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FINALS > Radiology > Flashcards

Radiology Flashcards

1
Q

name radiographs from lowest to highest dose

A

OPT
full mouth periapicals
CBCT

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2
Q

what are skull radiographs

A

plain radiographs used primarily for assessing maxillofacial trauma

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3
Q

what are the four main types of skull radiographs

A

occipitomental
PA mandible
reverse town’s
true lateral skull

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4
Q

what are occipitomental radiographs primarily used for

A

fractures of the midface

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5
Q

what are PA mandible radiographs primarily used for

A

fractures of the posterior mandibles - BUT not including condyles

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6
Q

what are reverse Towne’s radiographs primarily used for

A

fractures of the mandibular condyles

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7
Q

how are occipitomental radiographs usually taken

A

at two different angles
can be - 0, 10, 30 or 40 degrees
usually pick two numbers not next to one another

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8
Q

what is Water’s view

A

using two different angles to take an occipitomental radiograph

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9
Q

how is the patient positioned for an occipitomental radiograph

A

facing receptor
head tipped back so orbitomeatal line is 45 degrees to receptor
x-ray beam positioned at the operator’s chosen degree and centred through the occiput

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10
Q

why are PA mandible radiographs not suitable for viewing facial skeleton

A

due to superimposition of base of skull and nasal bones

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11
Q

what are indications of PA mandible radiographs

A

lesions and fractures involving the posterior 1/3 of body of mandible, angles, rami and mandibular hyper or hypoplasia

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12
Q

how is the patient positioned for a PA mandible radiograph

A

face towards receptor
head tipped forward so orbitomeatal line is perpendicular with receptor (forehead nose position)
x-ray beam perpendicular to receptor and centred through cervical spine at level of rami

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13
Q

why is the x-ray beam projected from posterior side in PA mandible, occipitomental and reverse towne’s radiographs

A

reduces magnification of the face since the face is closer to the receptor
reduced effective dose needed

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14
Q

what are indications for taking a reverse towne’s radiograph

A

high fractures of condylar necks
intracapsular fractures of TMJ
condylar hypo or hyperplasia

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15
Q

how is the patient positioned for a reverse towne’s radiograph

A

face towards receptor
head tipped forward so orbitomeatal line perpendicular with receptor
mouth open so condyle heads move out of glenoid fossa
x-ray beam 30 degrees below perpendicular line to receptor and centred through condyles

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16
Q

what type of radiation does CBCT involve

A

ionising

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17
Q

how does CBCT machine work

A

conical/ pyramidal x-ray beam
square digital receptor
rotates around head
no more than 1 full rotation

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18
Q

how is patient positioned for CBCT

A

machine specific
usually standing but can be sitting
frankfort plane parallel to floor
mid sagittal plane centred

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19
Q

name four benefits of CBCT over plain radiography

A

no superimposition
ability to view subject from any angle
no magnification or distortion
allows for 3D reconstruction

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20
Q

name four disadvantages of CBCT over plain radiography

A

increased radiation dose
lower spatial resolution
susceptible to artefacts
equipment more expensive

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21
Q

what are two benefits of CBCT over conventional CT

A

lower radiation doses
potential for sharper images

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22
Q

what are three benefits of conventional CT over CBCT

A

able to differentiate soft tissues better
larger field of view
better soft tissue contrast

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23
Q

name four uses of CBCT in dentistry

A

view proximity of IAN during lower 8 surgery
measuring alveolar bone dimensions for implants
visualising complex root canal morphology
assessing large cystic jaw lesions

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24
Q

name the three orthogonal planes in CBCT

A

axial
sagittal
coronal

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24
Q

what are three imaging factors/ variables

A

field of view
voxel size
acquisition time

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25
Q

how are imaging factors/ variables worked out

A

differs from patient to patient
takes in ALARP principles

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26
Q

what is the FOV

A

the size of captured volume of data

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27
Q

what is voxel size

A

the image resolution
voxels are 3D pixels

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28
Q

what does an increase in FOV cause

A

increase in radiation dose and increase in number of tissues irradiated and increase scatter

