History

• Early films were hand made and consisted of glass plates

or roll films, cut to proper length and wrapped in black
paper and rubber dam material to prevent moisture
leakage. The major disadvantage was lack of image
sensitivity.
• The first machine wrapped dental x-ray film packet,
called Regular film (Kodak), became commercially
available in 1919. It was single emulsion
• In 1920’s cellulose nitrate base was used which was highly
inflammable and when burned emitted large quantities of
poisonous gases.
• In 1924, non-inflammable cellulose triacetate was marketed.
• In 1940, ultra speed films became available.
• In 1960’s, a film base of polyester (Dacron) was introduced.
• In 1980’s introduction of Ekta speed film has reduced the
exposure 50%.
 Types
Intraoral films Extra oral films

• Duplicating films Self developing films

Intraoral X-ray films

• Periapical films

• Bitewing films

• Occlusal films
 Periapical Film

• Periapical pathology
• Periodontal evaluation
• Caries detection
• Endodontic treatment
 Bitewing Film

Interproximal Caries
Alveolar Bone Involvement
 Occlusal film
• Identify extent of large lesions
• Locate objects bucco-lingually
• Show developing anterior teeth
• Image trismus patients
 INTRA ORAL FILM SIZES
SIZE 0 22*35 mm For small children

SIZE 1 24*40mm For anterior teeth views

SIZE 2 31*41mm Standard film size for

adults

SIZE 3 27*54mm Exclusively for bitewing

radiographs

SIZE 4 57*76mm Used for occlusal

radiographs
 DENTAL X-RAY FILM

The dental x-ray film serves as an image receptor or recording medium.

Contents of a Film Packet:

1. Outer package wrapping
2. Black paper wrapper
3. Film
4. Lead foil sheath
 DENTAL X-RAY FILM PACKET

1. Outer package wrapping:

A) Soft vinyl or paper wrapper that seals the

film packet.

B) Presence of a raised identification dot on

the tube side of the film on one corner

2. Paper film wrapper:

The film is encased in a protective black

paper wrapper that shields the film from light.

3. Lead foil sheath:

It is present behind the film away from the

tube.
Composition of the film
 FILM COMPOSITION
PRINCIPAL COMPONENTS:

a) Emulsion

b) Base
c) Adhesive layer
d) Protective layer
EMULSION:
Sensitive to x-rays and visible light, records the radiographic image. It contains
1) Silver halide grains: They absorb radiation during x-ray exposure and store
energy from radiation. The mean diameter of silver halide crystals is 0.70 to
0.75mm.
2) Vehicle Matrix: Composed of gelatin .They suspend the silver halide grains and
keep them evenly dispersed.
 According to emulsion
coating

• Double coated films

– Direct exposure films (Non-screen films)
– Screen type films (Double screen films)
• Single coated films
- Screen type films (single screen)
– Photofluorographic films
– Cathode ray tube films
– Duplication films
– Substracton films
– Laser imaging films
 FILM COMPOSITION

BASE:

• Composed of polyester polyethylene terephthalate and is

0.18mm thick

• The function of the film base is to support the emulsion.

3 characteristics of base must be considered

 It must not produce a visible pattern or absorb too much light when
radiograph is viewed

 The flexibility, thickness and strength of the base must allow for ease
of processing

 The base must have dimensional stability

ADHESIVE LAYER:
Ensures good adhesion of the emulsion to the
base.
PROTECTIVE LAYER:
It is an additional layer of matrix added to the
film emulsion to protect it from scratching,
contamination and processing damage.
FILM SPEED:

• It is defined as the amount of radiation required to produce a

radiograph of standard density and is determined by

• Size of silver halide crystals

• Thickness of emulsion

• ADA recommends the use of E speed film for introral

radiographs
 Self-developing films
• The x-ray film is presented in a special sachet containing
developer and fixer.
• Following exposure, the developer tab is pulled, releasing
developer solution which is milked down towards the film and
massaged around it.
• After 15 sec. fixer tab is pulled and fixer solution is milked
down and agitates the film.
• After fixing, chemicals are discarded.
 Advantage of self developing film

It eliminates the need of dark room for processing and it is time

saving.
 Disadvantages
• Poor image quality.

