1. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. Chapter 20 Exposure and Technique Errors

2. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 2 Dental Radiography  Questions  What receptor exposure and technique errors may be observed on dental radiographs?  What horizontal and vertical angulation errors may be observed on dental radiographs?  What is the proper receptor placement for bite- wing radiographs?

3. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 3 Dental Radiography  Chapter 20 Reading:  Iannucci & Howerton (pp. 226-238)

4. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 4 Dental Radiography  Chapter 20 Outline  Exposure and Technique Errors  Receptor exposure errors  Periapical technique errors  Bite-wing technique errors  Miscellaneous technique errors

5. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 5 Receptor Exposure Errors  Purpose  To describe receptor exposure problems and periapical, bite-wing, and miscellaneous technique errors

6. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 6 Receptor Exposure Errors  Iannucci & Howerton (p. 227)  Exposure problems  Unexposed receptor  Film exposed to light  Time and Exposure Factor Problems  Overexposed receptor  Underexposed receptor

7. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 7 Unexposed Receptor  Iannucci & Howerton (p. 227) (Fig. 20-1)  Appearance  The image appears clear.  Cause  Failure to turn on the x-ray machine  Electrical failure  Malfunction of the x-ray machine  Correction  Make certain the x-ray machine is turned on and listen for the audible exposure signal.

8. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 8 Film Exposed to Light  Iannucci & Howerton (p. 227) (Fig. 20-2)  Appearance  The image appears black.  Cause  The film was exposed to white light.  Correction  Do not unwrap in a room with white light.  Check the darkroom for light leaks.  Turn off all lights in the darkroom except the safelight.

9. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 9 Overexposed Film  Iannucci & Howerton (p. 227) (Fig. 20-3)  Appearance  Image appears dark.  Cause  Excessive exposure time, kilovoltage, milliamperage.  Correction  Check settings and reduce as needed before exposing receptor.

10. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 10 Underexposed Receptor  Iannucci & Howerton (pp. 227-228) (Fig. 20-4)  Appearance  The image appears light.  Cause  The receptor was underexposed.  Correction  Check the exposure time, kilovoltage, and milliamperage settings on the x-ray machine before exposing the receptor.

11. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 11 Periapical Technique Errors  Receptor Placement Problems  Correct receptor placement  Incorrect receptor placement Absence of apical structures Absence of apical structures Dropped film corner Dropped film corner  Angulation Problems  Incorrect horizontal angulation  Incorrect vertical angulation  PID Alignment Problems  Cone-cut with Beam Alignment Device  Cone-cut without Beam Alignment Device

12. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 12 Correct Receptor Placement  Iannucci & Howerton (p. 228) (Fig. 20-5)  Each periapical receptor must be positioned in a certain way to show specific teeth and related anatomic structures.  The edge of the periapical receptor must be placed parallel to the incisal or occlusal surfaces of the teeth and extend 1/8 th inch beyond the incisal or occlusal surfaces.

13. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 13 Absence of Apical Structures  Iannucci & Howerton (p. 228) (Fig. 20-6)  Appearance  No apices appear on the receptor.  Cause  The receptor was not positioned in the patient’s mouth to cover the apical regions of the teeth.  Correction  Make certain no more than 1/8 th inch of the receptor edge extends beyond the incisal-occlusal surfaces of the teeth.

14. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 14 Dropped Receptor Corner  Iannucci & Howerton (p. 228) (Fig. 20-7)  Appearance  The occlusal plane appears tipped or tilted.  Cause  The edge of the receptor was not placed parallel to the incisal-occlusal surfaces of the teeth.  Correction  Make certain the edge of the receptor is placed parallel to the incisal-occlusal surfaces of the teeth.

15. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 15 Incorrect Horizontal Angulation  Iannucci & Howerton (p. 229) (Fig. 20-8)  Appearance  Overlapped contacts  Cause  The central ray was not directed through interproximal spaces.  Correction  Direct the x-ray beam through interproximal regions.

16. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 16 Incorrect Vertical Angulation  Iannucci & Howerton (p. 229) (Fig. 20-9)  Foreshortened images  Appearance Short teeth with blunted roots Short teeth with blunted roots  Cause Excessive vertical angulation Excessive vertical angulation  Correction Do not use excessive vertical angulation with the bisecting technique. Do not use excessive vertical angulation with the bisecting technique.

17. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 17 Incorrect Vertical Angulation  Iannucci & Howerton (p. 229) (Fig. 20-10)  Elongated images  Appearance Long, distorted teeth Long, distorted teeth  Cause The vertical angulation was insufficient. The vertical angulation was insufficient.  Correction Use adequate vertical angulation with the bisecting technique. Use adequate vertical angulation with the bisecting technique.

18. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 18 Position Indicating Device (PID) Alignment Problems  Iannucci & Howerton (pp. 229-230) (Fig. 20-11)  Cone-cut with Beam Alignment Device  Appearance A clear area appears on the image. A clear area appears on the image.  Cause The PID was not properly aligned with the periapical beam alignment device. The PID was not properly aligned with the periapical beam alignment device.  Correction Make certain the x-ray beam is centered over the receptor. Make certain the x-ray beam is centered over the receptor.

19. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 19 PID Alignment Problems  Iannucci & Howerton (p. 230) (Fig. 20-12)  Cone-cut without beam alignment device  Appearance A clear area appears on the image. A clear area appears on the image.  Cause The PID was not directed at the center of the receptor. The PID was not directed at the center of the receptor.  Correction Make certain the x-ray beam is centered over the receptor. Make certain the x-ray beam is centered over the receptor.

20. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 20 Bite-Wing Technique Errors  Receptor Placement Problems  Correct receptor placement  Incorrect receptor placement  Angulation Problems  Incorrect horizontal angulation  Incorrect vertical angulation  PID Alignment Problems  Cone-cut with beam alignment device  Cone-cut without beam alignment device

21. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 21 Correct Receptor Placement  Iannucci & Howerton (pp. 230-231) (Figs. 20-13, 20-14)  Premolar bite-wing  The resulting image shows both the maxillary and mandibular premolars and distal contact areas of both canines.  Molar bite-wing  The resulting image shows both the maxillary and mandibular molars.

22. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 22 Incorrect Receptor Placement  Iannucci & Howerton (p. 231) (Fig. 20-15)  Premolar bite-wing  Appearance Distal surfaces of the canines are not visible on the image. Distal surfaces of the canines are not visible on the image.  Cause The bite-wing receptor was positioned too far posteriorly in the mouth. The bite-wing receptor was positioned too far posteriorly in the mouth.  Correction Make certain the anterior edge of the bite-wing receptor is positioned at the midline of the mandibular canine. Make certain the anterior edge of the bite-wing receptor is positioned at the midline of the mandibular canine.

23. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 23 Incorrect Receptor Placement  Iannucci & Howerton (p. 231) (Fig. 20-16)  Molar bite-wing  Appearance Third molar regions are not visible on image. Third molar regions are not visible on image.  Cause The bite-wing receptor was positioned too far anteriorly in the mouth. The bite-wing receptor was positioned too far anteriorly in the mouth.  Correction Make certain the anterior edge of the bite-wing receptor is positioned at the midline of the mandibular second premolar. Make certain the anterior edge of the bite-wing receptor is positioned at the midline of the mandibular second premolar.

24. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 24 Incorrect Horizontal Angulation  Iannucci & Howerton (pp. 231-232) (Fig. 20-17)  Appearance  Overlapped contacts on the image  Cause  The central ray was not directed through the interproximal spaces  Correction  Direct the x-ray beam through the interproximal spaces.

25. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 25 Incorrect Vertical Angulation  Iannucci & Howerton (p. 232) (Fig. 20-18)  Appearance  Images appear distorted on the image.  Cause  The vertical angulation was incorrect.  Correction  Always use a +10-degree vertical angulation with the bitewing technique.

26. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 26 Cone-Cut With Beam Alignment Device  Iannucci & Howerton (pp. 232-233) (Fig. 20- 19)  Appearance  A clear area appears on the image.  Cause  The PID was not properly aligned with the beam alignment device.  Correction  Make certain the PID and the aiming ring are aligned.

27. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 27 Cone-Cut Without Beam Alignment Device  Iannucci & Howerton (p. 233) (Fig. 20-20)  Appearance  A clear area appears on the image.  Cause  The PID was not directed at the center of the receptor.  Correction  Make certain the x-ray beam is centered over the receptor.

28. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 28 Miscellaneous Technique Errors  Film Bending  Film Creasing  Phalangioma  Double Exposure  Movement  Reversed Film

29. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 29 Film Bending  Iannucci & Howerton (pp. 233-234) (Fig. 20-21)  Appearance  Images appear stretched and distorted.  Cause  The film was bent excessively.  Correction  Check film placement before exposure.

30. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 30 Film Creasing  Iannucci & Howerton (p. 234) (Fig. 20-22)  Appearance  A thin radiolucent line appears on the image.  Cause  The film was creased.  Correction  Do not bend or crease the film excessively.

31. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 31 Phalangioma  Iannucci & Howerton (p. 234) (Fig. 20-23)  Appearance  The patient’s finger appears on the radiograph.  Cause  The patient’s finger was positioned in front of the receptor.  Correction  Make certain the patient’s finger is placed behind the receptor.

32. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 32 Double Exposure  Iannucci & Howerton (p. 234) (Fig. 20-24)  Appearance  A double image appears on the radiograph.  Cause  The receptor was exposed twice in the patient’s mouth.  Correction  Always separate exposed and unexposed receptors.

33. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 33 Movement  Iannucci & Howerton (p. 234) (Fig. 20-25)  Appearance  Blurred images appear on the radiograph.  Cause  The patient moved during exposure of the receptor.  Correction  Instruct the patient to remain still while the receptor is being exposed.

34. Copyright © 2012, 2006, 2000, 1996 by Saunders, an imprint of Elsevier Inc. 34 Reversed Film  Iannucci & Howerton (p. 235) (Fig. 20-26)  Appearance  Light images with a herringbone pattern appear on the radiograph.  Cause  The receptor was placed backward in the mouth and then exposed.  Correction  Always place the white side of the receptor adjacent to the teeth.