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29
Q

what does decrease voxel cause

A

increases radiation dose
increase scan time

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30
Q

what are the range of options for voxel size

A

0.4mm cubed to 0.085mm cubed

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31
Q

rate the following x-rays from highest dose to lowest : panoramic, CT, intraoral, CBCT

A

CT
CBCT
panoramic
intraoral

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32
Q

what are the two main types of artefact

A

movement artefact
streak artefact

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33
Q

name three contra-indications to CBCT

A

if plain radiographs are sufficient
high risk of debilitating artefacts
if there is pathology requiring soft tissue visualisation

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34
Q

how should you describe a lesion found on a radiograph

A

site
size
shape
margins
internal structure
affect on adjacent anatomy
number

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35
Q

how would you describe a lesions general shape

A

rounded
scalloped
irregular

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36
Q

how can you describe a lesions locularity

A

unilocular
pseudolocular
multilocular

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37
Q

how can you describe the margins of a lesion

A

well defined and corticated/ non-corticated
poorly defined and blending into adjacent anatomy

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38
Q

what does a corticated lesion suggest

A

benign lesion

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39
Q

what does a moth eaten lesion suggest

A

malignancy

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40
Q

how can you describe the internal structure of a lesion

A

entirely radiolucent
radiolucent with some internal radiopacity
radiopaque

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41
Q

name four reasons a lesion could present as radiolucent

A

resorption of bone
decreased mineralisation of bone
decreased thickness of bone
replacement of bone with abnormal less mineralised tissue

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42
Q

why may a lesion present as radiopaque - give four examples

A

increased thickness of bone
osteosclerosis of bone
presence of abnormal tissues
mineralisation of normally non-mineralised tissues

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43
Q

how may teeth be affected by a lesion present on a radiograph

A

displacement/ impaction
resorption
loss of lamina dura
widening of PDL
hypercementosis

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44
Q

name five potential causes of a periapical radiolucency

A

periapical granuloma
periapical abscess
radicular cyst
perio-endo lesion
ameloblastoma

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45
Q

how can infected cysts present on a radiograph

A

mimic radiographic features of malignancy
check clinically for features of secondary infection

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46
Q

name 6 types of jaw radiopacities

A

idiopathic osteosclerosis
sclerosing osteitis
hypercementosis
buried retained roots
unerupted teeth
supernumeraries

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47
Q

what is idiopathic osteosclerosis

A

localised area of increased bone density of unknown cause
is asymptomatic and often an incidental finding
can be relevant to ortho

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48
Q

how does idiopathic osteosclerosis present radiographically

A

well defined radiopacity
variable shape
less than 2mm
not associated with teeth but can appear next to them

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49
Q

what is sclerosing osteitis

A

localised area of increased bone density in response to inflammation
may present with symptoms
no expansion or displacement of adjacent structures

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50
Q

how does sclerosing osteitis present radiographically

A

well defined or poorly defined radiopacity
variable shape
directly related to source of inflammation

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51
Q

what is hypercementosis

A

excessive deposition of cementum around the root
asymptomatic

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52
Q

what diseases are hypercementosis associated with

A

Pagets disease
Acromegaly

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53
Q

what is the clinical relevance of hypecementosis

A

can make extractions more difficult

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54
Q

how does hypercementosis present radiographically

A

single or multi tooth involvement
homogenous radiopacity continuous with root surface
PDL space of tooth extends around periphery

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55
Q

what are buried retained roots

A

remnants of failed extractions or heavily broken down teeth

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56
Q

when would retained roots need to be managed

A

if infected
if symptomatic
if hampering treatment

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57
Q

name three reasons why salivary glands may be imaged

A

obstruction
dry mouth
swelling

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58
Q

what is ultrasound

A

no ionising radiation
uses high frequency sound waves at a frequency that cannot be heard audibly
as the waves hit different densities of the tissues it depends on length of time it gets back to the transmitter - determining the density in the photograph

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59
Q

what is the imaging protocol for salivary obstruction in order

A

ultrasound
plain film - mandibular true occlusal
sialography

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60
Q

name symptoms of salivary obstructive disease

A

meal time symptoms
rush of saliva into the mouth
saliva is bad tasting - salty
thick saliva
dry mouth

