Fundamentals of Interpretation Flashcards
What are the Interpretations Principles ?
1) Importance of recognizing normal anatomy
2) x-ray signs are the some in pano, PA, & CBCTs
3) Principle of symmetry
4) Radiographic signs: terminology & description
5) Categorization of disease and /or abnormalities
What is the importance of knowing anatomy?
- FOUNDATION of radiologic interpretation
- Structures are compared w/ a MENTAL IMAGE of NORMAL ANATOMY
Regardless of the ______________, the radiographic signs of disease & abnormalities remain the ___________
- Imaging modality
- Basically the same
How to interpret a PANO Radiograph?
1) FIRST evaluate IMAGE QUALITY: Image DENSITY, CONTRAST; CHECK for patent positioning errors, asymmetric magnification and/or distortion & artifacts
2) LOOK at BONY anatomy & compare mental “database” of normal
3) EVALUATE TMJs, ramus, & cervical spine
4) Along the bottom of the image, evaluate the hyoid bone & check for calcified carotid ATHEROMAS
5) LOOK at TEETH & ALVEOLAR RIDGES
6) EVALUATE diagnostic fast and region of interest
How to Interpret a FMX?
1) FIRST evaluate IMAGE QUALITY: Image DENSITY, CONTRAST; CHECK for HORIZONTAL angulation problems, closed contacts, cut off apices are all the teeth visible?
2) LOOK at BONY anatomy & compare mental “database” of normal
3) EVALUATE floor of sinus, alveolar bone, mandibular canal, lamina dura, PDL spaces, trabecular pattern, apical radiolucencies, etc
4) Check for restoration integrity, margins, caries, calculus, etc.
5) EVALUATE diagnostic task & region of interest
What is Viewing sequence GLOBALLY?
1) Assess symmetry of form & density
2) Follow cortical boundaries
3) Count teeth
What is Viewing sequence LOCALLY?
1) Assess periodontal ligament space & lamina dura
2) Evaluate root from & canal structure
3) Asses crowns for caries or abnormality
What is the Systematic Approach ?
1) Pt info (age, sex, race)
2) History
3) Symptoms
4) Clinical examination
5) Existing diagnostic radiographs
6) Image selection
7) Initial examination of images
What is the radiographic interpretation process, Abnormal Categorization ?
1) Developmental abnormalities
2) Acquired abnormalities
What are the acquired abnormalities?
- Cyst
- Bening neoplasia
- Malignant neoplasia
- Inflammatory lesion
- Bone dysplasia
- Vascular anomaly
- Metabolic disease
- Trauma
What is DMSLSIE?
D- Density M- Margin S- Size L- location S- shape I- Internal character E- effects on surrounding structures
What is the terminology for Radiolucent Lesions?
1) Corticated Unilocular Radiolucency (one basic lesion)
2) Non-corticated Unilocular Radiolucency (like soap bubbles–compartments)
3) Multilocular Radiolucency (Larger bubbles)
4) Multifocal (multi-locations ) Confluent Radiolucencies
- Well defined but not corticated
5) Moth-Eaten Radiolucencies (ragged border)
What is the terminology for Radiopaque Lesions?
1) Focal opacity
2) Target Lesion
3) Multifocal confluent Radiopacities
4) Irregular, ill-defined Radiopacities
5) Ground Glass Radiopacities (looks granular)
6) Mixed Density Radiopacities (mostly cystic w/ flecks of calcification)
7) Soft Tissue Opacities
What are the 5 soft Tissue Radiopacities?
1) Calcified lymph nodes (MOST TYPICAL ones that occur)
2) Sialoliths (submandibular gland)
3) Tonsiliths (MOST COMMON CALCIFICATION– may be a cause of halitosis as well!)
4) Phleboliths (calcified blood clots)
5) Calcified carotid atheromas (by bifurcation of artery)
- -Can be bilateral.
- -Common location = CCA
What are Radiographic Signs?
