ORAL DIAGNOSIS Oral Radiology pt 1 Flashcards
generation, emission, and absorption of radiation occur at the ___ level
subatomic
electrons exist in orbitals around the nucleus and carry an electrical charge of ___
negative 1
the nucleus contains ___ and ___
protons and neutrons
protons have a charge of +1 and a mass that is ___x the mass of the electron
1836
neutrons have no charge and are slightly ___ than protons
heavier
___ occurs when an electrically neutral atom loses an electron and becomes a positive ion; the free electron is a negative ion
ionization
electromagnetic radiation is the movement of energy through space as a combination of ___ and ___ fields
electrical and magnetic
___ theory considers electromagnetic radiation as small bundles of energy called photons that travel at the speed of light and contain a specific amount of energy. electromagnetic radiations comprise a spectrum of radiations with varying energy
quantum
___ theory considers electromagnetic radiations to be propagated in the form of waves.
wave
wavelength is inversely proportional to ___
- photon energy
- the shorter the wavelength, the higher the energy
the spectrum of electromagnetic radiation includes ___. which ones have sufficient energy to ionize biologic molecules, and what are they referred to as?
- spectrum includes gamma rays, x-rays, UV rays, visible light, infrared radiation (heat), microwaves, and radio waves, arranged in order of decreasing energies (or increasing wavelength)
- gamma rays, x-rays, and UV radiation have sufficient energy to ionize biologic molecules and are referred to as ionizing radiation
describe particular radiation
- atomic nuclei or subatomic particles moving at high velocity
- alpha and beta particles and electrons (cathode rays) are examples
what are the basic components of x-ray machines?
- x-ray tube containing a cathode and an anode
- power supply
in the cathode of an x-ray tube, the ___ is the source of electrons within an x-ray tube
tungsten filament
which part of the cathode electrostatically focuses electrons emitted by the incandescent filament into a narrow beam directed at a small area on the anode (focal spot)?
molybdenum focusing cup
what are the two components of the anode?
tungsten target and copper stem
what does the tungsten target of the anode do?
converts kinetic energy of electrons generated from the filament into x-ray photons
what is the focal spot?
- area on the tungsten target (of the anode) onto which the focusing cup directs electrons
- as the size of the focal spot decreases, the sharpness of the radiographic image increases
what does the copper stem of the anode do?
dissipates heat and reduces risk of target melting
what is the purpose of the power supply?
- heats the x-ray tube filament
- high-voltage transformer generates high potential differences between the anode and the cathode
- timer that controls time exposure
what is the purpose of heating the x-ray tube filament?
- provides low-voltage current by use of a step-down transformer that reduces the voltage of the incoming alternating current
- controlled by a milliamperage (mA) switch that regulates the temperature of the filament and the number of electrons emitted
- tube current
what is the purpose of the tube current?
- flow of electrons through the tube from the filament to the anode and back to the filament
- the quantity of radiation produced by an x-ray tube is directly proportional to the tube current (mA) and the exposure time
- controls the number of photons generated (intensity of the beam) but not the beam energy
high voltage transformer:
- the ___ control selects voltage from different levels on the autotransformer and applies it across the primary winding of the high-voltage transformer.
- the high-voltage transformer increases voltage significantly and provides the high voltage required by the x-ray tube to ___ and generate ___.
- ___ refers to the mean energy of an x-ray beam, which increases with increasing ___.
- the number of photons (beam intensity) also increases with increasing ___.
- because the current is alternating (60 cycles/sec), the ___ of the x-ray tube alternates, and the x-ray beam is generated as a series of pulses.
- kVp
- accelerate electrons from the cathode to the anode and to generate x-rays
- beam quality
- kVp
- kVp
- polarity
what is the purpose of the power supply timer?
controls the length of the time high voltage is applied to the tube and the time during which the tube current flows and x-rays are produced (time exposure)
in the production of x-rays, high-energy electrons produced by the ___ interact with tungsten atoms at the target, resulting in an energy loss, which is converted to ___ and ___
- filament
- heat and x-ray photons
___ is the primary source of x-ray photons from the x-ray tube
bremsstrahlung radiation
bremsstrahlung radiation results from ___
- stopping or slowing of high-speed electrons at the target
- an electron is attracted toward positively charged nuclei and loses velocity
- lost kinetic energy is given off in the form of new bremsstrahlung x-ray photons
- bremsstrahlung interactions generate x-ray photons with a continuous spectrum of energy
___ results when electrons from the filament collide with and eject an inner orbital electron, which is replaced by an outer orbital electron and release of a photon of specific energy
characteristic radiation
what are the factors that control the x-ray beam?
