5. How Do You Create An X-ray Image? Flashcards

1
Q

LOs

A
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2
Q

Types of radiographic film? What they’re used for?

A
  1. Direct action / wrapped packet film for intraoral
  2. Indirect action film used in conjunction with intesifying screens inside extra oral cassete
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3
Q

Intra oral radiographic film main sizes?
What part of mouth they’re used for?

A

A = 22 x 35 mm&raquo_space;» anterior periapical + childrens bitewings

B= 31 x 41 mm&raquo_space;> posterior periapicals + adult bitewings

C = 57 x 76mm&raquo_space;> occlusals

  • packaged in barrier envelopes to control infection
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4
Q

Intra oral radiographic film packaging, speed, colour etc

A

Surface facing X-ray beam = white

Reverse surface = white + colour

3 speeds - D,E,F
Different film speeds packaged using different colours

Single or double film - different coloured

No standardisation between companies
- hence, always ensure correct orientation, speed, etc

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5
Q

Intra oral radiographic film packet contents?

A

A = clear plastic barrier envelope

B = outer wrapper&raquo_space; white + colour coded

C = Plastic film with embossed dot in corner to indicate orientation , dot aims towards operator

D = protective black paper on either side of film , protect from mechanical damage

E = thin sheet of lead foil

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6
Q

How to hold an intra oral film

A
  • Hold the black paper to protect the film from damage from your fingers
  • once you’ve removed the black paper, hold the film on its edges
  • NOT on the emulsion
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7
Q

Structure of the film itself?

A
  • clear plastic base is covered by a thin layer of adhesive
  • both sides have thin layer of green silver halide emulsion
    (sensitive to x-ray photons + light)
  • Both sides of emulsion covered by a thin layer of protective gelatine
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8
Q

What is the emulsion sensitive to?

A
  • designed to be primarily sensitive to x-ray photons,
  • sensitive to light, so the packet must only ever be opened up in the dark.
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9
Q

Why is the lead foil inside the film packet embossed with a pattern?

A

Embossed with a pattern

Allows easy identification of error in placing film the wrong way round
- film would be pale + show pattern of foil instead

Lead foil prevents residual radiation passing into the patient

Prevents some scattered photons coming backwards + hitting film
- will degrade image

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10
Q

Why is the lead foil in the packet? (EXTRA INFO)

A
  1. prevents some residual radiation passing on into the patient
    → The x-ray machine generates the x-rays which pass into the patient. Some of these then hit the film. The lead foil is positioned behind the film, so the x-ray photons will have to pass through it before passing on into the patient. Therefore, the sheet of lead will prevent some, but not all, of these photons from going on into the patient.
  2. to prevent some scattered photons from coming backwards and hitting the film
    → the x-ray machine generates the x-rays, which pass into the patient and hit the film, as the lead foil is positioned behind the film it will prevent some of those photons which have hit the patient’s tissues beyond the film, from being scattered backwards onto the film. If not stopped, this radiation would scatter back onto the film and degrade the image
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11
Q

What is instant process / self developing film?

A

Film packaged in a plastic sachet

Attached to a developer and fixer solution tab

Exposed film causes developer tab to be pulled , solution will melt down through the sachet to affect the film

After 15 seconds , fixer tab is pulled to allow fixer to contact the film

Once fixed, chemicals are discarded and film is washed in water

No dark room / processing facilities required

Poor image quality

No protective lead foil

Used in emergency

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12
Q

How does indirect action film work ?

A

Used in conjunction with 2 intensifying screens
- one if front of film+ one behind film

Sandwiched together for extra-oral radiography in a cassette

Silver halide emulsion is sensitive to colours of light , not X-ray

Must be used with intensifying screens emitting the correct light colour

No orientation embossed for
- R and L lettering needed on outside of cassette

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13
Q

What is the function of intensifying screens inside the cassette?

A

Consist of fluorescent phosphors embedded in plastic matrix
- emit light when hit by X-rays

Phosphors include :
- calcium tungstate
- rare earth materials = gadolinium + lanthanum
- Yttrium

Different screens emit different colours of light
- blue
- green
- UV
- Red

Close contact between 2 intensifying screens and film m must be maintained
- avoids image blurring

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14
Q

What is the action of a conventional calcium tungstate intensifying screen ?

A

Calcium tungstate screen emits blue light

  1. Incoming X-ray photon
  2. Activates phosphor crystal that emits light
  3. Light diverges and hits film emulsion
  4. Cross over in clear film base
  5. Hits second rear emulsion
  6. Reverse effect of photons that hit the rear screen
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15
Q

What is the action of a UV system intensifying screen ?

A

Incoming X-ray photons activates phosphor crystal to emit light

Difference: little crossover effect through film base

Image produced has sharper edge definition / resolution

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16
Q

Summary of intensifying screens

A

Visible light emitted when screens are hit by X-ray
- via photo electric effect

Reduced number of X-ray photons needed
- dose to patient reduced

17
Q

What happens when there is a gap between intensifying screens and film ?

A

Larger area of film will be affected

Image will be less sharp + blurred

18
Q

Advantage of using rare earth green sensitive screens

A

Initial amount of X-ray needed to generate light less than conventional tungstate screen

Dose to patient reduced even further

19
Q

How to maintain intensifying screens?

A

Must be kept clean
- dirt / marks prevent emitted light from hitting the film

Must avoid scratching + damage

20
Q

How are cassettes constructed ?