1) Radiographic density
2) Margin characteristics
3) Shape
4) Location & Distribution
5) Size
6) Internal architecture
7) Effect on surround tissue
What is the difference in DENSITY in Benign lesions?
1) Radiolucent
2) Mixed Radiolucent- radiopaque
3) Septations, loculations
What is the difference in DENSITY in Malignant lesions?
1) Always radiolucent EXCEPT:
- Metastases
* Breast Cancer
* Prostate Cancer
-Osteogenic sarcoma
Note: It destroys NOT displacing
What is the difference in MARGINS in Benign lesions?
1) Well-defined
- Narrow zone of transition
2) Smooth, regular
3) Corticated
What is the difference in MARGINS in Malignant lesions?
1) ill-defined
- Wide zone of transition
2) Ragged
3) Moth-eaten
Note: Tells us a lot about the BIOLOGY of the LESION and its AGGRESSIVENESS
Well-defined borders are an indication of ___________________________________?
A slow growing, benign process
What is the difference in SHAPE in Benign lesions?
Round or Oval
What is the difference in SIZE in Malignant lesions?
Irregular
What is the effect on surrounding tissues in Cortical Bone w/ Benign lesions?
1) Expansion
2) Thinning
3) Aggressive benign may erode
What is the effect on surrounding tissues in Cortical Bone w/ Malignant lesions?
1) Erosion
2) Destruction
What is the effect on surrounding tissues w/ Maxillary Sinus in Benign lesions?
1) Displacement
What is the effect on surrounding tissues w/ Maxillary Sinus in MALIGNANT lesions?
1) Erosion
2) Destruction
What is the effect on surrounding tissues w/ the Inferior Alveolar Nerve in Benign lesions?
1) Displacement mandibular canal
2) No neuro-sensory deficits
Ex: Ameloblastoma
(well defined border)
What is the effect on surrounding tissues w/ the Inferior Alveolar Nerve in Malignant lesions?
1) Invasion & Destruction of canal
2) Anesthesia, paresthesia
Ex: SCCa
What is the effect on surrounding tissues w/ TOOTH POSITION in Benign lesions?
1) Displacement
2) May PREVENT eruption
Ex: Central Hemangioma (Slightly painful swelling)
What is the effect on surrounding tissues w/ TOOTH POSITION in MALIGNANT lesions?
1) “Floating Teeth”
Ex: Squamous cell carcinoma
What is localized root destruction usually associated with?
Pressure reabsorption from SLOWLY growing lesions or benign neoplasms such as ameloblastoma
What is the effect on surrounding tissues w/ TOOTH ROOTS in Benign lesions?
1) Horizontal or near Horizontal
What is the effect on surrounding tissues w/ TOOTH ROOTS in Malignant lesions?
1) More variable (opposite direction–>vertically)
2) Sometimes no root resorption
3) Spiked roots
What is the effect on surrounding tissues w/ Periodontal Ligament Space & Lamina Dura?
-Asymmetric WIDENING of the PDL space & loss of lamina dura sign of a MALIGNANT TUMOR, such as:
1) Osteosarcoma
2) Chondrosarcoma
3) Lymphoma
Regarding the PDL space & Lamina Dura, the Asymmetric WIDENING of PL ligament space & loss of lamina dura
(sign of a MALIGNANT TUMOR) can be CAUSED by what?
1) Scleroderma
2) VERTICAL root fracture
3) Ortho movement
Sclerotic bone reaction to a periodontal lesion appears ____ because of the deposition of bone on ____
Radiopaque, existing
Radiographic appearance of bone loss in localized aggressive periodontitis typically consists of ____ defects
Deep vertical
Untreated periodical inflammatory lesion may spread to involve a larger area of bone resulting in what?
Osteomyelitits
Typical appearance of the periphery of a malignant lesion is a(n) ___ defined border __ encapsulation
Ill, and absence of
Evidence of invasion of bone around teeth from squamous cell carcinoma may first appear as what?
Widening of the periodontal ligament space
Radiographic features of multiple myeloma include?
Punched-out lesions
