IMAGE RECEPTORS IN

DENTAL RADIOGRAPHY
& DADIOLOGY
Presenter:
KIFAMULUSI ERISA 20/U/16071

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Introduction;….
Objectives:

1. Know and understand the imaging systems in dental radiography.

2. Their applications in intraoral panoramic or extraoral projections.

3. Their processing and duplication.

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 Introduction:…….

Definition: Is a medium that changes the X-ray beam into a visible image after penetration
through an object.
History:
• 1896; 1st dental radiograph
• 1896-1913; X-ray packet (glass photographic plates; hand-wrapped in rubber dam)
• 1913; pre-packaged film (Eastman Kodak by hand)
• 1921; 1st machine-made packet (flat + lead sheet)
• 1923; film packets (regular + extra-fast)
• 1925; Double-coated emulsion film (reduced exposure + increased film speed)
• Note; exposure reduced from 6-8secs to a 1/10th sec!!!

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Types of Image receptors:
Two main types, namely;
Digital receptors;
• Solid –state sensors; Intraoral sensors and extraoral sensors.
• Photostimulable phosphor storage plates, or phosphor plates ( PSPs).
Radiographic film;
• Direct-action or non-screen film (wrapped or packet film); X-ray photon
sensitive.
• Indirect-action or screen film; light photon sensitive

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Digital Receptors
1. Solid-state sensors.
Intraoral sensors;
• small/thin/flat/rigid & rectangular.
• 5-6mm thickness.
• Are cabled.; 1-2m long
• Not auotoclavable; thus enveloped in plastic barrier for infection control
Extraoral sensors;
• Contain 2 charge-coupled devices (CCDs) in long, thin linear arrays ,few pixels wide
and many pixels long.
• Two images obtained but stitched together by the computer software to create one large
image.
2. Photostimulable phosphor storage plates (PSPs).
• Consist of many imaging plates, & no cable. Placed in plastic barriers for infection
control.
• Also has intraoral plates & extraoral plates without intensifying screen. Used for
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panoramic and skull radiography
Applications of Digital Receptors

Intraoral;
• Periapical radiographs.
• Bite wings

Extraoral radiography;
• panoramic/cephalometric digitals units
• used for panoramic and cephalometric lateral skull radiography.

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Solid-state Sensors; Construction design & technology.

Consist of tiny silicon chip-based pixels encased in a plastic housing.

Underlying technology involves either:
Charge-coupled devices (CCD);
• consisting of a sandwich of P- and N-type silicon, in a matrix.
• Xray photons hit the scintillation layer; converted to light; interacts via the
photoelectric effect with the silicon to form a charge packet; that represents the
latent image.
Complementary metal oxide semiconductors (CMOS).
• Consist of complementary metal oxide semiconductor pixel directly connected to
a transistor.
• Charge packet from each pixel is transferred to the transistor as a voltage and
assessed separately.

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Intraoral Sensors; characteristics.

• consists of between 1.5 million and 2.5 million pixels

• pixel
• sizes vary from 15 to 20 μm.
• Cable length; 1-2metres

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Extraoral Sensors
Used In combined panoramic/cephalometric digitals units, used for panoramic
and cephalometric lateral skull radiography
The lower array is used for panoramic imaging.
Both arrays are used for cephalometric radiography.
Used with a very narrow slit-shaped X-ray beam which is exactly aligned with the
CCD array(s).
X-ray beam + sensor move together during exposure; final image is built up
section by section as patient is scanned.

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2. PSPs (Photostimulable Phosphor Storage
Plates)
Consist of a range of imaging plates, can be used for both intraoral and extraoral
radiography. Lack cables..
Plates vary in sizes. But similar in size to conventional packet films.
Intraoral plates inserted into plastic barrier envelopes for control of infection.
Used for PA, bitewing and occlusal radiography.
Extraoral plates similar in size to traditional indirect action film used for
panoramic and skull radiography and are used in cassettes but without intensifying
screens.
Examples; Durr’s VistaScan™, Soredex’s Digora® Optime (intraoral) and PCT
(extraoral) and Planmeca’s ProScanner system.

