Common Radiographic Examinations Research Articles

Assessment of radiation doses for common radiographic examinations: an institutional dose survey.

Assessment of radiation doses for common radiographic examinations: an institutional dose survey.

Estimation of Entrance Surface Dose and Dose Area Product in Most Frequently Used Radiography Examinations in Hamadan

Background: Radiation dose in C-arm procedure and radiography may lead to late complications such as cancer. Entrance surface dose (ESD) and dose area product (DAP) are two practical indicators for patient dose estimation. This study aimed to calculate ESD and DAP based on exposure parameters for the most common radiographic examinations in educational hospitals of Hamadan. Methods: This work was conducted in three radiography centers in Hamadan in 2020. ESD was determined using a standard equation. Radiation parameters, including maximum kilovolt and milliampere-seconds (mAs), were obtained from the device console, and the output factor was obtained from the calibration certificate. Eventually, ESD and DAP were computed for the head, chest, abdomen, and pelvic radiography examinations. Results: Means of ESD and DAP were 0.68±0.44 mGy and 274.03±179.84 mGy.cm2 for head, as well as 0.13±0.07 mGy and 117.64±70.07 mGy.cm2 for chest. In addition, the corresponding valures were 1.31±0.82 mGy and 1187.17±738.3 mGy.cm2 for the abdomen, as well as 0.84±0.83 mGy and 764.84±753.59 mGy.cm2 for the pelvic. The difference in ESD and DAP for all examinations between centers was significant (P<0.05). Conclusion: Several factors affect radiation exposure and patient dose in radiography. Some of these factors are subjective and depend on technician knowledge. It is possible to reduce the patients’ dose while maintaining image quality by regular training of technicians.

Pelvic radiation dose measurement for trauma patients in multifield radiographic examinations: A phantom-based TLD dosimetry study.

Trauma patients often suffer from multiple injuries and require undergoing various radiography which is referred to as multifield radiographic examinations. Protective measures may be ignored for these examinations due to stressful emergency situations or patients' conditions. This study was conducted to evaluate the scattered doses received by the pelvis during different common multifield radiographic examinations with an emphasis on field size adjustment. A whole-body phantom, PBU-50, resembling the body mass, was used to carry out the common examinations for trauma patients (extremities, skull, chest, abdomen, pelvis, femur, and lumbar radiography), using a Pars Pad X-ray machine. To measure the primary entrance skin doses, three calibrated GR 200 thermoluminescence dosimeter (TLD) chips were placed in the central X-ray beam of scanned organs. Three TLDs were also placed on the pelvis symphysis pubis to measure the scattered dose received by the pelvis due to each carried-out radiography for standard and clinically used field sizes. A Harshaw 3500 TLD Reader was used to read the chips. TLD readouts (nano-Coulomb) were converted to dose (milli Gray [mGy]) using the predefined calibration curve. The scattered doses to the pelvis due to scanning a single organ differed from 0.80 to 1.70, and 0.82 to 4.09 mGy for standard and clinically used field sizes, respectively. The scattered doses to the pelvis in multifield examinations varied from 0.80 to 8.43 and 0.82 to 13.6 mGy for standard and clinically used field sizes, respectively, depending on the number of scanned organs and their distances from the pelvis. Multiple and repeated radiographs combined with insufficient protective measures can increase the patient's dose. The findings indicate that the scattered doses received by the pelvis can exceed the reference values in multifield radiography, especially if the radiation field is not restricted properly to the scanned organ.

Patient-Based Dose Audit for Common Radiographic Examinations With Digital Radiology Systems: A Retrospective Cross-Sectional Study.

This study aims to audit radiation doses of adult patients who underwent common diagnostic X-ray examinations and compare dose area product (DAP) values with the established International Diagnostic Reference Level (IDRLs). Retrospective cross-sectional records of 339-patients who underwent 699-radiographic examinations between October 2018 and March 2019 were obtained. Patient-related factors, exposure, and DAP data were recorded for the six most common examinations. The mean and 75th percentile of DAPs were recorded and compared to IDRLs values. The 75th percentiles of the locally measured DAPs were below IDRLs for all examinations except for lateral lumbar, AP, and lateral thoracic spine, in which DAP-75th-percentile exceeded all IDRLs by up to 40.7%, 2.8%, 365.5%, respectively. Considering the type of detector used, the mean of the locally measured DAPs significantly exceeded the UK DRLs for the lateral thoracic spine and lateral lumbar spine. Locally measured DAP values were below the IDRLs except for thoracic and lumbar spine projections, which significantly exceeded.

