1. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Chapter 25 Digital Imaging

2. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 2 Dental Radiography  Questions  What equipment is used in digital imaging?  What types of digital imaging are available?  What are advantages and disadvantages of digital imaging?

3. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 3 Dental Radiography  Chapter 25 Reading  Iannucci & Howerton (pp. 301-311)

4. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 4 Dental Radiography  Chapter 25 Outline  Digital Imaging  Basic concepts  Types of digital imaging  Step-by-step procedures  Advantages and disadvantages

5. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 5 Introduction  Iannucci & Howerton (p. 301)  Purpose  To present the basic concepts of digital imaging  To introduce the types of digital imaging  To discuss the advantages and disadvantages of digital imaging

6. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 6 Basic Concepts  Iannucci & Howerton (p. 302)  Used to record radiographic images  No film or processing chemistry is used  Uses an electronic sensor and computerized imaging system that produces x-ray images almost instantly on a computer monitor

7. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 7 Terminology  Iannucci & Howerton (p. 302)  Charge-coupled device  Digital radiography  Digital subtraction  Digitize

8. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 8 Terminology  Direct digital imaging  Indirect digital imaging  Pixel  Sensor  Storage phosphor imaging

9. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 9 Purpose and Use  Iannucci & Howerton (p. 302)  To generate images that can be used in the diagnosis and assessment of dental disease

10. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 10 Purpose and Use  To detect lesions, diseases and conditions of the teeth and surrounding structures  To confirm or classify suspected disease  To provide information during dental procedures  To evaluate growth and development  To illustrate changes secondary to caries, periodontal disease, or trauma  To document the condition of a patient at a specific point in time

11. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 11 Fundamentals  Iannucci & Howerton (pp. 302-303) (Figs. 25-1, 25-2)  Digital imaging  A method of capturing a radiographic image using a sensor, breaking it into electronic pieces, and presenting and storing the image using a computer  Image used to describe the pictures that are produced  A sensor placed inside the mouth  The electronic signal is digitized

12. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 12 Radiation Exposure  Iannucci & Howerton (p. 303)  The typical sensor is more sensitive to x-rays than conventional film.  Exposure times are 50% to 80% less than that required for conventional radiography using E- speed film.

13. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 13 Equipment  Iannucci & Howerton (p. 303)  X-radiation source  Intraoral sensor  Charge-coupled device  Complementary metal oxide semiconductor/active pixel sensor  Charge injection device  Computer

14. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 14 X-Radiation Source  Iannucci & Howerton (pp. 303-304) (Fig. 25-3)  Most digital imaging systems use a conventional dental x-ray unit as the x- radiation source.  The x-ray unit timer must be adapted to allow exposures in a time frame of 1/100 of a second.

15. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 15 Intraoral Sensor  Iannucci & Howerton (p.304) (Figs. 25-4, 25-5)  A small detector that is placed in the mouth of the patient and used to capture the radiographic image  Wired The imaging sensor is linked by a fiber optic cable to a computer. The imaging sensor is linked by a fiber optic cable to a computer.  Wireless The imaging sensor is not linked by a cable. The imaging sensor is not linked by a cable.

16. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 16 Intraoral Sensor  Most popular types of direct sensor technologies  Charge-coupled device  Complementary metal oxide semiconductor/active pixel sensor

17. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 17 Charge-Coupled Device (CCD)  Iannucci & Howerton (p. 304)  The most common image receptor used in dental digital imaging  A solid-state detector that contains a silicon chip with an electronic circuit embedded in it  The electrons that make up the silicon CCD can be visualized as being divided into an arrangement of blocks or picture elements known as pixels  Pixel  A small box or “well” into which the electrons produced by the x-ray exposure are deposited

18. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 18 Charge-Coupled Device (CCD)  The x-ray photons that come into contact with the CCD cause electrons to be released from the silicon and produce a corresponding electronic charge.  Each pixel arrangement, or electron potential well, contains an electronic charge proportional to the number of electrons that reacted within the well.  Each electronic well corresponds to a specific area on the linked computer screen.

19. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 19 Complementary Metal Oxide Semiconductor/Active Pixel Sensor (CMOS/APS)  Iannucci & Howerton (pp. 304-305)  One manufacturer uses a CMOS/APS sensor instead of a CCD.  The chip is less expensive to produce and offers greater durability than the CCD.

20. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 20 Computer  Iannucci & Howerton (p. 305) (Figs. 25-6, 25-7, 25-8)  Used to store the incoming electronic signal  Converts the electronic signal from the sensor into a shade of gray that is viewed on the computer monitor  The computer digitizes, processes, and stores information received from the sensor  An image is recorded on a computer monitor in 0.5 to 120 seconds  Has split screen and magnification capability.

21. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 21 Types of Digital Imaging  Direct Digital Imaging  Indirect Digital Imaging  Scanning traditional radiographs  Storage phosphor imaging

22. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 22 Direct Digital Imaging  Iannucci & Howerton (p. 306) (Fig. 25-9)  Components include an x-ray machine, an intraoral sensor, and computer monitor  A sensor is placed into the mouth of the patient and exposed  The sensor captures the radiographic image and transmits it to the computer monitor  Software is used to enhance and store the image

23. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 23 Indirect Digital Imaging  Iannucci & Howerton (p. 306)  Components include a CCD camera and a computer.  An existing x-ray film is digitized using a CCD camera.  The image is displayed on a computer monitor.

24. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 24 Storage Phosphor Imaging  Iannucci & Howerton (pp. 306-307) (Figs. 25-10, 25-11)  A wireless digital imaging system  This is a reusable imaging plate coated with phosphors is used instead of a sensor with a fiber optic cable.  The phosphor-coated plates are flexible and fit into the mouth.  A high-speed scanner is used to convert the information into electronic files.  This type of digital imaging is less rapid than direct digital imaging.

25. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 25 Step-by-Step Procedures  Sensor Preparation  Sensor Placement

26. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 26 Step-by-Step Procedures  It is critical to refer to the manufacturer- provided instruction booklet for information concerning the operation of the system, equipment preparation, patient preparation, and exposure.

27. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 27 Sensor Preparation  Iannucci & Howerton (p. 307) (Figs. 25-12, 25-13)  Each sensor is sealed and waterproofed.  The sensor must be covered with a disposable barrier because it cannot be sterilized.

28. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 28 Sensor Placement  Iannucci & Howerton (pp. 307-308) (Fig. 25-14)  The sensor is held in the mouth by bite-block attachments or devices that aim the beam and sensor accurately.  The paralleling technique is the preferred exposure method.

29. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 29 Advantages and Disadvantages  Advantages of Digital Imaging  Disadvantages of Digital Imaging

30. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 30 Advantages of Digital Imaging  Iannucci & Howerton (pp. 307-309) (Figs. 25-15, 25-16, 25-17, 25-18)  Superior gray-scale resolution  Reduced exposure to x-radiation  Increased speed of image viewing  Lower equipment and film cost  Increased efficiency  Enhancement of diagnostic image  Effective patient education tool

31. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 31 Disadvantages of Digital Imaging  Iannucci & Howerton (pp. 309-310)  Initial set-up costs  Image quality  Sensor size  Infection control  Legal issues