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61
Q

how does saliva obstruction occur and present on imaging

A

can be due to sialolith or mucous plug
saliva stones are usually hyperechoic (white) as the sound waves cannot pass through

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62
Q

what is sialography

A

injection of iodinated radiographic contrast into salivary duct to look for obstruction
can be done with panoramic skull views

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63
Q

name two indications for sialography

A

looking for obstruction or stricture of salivary duct
planning for access for interventional procedures

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64
Q

name four risks of sialography

A

discomfort
swelling
infection
allergy to contrast

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65
Q

how is sialography carried out

A

find duct orifice
serial dialators used to allow cannula to be placed
contrast administered
primary image captured
patient rinses
post contrast phase taken to make sure no contrast left

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66
Q

how does acinar changes present in sialography

A

snow storm appearance

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67
Q

how are saliva stones treated

A

incision to FOM to remove stone
gland removal if stone is too posterior to be reached by intra-oral approach

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68
Q

what is the 4 selection criteria for stone removal

A

stone must be mobile
stone should be located within the lumen on main duct distal to border of mylohyoid
stone should be distal to hilum or anterior border of gland
duct should be patent and wide enough to allow passage of the stone

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69
Q

what tests are done for patients with suspected sjogren’s syndrome

A

blood tests
schirmer test
labial gland biopsy
sialometry

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70
Q

what is a scintiscan

A

injection of radioactive technetium to assess how well the glands are working

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71
Q

what imaging is first line to rule out obstruction or neoplasia of salivary glands

A

ultrasound

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72
Q

what is a benign salivary gland tumour

A

pleomorphic adenoma

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73
Q

how does a pleomorphic adenoma present

A

well defined
encapsulated peripheral vascularity
no lymphadenopathy

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74
Q

what is a malignant salivary gland tumour

A

adenoid cystic carcinoma
acinic cell carcinoma

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75
Q

how do adenoic cystic carcinoma/ acinic cell carcinoma present on images

A

irregular margins
poorly defined
increased internal vascularity
lymphadenopathy

76
Q

what is MRI

A

useful for pre-surgical assessment
can see deep margins of lesions that are not seen on ultrasound

77
Q

when should MRI be taken with regards to biopsy

A

before a biopsy
if after - inflammatory appearances present on scan which can complicate diagnosis

78
Q

what is SUMP

A

salivary gland neoplasm of unknown malignant potential

79
Q

when would minor salivary glands need imaged

A

if enlarged or pathological

80
Q

what is a lipoma

A

benign fatty mass that appears as hypoechoic with hyperehoic (white) striations
typically avascular

81
Q

if a lipoma has related vascular structures what should be investigated for

A

liposarcoma

82
Q

what is the best imaging to asses quality and quantity of bone

A

CBCT or CT
MRI for changes in bone marrow that may not be picked up from the above

83
Q

name four oral bony lesions that may be viewed with CBCT after plain radiographic view

A

Osteonecrosis
MRONJ
Osteomyelitis
Odontogenic lesions (cysts)

84
Q

how does osteonecrosis / MRONJ appear on CBCT

A

moth eaten radiolucency with not-well defined cortical margins
can see central radiopaques which is bony sequestra

85
Q

how does osteomyelitis present on CBCT

A

moth eaten radiolucency with widening of PDL
patient is not on drugs associated with MRONJ and has not had radiotherapy

86
Q

what can CBCT be used for to screen odontogenic lesions

A

proximity of important structures
buccal-lingual expansion can be seen

87
Q

if a suspected cyst presents with not much buccal-lingual expansion what is it likely to be and what supplemental test should be done

A

keratocyst
biopsy for histopathological investigation

88
Q

is imaging required for myofascial pain in TMD

A

no

89
Q

what requires imaging in TMD

A

internal derangement
degenerative disease (osteoarthritis)

90
Q

what is used to assess internal derangement of TMJ

A

MRI
determines if it is with or without reduction
determines which direction the disc moves in relation to the condyle

