Digital imaging

Islam Kassem

Level 6

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 Digital Radiography
• Advances in digital technology have led to a
unique “filmless” imaging system known as
digital radiography.
• Introduced in 1987, digital radiography has
influenced both how dental disease is
recognized and how it is diagnosed.
• In the last 2 years, the use of digital
radiography is rapidly increasing in both
general and specialty dental practices.
• Numerous companies are producing digital
radiography systems.

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 The Basics of Digital Radiography

• Digital radiography uses a sensor to capture a

radiographic image, breaking it into electronic
pieces and storing the image in a computer.
• The patient is exposed to less x-radiation than
with conventional radiography.
• The image is displayed on a computer screen
rather than on film.
• The term image (not radiograph) is used to
describe the pictures that are produced.
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The Basics of Digital Radiography- cont’d

• The x-ray beam strikes the sensor.

• An electronic charge is produced on the
surface of the sensor, and this electronic signal
is digitized.
• The digital sensor in turn transmits this
information to the computer.
• Software in the computer is used to store the
image electronically.

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 Radiation Exposure

• Digital radiography requires much less x-

radiation than conventional radiography
because the sensor is more sensitive to x-rays
than to conventional film.
• Exposure times for digital radiography are 50%
to 80% less than that required for radiography
using conventional film.
• With less radiation, the absorbed dose to the
patient is significantly lower.

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 Equipment

• For digital radiography, special equipment is

required. The essential components include:
• Dental x-ray unit
• Intraoral sensor
• Computer

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 Types of Digital Imaging

• Direct digital imaging

• Indirect digital imaging
• Storage phosphor imaging
• The difference between each method is in
how the image is obtained and in what size
the receptor plates are available (e.g.,
panoramic).

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 Digital Radiography
Digital dental radiography comes in two
forms:
• Direct : that connect directly to the
computer via USB and provides
immediate images
• Indirect : (photostimulable phosphor
plates, or PSP) which uses plates that are
radiated and then digitally scanned.

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 Indirect Digital radiography
• Indirect digital imaging utilizes a reusable plate in
place of the film. After X-ray exposure the plate
(sheet) is placed in a special scanner where the
latent formed image is retrieved point by point and
digitized, using laser light scanning.

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 Direct Digital Radiography
• There are two main types of digital sensors
available

• One is based on charge coupled device

technology and the other consists of
phosphor storage plates

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 Charge Coupled Device (CCD(
• Is a device for the movement of electrical charge
usually from within the device to an area where the charge can
be manipulated .
for example conversion into a digital valueThis is achieved by
shifting the signals between stages within the device one at a
time CCDs move charge between capacitive bins in the
device with the shift allowing for the transfer of charge
between bins

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 PSP system
PSP or Phosphor Storage Plate systems
The X-ray image is captured using a PSP. PSPs are
wireless. Since they are not directly connected to
the computer, adevice is required to read or
extract the data from the PSP and send the
image data to a computer.

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Advantages of digital imaging

Dose reduction
• Dose reductions of up to 90 per cent
compared to E-speed filmin the
diagnosis of caries.

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Image manipulation
• This is perhaps the greatest advantage of
digital imaging over conventional film.
• Contrast enhancement.
• Measurements. Digital callipers, rulers and
protractors are some of the many tools
available for image analysis.
• 3-D reconstruction. This application can be
theoretically used to reconstruct intra- and
extra-oral images
• Filtration. The addition of filters to the
airspace around the face can clarify the soft
tissue
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 .

Time
• Much time is gained especially with the CCD
system where the image is displayed at the
chair side immediately post exposure.

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Storage
• Now a CD ROM can hold over 30,000
images. This means that images can be
stored cheaply
and indefinitely.

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 .

Teleradiology
• The digital image file can be further
reduced in size by compression
techniques, and sent via a modem and
telephone line to colleagues for review.

Environmentally friendly
• No processing chemicals are used or
disposed of. Both CCD sensors and the
PSP plates are capable of being reused
for many thousands of exposures.

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Disadvantages of digital imaging

The majority of the disadvantages are

associated with the CCD system.
Cost
• Currently, the cost of converting
from intra-oral film to digital imaging
is approximately 6600 Euros.

