1. Principles of Radiographic Interpretation
Juan F. Yepes DDS, MD, MPH
Assistant Professor
Division of Oral Diagnosis, Oral Medicine and Oral Radiology
University of Kentucky, College of Dentistry
Spring 2009

2. What is that radiologist saying?
Well defined and
Corticated…..

3. General Objective
The objective of this lecture is to provide step-by-step- analytic process
that can be applied to the interpretation of diagnostic images.
Proficiency comes with PRACTICE!!!
Radiographic interpretation of caries
Radiographic interpretation of periodontal disease
Radiographic interpretation of benign conditions
Radiographic interpretation of malignant conditions

4. Some definitions….

5. Radiopaque
This refers to the item that is being imaged, i.e. in our case a part of the patient, and means that it blocks the transmission of x rays.

6. Radiolucent
This refers to the item that is being imaged, i.e. in our case a part of the patient, and means that it permits the transmission of x rays.

7. Dense (Density)
In radiology this usually refers to the film, and refers to the ability of the film to block the transmission of light (i.e. blackness)

8. Well localized
The item being reported is limited to a specific area, and does not extend beyond that locality.

9. Well localized

10. Poorly localized
The item being reported is not limited to a specific area, and extends into surrounding anatomical sites.

11. Poorly localized

12. Well defined
The edges of the item being reported are reasonably sharp and clearly define the extent of the lesion.

13. Well defined

14. Poorly defined
The edges of the item being reported are not sharp. The actual borders and thus the exact extent of the lesion are not clearly defined.

15. Poorly defined

16. well localized and well defined well localized, but poorly defined
The lesion may thus be
well localized and well defined or
well localized, but poorly defined
poorly localized and poorly defined
but generally not
poorly localized and well defined

17. Corticated
The entity being reported is not only well defined, but has a cortex, i.e. an osseous border, seen as a thin white line.

18. Corticated

19. Multilocular
The entity being reported is usually well defined and has a cortex, i.e. an osseous border, seen as a thin white line, but is partially or totally subdivided into several loculi.

20. Multilocular Loculus, loculi: the diminutive of locus.
Locus, loci: a place or position

21. Multilocular
Thus, multilocular implies several small places. As we use it, they are joined places.

22. Multilocular

23. Osteitis vs Osteomyelitis
Both terms mean that there is inflammation of bone.

24. Osteitis
inflammation of bone, involving the haversian spaces, canals, and their branches, and generally the medullary cavity, and marked by enlargement of the bone, tenderness, and a dull aching pain.
Dorland’s Illustrated Medical Dictionary 29th ed.

25. Osteomyelitis
inflammation of bone caused by infection, usually by a pyogenic organism, although any infectious agent may be involved. It may remain localized or may spread through the bone to involve the marrow, cortex, cancellous tissue, and periosteum.
Dorland’s Illustrated Medical Dictionary 29th ed.

26. Osteitis
inflammation of bone that remains localized, and may be more of a painful inconvenience

27. Osteitis

28. Osteomyelitis

29. Osteitis
Rarefying Osteitis
Sclerosing Osteitis

31. Rarefying Osteitis (Periapical lesion U. of K.)
Inflammation of bone that results in the removal of bone. The term is not a diagnosis, but a radiologic interpretation that includes abscess, cyst and granuloma.

32. Rarefying Osteitis (periapical lesion at UK)

33. Sclerosing Osteitis
I use the term sclerosing osteitis, i.e. inflammation of bone (osteitis) that causes sclerosis.

34. Sclerosing (or condensing) Osteitis

35. Sclerosing Osteitis

36. Periosteal Reaction
Any involvement of the periosteum by a pathological process that results in the deposition of periosteal new bone.

37. Inflammation of the Jaws and Periosteal Reactions
Sessile
Osteomyelitis
Periostitis
Healing
Orthogonal
Anemia
Sarcoma
Sarcoma

38. Periapical Radiolucency
This is merely a description of a finding, and should better be stated as a periapical radiolucent area or line. It does not denote disease. e.g. the maxillary sinus could be a periapical radiolucent area, as could the mental foramen.

39. What is that radiologist really saying?
Well defined and
Corticated

40. Well localized

41. Well localized
The radiologist infers that the appearance is consistent with a slow non-invasive growth, and thus that this is benign.

42. Poorly localized

43. Poorly localized
The radiologist infers that the appearance is consistent with a faster and invasive growth, and thus that this is malignant, or a spreading infectious/inflammatory lesion.

44. Well defined

45. Well defined
The radiologist infers that the appearance is consistent with a slow non-invasive growth, and thus that this is benign.

46. Poorly defined

47. Poorly defined
The radiologist infers that the appearance is consistent with invasive growth, and thus that this is malignant, or infectious/ inflammatory lesion.

48. Corticated

49. Corticated
The radiologist infers that the appearance is consistent with a slow non-invasive growth, and thus that this is benign.