• Expensive.

• Image deteriorates with time.

• No lead foil inside the film packet, film is very flexible and
easily bent and these films are difficult to use in film holders
 Duplicating film

• A duplicating film is a type of photographic film that is

used to make an identical copy of an intraoral and extra
oral radiograph.
• The duplicating film has emulsion only on one side only.
The emulsion side of the film appears shiny, whereas the
side without emulsion appears dull. The emulsion side of
the film must contact the radiograph during duplication
process.
 Sizes of various extraoral films
used are

• Panoramic films – 6’’ x 12’’ or 5’’ x 12’’

• Cephalometrics and skull views – 8’’ x 10’’

• Oblique lateral projection – 5’’ x 7’’

• CT and MRI films – 14’’ x 17’’

 Silver Halide Crystals

• Tabular globular

Tabular (flat) crystals with F-speed film (Insight), T-Mat film

and Ektavision film
Globular (rounded) crystals with D-speed film (Ultraspeed)
 Film Types

• Direct exposure film

• Screen films
 Direct Exposure Film

• Exposed by x-rays

• Used intraorally
 Screen Film

• Exposed by light
• Used with intensifying screens

• Used extraorally
 Intensifying Screen Function

• Phosphor crystals convert x-ray energy into

light energy (fluorescence); light then exposes
film.
• Screen/film combination uses 30-60 times less
radiation than direct exposure film. However,
image not as sharp as with direct exposure
film.
Intensifying Screen Composition

This side toward film

Base (yellow line) = plastic for support

Reflecting layer (gray line) = reflects light back
toward film
Phosphor layer (green line) = rare earth

Protective coat (white line) = clear plastic

 Various cassettes used

• Oblique lateral cassettes

• Skull cassettes

• Panoramic cassettes
– Rigid flat metal cassette (Planmeca)
– Flexible plastic cassette
– Curved metal cassette
 Cassettes
• Hold intensifying
screens in tight
contact with film

• Rigid (metal) or Rigid metal cassette

soft (vinyl)

Flexible vinyl cassette

Rigid Cassette
 Types of Screen Film

• T-Mat: green-sensitive; used with rare-earth

screens. Flat crystals.

• Ektavision: green-sensitive; used with rare

earth screens. Anti-crossover layer gives
sharper image. Flat crystals.
 Various screen-film combinations suitable
for e/o radiography are
• High contrast medium speed films suitable for skull
radiography.

• Faster films with less image details used for panoramic

radiography.

• Less contrast with wider latitude revealing wide range of

densities used for cephalometry.
 Various extraoral films
Kodak Ektavision G Dental Film:
• This is a high-contrast film.
With a speed of 400, the green-sensitive system is ideal for
panoramic, cephalometric, and TMJ radiography.

• This high-contrast film features Kodak T-GRAIN emulsion

technology with flattened silver-halide grains that provide greater
light-gathering capability than the pebble-shaped silver-halide
grains in conventional emulsions.
• At the same time, an absorbing dye significantly reduces the
light crossover between emulsions that can cause image blur.
The result is superb image quality with high resolution and
exceptional detail, with no loss of film speed.
 Kodak Ektavision L Dental Film

• This wide-latitude extraoral imaging film is part of the Kodak

Ektavision Extraoral Imaging System that includes Kodak
Ektavision Screens.

• Provide the sharpest images when used with Ektavision film.

 Kodak T-Mat G Dental Film
• High-contrast film for use with green-light-emitting Kodak
Lanex Screens.

• This film provides good detail at up to one-half the radiation

exposure of conventional (200-speed) blue-light-sensitive
films when used with Kodak Lanex Regular Screens.

• T-MAT G film also can be used with Kodak Lanex Medium

Screens to provide a 250-speed system.

• Both systems are recommended for panoramic,

cephalometric, and TMJ radiography.
 Kodak T-Mat H Dental Film
• Kodak T-Mat H Dental Film is a green-sensitive high-speed,
high-contrast film designed for use with Kodak Lanex Screens.