A

Film is sandwiched tightly between front and back intensifying screens

Layer of sponge rubber - helps to compress contents of cassette together

Consist of a light-tight aluminium or carbon fibre box

Available in different sizes for extra oral radiography

21
Q

Three main variables on control panel

A

Kv
- determines energy of photons + quality of X-ray beam
-Determines penetration of photons
- affects film contrast
- lower kV = better contrast between black and white

MA + time
- both determine quantity of X-ray photons
- affect degree of blackening of film
- overexposure = too black

22
Q

What is chemical processing ?

A

Events required to convert invisible latent imagine into visible radiographic image

Traditionally done manually
- film clipped into holder + dipped into chemicals

Automatic processors

23
Q

How does processing convert green silver halide emulsion ion film into radiographic image ?

A

Exposed side:

  • green silver halide emulsion becomes sensitised
  • film placed in developer
  • developer causes green silver halide to be reduced to black metallic silver

Unexposed side:
- remains green

Film inserted into a fixer to remove residual green emulsion
- reveals white base underneath

24
Q

Importance of development of radiographic film

A

Developer = alkaline solution

Reduced sensitised silver emulsion goes black metallic silver

Oxidised by air
- effectiveness reduced over time

Ability to blacken film should be monitored

Dependent on time + temp

Over developed = too dark
Under developed = too pale

25
Q

Importance of fixation of radiographic film ?

A

Film = acidic solution

Removes unsensitisied silver halide emulsion to reveal clear/white base

Films should be fixed for twice the clearing time

Inadequately fixed films = greenish yellow / milky appearance due to residual emulsion
- can become brown with time

26
Q

Two main types of digital receptors

A
  1. Intra + extra oral solid state receptors
  2. Intra + extra oral phosphor plate receptors
27
Q

Features of solid state digital receptors

A

Real-time = produced a image quickly

Use charge coupled device sensors or complementary metal oxide semiconductor sensors
Sensors are directly linked to a computer
- instantaneous image

Disadvantage :

Intra-oral sensors are bulky , difficult to position§

28
Q

What is the basic design of charge couple device solid state sensors ?

A

CCD = charged coupled device

Array of CCD pixels

Scintillation layer
- above CCD pixels
- fluoresces when hit by photons

Each pixel has N and P type silicon

29
Q

How does the CCD solid state receptor work?

A

X-rays ht scintillation layer
- works like an intensifying screen
- emits light

Light interacts with silicon in each CCD
- creates a charged packet , concentrated by electrodes and converted into analogue voltage signal

Passes into computer analog digital converter
- digital signal will have discrete numbers

Each pixel has voltage measured and given a numerical value , 0-255

Numerical values converted onto a grey scale , black - white

30
Q

Features of phosphor plate system receptors

A

Cordless

Different sizes of photostimulable phosphor storage plates available

Not directly linked to computer = no instantaneous image

Reader required to read plate + produce image via laser beam

Time consuming

Easy to use clinically

31
Q

How do the phosphate plate system receptors work ?

A

Plates have layer of phosphor layer on a backing plate

X-rays pass through patient + hit phosphor layer
- can be stored in phosphor plates

Plate is then placed in reader

Laser beam shone on plate to release X-ray energy stored in form of green light

Green light detected in reader by photomultiplier tube
- converts light into voltage

Laser beam travels down plate + releases energy

Voltage passes into computer analogue digital converter

Creates digital signal

Converted into grey scale

32
Q

How is a digital image constructed ?

A

Made of millions of pixels

2d image produced

265 shades of grey

Each pixel is allocated a shade of grey depending on amount of radiation that has reacher that part of sensor

33
Q

Technical issues of digital imaging

A

Not accurate

Overlapping pixels has grey shade averaged out

Smaller the pixels = more accurate representation

34
Q

How can image resolution be measured ?

A

Digital images
- measured by pixel size

Storage phosphor plates
- pixel sizes range from 60-70 microns

CCD
- pixel size ranges from 20-70 microns
- should have a better resolution than phosphor plates

Resolution measured in line pairs/mm = spatial resolution
- how many line pairs seen in a mm
- more line pairs = better resolution

Spatial resolution for direct action varies between 10-20 LPs/ mm
Spatial resolution for indirect action is about 5 LPs / mm
Spatial resolution for digital systems varies 7-25 lp / mm

35
Q

How do we process / enhance digital images?

A

Doesn’t involve chemicals
Uses computer software

Brightness altered
- increased pixel value
- 8 will be unchanged = max pixel value
- increases towards white end of scale

Altering contrast
- pixel value from middle of scale either increased towards 8 or decreases towards 1
- makes black/ white more evident
- role of kV in film captured imaging is irrelevant for digital imaging

Image inversed
- black + white alter

Image embossed / pseudo 3d

Image pseudo coloured
- may not be clinically useful

36
Q

Printing of digital hard copies

A

Several different printers
Ink jet printers mainly used
Can’t produced 256 shades of grey
Reduces quality

Thermo-sublimation printers
- expensive

37
Q

Adv of digital imaging

A

Lower radiation dose ( particularly using solid state receptors )

Elimination of film processing

Rapid image production

Image manipulation

Automated image analysis

Electrical storage

Patient education

38
Q

Disadv of digital imaging

A

Expensive

Large storage capacity

Sensors are bulky

Difficult to use

Easily damaged

Image manipulation
- loss of evidence of disease

PC crash

39
Q

Current recommendations for digital imaging

A

Sensor sizes should be available should be available in a range that is comparable to dental film

Sensitivity of detector system should be compatible with X-rays et being used
- ideally DC / constant potential
- short exposure times

Retakes are properly justified , recorded and included in QA stats