By Mohamed B. Hassanin, BDS, MSc , PhD Associate Professor Oral Radiology II :MDS 314 “ By Mohamed B. Hassanin, BDS, MSc , PhD Associate Professor

Principles of Radiographic Interpretation

Imaging as an Examination Tool Clinical examination Signs Symptoms Ordering the right type of imaging examination Ordering the right number of imaging examination Necessary vs unnecessary examinations Benefit to the patient

Viewing condition Viewbox Monitor Prints Ambient light reduced Quiet room Intraoral films mounted on a opaque holder Equal intensity of light on the view box Monitors: calibration Magnification Software limitations

Systematic Approach Intraoral images Extraoral images; Teeth, periodontium, bone, adjacent structures Tooth #1 to #16, and then #17 to #32 Extraoral images; Panoramic, other extraoral plain radiographs Cross sectional images CT, MRI

Localize the abnormality How many lesions? Where is the lesion? Localized vs generalized Single arch or both the arches Inside the bone or outside Relation to the crown Relation to the root Superior to the mandibular canal

Periphery Well defined or ill defined? Sharp margins Corticated margins Sclerotic margins Radiolucent band Blends into adjacent area Irregular margins

Shape Circular Oval Scalloped Multilocular

Internal structures Radiolucent Mixed Radiopaque Trabeculation Septa Calcifications Tooth or similar entities

Adjacent structures Teeth Lamina dura Crestal bone Periodontal spaces Alveolar bone Nerve canals Maxillary sinuses Cortical bones

Description, description, description Speak out loudly List it down Compare findings in different images Clinical information

Radiographic findings Abnormal Developmental Acquired Cysts Tumors (benign/malig) Inflammatory Bone dysplasia Vascular Metabolic Trauma Normal

Characterize your lesion and state your D/D Vascular Infection Neoplasm Drugs Idiopathic/inflammatory Congenital Autoimmune Trauma Endocrine/metabolic

In the Land of 10,000 lakes,…

…we see the fish!

Liar, Liar!! Do Our Eyes Lie?

Dirty words! Sun-ray appearance Ground glass Cotton wool Onion skin Driven snow Etc, etc

When not to order imaging You have not clinically / radiographically evaluated the patient No benefit to the patient Additional images may not provide extra information No ‘routine’ radiograph

What goes on the report Patient, doctor, clinic identification Date, type and number of examination Reasons for the examination Clinical information Relevant observation Radiographic Impressions Any further tests, examinations