Estimation of Skin Radiation Dose from Common Radiographic Examinations: A Preliminary Study to Establish Diagnostic Reference Levels (DRLs)

The aim of this study was to estimate the skin radiation dose received by adults’ patients undergoing mostcommon eight X-ray examinations. The study was conducted in three hospitals in three different Iraqi cities:Najaf, Babylon and Salah AL-Din. A minimum number of 10 patients were considered for each type ofX-ray examination in each hospital. The skin radiation dose calculation was performed by mathematicalequation using exposure factors, namely, X-ray tube voltage (kVp), tube loading (mAs) and source-skindistance (SSD). The skin radiation dose values were obtained for all patients involved in this study whoundergoing skull (AP and Lat), cervical (Lat), chest (PA), abdomen (AP), lumbar (Lat), pelvis (AP) andknee (AP) examinations. The resulted data were analyzed and compared with international reference doses.The average skin radiation dose ± standard deviation (SD) for the three hospitals were 0.77±0.43mGy forskull (AP), 0.66±0.39mGy for skull (Lat), 0.63±0.34mGy for cervical (Lat), 0.28±0.25mGy for chest (PA),4.36±2.92 mGy for abdomen (AP), 4.37±2.30mGy for lumbar (Lat), 1.65±1.09mGy for pelvis (AP) and0.40±0.25 mGy for knee (AP) examinations. For majority of the considered radiographic examinationsBalad general hospital recorded the highest skin radiation dose. Overall most of the recorded radiation doseswere within the internationally acceptable dose levels with some variations amongst different hospitals.

Incidental radiographic finding of charm needle or “susuk” in orthodontic panoramic and lateral cephalometric radiograph: a case report

Background: The most common radiographic examinations in orthodontic are panoramic and lateral cephalometry. In panoramic and lateral cephalometric images in adult patients, sometimes can be found a fine foreign object which sometimes confuses as it scattered the radiographic image, such as needles. The needles found in the patients are known as “susuk” in Malay and Indonesian language or charm needles which believed to enhance beauty, charism, health, youth, luck, and to relieve pain. This case reports aim to elaborate the incidental radiographic finding of charm needle or “susuk” in orthodontic panoramic and lateral cephalometric radiograph.Case Description: There was four adult woman conducted panoramic and cephalometric radiograph as a routine procedure before orthodontic treatment. The number of susuk inserted were varied, as it considered that the more needle increases the magical potency. In Case 1, the panoramic image depicts one “susuk” in the middle of the root of 44 (FDI notation) tooth. Besides, the cephalometric radiographs also show a “susuk” horizontally inserted at the root of the anterior lower teeth area. The panoramic image reveals one susuk around chin area below the apex of 42 teeth on Case 2 as well as on the soft tissue chin area in front of the apex of 41 teeth on cephalometric radiographs. In Case 3, two “susuk” were found inserted bilaterally symmetric at the upper premolar area by the panoramic image. Then, five “susuk” in the mandible and four “susuk” at the upper area of the maxilla were found in Case 4 by the panoramic image. Conclusion: The susuk are often exposed as incidental findings in panoramic and lateral cephalometric radiographs that are taken before performing routine orthodontic treatments. Understanding the presence of susuk is essential to avoid misdiagnosis and mismanagement and help radiologists to prevent confusion while interpreting images.

