W2 Flashcards

1
Q

Describe the History of Dental Radiology in brief

A

X-rays…
* Discovered by Professor Wilhelm Conrad Roentgen in 1895. Named them, Unknown rays (X-rays). published the article on X-rays on 5th Jan, “A Sensational Discovery”
* 2 weeks after Roentgen’s publication Dr Otto Walkhoff made the first picture of teeth - intraoral radiograph after an exposure of 25 min.
* Dr Edmund Kells - FIRST to expose dental radiograph in the United States

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2
Q

Describe the Atomic structure

A

7 protons (postitive charge) and 7 neutrons (neutral charge) in the nucleus
7 electrons (negative charge) orbiting around the nucleus

number of electrons = number of protons in an atom = atom has no net charge/electrically neutral

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3
Q

Define electromagnetic radiation and list the types (including x-rays)

A

Electromagnetic radiation: movement of energy through space as a combination of electric and magnetic fields
Types: X-ray, radiowaves, visible light, microwaves and gamma rays, travel at the speed of light (3X10^8m per second)

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4
Q

What is Electrostatic force?
Will electrons closer to the nucleaus have greater or less electrostatic force?

A

Attraction between the positive protons and negative electrons
Electrons in the orbit closest to the nucleus (the K-shell) will have a greater electrostatic force.

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5
Q

What is radiation? List the two types.

A

Radiation is the transmission of energy through space and matter
1. Particulate radiation: Alpha particles, Betaparticles and cathode rays
2. Electromagnetic radiation

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6
Q

What is ionisation and ionisation energy? How does it occur?

A

If an atom loses an electron, the nucleus becomes a positive ion and the free electron a negative ion = process of forming an ion pair = ionization.
Binding energy (ionization energy); is the amount of energy required to overcome the electrostatic force to remove an electron from its orbit

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7
Q

What does the left side and right side represent on this electromagnetic spectrum?

TEST

A

Ionising radiation = LEFT SIDE (strong waves, short wavelength, high freq., high penetrating ability = easily ionise)

Non-ionising radiation = RIGHT SIDE (long wavelength, low freq., low penetrating ability)

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8
Q

Compare Ionizing and Non-ionizing radiation

A

Ionizing radiations - Radiation consisting of particles, X-rays, or gamma rays with sufficient energy to cause ionization in the medium through which it passes.
Nonionizing radiations - ex. visible light, infrared, and microwave radiation, and radio waves do not have sufficient energy to remove bound electrons from their orbitals.

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9
Q

What does wavelength, frequency, distance and energy represent in electromagnetic radiation,

A

The wavelength (W) is the distance from the crestof one wave to the crest of the next wave.
The frequency (F) is the number of waves in a given distance (D).
Energy of a wave of electromagnetic radiation represents the ability to penetrate an object. Shorter W = greater energy

top wave above has a shorter wavelength, higher frequency and greater energy than the wave below it

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10
Q

Explain the characteristics of an X-ray

A
  • X-rays are high energy waves, with very short wavelengths (0.1 – 0.001 nm), and travel at the speed of light.
  • X-rays have no mass (weight) and no charge (neutral).
  • You cannot see x-rays; they are invisible.
  • X-rays travel in straight lines;
  • X-rays are differentially absorbed by the materials they pass through.
  • X-rays will cause certain materials to fluoresce (give of flight)
  • X-rays can be harmful to living tissue. therefore keep the number minimum
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11
Q

What does it mean by X-rays are differentially absorbed by the materials they pass through.?