- kilovoltage
- milliamperage and exposure time
- filtration
- collimation
- inverse square law
kVp affects both the ___ and the ___ of the x-ray photons
quality and quantity
when kVp increases, the total number of photons produced increases, and the mean energy and maximum energy of the x-ray beam ___
increase
___ and ___ affect the quantity of the x-ray photons produced
- milliamperage and exposure time
- when mA and exposure time increases, the total number of photons increases, but the mean and maximum energies of the x-ray beam are unchanged
filtration is accomplished by placing an ___ in the path of the beam
aluminum filter
what does filtration do?
reduces patient dose by preferentially removing lower energy (less-penetrating) photons from the beam
after filtration, total number of ___ decreases. what happens to the mean energy of the x-ray beam?
- total number of photons decreases
- however, because lower energy photons are preferentially removed, the mean energy of the x-ray beam increases
governmental regulations require total filtrations to be equal to the equivalent of ___
1.5mm of aluminum for up to 70kVp and 2.5mm of aluminum for higher voltages
a ___ is a metallic barrier with an aperture to reduce the size of the x-ray beam and the volume of irradiated patient tissue
collimator
dental x-ray beams are usually collimated to a circle of what diameter?
2.75 inches (7cm) in diameter with the collimator typically built into open-ended aiming cylinders
how do rectangular collimators reduce further unnecessary patient exposure?
they further limit the size of the beam to just larger than the image receptor
what is the inverse square law?
- intensity of the x-ray beam at a given point is inversely proportional to the square of the distance from the source
- changing the distance between the x-ray tube and the patient has a marked effect on beam intensity
- this principle is also applied to operator protection, where the operator stands at a distance of at least 6 feat from the x-ray source to minimize the intensity of the x-ray photons
in what ways do x-rays interact with matter?
- coherent scattering
- photoelectric absorption
- compton scattering
___ occurs when a low-energy photon passes near an outer electron, the photon ceases to exist, and the excited electron returns to ground state, generating another photon with the same energy as in the incident beam
coherent scattering
coherent scattering accounts for approximately ___% of interactions with photons in a dental x-ray beam
8%
___ occurs when a photon collides with a bound electron, which is ejected from its orbital, and the incident photon ceases to exist
photoelectric absorption
in photoelectric absorption, the frequency of photoelectric interaction is directly proportional to ___
- the third power of the atomic number of the absorber
- contributes greatly to the differences in radiographic density of enamel, dentin, bone, and soft tissue on radiographs
photoelectric absorption accounts for approximately ___% of interactions with photons in a dental x-ray beam
30%
___ occurs when a photon interacts with an outer orbital electron, which recoils from the impact, and the incident photon is scattered in a new direction with lower energy
compton scattering
compton scattering accounts for approximately ___% of interactions with photons in a dental x-ray beam
62%
___ is a measure of radiation quantity; capacity of radiation to ionize air
exposure
what is the unit for absorbed dose?
gray (Gy), where 1 Gy equals 1 joule/kg
what is effective dose?
- used to estimate risk in humans
- unit of effective dose is sievert (Sv)
___ is the decay rate of radioactive material
radioactivity
the radioactivity unit is ___
becquerel (B1), where 1 Bq equals 1 disintegration/sec
___ is the study of the effects of ionizing radiation on living systems
radiation biology
what are the deterministic effects of radiation biology?
- there is a threshold below which a response is not seen
- severity of response is proportional to dose
- changes resulting from killing of many cells after moderate to high doses of radiation
- example: oral mucositis after radiation therapy
what are the stochastic effects of radiation biology?