91
Q

what views are required when assessing internal derangement with MRI

A

para coronal
para sagittal

92
Q

in a normal closed position where should the articular disc be sitting

A

between 12 and 9 o’clock in the fossa

93
Q

where does the articular disc sit in normal opening

A

between the condylar head and articular eminence with the narrowest point directly between the two structures

94
Q

why may CBCT be used in orthodontics

A

to assess marked facial asymmetry

95
Q

what is SPECT

A

imaging modality used to assess activity of joint

96
Q

what imaging can be used for head and neck oncology

A

CT
MRI
Ultrasound
PET

97
Q

what are the contraindications for MRI scans

A

pacemakers
cochlear implants
claustrophobia

98
Q

what three things is MRI better for assessing

A

perineural spread
bone invasion via bone marrow changes
soft tissue characteristics of lesion

99
Q

what is the gold standard imaging for neck lumps

A

ultrasound

100
Q

what is a PET scan

A

positron electron tomography
used if patient presents with neck lump but no primary tumour

101
Q

how does PET scan work

A

inject fluorine labelled glucose
goes to metabolically active tissues
ascertains the primary tumour
however normal movements of muscles can cause false positives

102
Q

name causes of generalised malformed roots

A

systemic illness as a child
tetracyclines during pregnancy
idiopathic

103
Q

what is the definition of a cyst

A

pathological cavity having fluid, semi-fluid or gaseous contents which is NOT created by the accumulation of pus

104
Q

when is the only time a cyst can be filled with pus

A

if the cyst is infected

105
Q

name five clinical signs of cystic presence

A

pain in the bone
mobility of surrounding teeth
swelling around the area
numbness
egg shell crackling noise when pressed

106
Q

what are the imaging modalities for cyst investigations

A

initial - PA, occlusal, panoramic
supplemental - CBCT, PA mandible, occipitomental

107
Q

what radiographic features of cysts should be described

A

location
shape
margins
locularity
multiplicity
effect on surrounding anatomy
include unerupted teeth

108
Q

what are the classifications of odontogenic cysts

A

developmental vs inflammatory

109
Q

what are the classifications of non-odontogenic cysts

A

development vs other

110
Q

what are odontogenic cysts

A

occur in teeth bearing areas
all lined with epithelium
arising from hertwig’s epithelial root sheath

111
Q

what is the Rests of Serres

A

remnants of dental lamina

112
Q

what are the types of developmental odontogenic cysts

A

dentigerous
odontogenic keratocyst
lateral periodontal cyst

113
Q

what are the types of inflammatory odontogenic cysts

A

radicular cysts
paradental cysts
buccal bifurcation cysts

114
Q

what is a radicular cyst

A

inflammatory odontogenic
always associated with non-vital tooth
initiates from chronic inflammation from non-vital tooth at apex

115
Q

what is the difference between a radicular cyst and a periapical granuloma

A

radicular cysts tend to be larger
if radiolucency is more than 15mm it tends to be a radicular cyst

116
Q

name four radiographic features of radicular cyst

A

well corticated round radiolucency
cortical margin continuous with lamina dura of non-vital tooth
larger lesions may displace adjacent structures
long-standing lesions may cause external root resorption

117
Q

what are the histological features of radicular cysts

A

epithelial lined
connective tissue capsule

118
Q

name five reasons a patient may experience a numb lower lip

A

compression of nerve by cysts
trigeminal neuralgia
tumours
damage to nerve from IDB
infection

119
Q

what are the variants of radicular cysts

A

residual cysts
lateral radicular cysts

120
Q

what is a residual cyst

A

type of radicular cyst that persists after the non-vital tooth has been extracted

121
Q

what is a lateral radicular cyst

A

cyst associated with an accessory canal
located at the side of the tooth

122
Q

what are inflammatory collateral cysts and give two examples of types

A

cyst associated with vital tooth
paradental cyst - occurs at distal aspect of partially erupted mandibular 8
buccal bifurcation cyst - occurs at buccal aspect of mandibular 6

123
Q

what is a dentigerous cyst

A

developmental odontogenic cyst
happens during failed eruption
the reduced enamel epithelium has not completely resorbed
the cyst will surround the crown of an unerupted tooth