A

More dense materials (like an amalgam restoration) will absorb more x-rays than less dense material (like pulp tissue)

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12
Q

List the three basic components of an X-ray

A

the X-ray tubehead, which produces the x-rays
Support arms, which allow you to move the tubehead
The control panel, which allows you to alter the duration of the x-ray beam (exposure time)

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13
Q

List the components of an x-ray tube

A
  1. Focusing cup (Molybdenum): focuses electrons on target
  2. Tungsten Filament: releases electrons when heated
  3. Electron stream: electrons cross from filament to target
  4. Vacuum: to prevent collision of the moving electrons with gas molecules which can reduce the speed of electrons & prevents oxidation and burnout ofthe filament.
  5. Tungsten Target: x-rays produced when electrons strike target
  6. Copper stem: Houses the target and helps remove heat from target
  7. Leaded glass: Keeps x-rays from exiting tube in wrong direction
  8. **X-rays **produced in target are emitted in all directions
  9. Beryllium window: this non-leaded glass allows x-rays to pass through. The PID would be located directly in line with this window
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14
Q

What parts of the x-ray tube make up the cathode and anode.

A

Cathode = Negatively charged
Anode = Positively charged

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15
Q

What is thermionic emission?

A

When we depress the exposure button -> electricity flows through the filament -> hot -> electrons released

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16
Q

Why is the target made of Tungsten?

A

Tungsten = Only metal that has high atomic number, high melting point, high thermal conductivity and low vapor pressure

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17
Q

Describe the Line Focus Principle

A

target is placed at an angle of 20 degree to the X-ray beam = smaller source of X-rays and sharper image

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18
Q

Compare the two types of x-rays that are produced

A

Two types of x-rays produced in the target of the x-ray tube…
1. Bremmstrahlung/general radiation (majority): high-speed electrons pass close to, or strike, the nuclei of the target atoms. Electrons are slowed down and change direction = E released in form of X-rays
The higher the speed of the electrons, the higher the average energy of the x-rays produced
2. Characteristic radiation: High energy electron hits inner most electron (K shell) knocking off the electron. The elctron from L takes its place. The energy of X-Ray will be equal to the difference between the binding energies of the target electrons involved

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19
Q

What are the three factors that absorb the excess heat produced by X-rays?

A

High melting point of tungsten target
Conductive properties of copper stem
Oil surrounding X-ray tube

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20
Q

List the factors controlling X-Ray beam

A

kVp control: increase = number of X-rays and kinetic energy (greater penetration and contrast)
mA setting: increase = increase number of X-rays (sharper)
Exposure time: increase = increase number of X-rays (sharper)
Filtration: = only high energy X-rays
Collimation = reduce radiaton scope

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21
Q

Describe the three filters used in Inherent filtration. Describe the factor needed to achieve total filtration

A

Beryllium window, oil surrounding tube head, barrier material
= filter low energy X-rays = High E X-rays

Sometimes manafacture can add filter of Al = Total Filtration

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22
Q

What is collimation?

A

metallic barrier (lead disc) with anaperture in the middle used to reduce the size of the X-ray beam and therefore the volume of the irradiatedtissue in a patient

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23
Q

Explain the Interaction of X-Rays with matter

A

90% of X-Rays get absorbed
B - Of the absorbed X-rays, 70% undergo scattering within the tissues (compton and coherent scattering). These scattered radiations reach the film and degrade the image quality
C - The rest 30% of absorbed X-rays are critical in diagnostic imaging. More X-rays are absorbed by bone (causing bone to appear white on radiograph) than by soft tissues (which appear dark in radiograph)
(A) - 10% directly reach the film without interacting with the tissues

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24
Q

Define Attenuation and list and describe the three ways in which it can occur.

A

Attenuation = Reduction of x-ray beam intensity (thatr eaches film) by interaction with matter (tissues)
It occurs by…
1. Coherent scattering: X-ray beam hits outer shell electron causing vibration (8%)
2. Compton scattering: X-ray beam knocks out outer shell electron (62%)
3. Photoelectric absorption: X-ray beam knocks out innermost electron and electron from next shell drops to fill vacency (30%)

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25
Q

How does Ionizing radiation cause damage?