50. Multilocular

51. Multilocular
The radiologist infers that the appearance is consistent with a slow non-invasive growth, is not fluid-filled, and that this is a benign, non-cystic growth, i.e. a benign neoplasm.

52. Clinical Examination
Radiographs are prescribed when the dentist thinks that they
are likely to offer useful diagnostic information that will
influenced the TREATMENT plan.
Clinical information should be used first to select the type of
radiographs and later to aid in their interpretation.
ADQUIRING APPROPRIATE DIAGNOSTIC IMAGES
Quality of the Diagnostic Image
Is the image distorted?
Are the contrast and density adequate?

53. Clinical Examination ADQUIRING APPROPRIATE DIAGNOSTIC IMAGES
Quality of the Diagnostic Image
Number and Type of Available Images
Initially the clinical examination indicates the number and types
of films required. The interpretation of these films in turn may
suggest additional imaging.
Advanced techniques available (CBCT, MRI, ultrasound, CT, etc)

54. Clinical Examination ADQUIRING APPROPRIATE DIAGNOSTIC IMAGES
Quality of the Diagnostic Image
Number and Type of Available Images
Viewing Conditions
Ambient light in the viewing room should be reduced.
Intraoral radiographs should be mounted in a film holder.
Light from the viewbox should be of equal intensity across viewing
surface
Use of magnifier

55. Image Analysis Systematic Radiographic Examination
Profound knowledge of normal anatomy and normal variations.
Best learning method  Indentify NORMAL anatomy in every film
Do not limit your attention to only one particular are on the film
Intraoral Images
Periapical films before bitewings
Same sequence
Bone first, bone of the alveolar process second, dentition last
Extraoral radiography  Panoramic films (lateral skull projections)

56. Bone
Alveolar Bone
Dentition

57. Analysis of the Intraosseous Lesions
The preferred method of radiographic interpretation is STEP by STEP
This procedure helps ensure recognition and collection of all the
information contained in the image and in turn improves the
accuracy of the interpretation.
Localize the abnormality
Localized or Generalized
Position in the jaws
Single or multifocal
Size and shape

58. Analysis of the Intraosseous Lesions
Localize the abnormality
Localized or Generalized
Position in the jaws
Single or multifocal
Size
Assess the periphery and shape
Well defined ?
Corticated ?
Borders
Shape

59. Analysis of the Intraosseous Lesions
Corticated
Well defined
Step 2  Assess the periphery and shape

60. Analysis of the Intraosseous Lesions
Non - Corticated
Well defined
Step 2  Assess the periphery and shape

61. Analysis of the Intraosseous Lesions
Step 2  Assess the periphery and shape
Step 3: Analyze the internal structure
Totally radiolucent
Totally radiopaque
Mixed density

62. Analysis of the Intraosseous Lesions
Step 3: Analyze the internal structure
Totally radiolucent
Totally radiopaque
Mixed density

63. Analysis of the Intraosseous Lesions
Step 3: Analyze the internal structure
Totally radiolucent
Totally radiopaque
Mixed density

64. Analysis of the Intraosseous Lesions
Step 3: Analyze the internal structure
Totally radiolucent
Totally radiopaque
Mixed density

65. Analysis of the Intraosseous Lesions
Step 4: Analyze the effects of the lesion on surround structures
Teeth, lamina dura, and periodontal ligament space
Surrounding bone density and trabecular bone pattern
Inferior alveolar canal and mental foramen
outer cortical bone and periostial reactions

66. Analysis of the Intraosseous Lesions
Step 4: Analyze the effects of the lesion on surround structures
Teeth, lamina dura, and periodontal ligament space
Surrounding bone density and trabecular bone pattern
Inferior alveolar canal and mental foramen
outer cortical bone and periostial reactions

67. Analysis of the Intraosseous Lesions
Step 4: Analyze the effects of the lesion on surround structures
Teeth, lamina dura, and periodontal ligament space
Surrounding bone density and trabecular bone pattern
Inferior alveolar canal and mental foramen
outer cortical bone and periostial reactions

68. Analysis of the Intraosseous Lesions
Step 4: Analyze the effects of the lesion on surround structures
Teeth, lamina dura, and periodontal ligament space
Surrounding bone density and trabecular bone pattern
Inferior alveolar canal and mental foramen
outer cortical bone and periostial reactions

69. Analysis of the Intraosseous Lesions
Step 4: Analyze the effects of the lesion on surround structures
Teeth, lamina dura, and periodontal ligament space
Surrounding bone density and trabecular bone pattern
Inferior alveolar canal and mental foramen
outer cortical bone and periostial reactions

70. Analysis of the Intraosseous Lesions
Step 5: Formulate a radiographic interpretation
Decision 1 Normal Abnormal
Decision 2 Developmental Acquired
Decision 3 Classification: Cyst, benign tumor, malignant tumor, etc..
Decision 4 Ways to proceed: Further imaging, treatment, biopsy, or
observation
RADIOLOGY REPORT