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PSP Construction

consist of a layer of europium activated barium fluorohalide (BaFX : Eu2+ )

phosphor on a flexible plastic backing support.

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Image Production with PSPs

Image production is not instantaneous.

Two distinct stages are involved namely;

• Phosphor layer absorbs and stores the X-ray energy that has not been attenuated
by the patient.
• Image plate is placed in a reader, scanned by a laser beam

X-ray energy stored in the phosphor layer, released as light, detected by a

photomultiplier tube, converted into a voltage, relayed to computer & displayed as
a digital image.

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Radiographic Film

Traditionally used as the image receptor in dentistry and is still widely used.
There are two basic types:
Direct-action or non-screen film (wrapped or packet film). Sensitive primarily to
X-ray photons.
Indirect-action or screen film; used in combination with intensifying screens in a
cassette . Sensitive primarily to light photons emitted by intensifying screens.
Shorter exposure , lower dose of radiation.

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Direct-action Film
Uses;
intraoral radiography (image quality and fine anatomical).
Sizes;
 31 X 41 mm For PA & Bitewings
22 X 35mm for PA & bitewings
57 X 76mm for occlusals
Contents of direct film packet;
outer packet/wrapper; non-absorbent paper/plastic and is sealed to prevent the
ingress of saliva.
Front side; pebbled/smooth surface and is usually white.
Back side; two colours, each represents different film speeds.

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Direct film packet contents………….
Black paper on either side; protect against Light, Damage by fingers, & Saliva.
lead foil sheet; prevent passage of residual radiation into the patient’s tissues,
Scattered X-ray photon interactions within tissues beyond the film, scattering back
on to the film and degrading the image.
Lead foil is embossed with dot; appears on the resultant radiograph

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Radiographic Film Structure/ components:
plastic base; clear, transparent cellulose acetate –supports the emulsion. do not
contribute to final image.
Thin layer of adhesive – fixes the emulsion to the base.
Green emulsion on both sides of the base – silver halide crystals embedded in a
gelatine matrix.
• Clinically; viewed correctly from either side, unlike single emulsion fim.
 Gelatin layer; shields emulsion from mechanical damage

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Film orientation:
embossed dot on one corner helps with orientation
 Its position is marked on the back of the packet or can be felt as a raised dot on
the front.
The side of the film on which the dot is raised is placed towards the X-ray beam.
When the films are mounted, the raised dot is towards the operator
Films are arranged anatomically and viewed as if the operator were facing the
patient.

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Indirect-action Film

Film/screen combinations are used as image detectors because of the reduced dose
of radiation to the patient.
Uses;
Extraorally for:
Oblique lateral radiographs
All skull radiographs
Panoramic radiographs
All routine medical radiography

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Indirect-action Film Construction

silver halide emulsion; sensitive to light rather than X-rays.

Emulsions are sensitive to different colours of light and include;
• Standard silver halide emulsion; sensitive to BLUE light
• Modified silver halide emulsion sensitive to ULTRAVIOLET light
• Orthochromatic emulsion sensitive to GREEN light.
• Panchromatic emulsion sensitive to RED light.
Correct combination of film and intensifying screens is used.
No orientation dot; identifications e.g metal letters, L or R , placed on the outside
of the cassette or electronic marking.

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Characteristics of Radiographic Film

These are theoretical terms and definitions used to describe how radiographic film
responds to exposure to X-rays.
Optical density (OD); degree of film blackening. Measured directly using a
densitometer. Ranges (0.25–2.50).

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Charateristics ctd’….

Characteristic curve; shows variation in OD (degree of blackening) with

different exposures.

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Charateristics ctd’….
Background fog density; small degree of blackening/darkening evident even
with zero exposure. i.e, by sources other than primary beam of radiation. E.g
chemical, light, & scatter radiation.
due to: colour/density of plastic base, dev’t of some unexposed silver halide
crystals, improper storage.
should be less than 0.2 if film stored correctly.