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Sensor dimensions
• These are still quite bulky for the
CCD system and awkward to position
due to trailing fibre optic wires.
Cross-infection control
• Each intra-oral sensor and plate
must be covered by a plastic bag,
and this bag is changed between
patients. However, if they become
directly contaminated there is no
way of sterilizing them and they
should be discarded regardless of
expense. ikassem@dr.com
 .

Medicolegal
• Concerns have been raised in the
past about the ability to manipulate
the images for fraudulent purposes.
Manufacturers of software
programmes have installed ‘audit
trails’, which can track down and
recover the original image.

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 Extra-oral digital imaging

• Extra-oral digital imaging is available using

both systems.
• The larger CCD sensors are extremely
expensive and usually requires the purchase
of new X-ray generators
• These constrictions effectively mean that
the PSP method is the one most commonly
used.

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Panoramic radiography
• The PSP method of panoramic digital
imaging is very similar to
conventional film. The film and
intensifying screen are replaced by a
storage phosphor plate.
• The plate is scanned after exposure,
which can take up to 3 minutes or
longer depending on the product
used.
• The resolution of these systems is
greater than 4 LP/mm.
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Cephalometric radiography

• The effect of dose reduction obtained with

PSP on the identification of cephalometric
landmarks did not effect the localization of
cephalometric landmarks.
• It is also worth noting that with CCD
sensors the image is acquired over 15
seconds as the sensor and narrow X-ray
beam move up the facial bones and could
lead to an increase in the incidence of
movement artefact.

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 Applications of Digital
radiographs in Dentistry
In Periodontics :
• to evaluate the level and condition of the
alveolar ridge
• to search for factors which may influence
periodontal disease such as calculus,
overhangs, etc.,
• to prepare treatment plans and finally to
evaluate the results of treatment.
• comparison of images of the same teeth
taken “before” and “after” treatment

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In Fixed Prosthodontics :

• With digital radiography you will be able to check

the fit of new crowns, bridges, posts, and implant
impression copings and abutments and also
verfication of proper seating of the restoration
without increase in cement space as in cases of
post and core .
• Gives information about the changes within the
periodontium of the abutments in partial fixed
prosthesis , if there is any recurrent caries under
restoration and if there is any periapical lesion
following improper post and core restoration .

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In Endodontics :
Canal Length Measurement by Digital Radiography

The canal length is measured from the

radiographic apex to a reference
point on the crown. Studies of
periapical healing after endodontic
treatment have shown the
importance of confining endodontic
instrumentation and obturation
within the root.
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In Orthodontics :
• They offer higher-resolution images
within the mouth – enabling the
orthodontist to diagnosis and correct
problems with greater accuracy.
• The digital cephalometric radiograph can
be analyzed more precisely using
dedicated software.
• These digital tools are very important in
the studies of the growth and
development of the stomatognathic
system

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In Implantology :
• used to plan the placement of
endosseous dental implants using
three-dimensional computed
tomography images obtained with
commercial software.
• uses digital subtraction radiography
to assess longitudinal bony change
around dental implants.

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In TMJ :
• Plain films are used primarily to evaluate
for bone disease such as osteoarthritis and
traumatic injuries. Digital radiography
improve diagnosis by providing helpful
tools such as: image sharpening, contrast
and brightness enhancement, zooming,
color coding, iso density and spotlight,
angle and length measurement
• CBCT “tomography” used for the
measurement of the angle of the long axis
of the condylar heads

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In Diagnosis of Pathological lesions :
• Many developmental lesions and
anomalies can be detected in earlier
stage with digital systems than with
conventional methods
• The possibilities to vary the brightness
of an image is often of great diagnostic
value. the same physical brightness
difference e.g. between a pathological
lesion and its background, is easier
perceived against a darker background
that against a light one .

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 As this radiograph gradually gets
darker, the lesions at the apices of the
first molar become more visible

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In Surgery:
• X-ray based imaging is routinely used for
preoperative diagnosis and planning, for
intraoperative guidance and control, and
for the postoperative evaluation of
computer-assisted surgery (CAS) in the
majority of its applications
• Possibility to locate impacted molars and
cuspids and to measure the dimensions of
the alveolar bone with great accuracy.
• identify potential pathologies and
structural abnormalities with
unprecedented accuracy

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• You can get the lecture on

• http://www.slideshare.net/islamkassem

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