Evaluation and correction of faults and errors most frequently encountered in the practice of intraoral roentgenography

Oral

Roentgenology

EVALUATION AND CORRECTION OF FAULTS AND ERRORS FREQUENTLY ENCOUNTERED IN THE PRACTICE OF INTRAORALROENTGENOGRAPHY MATTHEW

LOZIEIZ,

1 ).T).S..”

B.S.,

Nwv

\.ORK,

MOST

;1;. I-.

S THE: practice of intraoral t~oetttgettogt~al)lt~ we arc rtsuall~- cwtwt~tte~l with investigation of comparativcl~- fine ilIlt mirttitc OrgilIlS (larllitlit dulYI. pet%dental membrane and crest, pulp and p1t1p horns), with csamination of harcl ant1 soft tissues sometimes grossly diRerin, w in tlensif>~ ant1 thickness with eacah inclividnal patient and with each artv of invest iga.tion. IV0 :lUZ ills0 concernetl to ~ltl~ltOlttit~itl \-aCations wit,h perusal of osseous ant3 tlerital strwtures s~hjwt illld, being partly 01' f’nllJ* C0\Pt4ctl itll(l ftYXjltctttl!- out of sight, to il tleglYV itl\-isible lo the operator. We are not infrequent 1). tjeitt g t’ott ft~onted hew wit tt supcrim~~ositioti of the i~t’W lo bc examined by dense atttl sotttelittrcs wttt’rtsittgty interfering neighboring structures. The handlin g 01’ t hc esc~ctlingly delicat t? aticl casil,v ~ulnt~rahlc

I

film

cniulsion,

together

with

tltc

ntiwrtaitt

cletttcnts

of

exposure

timing,

illi,ttnitia-

lion. fogging, processitig solution tetll~WlXlUr~‘, Iwtcltcy, anti purity. is still allother factor here to be taken into c,onsideratiott. Tn view of what has jitsl bceii saitl, il ~wwr~ics wadily obvious why iaults aiic1

crivrs

owiu

hew

so

I’tw~itcitll~->

ilt

spite

ut’

every

care

artcl

precaution.

it not, therefore, light, of an csperimetit, \\‘ouId

satisfactory, wtwctiott

Atnoti~

bc a~lvisabla to regar~l eac~ltnew roentgenograph in the and whet1 the I’or~t~cr dots not appear to be rniircl) its sI~ortcoltiirigs to lw aswrfairtccl C!iIWfltll~’ and pmpcr tiieatls (01 tlecidetl upon befow illlOt ltcr rsattiittatiott is undcrtakn~. tltc

xtrions

O~ill roctit~ettograpli~, measures, may be cited.

errot3 the

ittld fol towing,

faults

most

together

I’rcqacttll~ with

1 heir

eticomiterotl respective

in

itttra-

corrcctiw

1. Incorrect Vertical Dimension.-‘WhcnwfJr :I l~o~~~t~~t~o~~i~l,h displays ittt iticotwct vehcal dilneiisiott. the region under examination being displayed as either elongated or I’oreshot~lrtted. the correction tttay be effected, first. 1)~~ il~L~Jro1:Cd alignmcn f of the tooth undrr rmn~inatio~z (the tooth, c~swpt when dealing with a molar, shoultl bc aligtwtl perpendicularly to the I)littte of the floor; the nose-ear and the lilwar line latttlmarks nta..v I-J~ entirely disregarded!, and, second. through (1, ~hwt~l(~ i)t tkc pt~(~~~iou.sly c'mplq~ed ve~ti~ohorizoninl trn,qulatiou.