2 ways

A

Direct effect: Energy of photon is transferred directly to biological macromolecules (DNA/RNA)
Indirect effect: 75% of our cells contain H20. Radiolysis of water (Radiation interacts with H2O = H2O2 (Hydrogen peroxide) = damage the cell by breaking down proteins or DNA)

TEST

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26
Q

Radiation effects at cellular level

A

Effect on…
* Proteins: Changes in the secondary and tertiary structure, disruption of the side chains, breakage of hydrogen and sulfide bonds
* Nucleus: DNA - change or loss of base, disruption of Hydrogen bonds, breakage of DNA strands.
* Chromosomes: type of damage that is visualized depends on stage of cell cycle
* Cytoplasm: high doses are required to cause visible damage = increased permeability to Na and K = changes in cellular mechanisms
* Mitosis: delayed mitosis
* Cell death
* Cell recovery

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27
Q

List the three radiation effects at tissue and organ level

TEST - 3 effects of radiation on tissue

A

Deterministic effects => Somatic Deterministic effects
Stochastic effects => Somatic Stochastic effects OR Genetic stochastic effects

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28
Q

Define Somatic Deterministic effects and list examples

A

Damaging effects to the body of the person exposed that will definitely result from high dose radiation
* threshold dose below which there will be no effect
* Severity of effect is directly proportionate to the dose of radiation
* Ex. Radiotherapy -> Skin reddening, Cataract, Mucositis

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29
Q

Effects of Radiotherapy on oral cavity

TEST?

A
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30
Q

Can somatic deterministic effects be seen with Dental Radiology?

A

No somatic deterministic effects due to small dose (well below threshold)

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31
Q

Define Somatic Stochastic effects and list examples

TEST

A

Effects (carcinogenesis) that may (probability of occurrence) develop as a result of exposure to radiation
Probability of getting cancer depends on amount of radiation exposure. Higher the dose = higher probability of getting a cancer.
* There is no threshold dose
* Severity of effect is not proportionate to the dose of radiation
Ex. Japanese atom bomb survivors developed cancer, irradiation treatment for postpartum mastitis

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32
Q

Since there is no evidence of a lower threshold for the appearance of Somatic Stochastic Effects, the prudent course of action is to ensure that all radiation exposures follow a principle known as….

A

ALARA (As Low As Reasonable Achievable)
Effects of Diagnostic dose (very low) of radiation ‐ eg ‐Dental X‐Ray radiation is not much but considered as a risk factor therefore avoid unnecessary exposure of radiation to patients therefore avoid unnecessary exposure of radiation to patients

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33
Q

Are pregnant patients able to have intraoral X-rays?

A

should have radiographs taken if and only if absolutely indicated for diagnosis by *weighing the advantages and disadvantages** However radiation protection measures should be taken for pregnant patients especially in the 1st and 3rd trimester to avoid risk to the unborn

No contraindicated, make assessment if necessary

34
Q

Define Genetic Stochastic effects and list examples

A

Effects due to Mutation in gene/chromosome of a germ cell (sperm or ovum)
Radiation to the reproductive organs may damage the DNA of germ cell and result in congenital abnormality of the offspring

35
Q

Describe the consideration of Genetic Stochastic effects in Dental Radiology

A

No much effect, since dental radiography does not involve irradiating the reproductive organs. BUT STILL THERE MAY BE A RISK OF SCATTERED RADIATION TOTHE REPRODUCTIVE ORGANS. Hence all radiation exposures should follow ALARA principle

36
Q

List the various radio-sensitivity of different tissues/organs

A

High = high mitotic activity (cell division)

37
Q

Describe the different direct effects of radiation on somatic cells vs reproductive stem cells.

A

If the radiation hits somatic cell = radiation induced malignancy
If the radiation hits reproductive stem cell = radiation induced congenital abnormality

38
Q

Describe Acute Radiation Syndrome

A

Effects of whole body irradiation
Somatic Deterministic effect
Collection of signs and symptoms experienced by humans exposed by medical radiotherapy, atom bomb blastsand radiation accidents.

Doses
39
Q

What dose of radiation produces harmful effects?

A

Any exposure, however small it may be,can produce harmful effects

40
Q

Describe the two sources of radiation

A
41
Q

What is Dosimetry?