- there is no minimum threshold dose
- probability of response, rather than severity, is dose-dependent
- changes resulting from damage to DNA of single cells
- examples: radiation-induced cancer and heritable effects
what is the direct effect of radiation chemistry?
-direct alteration of biologic molecules (carbohydrates, lipids, proteins, DNA) by ionizing radiation
approximately what fraction of biologic effects of x-ray exposure result from direct effects?
1/3
what is the indirect effect of radiation chemistry?
- radiation effects mediated through water
- ionizing radiation converts water to hydrogen and hydroxyl free radicals (radiolysis of water), which alter biologic molecules
what fraction of radiation-induced biologic damage results from indirect effects?
2/3
changes in what biologic molecules is the primary mechanism for radiation-induced cell death, mutation, and carcinogenesis?
nucleic acids (damage to the DNA molecule)
describe cellular radiation effects of the nucleus
- nucleus is far more radiosensitive than cytoplasm, especially in dividing cells
- the sensitive site in the nucleus is DNA
- chromosome changes serve as useful markers for radiation injury
what are the effects of cellular radiation on cell kinetics?
- mitotic delay
- cell death
- recovery
describe mitotic delay as a result of cellular radiation
- mitotic delay occurs after irradiation of dividing cells
- severity is dose-dependent
describe cell death as a result of cellular radiation
- cell death is caused largely by damage to chromosomes, preventing successful mitosis
- radiation also causes cell death by apoptosis
describe recover as a result of cellular radiation
- cell recovery involves enzymatic repair of single-strand breaks of DNA
- double-strand breaks (damage to both strands of DNA at the same site) is usually lethal to the cell
describe radiosensitivity as it relates to cell type
cells that are mitotically active and undifferentiated and have long mitotic futures (oral mucous membrane basal cells) are more radiosensitive than cells that no longer divide (neurons or striated muscle cells)
what are the short term radiation effects at the tissue and organ level?
rapidly proliferating tissues (bone marrow, oral mucous membrane) are lost primarily by mitosis-linked death
what are the long term radiation effects at the tissue and organ level?
long-term deterministic effects depend primarily on mitotic activity of the parenchymal cells and the extent of damage to fine vasculature
what is the rationale of radiotherapy?
- irradiation often used to treat radiosensitive oral malignant tumors, usually squamous cell carcinomas
- fractionation of total x-ray dose into multiple small doses provides greater tumor destruction than is possible with a large single dose
what is the radiation effect on oral mucous membranes?
- near the end of the second week of therapy, as basal epithelial cells die, the mucous membrane begins to show areas of redness and inflammation (mucositis)
- as mucous membrane breaks down, it forms a white-to-yellow pseudomembrane (desquamated epithelial layer)
- at the end of therapy, mucositis is most severe, discomfort is at the maximum, and food intake is difficult
- secondary yeast infection by c. albicans is a common complication and may require treatment
- after radiation therapy is completed, mucosal healing begins and is usually complete by about 2 months
- at later intervals (months to years), the mucous membrane becomes atrophic, thin, and relatively avascular, which complicates denture wearing
describe the radiation effect on taste buds
radiation therapy causes extensive degeneration of normal histologic architecture of taste buds and loss of taste acuity during the second or third week
describe the radiation effect on salivary glands
- dose-dependent and progressive loss of salivary secretion usually seen in the first few weeks after initiation of radiotherapy
- mouth becomes dry and tender, and swallowing becomes difficult and painful because residual saliva loses normal lubricating properties
- reduced salivary flow that persists beyond 1 year is unlikely to show significant recovery
- salivary changes have a profound influence on oral microflora, often leading to radiation caries
what is the radiation effect on teeth?
- irradiation of developing teeth with therapeutic doses severely retards tooth formation
- depending on the severity of the dose, aberrant formation or arrested root development may occur
describe radiation caries
carious lesions result from changes in salivary glands and saliva, including reduced flow (resulting in xerostomia), decreased pH, reduced buffering capacity, and increased viscosity
how are the best restorative results achieved for restoration of radiation caries?
combination of restorative dental procedures, excellent oral hygiene, and topical applications of sodium fluoride
primary radiation damage to mature bone results from ___
radiation-induced damage to the vasculature of the periosteum and cortical bone, which are normally already sparse