• This film is the best choice for double-film techniques that

produce two original radiographs from a single exposure.

• Employing the same exposure procedures as Kodak T-Mat G

and T-Mat L films, T-Mat H film provides high-contrast images
with excellent detail in one-quarter the exposure time of
equivalent blue-light-sensitive film systems.
 KODAK T-MAT L Dental Film.

• Kodak T-MAT L Dental Film is an excellent choice when soft

tissue must be visualized and/or exposure control is difficult.

• This wide-latitude film is designed for use with green-light-

emitting Kodak Lanex Screens.
 Kodak X-Omat DBF Dental Film

Kodak X-Omat DBF Dental Film is a high-contrast film which

responds well to ultraviolet, blue-light-emitting intensifying
screens.
 Latent Image
• Pattern formed by the interaction of x-rays (intraoral film) or
light (extraoral film) with the silver halide crystals in the
emulsion. Development centers created.
 Latent Image
Air/soft tissue Bone
Many x-rays penetrate Fewer x-rays penetrate
and expose many silver and not as many silver
halide crystals halide crystals are
exposed
= development center
Amalgam/gold
Few, if any, x-rays
penetrate; silver
halide crystals not
exposed
Basic Steps of Processing
Automatic/Manual

Develop
Rinse (Manual only)
Fix
Wash
Dry
 Developing
Development centers converted to black
metallic silver

Air/soft tissue Bone Amalgam/gold

Developing Solution

Developer
Preservative
Activator
Restrainer
 Developer

Converts exposed silver halide

crystals into black metallic silver
grains
Contains:
 Hydroquinone
 Metol or elon
 Phenidone
 Preservative

Sodium Sulphite:
Helps prevent developer from being
oxidized by the air
 Activator

Potassium carbonate:
Provides alkaline solution needed by
developer; softens gelatin, allowing
developer to reach crystals
 Restrainer

potassium bromide:
slows down rate of
development of unexposed
crystals
 Fixing
Unexposed crystals removed from
film

Air/soft tissue Bone Amalgam/gold

Fixing Solution
Clearing Agent
Acidifier
Preservative
Hardener
 Clearing Agent

Ammonium thiosulphate:
Dissolves and removes
unexposed silver halide
crystals from emulsion
 Acidifier

Acetic acid:
Neutralizes any
contaminating alkali from
the developer
 Preservative

Sodium sulphite:
Inhibits decomposition (oxidation)
of clearing agent
 Hardener

Aluminium chloride:
Hardens emulsion so film can
be handled
 Transducers
• Ultrasonic transducers are used to convert electric signal into
ultrasonic energy that can be transmitted into tissues and to
convert ultrasonic energy reflected back from tissues into an
electric signal.

• Most important component of transducer is thin piezoelectric

crystal element located near the face of the transducer.
• Naturally occurring piezo-electric crystal is made of quartz.

• Artificial piezo-electric materials are ferro-electrics i.e. Barium

titanate which is the first ceramo-ferroelectric to be
discovered.
• This has been largely replaced by lead zirconate titanate (PZT).

• The piezo-electric materials are made of innumerable dipoles

arranged in a geometric pattern.

• The electrodes behave as a capacitor and it is the voltage

between them that produces the electric field which in turn
causes the crystal to change the shape.
• When the crystal vibrates it generates the sound waves, which
passes through body and echoes reflect back towards the
transducers causing compression of the crystal and induces a
voltage between the electrodes.

• The voltage is amplified and serves as an ultrasonic signal for

display on the TV monitor.
 Computed tomography
• In 1972 Godfrey Hounsefield announced the invention of
revolutionary imaging technique which he called as
computerized axial transverse imaging.

• Basic concept: Thin cross-section of head, a tomographic slice,

examined from multiple angles with pencil like x-ray beam
and then transmitted radiations received on the detectors and
then displayed on the computer as a tomographic image.
Detectors
 There are two types of detectors
Scintillation crystals
• These materials produce light when ionization radiations react
with them. Combination of scintillation crystal and light
detector is called as scintillation detector.