124
Q

what is the histological features of a dentigerous cyst

A

thin non-keratinised stratified squamous epithelium
arises from reduced enamel epithelium

125
Q

what is the difference between a dentigerous cyst and enlarged follicle

A

follicle enlargement is less than 5mm

126
Q

what can increase in size of a dentigerous cyst lead to

A

damage to bone
fracture of bone
numbness of lip
pathology

127
Q

what is an eruption cyst

A

variation of dentigerous cyst but contained within soft tissue rather than bone
associated with erupting tooth
associated with rests of serres

128
Q

what is an odontogenic keratocyst

A

developmental odontogenic cyst
has no specific relationship to teeth
has scalloped margins
can cause displacement of adjacent teeth and root resorption

129
Q

what is the characteristic expansion of an odontogenic keratocyst

A

enlarges markedly in medullary bone before displacing cortical bone
so there is more mesio-distal expansion compared to buccal-lingual

130
Q

what are pre-operative diagnostic tests for OKC and what will the histology show

A

cyst aspirate
will contain squames and low soluble protein content

131
Q

name four histological features of an OKC

A

keratin in lining
parakeratosis
nuclei all at same level
when inflamed - keratin is lost

132
Q

what is the biggest problem of OKC

A

recurrence

133
Q

what is a syndrome associated with multiple odontogenic keratocysts

A

Basal Cell Naevus Syndrome
can cause multiple basal carcinomas of the skin
also known as Gorlin-Goltz syndrome

134
Q

what is a naso-palatine duct cyst

A

non-odontogenic developmental cyst
arising from remnants of nasopalatine duct epithelium
occurs in anterior maxilla at the midline

135
Q

how does naso-palatine duct cyst present

A

often asymptomatic
patient may have salty taste in mouth
larger cysts may displace teeth
ALWAYS involves midline

136
Q

what radiographic images are best for viewing nasopalatine duct cyst

A

periapical or standard maxillary occlusal

137
Q

how does nasopalatine duct cyst present radiographically

A

corticated radiolucency between roots of incisors
unilocular
may appear heart shaped

138
Q

what type of imaging can be used if greater visualisation of a cyst is required for surgical planning

A

CBCT

139
Q

what is a solitary bone cyst

A

non-odontogenic cyst without epithelial lining
most common in young people

140
Q

what is the radiographical presentation of solitary bone cyst

A

mostly occurs premolar/ molar region of mandible
variable definition and cortication
may have scalloped margins - pesudolocular

141
Q

what is a stafne cavity

A

no a cyst - is a depression in the bone
only occurs in mandible
contains salivary or fatty tissue

142
Q

how does Stafne cavity present radiographically

A

often in angle or body of mandible
asymptomatic
well define corticated radiolucency
rarely displaces adjacent structure

143
Q

what is the general rule for odontogenic vs non-odontogenic cysts

A

if below level of IAN canal = non-odontogenic

144
Q

how are odontogenic tumours classified

A

divided based on origin
epithelial
mesenchymal
mixed

145
Q

why do only mixed tumours have dentine and enamel formation

A

due to the concept of induction - ameloblasts only form enamel once dentine starts being deposited
dentine originates from mesencyme
ameloblasts come from epithelium

146
Q

what are the three odontogenic sources of epithelium

A

rests of malassez
rests of serres
reduced enamel epithelium

147
Q

what are rests of malassez

A

remnants from hertwigs epithelial root sheath which forms the outline of hard tissue of roots
once the formation ceases HERS breaks down but some remnants remain active in PDL

148
Q

what are rests of Serres

A

remnants of dental lamina which is responsible for formation of tooth germ
remnants remain in jaw

149
Q

what is reduced enamel epithelium remnants

A

remnants that cover the crown of unerupted tooth
can be source of odontogenic tumour

150
Q

name the three types of epithelial odontogenic tumours

A

ameloblastoma
adenomatoid odontogenic tumour
calcifying epithelial odontogenic tumour

151
Q

name the mesenchymal odontogenic tumour

A

odontogenic myxoma

152
Q

name the mixed odontogenic tumour

A

odontoma (odontome)