the straight wrtic:il line bisecting the upper antl *2:y the “cone-rlircction:ll line” is want to visuxlizc? th
4. Incomplete Display of Pathosis.-\\‘ht,tt tltcj t.(,1~ttiyett~,p.t.;tlrlt ~‘;rils !(I owtttwttv~~ itI ifitt~t show the existing lesion itt its (sttlitd>., ;I ti01 itrftwlttettl ~~ht~ty~c~licltt c’;ltt IIf, clff’c~c*lf~(l oil ttf~t. 1))’ it 111~~1’~’ ill’(‘ll!‘;I If’ owl t,oeittgellog~;tphv. :lll~l 01’ ;I tocatiott of the filttt packet itt wlaiiolt to thch iI1’1’il 01’ ~~xiitttitiitli~Iti slight]?- tliffwntt ~c~~~tic~ohot~i~ottt~tl;tttglll;ttic)lt. ott(’ 11su;rI1~,twlttit’itte. ii (‘(II’. it~lflitiott;ll l~clf~llt~!c~tlfl~t.r.;rl,ll twtion 0T rlot~p:itic~tr. l”l’O~~llt’lltl~ tllOI’(’ thilll ltllf’ 1tl:ly 1>6A t*equil*etl to 0J~t;lilt il~lf~f~lliltf~ iltl(l s;rtist’;ic~tc~t~yclisj)tay 111’ t tt(s osislitrz sut~t~otttttlittg itnitivc~l\~f~( I 1issucb. lesion ils Well ilS its I)r’ol)c’t’ t~f~l;ltiott to tIltI \VhCIlcver* all Zlrl?il of pathosis is vet.>- estettsivt*, ill1 (‘Xtl’nOl’Zll iI~)])t’~l~l~‘ll IlllISt lw

tY?sottecl

to.

l<‘or* accurate 01mI’Vcd :

location

01’ the fitttt l);tcke!. the following

fit(*tot.s sh~ultl 1~5

a. When examining uppc~~’ molars, tllr (*enter of 1tl(l film j,ilVltt’s. The ft*ee Jlot.(let (11’th<~ packet is aligned parallel with the ocClus>tl surfaces ol’ the teeth. 11. When examining lowet. tttolaw. the center of’ the filttt l):tc’ket is ltesi It is Iwsitionetl oncl-sisth inch nhorc thv locatetl at the tooth to be esarttined. occlusat surfaces OS the trt01;1t’s ant1 l)~errtt)l>t 1’s. The ft*ee ltot*(let~ (ti’ the ltitpket is aligned parallel with thtb oe(~l~sat sltt~fitef~s of the terth. V. When examining ul)lwr (silttittes. the ctctttet. (~1’the filtn packet is best locatetl at the tooth. The 1’1w hortler of the packet. is lwst not aligttetl p;tt*;tlleI with the in&al suditees, the tlistal corwer lwittg positiotretl ~t)rtsitle~;tht~ lowet l,hart the mesiat. (1. When exarttining Itrwct~ c~a,nincs. the venter of the film p;tc*ket is Itest located nt the tooth. The free Itordct~ of the film packet is best rtot aiignc(l with the in&al and ocelt~sitl sut*fit(!es of the teeth. the tlistal cwtw1t’ ljeittg considerably above the tnesia I. e. When examining the ut)pet’ J~T’~t~lO~ill’S, the tnesial aspect of th,l filttt packet is best aligneti with the tttesial sIIt?itce of the c,o~t,es])orrtlittg l;rtrt+;~l incisot.. The fwe lmrdet~ of the filter 1)acket is somewhat in line n-ith the itte&l sut*fares of the latwal itrcisor ittttl ennine. hut as it cstettcls tlist;tIIy it is Ztligrled ~~f~llSidf?Elbl~ llf+lO\V th0 OCVIUSilI Slll”f’ilf’W Of the J~lY?ttlO~~ll~S iltlfl lllO~il~‘S. 01’ tl-lf> filltl E. When examining the lower I)t*etttolars. the ltlOSiil1 ilSl)(‘Ct packet is aligned with the tttcsial swface of Ih(a c~ot~t~csl)ortditta Iiltet*itI itt&or+. The free l~otder of the fitttt Irit(dkt~t is somewhat itt line with the irt&tl surfaces of the lateral ittcisot. ;ttttl cirttirte, Itut as it, esterrtls tlistitllg it is rlligttctl considerably above the occluswl surfaces of the pren-tolays ntttl trtol>t.rs.