A

Determining the quantity of radiation exposure or dose

42
Q

Define exposure

A

Measure of ability of radiation to produce ionization in air

43
Q

What is the absorbed dose?

A

measure of the energy deposited in a medium by ionizing radiation per unit mass - depends on absorbing medium
Eg. X-ray beam maydeposit four times more dose in bone than in air
Used to estimate the risk of acuteradiation syndrome

SI Unit – Gray(Gy)

44
Q

What does the Equivalent dose represent?

A

Used to compare the biologic effects ofdifferent types of radiation on a tissue or organ
Equivalent dose = Absorbed dose X RadiationWeighing factor(WR)

45
Q

What does the SI unit stand for?

A

SI Unit = Sievert (Sv)

46
Q

What does the Effective dose represent?

A

measure of the cancer risk to a whole organism due to ionizing radiation delivered non-uniformly to part(s) of its body
* It takes into account both - the type of radiation and the type and amount of tissue exposed
Effective dose = Equivalent dose X Tissue Weighing factor (WT )

47
Q

What does tissue Weighing factor (WT) represent?

A

Determined based on sensitivity of organs to radiation. More the Weighing factor more the risk of cancer

48
Q

What does the Collective effective dose represent?

A

Measure used when considering the total effective dose to the population from a particular source of radiation

Collective effective dose = Effective dose X population

49
Q

What does ARPANSA stand for?

A

Australian Radiation Protection and Nuclear safety agency (ARPANSA)

50
Q

What are the dose limits according to ARPANSA

Impt.

A
  • Dose limits for Public – 1 mSv in a year averaged over a period of 5 consecutive calendar years
  • Dose limits for Occupational – 20 mSv per year, averaged over a period of 5 consecutive calendar years
  • Dose limits for pregnant dental practitioner – 1mSv
51
Q

The degree of risk from radiation can beexpressed in 2 ways:
1) Equivalent natural exposure
2) Probability of stochastic effect

Describe the equivalent natural exposure for bitewings and OPG

A
  • 2 bitewings – 0.004 mSv – approximately thesame as 2 hours on a plane
  • OPG – 0.007 mSv – approximately the same asjust over 3 hours on a plane
52
Q

Is the statement “having 2 intraoral radiographies = 1/2 million risk of cancer” considered to be
1) Equivalent natural exposure
2) Probability of stochastic effect

A

2) Probability of stochastic effect

53
Q

What is the Objective of Radiation protection

A

To provide an appropriate standard of protection for man without unduly limiting the beneficial practices giving rise to radiation exposure

54
Q

List the three guiding principles in radiation protection

A
  • Principle of justification - do more good than harm. In practice thisprinciple influences what patients we select for radiographicexaminations and what examinations we choose
  • Principle of optimization - use every means to reduce unnecessaryexposure to their patient and themselves – ALARA Principle
  • Dose limitation - for occupational and public exposures to ensure that noindividuals are exposed to unacceptably high doses
55
Q

Describe Radiation protection for the Patient

A
  • No unnecessary radiographs
  • Only advised after taking detailed history, a thorough clinical examination and considering dental and general health needs of the patient
  • Optimization: reducing the exposure as much as possible - proper settings and technique
  • Avoid repeats: Adequate training, technique, handling, processing, interpretation and documentation of findings
  • Equipment Reliability: functioning properly, settings for the exposure factors (exposuretime, mA, kVp)
  • Lead barriers ie, apron (thickness .25mm)
  • Pregnancy Precautions: ask, avoid, shield
56
Q

Describe Radiation protection for the Operator

A

Time – Distance – Shielding principle
* Reduce the exposure time
* Increase distance from the source
* Shielding using lead barriers and room (thick wall, concrete, barium, plaster, lead)
* Never hold the film for the patient during exposure, parent or individuel with lead apron
* Wear your exposure badge and check the exposure report monthly