• First two generations of CT scanners use Thallium activated

sodium iodide scintillation crystals optically attached to photo
multiplier tubes.
• Xenon gas ionization chamber
Those rotate-rotate CT scanners make use of this type of detector.
Gas filled detector consists of:-
– Anode and cathode
– A counting gas
– Voltage between anode and cathode
– Walls separating detector
– Window for radiation photons to enter the detector
• Gas filled detectors are thin and flat and operated in
ionization chamber mode.
• Anode is made of copper and cathode side plate made of
tantalum.
• Size of chamber: 1-2mm wide
10mm high
8-10cm deep
 Magnetic resonance imaging
• It is recently developed imaging modality that totally replaces
conventional x-ray generating equipment and film.
• It involves behavior of protons in magnetic field. Patient is placed in
a large magnetic field (0.5 to 1.5 tesla)
• Hydrogen atoms spin on an axis and behave like small magnets to
produce net magnetization vector (NMV) aligns itself readily with
the long axis of magnetic field.
• Radio frequency signal (RF) is pulsed into the patient by body coil
transmitter at 90 degrees to magnetic field.
• Surface coil acts as receiver coils and detect small electric
current induced by magnetic flux of synchronized processing
protons.
• This forms MR signal MR signal is analyzed by computer to
form tomographic image in axial, coronal and sagittal planes.
• Some surface coils act as both transmitter and receiver.
Several types of radiofrequency coils are there i.e. saddle
shaped coil and solenoidal coil.
• RF coil are the devices that produces H1 (varying magnetic
field).

• H1 field is formed in pulsations, RF coil maybe used to detect

MR signal during time when it is not producing H1 field.

• It is only during this time that MR signal can be detected. So

one RF coil can be used to produce H1 field and to detect MR
signal
• Preferably two RF coils should be used and placed
perpendicular to each other in magnetic field.

• Job of electronics is to apply RF voltage in pulsed sequence

across RF coil, detect MR signal and display the information in
desired form and construct the image from data.
 Xero-radiography
• Invented by physicist Chester F. Carlson in 1937.

• It is a complex electrostatic process based on special material called

a photoconductor.

• The photoconductor used in xero-radiography is amorphous

selenium which is deposited as a thin layer on the sheet of
aluminium to form xero-radiographic plate which is analogous to
film used in conventional radiography.
 Xero-radiographic plate

• It is a sheet of aluminium on which a layer of amorphous

selenium has been deposited.

• In addition there is an inter phase layer between selenium

and aluminium which is formed by heating of surface of
aluminium substrate to form a thin layer of aluminium oxide
and an over coating made of cellulose acetate 0.1 µ thick
protecting the selenium surface.
• The crystalline form of selenium is not used in

xeroradiography as it has relatively high electrical

conductivity.
 Digital radiography
• It is a film less imaging system, introduced to the dentistry in
1987. Digital imaging can be direct digital imaging system and
indirect digital imaging system.
• Direct digital imaging: It is a method of obtaining digital image
in which an intraoral sensor is exposed to x-ray to capture a
radiographic image that can be viewed on a computer
monitor.

• Indirect digital imaging: It is a method of obtaining digital

image in which an existing radiograph is scanned and
converted to a digital form using a CCD camera.
• Storage phosphor imaging: It is a method of obtaining digital
image in which the image is recorded on phosphor coated
plate and then placed into electronic processors where laser
scans the plate and produces image in the computer screen.
 Equipments:
• In direct digital imaging are x-ray source, intra oral sensor and
computer.

• In indirect digital imaging are CCD camera and computer.

• The intraoral sensor is a small detector that is placed

intraorally to capture a radiographic image.
 Intraoral sensors
Three types of sensors are in use:
1. Charged couple devices (CCDs) first developed in 1960s and
used a thin wafer of silicon for image recording when exposed
to the radiation covalent bonds between the silicon atoms are
broken and there is a formation of electron hole pairs.
• Electrons are then attracted towards the positive potentials
where they create charged packets.
• Each packet corresponds to one pixel. Charged pattern
formed from individual pixel represents latent image which is
then transferred to read out amplifier and transmitted as a
voltage to analogue-digital converter located with in or
connected to computer.
2. Complementary metal oxide semiconductors
(CMOS)/Active pixel sensors –
• Are the silicon based semiconductors.