Direct and indirect entrance surface dose measurement in X-ray diagnostics using nanoDot OSL dosimeters

This study investigated the suitability of nanoDot optically stimulated luminescence (OSL) dosimeters for entrance surface dose (ESD) measurements in common X-ray diagnostics. OSL dosimetry system supplied by Landauer Inc, (Glenwood, IL, USA) consisting of nanoDot OSL dosimeters and microStar reader were used. ESDs were measured with nanoDots placed on whole-body anthropomorphic phantom (for direct measurements) and in free air without backscatter material (for indirect measurements) in accordance with the IAEA Technical Report Series No. 457. Measurements were carried out in five X-ray projections including AP abdomen, AP chest, PA chest, AP thoracic spine and AP skull. The mean ESD for each projection was evaluated from multiple measurements with three different field sizes. Mean ESDs (direct measurements) for AP abdomen, AP chest, PA chest, AP thoracic spine and AP skull were 4.3 mGy, 0.7 mGy, 0.3 mGy, 6.8 mGy and 2.8 mGy respectively. While in the case of indirect measurements, the corresponding mean ESD values were 4.8 mGy, 0.7 mGy, 0.2 mGy, 7.2 mGy and 3.7 mGy respectively. The results were found to be within IAEA and European Commission (EC) diagnostic reference levels (DRLs) range. The percentage difference of the ESDs measured by direct and indirect methods in all projections were between 0 to 40%. It was affirmed that nanoDot OSL dosimeter is a good candidate for ESD measurement in common radiographic examinations, while taking into account the effect of energy dependence.

Dose Audits of Patients Undergoing Some Common Radiographic Examinations in Selected Nigerian Hospitals

This study aims at determining radiation doses for patients undergoing six (6) common radio graphic examinations in eight X – ray units in the southern part of Nigeria using computational method. Both public and private – owned hospitals were used for the study. Patient data and technical parameters were collected during the examinations. The meanentrance surface air kerma (ESAK) obtained from all the x-rays units considered ranged from 0.35 to 1.96mGy for Chest PA, 1.01 to 17.55mGy for Abdomen PA; 1.08 to 16.14mGy for pelvis AP,1.12 to 10.06mGy for Pelvis LAT, 0.08 to 3.54mGy for Skull AP/PA; 1.07 to 4.61 for Skull LAT, 1.67 to 12.46mGy for Lumber Spine AP, 1.82 to 14.24mGy for Lumber Spine LAT. Local diagnostic reference levels (LDRLs) were established based on the third quartile of ESAKs values. The established LDRLs were compared with previously established DRLs from other countries. The ESAKs values obtained in this study were found to be within the international established DRLs except in few cases.

A phantom study for the optimization of image quality and radiation dose for common radiographic examinations in digital radiography

Introduction: Phantom studies facilitate the implementation of radiation dose surveillance as a function of radiographic technical parameters for minimizing patient radiation dose. The evidence of such investigations can then be used to evaluate technical parameters used in the radiographic procedures to reduce radiation dose without compromising the image quality. Material and Methods: This experimental study was carried out using an anthropomorphic phantom and the Leeds test object. Computed radiographic system was utilized and the images were printed for objective evaluation. Dose-area-product (DAP) readings were obtained using a DAP meter for the technical parameters employed for the radiographic procedures. Results: The use of 0.2 mm additional copper filtration resulted in the lowest radiation doses for all four radiographic procedures (i.e. posteroanterior chest, anteroposterior abdomen and lumbar sacral spine projections). The highest tube potential appropriate to the body part being imaged, patient size, image receptor response and required information resulted in the minimum radiation dose to the patient without compromising the image quality. The focus to film distance utilized for the radiographic procedure must be in accordance with the focus to grid distance specified by the manufacturer when using the bucky to eliminate grid “cut-off.” Conclusion: The optimization of image quality and radiation dose can be accomplished by using a phantom and selecting the imaging parameters that yield an acceptable image quality with the lowest entrance surface dose while considering the adjustment for patient size.

DOSIMETRY OF ADULT AND PEDIATRIC PATIENTS FOR COMMON DIGITAL RADIOGRAPHY EXAMINATIONS.

