dig·i·tal a·nal·o·gue

(d¹j“¹-tl) adj.. (²n“…-lôg”) n.

1. Of a digit. Similar or alike
2. Expressed as or
giving a read-out
in digits:
a digital clock.
-- dig“i·tal·ly adv..

Digitization : conversion of data into

Digitalization
binary numbers using a computer
The American Heritage® Concise Dictionary,
Third Edition 1994
 DIGITAL
Digitus – Greek word, meaning finger – countability
Digital radiogaphy – defined as a system for acquisition,
processing and display of radiographic images using modern
data processing technology
Digitization: conversion of data into
binary numbers using a computer
 THE
THE DIGITAL
DIGITAL ERA
ERA
Direct Digital Photography in 1992

Direct Digital Radiography in 1989

Radio-Visio-Graphy (Trophy, France)

1970s:
1970s: Solid statedeveloped
Scanners > Indirect Digitization
photodiodes

Photodiodes (valve type) in 1960s

Computer: machine that

performs tasks under the
control of a set of instructions First transistor in 1948
called a program.
Brattain,
1956 Bardeen
Nobel Prize & Shockley
in physics
Bell Laboratories
First digital computer in 1942
 Digitization: conversion of data into
binary numbers using a computer

Direct Digitization
e.g. direct digital radiography
as in RVG, video cameras
Indirect Digitization
e.g. scanning of conventional
radiographs & photographs
 HISTORY

Dr. Francis Mauyen 1987

Paul Suni, Finnish physicist

 INTRODUCTION
Digital radiography refers to a method of capturing a
radiographic image using a sensor, breaking it into electronic
pieces and presenting & storing the image using a computer.
 Advantages

Less radiation, reduced patient dose

Eliminates chemical processing
Electronically transferred to other health care providers
Superior gray-scale resolution of 256 colors of gray;
conventional film-16-25 shades of gray
Enhancement of diagnostic image
Detection of defects & 3D visualization of dental structures
Effective patient education tool.
Computer hardware/software allows to view & store images
Multiple images are obtained without changing film holders or
using new films
 Disadvantages
Initial expense of setting up of a digital imaging system
Sensor size thicker than intraoral film
Infection control difficult
Receptors susceptible to rough handling and costly to replace
Legal issues
 Uses
Detect lesions, diseases , conditions of teeth and
surrounding structures
To confirm & classify suspected disease
Information in RCT, surgical placement of implants
Evaluate growth & development
Illustrate changes secondary to caries, periodontal disease
or trauma
Methods to obtain digital mage
Direct digital imaging

Indirect digital imaging

Storage phosphor imaging

 Equipment
X-radiation source

Intraoral sensor

Digital image display

 Analog Vs Digital
Analog- Conventional film images,
size & distribution of black metallic silver
result in continuous density spectrum

Digital – numeric format of the image

content & its discreteness
• Spatial distribution of picture
elements(pixels)
• Different shades of gray of each of the
pixels
Digital image - individual pixel has matrix of rows & columns
Electrons in electronic detector is visualized as being divided
into blocks or picture elements – PIXEL
Pixel-digital equivalent of a silver crystal , very structured
At each pixel of electronic detector, absorption of x-rays-
generates small voltage.
Voltage fluctuate at each pixel b/n min and max value- analog
signal
Digital image is produced-ANALOG – DIGITAL
CONVERSION (ADC)
In digital radiography, instead of the silver halide grain the
image is constructed using pixels or small light sensitive
elements. These pixels can be a range of shades of grey
depending on the exposure, and are arranged in grids and rows
on the sensor, unlike the random distribution of the crystals in
standard film.
However, unlike film the sensors are only the radiation detector
and the image is displayed on a monitor.
The signal that is produced by the sensor is an analogue signal,
i.e, a voltage that varies as a function of time.
The sensor is connected to the computer and the signal is
sampled at regular intervals.
The output of each pixel is quantified and converted to numbers
by a frame grabber within the computer.
The range of numbers is normally from 0- 256 with 0
representing black, 256 representing white and all other shades
of grey
The number of grey levels relates to contrast resolution and the
size of the pixels is related to spatial resolution
Together these determine the overall resolution ( ability to
distinguish small objects close together ) of the image.
Resolution can be expressed in line pairs per millimeter
Most conventional E speed films have a resolution of 20
LP/mm where as the digital images the resolution ranges from
7-10 LP/mm.
 Steps in ADC
Sampling: small range of voltage grouped as single value
Quantization : signal is quantized-every sampled signal is
assigned a value.
Values stored in computer
Computer organizes each pixel in their location
Gives them a shade of grey that corresponds to the number that
was assigned during the quantization step
 DIGITAL DETECTORS
CHARGE COUPLED
DEVICE ( CCD )

