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Digital imaging
    Islam Kassem

       Level 6

      ikassem@dr.com
Digital Radiography
• Advances in digital technology have led to a
  unique “filmless” imaging system known as
  digital radiography.
• Introduced in 1987, digital radiography has
  influenced both how dental disease is
  recognized and how it is diagnosed.
• In the last 2 years, the use of digital
  radiography is rapidly increasing in both
  general and specialty dental practices.
• Numerous companies are producing digital
  radiography systems.

                     ikassem@dr.com
ikassem@dr.com
The Basics of Digital Radiography

• Digital radiography uses a sensor to capture a
  radiographic image, breaking it into electronic
  pieces and storing the image in a computer.
• The patient is exposed to less x-radiation than
  with conventional radiography.
• The image is displayed on a computer screen
  rather than on film.
• The term image (not radiograph) is used to
  describe the pictures that are produced.
                     ikassem@dr.com
The Basics of Digital Radiography- cont’d

• The x-ray beam strikes the sensor.
• An electronic charge is produced on the
  surface of the sensor, and this electronic signal
  is digitized.
• The digital sensor in turn transmits this
  information to the computer.
• Software in the computer is used to store the
  image electronically.

                      ikassem@dr.com
ikassem@dr.com
ikassem@dr.com
Radiation Exposure

• Digital radiography requires much less x-
  radiation than conventional radiography
  because the sensor is more sensitive to x-rays
  than to conventional film.
• Exposure times for digital radiography are 50%
  to 80% less than that required for radiography
  using conventional film.
• With less radiation, the absorbed dose to the
  patient is significantly lower.

                    ikassem@dr.com
Equipment

• For digital radiography, special equipment is
  required. The essential components include:
  • Dental x-ray unit
  • Intraoral sensor
  • Computer




                        ikassem@dr.com
Types of Digital Imaging

•   Direct digital imaging
•   Indirect digital imaging
•   Storage phosphor imaging
•   The difference between each method is in
    how the image is obtained and in what size
    the receptor plates are available (e.g.,
    panoramic).


                      ikassem@dr.com
ikassem@dr.com
Digital Radiography
Digital dental radiography comes in two
forms:
• Direct : that connect directly to the
  computer via USB and provides
  immediate images
• Indirect : (photostimulable phosphor
  plates, or PSP) which uses plates that are
  radiated and then digitally scanned.

                  ikassem@dr.com
Indirect Digital radiography
• Indirect digital imaging 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.




                       ikassem@dr.com
Direct Digital Radiography
• There are two main types of digital sensors
  available

• One is based on charge coupled device
  technology and the other consists of
  phosphor storage plates



                   ikassem@dr.com
Charge Coupled Device (CCD(
• Is a device for the movement of electrical charge
usually from within the device to an area where the charge can
    be manipulated .
for example conversion into a digital valueThis is achieved by
    shifting the signals between stages within the device one at a
    time CCDs move charge between capacitive bins in the
    device with the shift allowing for the transfer of charge
    between bins



                            ikassem@dr.com
PSP system
PSP or Phosphor Storage Plate systems
The X-ray image is captured using a PSP. PSPs are
  wireless. Since they are not directly connected to
  the computer, adevice is required to read or
  extract the data from the PSP and send the
  image data to a computer.




                      ikassem@dr.com
ikassem@dr.com
Advantages of digital imaging

Dose reduction
• Dose reductions of up to 90 per cent
  compared to E-speed filmin the
  diagnosis of caries.



                 ikassem@dr.com
Image manipulation
• This is perhaps the greatest advantage of
  digital imaging over conventional film.
• Contrast enhancement.
• Measurements. Digital callipers, rulers and
  protractors are some of the many tools
  available for image analysis.
• 3-D reconstruction. This application can be
  theoretically used to reconstruct intra- and
  extra-oral images
• Filtration. The addition of filters to the
  airspace around the face can clarify the soft
  tissue
                     ikassem@dr.com
ikassem@dr.com
ikassem@dr.com
.


Time
• Much time is gained especially with the CCD
  system where the image is displayed at the
  chair side immediately post exposure.




                  ikassem@dr.com
Storage
• Now      a CD ROM can hold over 30,000
  images. This means that images can be
  stored cheaply
   and indefinitely.




                ikassem@dr.com
.

Teleradiology
• The digital image file can be further
  reduced in size by compression
  techniques, and sent via a modem and
  telephone line to colleagues for review.