5. Superimposition.--lf ;t tty of the neighboring dense :~rt;ttontic;tl str*uctures, such as the rnal:tr hone ant1 prwess? the syrttphysis, the mental ptw tuberawe the corwroid p~~wrss, or the nasal stt7tetutw, irtt~ed’ew with cleat. portrayal of the tissue untlcr c~s;ttt~itratiotr. it f*hitttge itt Ihe locatiort c~f the poittt of inciclcrtce will, ilS a lwtc, el’f’wt ;I tlecitletl itrt~~t~o~f~rrrc~ttt.Whtw tttc voronoid prwcess happens to obstruct the tuberosity arttl,/o~* the upper t,hitatl tnoln.~ IF gion, making the exposuw with the pat,ient ‘s ntouth wide open (a pr*actice which ordinarily is not recontttten(.~e(l) will do away with the snpr~itn~rositiott,

I”.\VI,‘l’S

.\SI)

ERRORS

IS

IXTR.~OK.\L

IiOKST~;l~NO~;R.tI’I

IT

-1:Nl

after it is washed off in water, into the tlevclopin~ solution for a few ruinutrs will disperse the fog caused by the fiser. This ~~~wwlurc (‘itrt he carried WIsafely in white light,. Irnrnersing a tlevelopctl film into a Itatdetrin~ Itirtlt hefor<, depositing it into the fiser will dispense with lltc f’o,(J’ c2RtlSf3J I,)- tJ?C’ tkdOJW. 0’ is caused ~J,I- tlic tisc of aact filtn nlatclrial, Sli111’ tJ. (‘h cnticnl Fog.-This -So, or exhausted processin g solutions, 1)~ proccssin~ of ttottt ropiwl filtn ctii ulsiotts itt warin solutions. hy leaving fingerprints on the wet filui snrt’acc clurinfi prowssing, and by staining the filni surface while rerttovin~ it l’twitt its pac*ltel. 01’ sWolttl;l r!’ c. I-ndiation Fey.-This type foa is CmIscd l)J- J)lklitr>radiations affectingr the unprotectctl exposed or uncs~~osctl film. f. (;reenish Fog.-This fog is usually ranscd 1)~ ;t ~ontaniinatd or* e’shansted fising solution, which is not, sufficiently acitl to nr~tiralixc the alkn.linit>of the developing solution. q, I’cllot~~ish-brolr~11rFoq.-This lype So K is ortlirt~ttil~ cansetl 1)~ inatlequatc fixation and/or insufficient washing of the fisrtl filtrt, c*;rLrsitt# fortnation OI silver sulfide stains on the film surfaces. I~nlcss the fixation period is cstentiwl to twenty rninul-cs or longer, followed by washing in voltl, pwf’:mhl~- c4rcLrl:rt inc?. water for at least an hour or loitpx, the ~cllo~~~isli-t~r~o~~-it stain, ilt first rwtiwl:irnperceptihle, will within a short period of lintr contpletely tlcstrop the rwi’ulness of the roentpnograph. 9. Incorrect Free Film Margin.-II’ a roent~cno~raph displays an intpr*opc’t+ or asytnmetrieal free filni rxtrgin. a ftOeyL1elttl~ e?lCOl??lt t>pecl CI’I’Ot’, il nlOrY? iIf’c.ut*ate alignment of the film packet, nrargin in relation to the occlns;rl or itrcis;>l sLLr*faces of Ihe teeth tluring the 1)1>Lct~rnentof ihta I)ilekeI, topthclr. with ilIlt retention, is ncc~~ssa~y for c~ot~rwtioii. A its more adequate :ltli~~~tiltiO?l eotnrtlon error ol~ervcd is lack of ilrr ntleyuate ftw filtu rnargiu irt the nrasilla and presence of escessivc mar+1 in the ntantlilrlc. To vorrwt the forttrw. the film l)acket, while it is being positioned: shoultl estjrntl just ottwlu:rr~tct~ inch helow the molars. To correct thr latter. the fc~llowitt~ tltt>itsLLt’esshonl~l h? ZttlOJttfYl

