EXPOSURE AND TECHNIQUE ERRORS DA 105 Dental Radiography Questions What film 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 film placement for bitewing radiographs? Dental Radiography Exposure and Technique Errors Film exposure errors Technique errors (periapical films) Technique errors (bite-wing films) Miscellaneous technique errors Exposure and Technique Errors Purpose To describe film exposure problems and periapical, bite-wing, and miscellaneous technique errors Film Exposure Errors Exposure Problems Unexposed film Film exposed to light Time and Exposure Factor Problems Overexposed film Underexposed film Unexposed Film Appearance The film 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 An unexposed film appears clear Film Exposed to Light Appearance Cause The film appears black 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 A film exposed to light appears black Overexposed Film Appearance Cause Film appears dark Excessive exposure time, kilovoltage, milliamperage Correction Check settings and reduce as needed before exposing film An overexposed film appears dark Underexposed Film Appearance Cause The film appears light The film was underexposed Correction Check the exposure time, kilovoltage, and milliamperage settings on the x-ray machine before exposing the film An underexposed film appears light Technique Errors (Periapical Films) Film Placement Problems Correct film placement Incorrect film placement Angulation Problems Absence of apical structures Dropped film corner Incorrect horizontal angulation Incorrect vertical angulation PID Alignment Problems Cone-cut with Film Holder Cone-cut without Film Holder Correct Film Placement Each periapical film must be positioned in a certain way to show specific teeth and related anatomic structures The edge of the periapical film must be placed parallel to the incisal or occlusal surfaces of the teeth and extend 1/8th inch beyond the incisal or occlusal surfaces Correct periapical film placement demonstrates the entire tooth, including the apex and surrounding structures Absence of Apical Structures Haring (p. 276) (Fig. 20-6) Appearance No apices appear on the film Cause The film was not positioned in the patient’s mouth to cover the apical regions of the teeth Correction th inch of the film Make certain no more than 1/8 edge extends beyond the incisal-occlusal surfaces of the teeth Improper film placement; no apices appear on this film Dropped Film Corner Appearance The occlusal plane appears tipped or tilted Cause The edge of the film was not placed parallel to the incisal-occlusal surfaces of the teeth Correction Make certain the edge of the film is placed parallel to the incisal-occlusal surfaces of the teeth Improper film placement; a dropped film corner is seen when the edge of the film is not placed parallel to the incisal or occlusal surfaces of the teeth Incorrect Horizontal Angulation Appearance Cause Overlapped contacts The central ray was not directed through interproximal spaces Correction Direct the x-ray beam through interproximal regions Incorrect horizontal angulation results in overlapped contact areas Incorrect Vertical Angulation Foreshortened images Appearance Cause Short teeth with blunted roots Excessive vertical angulation Correction Do not use excessive vertical angulation with the bisecting technique If the vertical angulation is too steep, the image of the tooth on the film is shorter than the actual tooth; the images are foreshortened Incorrect Vertical Angulation Elongated images Appearance Cause Long, distorted teeth The vertical angulation was insufficient Correction Use adequate vertical angulation with the bisecting technique If the vertical angulation is too flat, the image of the tooth on the film is longer than the actual tooth; the images are elongated PID Alignment Problems Cone-cut with film holder Appearance Cause A clear area appears on the film The PID was not properly aligned with the periapical film holder Correction Make certain the x-ray beam is centered over the film A cone-cut is seen when the PID is not properly aligned with the periapical filmholding device PID Alignment Problems Cone-cut without film holder Appearance Cause A clear area appears on the film The PID was not directed at the center of the film Correction Make certain the x-ray beam is centered over the film A cone-cut appears as a curved unexposed (clear) area on a radiograph Technique Errors (Bite-Wing Films) Film Placement Problems Angulation Problems Correct film placement Incorrect film placement Incorrect horizontal angulation Incorrect vertical angulation PID Alignment Problems Cone-cut with film holder Cone-cut without film holder Correct Film Placement Premolar bite-wing The resulting film shows both the maxillary and mandibular premolars and distal contact areas of both canines Molar bite-wing The resulting film shows both the maxillary and mandibular molars Correct film placement for the premolar bite-wing Correct film placement for the