57
Q

Describe Radiation protection for the Public

A
  • Never allow other people
  • X ray beam to be directed towards the outside wall
  • Hazard light and sign on the door
58
Q

What are the Responsibilities of a Clinician

A
  • Ensure if radiograph is really indicated
  • Use the best radiographic technique
  • Proper processing
  • Interpretation of radiographs to be shared with Dento-maxillofacial Radiologist
  • Maintain radiographic records
59
Q

Describe the Radiation safety Act 1999

A

Regulations relating to dental radiography
* Dispose & Relocate: notification of disposal and application to relocate out of state
* Monitoring badges: Extra-oral - based on work-load (justify in plan)
* Radiation Safety Officer: possession licensee unless the possession licensee is a company
* Radiation Safety Plan: Radiation Safety and Protection Plan (RSPP) is adocument submitted by a possession licence applicant to ensure that persons and the environment, are protectedfrom the harmful effects of radiation
* Radiographic Record (Log Book)
* Audits: examining log books, lead aprons, x-ray equipment.

60
Q

Who can get a license

A
  • Registered dentists
  • Registered oral health therapists
  • Registered dental therapists
  • Registered dental hygienists
  • Dental assistants
  • Student dental assistants
  • Student dental practitioners
61
Q

What are the details required for the radiographic record (log book)

A
  • Date radiograph taken
  • Name of patient
  • DOB of patient
  • Gender of patient
  • Name of radiographer
  • Type of radiograph
  • Exposure factors (unless standard)
62
Q

What is Dosimetry?

A

Determining the quantity of radiation exposure or dose

63
Q

What dose of radiation produces harmful effects?

A

Any exposure, however small it may be,can produce harmful effects

64
Q

Describe the two sources of radiation

A
65
Q

What does the absorbed dose represent?

A

measure of the energy deposited in a medium by ionizing radiation per unit mass - depends on absorbing medium
Eg. X-ray beam maydeposit four times more dose in bone than in air
Used to estimate the risk of acuteradiation syndrome

SI Unit – Gray(Gy)

66
Q

Define exposure

A

Measure of ability of radiation to produce ionization in air

67
Q

What dose of radiation produces harmful effects?

A

Any exposure, however small it may be,can produce harmful effects

68
Q

Describe the two sources of radiation

A
69
Q

What is Dosimetry?

A

Determining the quantity of radiation exposure or dose

70
Q

Define exposure

A

Measure of ability of radiation to produce ionization in air

71
Q

What does the absorbed dose represent?

A

measure of the energy deposited in a medium by ionizing radiation per unit mass - depends on absorbing medium
Eg. X-ray beam maydeposit four times more dose in bone than in air
Used to estimate the risk of acuteradiation syndrome

SI Unit – Gray(Gy)

72
Q

What dose of radiation produces harmful effects?

A

Any exposure, however small it may be,can produce harmful effects

73
Q

What does the absorbed dose represent?

A

measure of the energy deposited in a medium by ionizing radiation per unit mass - depends on absorbing medium
Eg. X-ray beam maydeposit four times more dose in bone than in air
Used to estimate the risk of acuteradiation syndrome

SI Unit – Gray(Gy)

74
Q

Define exposure

A

Measure of ability of radiation to produce ionization in air

75
Q

What is Dosimetry?

A

Determining the quantity of radiation exposure or dose

76
Q

Describe the two sources of radiation

A
77
Q

Define exposure

A

Measure of ability of radiation to produce ionization in air

78
Q

Describe the two sources of radiation

A
79
Q

What does the absorbed dose represent?

A

measure of the energy deposited in a medium by ionizing radiation per unit mass - depends on absorbing medium
Eg. X-ray beam maydeposit four times more dose in bone than in air
Used to estimate the risk of acuteradiation syndrome

SI Unit – Gray(Gy)

80
Q

What is Dosimetry?

A

Determining the quantity of radiation exposure or dose

81
Q

What dose of radiation produces harmful effects?

A

Any exposure, however small it may be,can produce harmful effects