The present work reports dosimetry data on adult and pediatric patients for some common radiographic examinations during the standard hospital routine. The measurements are the part of quality assurance program to determine radiation exposures to patients in these examinations. The entrance skin doses (ESDs) of the patients were measured from 2451 projection for 12 diagnostic examinations in digital radiography (DR). The ESDs in adult patient were measured using thermoluminescence dosemeters placed on the skin of the patient. In pediatric patients, ESDs were evaluated from the measured air kerma with ionization chamber, patient specific parameters and known values of machine exposure factors during examinations. The third quartile values of ESDs are proposed as local diagnostic reference levels (LDRLs) for radiographic examinations having statistical significant number of exposures (n ≥ 20). The proposed LDRL values are also compared with earlier published LDRL/DRL values.

Optimization of Dose and Image Quality in Full-fiand Computed Radiography Systems for Common Digital Radiographic Examinations

IntroductionA fine balance of image quality and radiation dose can be achieved by optimization to minimize stochastic and deterministic effects. This study aimed in ensuring that images of acceptable quality for common radiographic examinations in digital imaging were produced without causing harmful effects. Materials and MethodsThe study was conducted in three phases. The pre-optimization involved ninety physically abled patients aged between 20 to 60 years and weighed between 60 and 80 kilograms for four common digital radiographic examinations. Kerma X_plus, DAP meter was utilized to measure the entrance surface dose (ESD) while effective dose (ED) was estimated using CALDose_X 5.0 Monte Carlo software. The second phase, an experimental study utilized an anthropomorphic phantom (PBU-50) and Leeds test object TOR CDR for relative comparison of image quality. For the optimization phase, the imaging parameters with acceptable image quality and lowest ESD from the experimental study was related to patient’s body thickness. Image quality were evaluated by two radiologists using the modified evaluation criteria score lists. ResultsSignificant differences were found for image quality for all examinations. However significant difference for ESD were found for PA chest and AP abdomen only. The ESD for three of the examinations were lower than all published data. Additionally, the ESD and ED obtained for all examinations were lower than that recommended by radiation regulatory bodies. ConclusionOptimization of image quality and dose was achieved by utilizing an appropriate tube potential, calibrated automatic exposure control and additional filtration of 0.2mm copper.

Dose Evaluation for Common Digital Radiographic Examinations in Selected Hospitals in Pahang Malaysia

Introduction: In digital radiography, radiographers tend to increase exposure factors to acquire an acceptable image quality thereby increasing radiation dose to patients. Regarding this, the present study aimed to re-evaluate the exposure parameters and to ascertain the entrance surface dose (ESD) and effective dose (ED) of posterior-anterior (PA) chest, abdomen, and anterior-posterior (AP) lumbosacral spine radiography. Materials and Methods: This study was conducted on 180 physically able patients with age of 20-60 years and weight of 60-80 kg referred to Hospital Sultan Haji Ahmad Shah (HOSHAS) and Hospital Tengku Ampuan Afzan (HTAA).Image acquisition was performed using digital radiography. The ESD and ED were determined using CALDose_X 5.0 software. Results: The ESD and ED for PA chest were 0.098 mGy and 0.012 mSv in HOSHAS, while in HTAA were 0.161 mGy and 0.021 mSv respectively. Regarding the abdomen, the ESD and ED were 2.57 mGy and 0.311 mSv in HOSHAS and 2.16 mGy and 0.262 mSv in HTAA respectively. For AP lumbosacral spine, the ESD and ED for HOSHAS were 2.65 mGy and 0.222 mSv, while in HTAA were 2.357 mGy and 0.201 mSv respectively. Conclusion: The findings revealed the use of high kVp, automatic exposure control, correct focus image receptor distance, tight collimation and additional filter resulted in a lower ESD. The ESD and ED obtained in this study were comparable with those reported by other studies and lower than the values recommended by the United Nations Scientific Committee on the Effects of Atomic Radiation in 2008.