153
Q

name features of ameloblastoma

A

locally destructive but slow growing
painless
occurs in posterior mandible

154
Q

what is the typical radiographic appearance of ameloblastoma on adjacent structures

A

knife edged external root resorption of adjacent teeth

155
Q

what are the two types of ameloblastoma

A

follicular type
plexiform type

156
Q

how does the follicular type of ameloblastoma present histologically

A

islands present with fibrous tissue background
stellate reticulum like tissue
no connective tissue capsule

157
Q

name histological features of plexiform type of ameloblastoma

A

cells arranged in strands rather than islands
stellate reticulum like tissue present
no connective tissue capsule

158
Q

how is ameloblastoma managed

A

surgical resection with margin of 1mm of normal bone
recurrence common
small risk of malignancy

159
Q

how does adenomatoid odontogenic tumour present

A

unilocular radiolucency with internal calcifications around the crown of unerupted maxillary canine
well defined margins
impedes eruption

160
Q

how is adenomatoid odontogenic tumour differentiated from dentigerous cyst

A

adenomatoid odontogenic tumour usually attaches apically to CEJ

161
Q

what are the histological features of adenomatoid odontogenic tumour

A

epithelial cells arranged in duct like structures
rosette appearance
degree of calcification
fibrous tissue capsule

162
Q

how does calcifying epithelial odontogenic tumour present

A

slow growing but can grow to large
radiolucency that has internal radiopacities
variable appearance

163
Q

how does an odontogenic myxoma present

A

well defined radiolucency and thin corticated margin
slow growth causing notable buccal-lingual expansion
scallops between teeth

164
Q

what is the management for odontogenic myxoma

A

curettage or resection
follow up as recurrence common

165
Q

how do odontomas present

A

compound - ordered dental structures that appear as mini teeth
complex - disordered mass of dental tissues

166
Q

what type of odontoma is more common

A

compound 2 x more common than complex

167
Q

what special tests are done for bone abnormalities

A

blood calcium
osteoblast activity - serum alkaline phosphatase
osteoclast activity - collagen in urine
parathyroid hormone
vitamin D assays

168
Q

what are tori

A

developmental abnormality of bone
2 types - torus palatinus and torus mandibularis

169
Q

what is osteogenesis imperfecta

A

developmental abnormality of bone
causes weak bones and multiple fractures

170
Q

what is achondroplasia

A

dwarfism

171
Q

what is osteoporosis

A

lack of osteoclast activity
failure of resorption
marrow obliteration

172
Q

what is fibrous dysplasia

A

gene defect causing slow growing asymptomatic lesion

173
Q

what are the two types of fibrous dysplasia

A

monostotic
polyostotic

174
Q

what is monostotic fibrous dysplasia

A

single bone involvement

175
Q

what is polyostotic fibrous dysplasia

A

multiple bones involved
same side of body

176
Q

what syndrome can fibrous dysplasia be associated with

A

Albrights syndrome
early puberty
increased pigmentation of the skin

177
Q

what are the radiographic features of fibrous dysplasia

A

cotton wool appearance
margins blend into adjacent bone

178
Q

what is rarefying osteitis

A

localised loss of bone in response to inflammation
always occurs secondary to another form of pathology

179
Q

what is sclerosing osteitis

A

localised increase in bone density in response to low grade inflammation
always around tooth with necrotic pulp

180
Q

what is idiopathic osteitis

A

localised increase in bone density of unknown cause

181
Q

what is alveolar osteitis

A

dry socket
complication of extraction
very painful - loss of blood clot

182
Q

what is osteomyelitis

A

infection of the bone

183
Q

what is the condition that occurs in children that is a subsection of osteomyelitis

A

Garre’s sclerosing osteomyelitis

184
Q

what is bone necrosis

A

occurs if there has been severe infection (osteomyelitis) that has cut off blood supply

185
Q

what are the two types of bone necrosis

A

avascular - age related ischaemia
irradiation - ORN

186
Q

what are osteoclast inhibitor drugs used for (anti-resorbtive)

A

osteoporosis
Paget’s disease
bone metastases

187
Q
A

FINALS (25 decks)

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