Environmentally friendly
• No processing chemicals are used or
  disposed of. Both CCD sensors and the
  PSP plates are capable of being reused
  for many thousands of exposures.

                  ikassem@dr.com
Disadvantages of digital imaging


 The majority of the disadvantages are
 associated with the CCD system.
 Cost
 • Currently, the cost of converting
   from intra-oral film to digital imaging
   is approximately 6600 Euros.

                   ikassem@dr.com
Sensor dimensions
• These are still quite bulky for the
  CCD system and awkward to position
  due to trailing fibre optic wires.
Cross-infection control
• Each intra-oral sensor and plate
  must be covered by a plastic bag,
  and this bag is changed between
  patients. However, if they become
  directly contaminated there is no
  way of sterilizing them and they
  should be discarded regardless of
  expense.                ikassem@dr.com
.


Medicolegal
• Concerns have been raised in the
  past about the ability to manipulate
  the images for fraudulent purposes.
  Manufacturers of software
  programmes have installed ‘audit
  trails’, which can track down and
  recover the original image.


                 ikassem@dr.com
Extra-oral digital imaging

• Extra-oral digital imaging is available using
  both systems.
• The larger CCD sensors are extremely
  expensive and usually requires the purchase
  of new X-ray generators
• These constrictions effectively mean that
  the PSP method is the one most commonly
  used.


                   ikassem@dr.com
Panoramic radiography
• The PSP method of panoramic digital
  imaging is very similar to
  conventional film. The film and
  intensifying screen are replaced by a
  storage phosphor plate.
• The plate is scanned after exposure,
  which can take up to 3 minutes or
  longer depending on the product
  used.
• The resolution of these systems is
  greater than 4 LP/mm.
                  ikassem@dr.com
ikassem@dr.com
ikassem@dr.com
Cephalometric radiography

• The effect of dose reduction obtained with
  PSP on the identification of cephalometric
  landmarks did not effect the localization of
  cephalometric landmarks.
• It is also worth noting that with CCD
  sensors the image is acquired over 15
  seconds as the sensor and narrow X-ray
  beam move up the facial bones and could
  lead to an increase in the incidence of
  movement artefact.


                    ikassem@dr.com
ikassem@dr.com
Applications of Digital
      radiographs in Dentistry
In Periodontics :
• to evaluate the level and condition of the
  alveolar ridge
• to search for factors which may influence
  periodontal disease such as calculus,
  overhangs, etc.,
• to prepare treatment plans and finally to
  evaluate the results of treatment.
• comparison of images of the same teeth
  taken “before” and “after” treatment

                    ikassem@dr.com
In Fixed Prosthodontics :

• With digital radiography you will be able to check
  the fit of new crowns, bridges, posts, and implant
  impression copings and abutments and also
  verfication of proper seating of the restoration
  without increase in cement space as in cases of
  post and core .
• Gives information about the changes within the
  periodontium of the abutments in partial fixed
  prosthesis , if there is any recurrent caries under
  restoration and if there is any periapical lesion
  following improper post and core restoration .



                       ikassem@dr.com
ikassem@dr.com
In Endodontics :
Canal Length Measurement by Digital Radiography


The canal length is measured from the
 radiographic apex to a reference
 point on the crown. Studies of
 periapical healing after endodontic
 treatment     have     shown     the
 importance of confining endodontic
 instrumentation     and   obturation
 within the root.
                            ikassem@dr.com
ikassem@dr.com
In Orthodontics :
• They offer higher-resolution images
  within the mouth – enabling the
  orthodontist to diagnosis and correct
  problems with greater accuracy.
• The digital cephalometric radiograph can
  be analyzed more precisely using
  dedicated software.
• These digital tools are very important in
  the studies of the growth and
  development of the stomatognathic
  system

                    ikassem@dr.com
In Implantology :
• used to plan the placement of
  endosseous dental implants using
  three-dimensional          computed
  tomography images obtained with
  commercial software.
• uses digital subtraction radiography
  to assess longitudinal bony change
  around dental implants.

                ikassem@dr.com
ikassem@dr.com
In TMJ :
• Plain films are used primarily to evaluate
  for bone disease such as osteoarthritis and
  traumatic injuries. Digital radiography
  improve diagnosis by providing helpful
  tools such as: image sharpening, contrast
  and brightness enhancement, zooming,
  color coding, iso density and spotlight,
  angle and length measurement
• CBCT “tomography” used for the
  measurement of the angle of the long axis
  of the condylar heads

                   ikassem@dr.com
ikassem@dr.com
In Diagnosis of Pathological lesions :
• Many developmental lesions and
  anomalies can be detected in earlier
  stage with digital systems than with
  conventional methods
• The possibilities to vary the brightness
  of an image is often of great diagnostic
  value. the same physical brightness
  difference e.g. between a pathological
  lesion and its background, is easier
  perceived against a darker background
  that against a light one .