Evaluation of levels of exposure of adult patients from common radiographic examinations in the Russian Federation in 2009–2014

Diagnostic reference levels are the main and the most effective tools of optimization of the radiation protection of patients from medical exposure. Diagnostic reference levels should be established based on the results of dedicated dose surveys, allowing evaluating typical patient dose distributions in a selected dose quantity for the selected X-ray examinations. The aim of the current study was to assess the distributions of typical effective doses in representative Russian regions. Materials and methods: Typical patient effective doses for the 13 most common radiographic X-ray examinations were collected in 203 X-ray rooms in 101 hospitals in six regions of Russian Federation in 2009–2014. A differentiated approach was used for the estimation of the typical effective doses depending on the image acquisition technology. Effective doses were estimated using «EDEREX» (Russia) computational software. Results and discussion: Results of the dose data analysis indicate the lack of significant differences between the distributions of the typical effective doses between the selected regions, allowing merging the regional samples and further evaluating the pooled (joint) sample. A significant ratio of maximum to minimum (up to two orders of magnitude) due to a presence of X-ray units with abnormally high and low typical effective doses was observed for all 13 selected X-ray examinations. Abnormally high typical effective doses can be explained by performing the examinations using high values of tube current-time product (150–600 mAs) on a maximum field size (up 40×40 cm). Removal of the typical effective doses below 5%-percentile and above 95%-percentile of typical effective dose distributions for all examinations would result in a reduction of a mean effective dose by up to 30% and reduction of a 75%-percentile of the distributions by up to 15%. No significant differences between the distributions of TED for analogue and digital X-ray units were observed for the pooled sample for selected examinations except for the examination of the chest in posterior-anterior projection. Conclusions: These results should be considered in the process of establishing and implementing DRLs as well as in the cost-benefit analysis of the optimization in radiography.

Practical implementation of the diagnostic reference levels concept for the common radiographic examinations

The modern approach to the radiation protection of the patients from medical exposure is mainly based on the principle of optimization using diagnostic reference levels. Implementation of diagnostic reference levels and optimization in Russian radiological practice is limited due to lack of methodology of data collection and patient dose assessment, investigation and management of abnormally high and low patient doses. Current study is focused on the justification of the diagnostic reference levels concept and practical aspects of establishment of diagnostic reference levels for common radiographic X-ray examinations and their use in clinical practice. It is proposed to establish diagnostic reference levels as the 75%-percentiles of X-ray unit distribution by the patient standard doses for a given X-ray examination. Methodology for standard doses assessment is presented for different types of X-ray units. Based on the results of dose data collection in different regions of the Russian Federation in 2009–2014, the national diagnostic reference levels values are estimated in terms of effective dose for the radiographic examinations of skull, chest, cervical, thoracic and lumbar spine, abdomen and pelvis. The methodology of the optimization process is developed for the hospital use. It includes a comparison of the patient standard doses with the national diagnostic reference levels, investigation and correction of abnormally high and low patient doses. A list of corrective measures is proposed: from additional training of the staff and manual adjustment of the parameters of examinations to the replacement of an X-ray unit. It is conferment that even a limited implementation of the optimization methodology would allow to reduce standard doses with a factor of 1,5.

PROPOSALS FOR THE ESTABLISHMENT OF NATIONAL DIAGNOSTIC REFERENCE LEVELS FOR RADIOGRAPHY FOR ADULT PATIENTS BASED ON REGIONAL DOSE SURVEYS IN RUSSIAN FEDERATION.

In 2009-2014, dose surveys aimed to collect adult patient data and parameters of most common radiographic examinations were performed in six Russian regions. Typical patient doses were estimated for the selected examinations both in entrance surface dose and in effective dose. 75%-percentiles of typical patient effective dose distributions were proposed as preliminary regional diagnostic reference levels (DRLs) for radiography. Differences between the 75%-percentiles of regional typical patient dose distributions did not exceed 30-50% for the examinations with standardized clinical protocols (skull, chest and thoracic spine) and a factor of 1.5 for other examinations. Two different approaches for establishing national DRLs were evaluated: as a 75%-percentile of a pooled regional sample of patient typical doses (pooled method) and as a median of 75%-percentiles of regional typical patient dose distributions (median method). Differences between pooled and median methods for effective dose did not exceed 20%. It was proposed to establish Russian national DRLs in effective dose using a pooled method. In addition, the local authorities were granted an opportunity to establish regional DRLs if the local radiological practice and typical patient dose distributions are significantly different.

Organ Doses From Diagnostic Medical Radiography-Trends Over Eight Decades (1930 to 2010).