• Widely used in construction of computer central processing

unit chips as well as video camera detectors.

• They are less expensive than CCDs. Only one manufacturer

(Shick Technologies) uses this sensor instead of CCDs and
claims 25% of greater resolution.
3.Charge injection device (CID) –
are the silicon based solid state imaging receptors.
• Welch-Allyn introduced this technique to be used with its
reveal intraoral camera platform. Equipment contains :
– CID x-ray sensor
– Cord
– Plug inserted into reveal light source on camera platform.
Phosphor Stimulable Phosphor Plate (PSP):
• Are used for wireless digital imaging system in which instead of
sensor reusable phosphor coated plates are used.
• Radiations fall on the plate, image is recorded and then the high
speed scanner converts the information into electronic field. Once
exposed plate is removed from the mouth and placed in the
electronic processor where the laser scans the plate and produces
an image that is transferred to the computer screen. No chemicals
are used for processing.
• PSP absorbs and store energy from x-rays and then release
this energy as the light when stimulated by other light of
appropriate wavelength. It makes use of barium doped fluoro-
halide for imaging.

• PSP is used for intraoral, panoramic, and cephalometric

imaging.
• Advantages of Digital Radiography over conventional film-
based radiography

• Lower dose of radiation required

Computer manipulation of the image resulting in:

• Alteration in contrast

• Alteration in resolution

• Image enhancement
• Automated image analysis

• No need for conventional processing, thus avoiding all

processing film faults and the hazard associated with handling
the chemical solution

• Storage and archiving the patient information

• Transfer of images between institutions (teleradiology).

 Disadvantages
• Expensive, especially panoramic systems
• Large disc space is required to store the images
• In direct digital systems the sensor and the computer have to
be connected directly, and the connecting cable can make
intraoral placement of the sensor difficult
• There is some loss of image definition and resolution
compared with film, both on the TV monitor and the hard copy
printout
• Image manipulation can be time-consuming and misleading to
the inexperienced

• It is difficult with some intraoral systems to view multiple

images at once, e.g. a full mouth survey

• The hard copy images can fade with time-this may be a major
problem since a radiograph taken of a 6-year-old child legally
should be kept until the patient has reached 25
 Advantages of Ultrasound over
conventional X-ray imaging
• Sound waves are NOT ionizing radiation

• There are no known harmful effects on any tissues at the

energies and doses currently uses in diagnostic ultrasound

• Images show good differentiation between different soft

tissues and are very sensitive for detecting focal disease in the
salivary glands

• Technique is widely used and inexpensive

 Disadvantages
• Ultrasound has a limited use in the head and neck region
because sound waves are absorbed by bone. Its use is
therefore restricted to the superficial structures
• Technique is very operator dependent
• Images can be difficult to interpret for inexperienced
operators because image resolution is often poor
• Real-time imaging means that the radiologist must be present
during investigation
 Advantages of Computed Tomography
over conventional X-ray imaging
• Enables detailed imaging of intracranial lesions.

• Imaging of hard and soft tissues

• Images can be manipulated

• Axial tomographic sections are obtainable

• Images can be enhanced by use of IV contrast media providing

additional information.
 Disadvantages
• Expensive

• Facilities are not widely acceptable

• Very thin contiguous slices may result n high dose of

radiations

• Metallic objects, such as fillings may produce marked streaks

or artifacts across CT image

• Inherent risk associated with IV contrast agents.

 Conclusion
• Conventional radiography i.e. X-ray films and the further
advancements in radiographic imaging modalities having
various pros and cons which has been briefly described,
provides a clinician with an indispensable tool to diagnose,
manage and treat various lethal diseases.
 References:

• Christensen’s Physics of Diagnostic Radiology, 4th edition.

• Oral Radiology-Principles and Interpretations, Stuart C. White

& Michael J. Pharoah, 5th edition.

• Essentials of Dental Radiography and Radiology, Eric Whaites,

2nd edition.

• Dental and Maxillofacial Radiology, Freny R Karjodkar, 2nd

edition.