                     ikassem@dr.com
As this radiograph gradually gets
darker, the lesions at the apices of the
   first molar become more visible

                 ikassem@dr.com
In Surgery:
 • X-ray based imaging is routinely used for
    preoperative diagnosis and planning, for
    intraoperative guidance and control, and
    for the postoperative evaluation of
    computer-assisted surgery (CAS) in the
    majority of its applications
 • Possibility to locate impacted molars and
    cuspids and to measure the dimensions of
    the alveolar bone with great accuracy.
• identify     potential      pathologies  and
   structural         abnormalities        with
   unprecedented accuracy

                    ikassem@dr.com
• You can get the lecture on


• http://www.slideshare.net/islamkassem




                     ikassem@dr.com
ikassem@dr.com

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Digital imaging

  • 1. Digital imaging Islam Kassem Level 6 ikassem@dr.com
  • 2. Digital Radiography • Advances in digital technology have led to a unique “filmless” imaging system known as digital radiography. • Introduced in 1987, digital radiography has influenced both how dental disease is recognized and how it is diagnosed. • In the last 2 years, the use of digital radiography is rapidly increasing in both general and specialty dental practices. • Numerous companies are producing digital radiography systems. ikassem@dr.com
  • 4. The Basics of Digital Radiography • Digital radiography uses a sensor to capture a radiographic image, breaking it into electronic pieces and storing the image in a computer. • The patient is exposed to less x-radiation than with conventional radiography. • The image is displayed on a computer screen rather than on film. • The term image (not radiograph) is used to describe the pictures that are produced. ikassem@dr.com
  • 5. The Basics of Digital Radiography- cont’d • The x-ray beam strikes the sensor. • An electronic charge is produced on the surface of the sensor, and this electronic signal is digitized. • The digital sensor in turn transmits this information to the computer. • Software in the computer is used to store the image electronically. ikassem@dr.com
  • 8. Radiation Exposure • Digital radiography requires much less x- radiation than conventional radiography because the sensor is more sensitive to x-rays than to conventional film. • Exposure times for digital radiography are 50% to 80% less than that required for radiography using conventional film. • With less radiation, the absorbed dose to the patient is significantly lower. ikassem@dr.com
  • 9. Equipment • For digital radiography, special equipment is required. The essential components include: • Dental x-ray unit • Intraoral sensor • Computer ikassem@dr.com
  • 10. Types of Digital Imaging • Direct digital imaging • Indirect digital imaging • Storage phosphor imaging • The difference between each method is in how the image is obtained and in what size the receptor plates are available (e.g., panoramic). ikassem@dr.com
  • 12. Digital Radiography Digital dental radiography comes in two forms: • Direct : that connect directly to the computer via USB and provides immediate images • Indirect : (photostimulable phosphor plates, or PSP) which uses plates that are radiated and then digitally scanned. ikassem@dr.com
  • 13. Indirect Digital radiography • Indirect digital imaging 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. ikassem@dr.com
  • 14. Direct Digital Radiography • There are two main types of digital sensors available • One is based on charge coupled device technology and the other consists of phosphor storage plates ikassem@dr.com
  • 15. Charge Coupled Device (CCD( • Is a device for the movement of electrical charge usually from within the device to an area where the charge can be manipulated . for example conversion into a digital valueThis is achieved by shifting the signals between stages within the device one at a time CCDs move charge between capacitive bins in the device with the shift allowing for the transfer of charge between bins ikassem@dr.com
  • 16. PSP system PSP or Phosphor Storage Plate systems The X-ray image is captured using a PSP. PSPs are wireless. Since they are not directly connected to the computer, adevice is required to read or extract the data from the PSP and send the image data to a computer. ikassem@dr.com
  • 18. Advantages of digital imaging Dose reduction • Dose reductions of up to 90 per cent compared to E-speed filmin the diagnosis of caries. ikassem@dr.com
  • 19. Image manipulation • This is perhaps the greatest advantage of digital imaging over conventional film. • Contrast enhancement. • Measurements. Digital callipers, rulers and protractors are some of the many tools available for image analysis. • 3-D reconstruction. This application can be theoretically used to reconstruct intra- and extra-oral images • Filtration. The addition of filters to the airspace around the face can clarify the soft tissue ikassem@dr.com
  • 22. . Time • Much time is gained especially with the CCD system where the image is displayed at the chair side immediately post exposure. ikassem@dr.com
  • 23. Storage • Now a CD ROM can hold over 30,000 images. This means that images can be stored cheaply and indefinitely. ikassem@dr.com
  • 24. . Teleradiology • The digital image file can be further reduced in size by compression techniques, and sent via a modem and telephone line to colleagues for review. Environmentally friendly • No processing chemicals are used or disposed of. Both CCD sensors and the PSP plates are capable of being reused for many thousands of exposures. ikassem@dr.com