COMPLEMENTARY
METAL OXIDE
SEMICONDUCTORS

PHOTOSTIMULABLE
PHOSPHOR PLATES

FLAT PANEL
DETECTORS
 Charge-Coupled Device (CCD)
is a sensitive electronic device
that stores packets of information
as electric charge.
Developed in late 1970s for video applications by Boyle
A CCD is made of an array of
& Smith
Bell Telephone Laboratories
photodiodes (devices that
conduct electricity when light
or x-rays strike them) on top of
a semiconductor.
 CHARGE COUPLED DEVICE(CCD)
DETECTOR
Thin silicon wafer
Silicon crystals are formed in a picture element (pixel)matrix
X radiation breaks covalent bonds b/n silicon atom – electron
hole pairs
Electrons attracted to most positive potential of device-
“charge packets”
Each packet corresponds to one pixel- latent image
Image is read by transferring each row of pixel charges from
one pixel to the next – BUCKET BRIGADE fashion
Charge on reaching the end of its row is transferred to read
out amplifier & transmitted as voltage to AD converter of
computer
Pixel size- 20 to70 microns
CCD/CMOS-based Sensor

X-ray
Beam

Scintillator
Fiber Optics
CCD
CCD/CMOS
CCD more sensitive to light than X-rays
Layer of scintillating material(a flourescent screen sensitive to
high frequency electromagnetic radiation and emitting
electromagnetic waves of longer wavelength (Gadolinium
oxybromide)coated on the CCD surface/coupled to surface –
fiber optics
 An element with electrical resistivity
intermediate between that of a conductor and
that of an insulator is called as a semiconductor.
Silicon crystal: Atomic
arrangement
+4e +4e +4e

+4e +4e +4e

+4e +4e +4e

+ve electron
“electron- hole pair”
“Charge-Coupled Device”

+4e +4e +4e hole

Pure silicon
Inherent temperature Vibration of atoms
Ejection of some electrons
to the conduction band
Movement of electrons
to the +ve terminal
Electrical conduction
Electrical conductivity is increased by ‘doping’ i.e.
addition of impurities to the semiconductor material
thus increasing the availability of electrons.

The semiconductor elements used most commonly

are silicon and germanium.
The impurities added most commonly are Other impurities added are indium, gallium
arsenic, and boron
antimony and phosphorus
p- n-
giving rise to n-type of giving rise to p-type of
type type
semiconductor. semiconductor.
 Photodiode
silicon dioxide Metallurgical junction
insulating layer

p-type

n-type

Aluminium
 Photodiode
Radiation

p-type
Electron      
   
well   
n-type
Image Capture from a Photodiode

 p-type 

    
   

n-type Display
Storage
Printer

Computer
serial output hardware &
output register amplifier software
 “Bucket Brigade Device”

“Charge-Transfer Device”

serial
output register
 COMPLEMENTARY METAL OXIDE
SEMICONDUCTORS(CMOS)
Transistors are integrated into each pixel and the charge acquired
by the pixel is directly amplified and transferred.
Silicon semiconductors
Electron hole pairs in each pixel = amount of x-ray energy
absorbed
Charge transferred to transistor as small voltage
Voltage in each transistor is read separately by the frame grabber
Is then stored and displayed as digital gray value
Used commonly in CPU chips & video camera detectors
25 % more resolution
Greater durability
 PHOTOSTIMUABLE PHOSPHOR
PLATES, OR PSP
are plates that after being radiated can be scanned into a
computer's imaging software via a special scanner.
Indirect digital PSP utilizes a reusable plate in place of the
film.
After X-ray exposure the plate (sheet) is placed in a special
scanner where the latent formed image is retrieved point by
point and digitized, using laser light scanning.
The digitized images are stored and displayed on the computer
screen.
 PHOTOSTIMULABLE PHOSPHOR PLATES (PSP)
Absorb & store energy from X-rays

Release energy as light(phosphorescence) – stimutated by light of an

appropriate wavelength

Europium doped bariumfluorohalide

Crystal lattice-barium+iodine+chlorine(bromine)

Red light 600nm-electrons released by bariumfluorohalide to

conduction band

When electron returns to europium ion, energy is released in green

spectrum b/n 300 and 500 nm
Red filter at photomultiplier tube selectively removes
stimulating light, & green light converted to voltage

Voltage signal quantified by ADC converter, stored &

displayed as digital image

PSP plates –sizes as intraoral films and panoramic and

cephalometric imaging

PSP plate -erased before use to eliminate ghost images

Plates processed quickly

Susceptible to bending & scratching – permanent artifacts in

receptor – obscure information of potential diagnostic value
Latent image on PSP plate can be read by:
 Stationary plate scans - rotating multifaceted mirror reflecting
beam of red laser light.
 Rotating plate scans – rotation of drum past a fixed laser
provides a scan

Resolution of PSP systems determined by:

 Thickness of phosphor material
 Diameter of the laser beam
Storage Phosphor

X-ray
Beam

Imaging Plate
Storage Phosphor
Helium-Neon
Laser

Photoreceptor

Imaging Plate
Storage Phosphor
Storage Phosphor
DIGITAL DETECTOR CHARACTERISTICS
CONTRAST RESOLUTION

