Principles of Radiographic Interpretation
Juan F. Yepes DDS, MD, MPH
Assistant Professor
Division of Oral Diagnosis, Oral Medicine and Oral Radiology
University of Kentucky, College of Dentistry
Spring 2009
What is that radiologist saying?
Well defined and
Corticated…..
General Objective
The objective of this lecture is to provide step-by-step- analytic process
that 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
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
Sessile
Osteomyelitis
Periostitis
Healing
Orthogonal
Anemia
Sarcoma
Sarcoma
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 and
Corticated
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)
Dentition
Alveolar
Bone
Bone
Analysis of the Intraosseous Lesions
The preferred method of radiographic interpretation is STEP by STEP
This procedure helps ensure recognition and collection of all the
information contained in the image and in turn improves the
accuracy 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
Corticated
Well defined
Step 2  Assess the periphery and shape
Analysis of the Intraosseous Lesions
Non - Corticated
Step 2  Assess the periphery and shape
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