  • 25. Disadvantages of digital imaging The majority of the disadvantages are associated with the CCD system. Cost • Currently, the cost of converting from intra-oral film to digital imaging is approximately 6600 Euros. ikassem@dr.com
  • 26. Sensor dimensions • These are still quite bulky for the CCD system and awkward to position due to trailing fibre optic wires. Cross-infection control • Each intra-oral sensor and plate must be covered by a plastic bag, and this bag is changed between patients. However, if they become directly contaminated there is no way of sterilizing them and they should be discarded regardless of expense. ikassem@dr.com
  • 27. . Medicolegal • Concerns have been raised in the past about the ability to manipulate the images for fraudulent purposes. Manufacturers of software programmes have installed ‘audit trails’, which can track down and recover the original image. ikassem@dr.com
  • 28. Extra-oral digital imaging • Extra-oral digital imaging is available using both systems. • The larger CCD sensors are extremely expensive and usually requires the purchase of new X-ray generators • These constrictions effectively mean that the PSP method is the one most commonly used. ikassem@dr.com
  • 29. Panoramic radiography • The PSP method of panoramic digital imaging is very similar to conventional film. The film and intensifying screen are replaced by a storage phosphor plate. • The plate is scanned after exposure, which can take up to 3 minutes or longer depending on the product used. • The resolution of these systems is greater than 4 LP/mm. ikassem@dr.com
  • 32. Cephalometric radiography • The effect of dose reduction obtained with PSP on the identification of cephalometric landmarks did not effect the localization of cephalometric landmarks. • It is also worth noting that with CCD sensors the image is acquired over 15 seconds as the sensor and narrow X-ray beam move up the facial bones and could lead to an increase in the incidence of movement artefact. ikassem@dr.com
  • 34. Applications of Digital radiographs in Dentistry In Periodontics : • to evaluate the level and condition of the alveolar ridge • to search for factors which may influence periodontal disease such as calculus, overhangs, etc., • to prepare treatment plans and finally to evaluate the results of treatment. • comparison of images of the same teeth taken “before” and “after” treatment ikassem@dr.com
  • 35. In Fixed Prosthodontics : • With digital radiography you will be able to check the fit of new crowns, bridges, posts, and implant impression copings and abutments and also verfication of proper seating of the restoration without increase in cement space as in cases of post and core . • Gives information about the changes within the periodontium of the abutments in partial fixed prosthesis , if there is any recurrent caries under restoration and if there is any periapical lesion following improper post and core restoration . ikassem@dr.com
  • 37. In Endodontics : Canal Length Measurement by Digital Radiography The canal length is measured from the radiographic apex to a reference point on the crown. Studies of periapical healing after endodontic treatment have shown the importance of confining endodontic instrumentation and obturation within the root. ikassem@dr.com
  • 39. In Orthodontics : • They offer higher-resolution images within the mouth – enabling the orthodontist to diagnosis and correct problems with greater accuracy. • The digital cephalometric radiograph can be analyzed more precisely using dedicated software. • These digital tools are very important in the studies of the growth and development of the stomatognathic system ikassem@dr.com
  • 40. In Implantology : • used to plan the placement of endosseous dental implants using three-dimensional computed tomography images obtained with commercial software. • uses digital subtraction radiography to assess longitudinal bony change around dental implants. ikassem@dr.com
  • 42. In TMJ : • Plain films are used primarily to evaluate for bone disease such as osteoarthritis and traumatic injuries. Digital radiography improve diagnosis by providing helpful tools such as: image sharpening, contrast and brightness enhancement, zooming, color coding, iso density and spotlight, angle and length measurement • CBCT “tomography” used for the measurement of the angle of the long axis of the condylar heads ikassem@dr.com
  • 44. In Diagnosis of Pathological lesions : • Many developmental lesions and anomalies can be detected in earlier stage with digital systems than with conventional methods • The possibilities to vary the brightness of an image is often of great diagnostic value. the same physical brightness difference e.g. between a pathological lesion and its background, is easier perceived against a darker background that against a light one . ikassem@dr.com
  • 45. As this radiograph gradually gets darker, the lesions at the apices of the first molar become more visible ikassem@dr.com
  • 46. In Surgery: • X-ray based imaging is routinely used for preoperative diagnosis and planning, for intraoperative guidance and control, and for the postoperative evaluation of computer-assisted surgery (CAS) in the majority of its applications • Possibility to locate impacted molars and cuspids and to measure the dimensions of the alveolar bone with great accuracy. • identify potential pathologies and structural abnormalities with unprecedented accuracy ikassem@dr.com
  • 47. • You can get the lecture on • http://www.slideshare.net/islamkassem ikassem@dr.com