molar bite-wing Incorrect Film Placement Premolar bite-wing Appearance Distal surfaces of the canines are not visible on the film Cause The bite-wing film was positioned too far posteriorly in the mouth Correction Make certain the anterior edge of the bite-wing film is positioned at the midline of the mandibular canine Incorrect film placement for the premolar bite-wing Incorrect Film Placement Molar bite-wing Appearance Cause Third molar regions are not visible on film The bite-wing film was positioned too far anteriorly in the mouth Correction Make certain the anterior edge of the bite-wing film is positioned at the midline of the mandibular second premolar Incorrect film placement for the molar bite-wing Incorrect Horizontal Angulation Appearance Cause Overlapped contacts on the film The central ray was not directed through the interproximal spaces Correction Direct the x-ray beam through the interproximal spaces Overlapped interproximal contacts result from incorrect horizontal angulation Incorrect Vertical Angulation Appearance Cause Images appear distorted on the film The vertical angulation was incorrect Correction Always use a +10-degree vertical angulation with the bite-wing technique Incorrect vertical angulation causes the images to appear distorted Cone-Cut With Film Holder Appearance Cause A clear area appears on the film The PID was not properly aligned with the film holder Correction Make certain the PID and the aiming ring are aligned A, A cone-cut is seen when the PID is not properly aligned with the bite-wing film-holding device. B, A cone-cut can also be produced with rectangular collimation; the PID is not properly aligned with the bite-wing film-holding device Cone-Cut Without Film Holder Appearance Cause A clear area appears on the film The PID was not directed at the center of the film Correction Make certain the x-ray beam is centered over the film A cone-cut appears as a curved unexposed (clear) area on a radiograph Miscellaneous Technique Errors Film Bending Film Creasing Phalangioma Double Exposure Movement Reversed Film Film Bending Appearance Cause Images appear stretched and distorted The film was bent excessively Correction Check film placement before exposure A bent film appears distorted Film Creasing Appearance Cause A thin radiolucent line appears on the film The film was creased Correction Do not bend or crease the film excessively A film crease appears as a thin radiolucent line Phalangioma Appearance The patient’s finger appears on the film Cause Haring (p. 282) (Fig. 20-23) The patient’s finger was positioned in front of the film Correction Make certain the patient’s finger is placed behind the film This film demonstrates a phalangioma; the bones of a patients finger appear on the film Double Exposure Appearance Cause A double image appears on the film The film was exposed twice in the patient’s mouth Correction Always separate exposed and unexposed films This film demonstrates a double exposure Movement Cause Appearance Blurred images appear on the film The patient moved during exposure of the film Correction Instruct the patient to remain still while the film is being exposed Movement results in a blurred image Reversed Film Appearance Light images with a herringbone pattern appear on the film Cause The film was placed backward in the mouth and then exposed Correction Always place the white side of the film adjacent to the teeth A reversed film appears light with a herringbone (or tire-track) pattern. The tire-track pattern is seen on the lead-foil backing within the film packet EXPOSURE AND TECHNIQUE ERRORS DIAGNOSTIC DENTAL RADIOGRAPH: 1.FILM EXPOSURE ERRORS: EXPOSURE PROBLEMS a) Unexposed film b) Film exposed to light TIME AND EXPOSURE FACTOR PROBLEMS a) Overexposed film b) Underexposed film APPEARANCE CAUSE CORRECTION TECHNIQUE ERRORS(PERIAPICAL FILMS) 1. 2. 3. FILM PLACEMENT PROBLEMS ANGULATION PROBLEMS PID ALIGNMENT PROBLEMS FILM PLACEMENT PROBLEMS ERROR CORRECT FILM PLACEMENT INCORRECT FILM PLACEMENT a) ABSENCE OF APICAL STRUCTURES b) DROPPED FILM CORNER APPEARANCE CAUSE CORRECTION ANGULATION PROBLEMS ERROR INCORRECT HORIZONTAL ANGULATION INCORRECT VERTICAL ANGULATION a) FORESHORTENED IMAGE b) ELONGATED IMAGE APPEARANCE CAUSE CORRECTION PID ALIGNMENT PROBLEMS ERROR CONE-CUT WITH FILM HOLDER CONE-CUT WITHOUT FILM HOLDER APPEARANCE CAUSE CORRECTION TECHNIQUE ERRORS(BITE-WING FILMS) 1. 2. 3. FILM PLACEMENT PROBLEMS ANGULATION PROBLEMS PID ALIGNMENT PROBLEMS FILM PLACEMENT PROBLEMS ERROR CORRECT FILM PLACEMENT 1)PREMOLAR BITEWING 2)MOLAR BITEWING INCORRECT FILM PLACEMENT 1)PREMOLAR BITEWING 2)MOLAR BITEWING ANGULATION PROBLEMS ERROR INCORRECT HORIZONTAL ANGULATION INCORRECT VERTICAL ANGULATION APPEARANCE CAUSE CORRECTION PID ALIGNMENT PROBLEMS ERROR CONE-CUT WITH FILM HOLDER CONE-CUT WITHOUT FILM HOLDER APPEARANCE CAUSE CORRECTION MISCELLANEOUS TECHNIQUE ERRORS ERROR 1.FILM BENDING 2.FILM CREASING 3.PHALANGIO MA 4.DOUBLE EXPOSURE 5.MOVEMENT 6.REVERSED FILM APPEARANCE CAUSE CORRECTION