SPATIAL RESOLUTION

DETECTOR LATITUDE

DETECTOR SENSITIVITY
 CONTRAST RESOLUTION
• Interaction of attenuation
characteristics of tissues being
imaged
• Image receptor capacity to
distinguish diff in no of photons
coming from diff areas of subject
• Ability of computer display to
portray diff in density
• Ability of observer to recognize
differences
NOISE- densities captured limited
by inaccuracies in image acquisition
 SPATIAL RESOLUTION

Capacity to distinguish fine detail

Limit of resolution-pixel size
Resolution measured- units of line
pair per millimeter
LINE PAIR(lp) - line & it’s
associated space
2 pixels required to resolve a line
pair
 DETECTOR LATITUDE
Ability of imaging receptor to capture a range of X-ray
exposure
Full range of densities – gingiva to enamel
PSP receptors – larger latitude

DETECTOR SENSITIVITY
Sensitivity of detector to respond to small amt of radiation
Factors affecting : detector efficiency ,pixel size, noise
 DIGITAL IMAGE DISPLAY
 CATHODE RAY TUBE(CRT)

 THIN FILM TRANSISTORS (TFT) :

FPD, laptop
 Signal to pixel transistor - causes
associated LCD to transmit light with
an intensity proportional to the
transistor voltage
 Computer monitor allows immediate
viewing of the exposure which the
computer digitizes, processes &
stores information
Image can be:
Stored permanently
Printed on hard copy : Film printers-laser sublimation
Paper printers-DPI
Transmitted electronically to insurance companies or
referrals
 IMAGE VIEWING FEATURES
SPLIT SCREEN TECHNOLOGY
MAGNIFICATION
IMAGE RESTORATION
IMAGE ENHANCEMENT
 IMAGE ENHANCEMENT
BRIGHTNESS & CONTRAST
SHARPENING & SMOOTHING
COLOR
DIGITAL SUBTRACTION RADIOGRAPHY
IMAGE ANALYSIS
IMAGE STORAGE
IMAGE COMPRESSION
IMAGE SYNTHESIS
 BRIGHTNESS & CONTRAST
Image histogram : tool to
examine gray values the
image is using
Min & max values & shape
of histogram equalization
and contrast inversion
Selectively enhance relevant
radiographic signs without
simultaneously distracting
signs.
 SHARPENING & SMOOTHING
Improve quality by removing blur or NOISE
Noise: characterized as high frequency noise(speckling) or low
frequency noise(gradual intensity changes)
Filters – DESPECKLING filters

IMAGE ANALYSIS
Designed to extract diagnostically relevant information from
image
Tools: digital rulers, densitometers
Segmentation, feature extraction, object classification
 IMAGE STORAGE
Internal hard disk
External hard disk
Digital tapes
CDs
DVDs
Digital image backup considerations:
 Type of backup media
 Time & method of backup
 Backup interval
 Storage location of backup media
 Backup technology
 Recovery time
 Recovery reliability
 IMAGE COMPRESSION
Reducing size of digital file for archiving &
transmission

IMAGE SYNTHESIS
Access information in 3 dimensions
CT, MRI, PET scanners
Diagnostic Accuracy
Primary Dental Caries

Recurrent Dental Caries

Periodontal Disease

Periapical Lesions

Endodontic File Length Determination

CCD Extra-oral Radiograpy
Tomography
Panoramic Radiography
Cephalometric Radiography
 The Next Generation
Three Dimensional Imaging

TACT

Small Volume CT
 TACT™ Methodology
Series of images
taken from
different
angles
Slices of a maxillary molar
Small Volume CT
Computer Aided Diagnosis (CAD)
Observational Errors

Misinterpretation Errors

Integration of Data Errors

Most Beneficial in Observational Errors

 What is DICOM
Digital Imaging and Communication in Medicine

Standard for communication of images and image related

information between devices
International in scope

All biomedical imaging

Voluntary standard
 DICOM Workflow
DICOM Display
Workstation
Storage, Query/Retrieve,
Study Component
LiteBox

Query/Retrieve
Results Management

DICOM
Acquisition
Media Exchange Print Management
DICOM Query/Retrieve,
Archive Patient & Study
 Digital Subtraction Radiography
First introduced by B. Ziedses des Plantes in
1935
Cancels out the complex anatomic background against which
this changes occurs
Enhances visualization of mineral changes occurred over time
against homogenous background of unchanged anatomy
Baseline projection geometry has to be accurate
Suited for acquiring quantitative information – linear, area &
density measurements
Digital Subtraction Radiography

-
 Factors affecting detection task

Diff in image contrast & intensity

Fluctuations in exposure factors
Changes in projection geometry
Interoperability ????????
 CONCLUSION
For a seamless transition to a filmless world, more digital
imaging equipment improvements will be necessary. The
dental profession should take a more proactive stance in
informing manufacturers what they really want. We must
persist in making manufacturers aware of shortcomings,
Inconsistent diagnostic image quality

Hardware management