:

a. Refot*e introducing the film packet into t htl ntouth. always ltrovitle it(le(luat(~ roortr for it an&r the patient’s tongue. 1). Introduce the film packet. in :L clwitletlly slanting position with its lowrr* nrargin towiLr*tl the IWW of the tongue. (2. Position the film packet,, with its looter vot’tww ;tde~~uiltely rrliwctl. cawfnlland painlessly-. (1. Aftry obtaining the J)t’O])Cr free film ltortler (which it1 the molar region should extent1 one-sixth inch altow the OCC~OSU~ sLLt*fil(‘(hsof the teeth) ant1 ltcfore releasing your finger from the packet, olttain its adequate retention lty the pat,ient. e. I-se the smaller-size, No. 0, pet’iapical film l);rczktat in esirttrination ot lower canines and incisors, as well as in csaii~irtatic~ti of etlentulous Incvcr~ ittolar regions. Outlining on the filnL l)acket with a pencil lirtc the required free filrtt l~ortler ttefore positioning the film in the ntouth rttity sortretitrtes 1~ helpful.

Among the n1;111yc+hemicnl injuries sioil. the following van be vited :

sonletimw

inflictccl

upon the filn~ ~mul-

or wticulation~ c~alw~l 1)~ ~)roccssing in warm a. Otxngc per1 blistering solutions or washing in W\T;I~II water. 1). Tiny while spots or (lots clue to air or carlwn dioxide buhhle formation and to floating foreign particles usually result from inadequate agitat.ion of the fil?n in the fixing solutioll. The floating foreign I)articlcs, sometimes found in the l)rocessing room, CO?IW from the evwl)oration of the spilled processing solution which was allowed to tlry insteatl of being \vilJed away in~nretliatcly. (2. TWO short l)arallel white stl*r:~ks sometimes e~l~ouuteretl on one of the l)ortlers 01 iI I)I*o(*(++setlfil?~? are due to the emplc)~~ll~‘llt of >t fill11 clip cor:t:lnl‘1’0 avoitl this nlishnp. film clips. after+ heinK inatetl iit oltl I)rocessing solution. l)PfOYf2 USN1 ClgS;Iin. 11set1OI~CP,sh0~11tl nlwi?yS 1~ lvashctl in ?an?li??, 0’ tl. I’~~wIw~~ of’ white scum on prwcssctl fi1111 is clue to prwessi??g in fixing solution with ;I tlrcicldly milky-like >l])],e>lr~net. I+‘our princi[)al f;lvtorS 1llil.y 1:~ wsl~oiisil~lr for such condition of the fixer: \\ai(‘l’

1. Illiltlcquatt rinsing of filnis after they art rcnrovccl from the tlcvcloper This CllCltliC~ill, when cleposittvl into the fiStll.. (.ontainillg sotliuiti carlwtlatc. tC?fltlS to j)l’e’c’if)ititlc il Slllcl$e Of sluntinum StllfiltC’. 2. Inadequate or incorrwt noising of’ the fistlr chemicals during the I)t’el);ll*;lIion of the solutiorl. 2. I’sinp water of diRerent t,enlpernturcs clnring the preparation of 1he fisc1*. 4. Ignoring the manufacturer’s instructions ils to which chemical should lw nlisetl ant1 addrcl first during the preparation of t,hc fixer. The employment of either fully prtparctl or concentrated processing solntions to which only water need lw atldcd is rwonl~tlentletl at all times for lwtter wsults in processing. e. T:lw(:k spots or irregular black lines on the roetltgenugraph are usually (‘artful nonhurrjetl hilll(lliltg of the film packet while tluc to static electricity. it is bring opened will ol)viate this ltlishilp. f. SuIilll irreguli>r dark sl)ots a~ usuillly (111~to (lust partjicles fou?ld somctinlrs floating in the l)rocessing room ant1 nclherinp to the surface of the str*iI)lwtl filln lwfore it was inserted into the processing solution. p. Slnilll, irregular light sl)ots ()I’ depressions ill*t’ (‘iIuse(l 1)~ Tv