taurodontism
    11. Turner’s tooth
    12. Dilaceration
    13. dentin dysplasia
    14. amelogenesis imperfecta
    15. dentinogenesis imperfects
    16. dens evaginatus
    17. dens invaginatus (dens en dente)
    18. odontodysplasia
33. Recognize radiographic features of regressive changes in the dentition including:
    1. attrition
    2. abrasion
    3. abfraction
    4. erosion
    5. resorption
    6. secondary dentin formation
    7. pulp stones
    8. pulpal sclerosis
    9. cementicles
    10. hypercementosis
    11. bone resorption
34. State radiographic aspects of common traumas to the teeth and facial structures and recall methods of management of the traumas.
35. Determine the appropriate radiographic exposure according to the needs of the operator and the characteristics of the patient.
    1. Use the exposure technique which minimizes patient discomfort and anxiety.
    2. Relate receptor and tube-head placement for disto-oblique exposure techniques.
    3. Recall methods used to localize an object in the oral cavity.
    4. Recognize appropriate use of film duplicating.
    5. List steps in film duplicating.
36. Accept responsibility for decisions regarding need for exposure, interpretation and utilization of radiographs.
    1. Precede decisions regarding need for radiographs with a review of the health history.
    2. Perform clinical examination prior to exposing any radiographs.
    3. Adhere to accepted guidelines for prescribing radiographs.
    4. Review all available radiographs of each patient for interpretation of presence or absence of disease.
    5. Record radiographic findings in the patient record.