Dr Islam Shawky
Lecturer of Oral Radiology,Faculty of Dentistry,Misr International University
MSc,PhD Oral and Maxillofacial Radiology,Faculty of Dentistry,Cairo University
Radiographic
Images
Analogue Image
Digital Image
(Film based Image)
Analogue Images
Processing
X-ray film
with
Latent Image
Analogue Images
are produced on dental films
The final image is a fixed image that is difficult to
manipulate.
Digital Image
• It is an image saved in a computer’s memory.
• It is composed of pixels(the picture elements and is
the smallest information unit) arranged in the form
of a matrix
Resolution (ability to display fine details).
Contrast (ability to distinguish different densities) of
the digital image
Both depend on the number of pixels and the gray
scale value of each pixel.
The conversion of this image into a digital one is
known as digitization.
Digital Radiography Systems
Depending on the type of image receptor
Indirect Digital Direct Digital Radiography
Radiography DDR
(Filmless)
IDR(Film-based)
(I) Indirect Digital Radiography
Conversion of an analogue
image to a digital image
[I] Indirect Digital Radiography (IDR) or Film-
based Digital Radiography:
a. Image detection:
The conventional dental film serves to receive and detect
the x-ray photons.
b. Image digitization:
The information on the radiograph is digitized by
transparency scanners, or digital cameras.
NB:
Indirect Digital Radiography still requires the use of
chemically processed dental film with the additional
time required to digitize, process and analyze the
resultant images.
Processing
X-ray film
ImageWith
Receptor
Latent Image
Photo stimulable Phosphor Charge Coupled Device
(PSP)
(CCD)
(Cordless System)
(Real Time or Corded System)
A] Charged Coupled Device (CCD):
The Image Receptor is an electronic sensor and is
connected to a computer by a "cable" or a wire.
That is why it is called charged coupled device as both
(the sensor and the computer) are coupled to each
other.
Charge Coupled Device (CCD)
Sensor Cable Computer
A] Charged Coupled Device (CCD):
Advantages:
1. Instant images (real time imaging) (direct).
2. Better resolution
3. More durable sensors.
Limitations:
1. Expensive thick and bulky sensors with cable.
2. Small size of the active area on the sensor.
B] Photostimulable phosphor plate imaging
system (PSP)
The Image Receptor is a PSP plate or an imaging
plate (IP).
There is no connection between the imaging plate
and the computer (cordless system).
Photo Stimulable Phosphor (PSP)
Plastic
plate
sleeve
Photostimulable Laser read out
Computer
Phosphor scanner
Imaging Plate
Advantages:
1. More sizes to choose from.
2. More comfort to the patient being a cordless
system.
3. Inexpensive plates.
Limitations:
1. Easy damage to plates
2. Less resolution of images in comparison to CCD.
3. More time consuming than CCD system (laser scan
takes about 20seconds)
Advantages of DR over conventional
Radiography:
1. Digital images are dynamic images that can be
enhanced for improving the quality of the image
thus allowing more accurate interpretation and
diagnosis.
Facilities for image enhancement include:
- Density - Contrast - Zooming - Black
to white conversion - Pseudo coloring - Edge
enhancement and sharpening
Full mouth series
Magnified image
contrast
brightness
Adjust brightness, contrast
“Flashlight”or zooming feature
Measuring curved root
Colorization
Reverse black and white
Tooth # 4 has Combo perio/endo involvement.
Crack noted in apical third of tooth.
Removal of # 4 indicated, to be followed by new
bridge or implants.
Notes (problem, cost, etc.)
Combining intraoral/radiograhic
2. Digital radiography provide greater sensitivity in
detecting early subtle bone changes
3. DR is superior to conventional radiography in
comparative studies from serial radiographs thus it
provides better assessment of disease progress or
treatment effects.
4. DDR uses only 10% of the radiation dosage required
for conventional radiography (more than 80%
reduction in radiation)
5. DDR provides instant (real-time display).
6. DDR eliminates the use of a dark room, film costs,
as well as providing environmental safety due to
elimination of processing chemicals.
7. DR provides improved patient education and
communication as well as being more impressive
to the patient.
8. DR provides improved archival quality of images
being stored on electronic media and prevents
deterioration of images.
9. DR provides easier transfer of information and
consultation through "Tele-radiography“.
Clinical applications of DR in Dentistry:
1. DR in periodontology:
a. Detection of incipient bone changes.
b. Following bone grafting procedures.
c. Linear and densitometric analysis for bone height and
density assessment.
2. DR in endodontics:
a. Accurate and fast determination of working
length.
b. Better visualization of root canal, tooth apex and
apical curvatures.
c. Color enhancement provides an aid in revealing
any defect in root canal filling.
3. DR in caries detection:
DR has increased the accuracy of detection of caries
through image analysis facilities which improve
the quality of the image and thus their diagnostic
quality.
4. DR in Implantology:
a. Provides an accurate tool in pre-operative implant
planning as it provides assessment of alveolar ridge
height and quality as well as accurate consideration
of neighbouring anatomic structures.
b. Post-operative assessment of bone remodeling
through evaluation of peri-implant height and density
changes and comparing them to successive images.
Digital Subtraction Radiography
A computerized process that is done by serially taken
two radiographs of the same area in the mouth with the
same image geometry at different time intervals. The
first image can be subtracted from the second one to
identify changes that may have occurred during a certain
time period.
Result:
0 (neutral or gray) No change
+ (Brighter) Bone Gain
- (Darker) Bone loss
5. DR in detection of peripical lesions:
DR provides an accurate method for detection of early
periapical lesions through monitoring changes in
bone density before being seen on conventional
radiographs.
7. DR in Oral Surgery and Orthognatic surgery:
DR helps in assessment of bone density changes
following bone grafting.
Thank You