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 Characteristics ctd’…..
Film Speed; exposure required to produce an OD of 1.0 above background fog.
• the faster the film = less exposure = lower the radiation dose
• It’s a function of number and size of silver halide crystals.
the larger crystals = faster. But poorer image quality.
Film definition and Detail; depends on crystal size. Larger = poorer definition.
Smaller = better definition. Dilemma ??? poorer definition or better definition
Film Sensitivity; reciprocal of exposure required to produce an OD of 1.0 above
background fog. Fast film = ↑ sensitivity.
Film Latitude; measure of range of exposures of characteristic curve. wider film
latitude, ↑range of object densities that may be seen.
Film Contrast; difference in OD between 2 points on a film that have received
different exposures
Resolution; ability to differentiate between different structures close together.
Determined by; penumbra effect (image sharpness), crystal size & contrast.
measured in line pairs per millimetre. 25
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Intensifying Screens

Consist of fluorescent phosphors.

Intensify or ↑radiation and thus decrease exposure time
Action;
The front screen absorbs low-energy X-ray photons and the back screen absorbs
high-energy photons.
 The2 screens stop transmitted X-ray beam, convert it to visible light by
photoelectric effect.
Radiation needed for exposure is reduced; but resolution (fine detail) is decreased

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Types of Intensifying Screens

Rare Earth Elements; Modern, produce very fast screen speeds, require low
radiation dose , no excessive loss of image detail.
• They include; Lanthanum, Gadolinium, Terbium activated screens(green light),
Thulium activated(emit blue light)
• Difficult and expensive to separate from earth and from each other
• 5X faster than calcium tungsten screens
Calcium tungstate; was the original material. No longer used.
• Their speed depends on; thickness of phosphor layer, size of phosphor crystals,
presence/absence of light-absorbing dyes within the screen, conversion efficiency
of crystals.
• All calcium tungstate screens emit BLUE light.
• Slower than rare earth screens
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Cassette Usage
Of different shapes, but similar construction.
consist of a light-tight aluminium or carbon fibre container with radiographic film
sandwiched tightly between two intensifying screens.
Any loss in film/screen contact leads to degradation of final image/poor
definition.
Used in extraoral and panoramic radiography

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Practical Considerations;..

Film Storage;
• Refrigerator in cool, dry conditions
• Away from all sources of ionizing radiation
• Away from chemical fumes (Hg and Hg-containing cpds)
• boxes placed on their edges, to prevent pressure artefacts.
Screen Maintenance;
• Regular cleaning with appropriate cleaning agent
• Careful handling; avoid scratching or damaging the surface
• Regular checks for loss of film/screen contact.

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Duplicating film:
Satisfy requests for radiographs & maintain integrity of office records
RULE: Radiographs should never leave the dental office unless they have been
duplicated.
Procedure;
• The original is placed in close contact with emulsion side of duplicating film
positioned so that light strikes the original 1st .
• Films are exposed to light for about 6 to 8 seconds.
• Duplicating film is processed.

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Conclusion;..
Digital Receptors: two main types; solid-state sensors, and photostimulable
phosphor storage plates (PSPs).
Applications: both intraoral and extraoral radiography, enhancing imaging
capabilities.
Solid-state Sensors: compact and versatile, suitable for intraoral radiography,
use CCD and CMOS technologies.
Extraoral Sensors: used in extraoral radiography, e.g panoramic and
cephalometric imaging.
PSPs: flexible and suitable for both intraoral & extraoral radiography.
Radiographic Film: direct-action and indirect-action film types
Film Characteristics: Optical density, film speed, resolution,& contrast.
Intensifying Screens: reduce radiation exposure & enhance image quality
Cassettes: maintain film-screen contact and ensure quality radiographic images
Practical Considerations: proper film storage, screen maintenance, and film-
screen contact for successful dental radiography. 32
References;
Eric Whaites, Nicolas Drage. Chapeter 4 “Image receptors”
Essentials of Dental Radiography and Radiology, 6 th Edition.
Frommer, Stabulas-Savage. Chapter 4 “Image receptors” Radiology
For The Dental Professional, 9th Edition.

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