Principles of Radiographic Interpretation
Juan F. Yepes DDS, MD, MPHAssistant Professor
Division of Oral Diagnosis, Oral Medicine and Oral RadiologyUniversity of Kentucky, College of Dentistry
Spring 2009
What is that radiologist saying? Well defined andCorticated…..
The objective of this lecture is to provide step-by-step- analytic processthat 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
General Objective
Some definitions….
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.
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.
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)
Well localized
The item being reported is limited to a specific area, and does not extend beyond that locality.
Well localized
Poorly localized
The item being reported is not limited to a specific area, and extends into surrounding anatomical sites.
Poorly localized
Well defined
The edges of the item being reported are reasonably sharp and clearly define the extent of the lesion.
Well defined
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.
Poorly defined
The lesion may thus be well localized and well defined
or well localized, but poorly defined
or poorly localized and poorly defined
but generally not poorly localized and well defined
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.
Corticated
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.
Multilocular
Loculus, loculi: the diminutive of locus.
Locus, loci: a place or position
Multilocular
Thus, multilocular implies several small places. As we use it, they are joined places.
Multilocular
Osteitis vs Osteomyelitis
Both terms mean that there is inflammation of bone.
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.
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.
Osteitis
inflammation of bone that remains localized, and may be more of a painful inconvenience
Osteitis
Osteomyelitis
Osteitis
Rarefying Osteitis
Sclerosing Osteitis
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.
Rarefying Osteitis (periapical lesion at UK)
Sclerosing Osteitis
I use the term sclerosing osteitis, i.e. inflammation of bone (osteitis) that causes sclerosis.
Sclerosing (or condensing) Osteitis
Sclerosing Osteitis
Periosteal Reaction
Any involvement of the periosteum by a pathological process that results in the deposition of periosteal new bone.
Inflammation of the Jaws and Periosteal Reactions Osteomyelitis
Periostitis
Healing
Anemia
Sessile
Sarcoma
Sarcoma
Orthogonal
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.
What is that radiologist really saying?
Well defined andCorticated
Well localized
Well localized
The radiologist infers that the appearance is consistent with a slow non-invasive growth, and thus that this is benign.
Poorly localized
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.
Well defined
Well defined
The radiologist infers that the appearance is consistent with a slow non-invasive growth, and thus that this is benign.
Poorly defined
Poorly defined
The radiologist infers that the appearance is consistent with invasive growth, and thus that this is malignant, or infectious/ inflammatory lesion.
Corticated
Corticated
The radiologist infers that the appearance is consistent with a slow non-invasive growth, and thus that this is benign.
Multilocular
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.
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?
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)
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
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)
Bone
Alveolar Bone
Dentition
Analysis of the Intraosseous Lesions
The preferred method of radiographic interpretation is STEP by STEP
This procedure helps ensure recognition and collection of all theinformation contained in the image and in turn improves theaccuracy of the interpretation.
1. Localize the abnormality
- Localized or Generalized- Position in the jaws- Single or multifocal- Size and shape
Analysis of the Intraosseous Lesions
1. Localize the abnormality
- Localized or Generalized- Position in the jaws- Single or multifocal- Size
2. Assess the periphery and shape
- Well defined ?- Corticated ?- Borders- Shape
Analysis of the Intraosseous Lesions
Step 2 Assess the periphery and shape
Corticated
Well defined
Analysis of the Intraosseous Lesions
Step 2 Assess the periphery and shape
Non - Corticated
Well defined
Analysis of the Intraosseous Lesions
Step 2 Assess the periphery and shape
Step 3: Analyze the internal structure
- Totally radiolucent- Totally radiopaque- Mixed density
Analysis of the Intraosseous Lesions
Step 3: Analyze the internal structure
- Totally radiolucent- Totally radiopaque- Mixed density
Analysis of the Intraosseous Lesions
Step 3: Analyze the internal structure
- Totally radiolucent- Totally radiopaque- Mixed density
Analysis of the Intraosseous Lesions
Step 3: Analyze the internal structure
- Totally radiolucent- Totally radiopaque- Mixed density
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
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
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
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
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
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