This study provides a retrospective assessment of doses to 13 organs for the most common radiographic examinations conducted between the 1930s and 2010, taking into account typical technical parameters used for radiography during those years. This study is intended to be a resource on changes in medical diagnostic radiation exposure over time with a specific purpose of supporting retrospective epidemiological studies of radiation health risks. The authors derived organ doses to the brain, esophagus, thyroid, red bone marrow, lungs, breast, heart, stomach, liver, colon, urinary bladder, ovaries, and testes based on 14 common radiographic procedures and compared, when possible, with doses reported in the literature. These dose estimates were based on radiographic exposure parameters described in textbooks widely used by radiologic technologists in training from 1939 to 2010. The derived estimated doses presented here are believed to be representative of typical organs for an average-size adult who might be considered to be similar to the reference person. There were large variations in organ doses noted among the different types of radiographic examinations. Doses were highest in organs within the area imaged and next highest in organs in close proximity to the area imaged. Estimated organ doses have declined substantially [overall 22-fold (±38)] over time as a consequence of changes in technology, imaging protocols and protective measures. For some examinations, only slight differences were observed in doses for the decades of the 1960s, 1970s, and 1980s due to minor changes in technical parameters. Substantial dose reductions were observed in the 1990s and 2000s.

Measurement of Entrance Skin Dose and Calculation of Effective Dose for Common Diagnostic X-Ray Examinations in Kashan, Iran.

The knowledge of the radiation dose received by the patient during the radiological examination is essential to prevent risks of exposures. The aim of this work is to study patient doses for common diagnostic radiographic examinations in hospitals affiliated to Kashan University of Medical sciences, Iran. The results of this survey are compared with those published by some national and international values. Entrance surface dose (ESD) was measured based on the exposure parameters used for the actual examination and effective dose (ED) was calculated by use of conversion coefficients calculated by Monte Carlo methods. The mean entrance surface dose and effective dose for examinations of the chest (PA, Lat), abdomen (AP), pelvis (AP), lumbar spine (AP, Lat) and skull (AP, Lat) are 0.37, 0.99, 2.01, 1.76, 2.18, 5.36, 1.39 and 1.01 mGy, and 0.04, 0.1, 0.28, 0,28, 0.23, 0.13, 0.01 and 0.01 mSv, respectively. The ESDs and EDs reported in this study, except for examinations of the chest, are generally lower than comparable reference dose values published in the literature. On the basis of the results obtained in this study can conclude that use of newer equipment and use of the proper radiological parameter can significantly reduce the absorbed dose. It is recommended that radiological parameter in chest examinations be revised.

Patient doses in radiographic examinations in Western and Eastern Azerbyjan provinces of Iran

This study was a part of national project to establish and optimize local and national diagnostic guidance levels. This work intends to evaluate image quality and entrance surface air kerma (ESAK) for patients' radiographic examinations in two north western provinces of country. Two hospitals got involved in the present study. The rate of the rejected images and image quality grades were determined. The ESAK were calculated by X-ray tube output measurements and X-ray exposure parameters (kVp, mAS, FFD, as well as patients thicknesses) for common radiographic examinations including: chest, skull, thoracic, lumbar in two projections and also abdomen and pelvis in one projection. The rate of images categorized as poor was 40%. Patients' dose in radiographic examination varied by a factor of up to 6.9, 13.84, 9.76, 11.33, 6.15, 8.69, 2.85, 3.05, 12.41, and 5.51 in chest (PA), chest (LAT), lumbar (AP), lumbar (LAT), thoracic (AP), thoracic (LAT), skull (PA), skull (LAT), abdomen and pelvis, respectively. The mean ESAK values for above mentioned techniques were 0.3, 0.7, 2.85, 6.87, 2.3, 4.9, 1.32, 1.05, 2.9 and 2.2 mGy, respectively. Poor image quality plays a major role in unnecessary radiation dose to the patients but in compare with other studies stated that patient dose levels in radiographic examinations in our study aren't higher than those in developed countries.

A comparative assessment of entrance surface doses in analogue and digital radiography during common radiographic examinations

Digital radiography is often performed at a higher dose rate than analogue radiography for image acquisition. The authors measured the Entrance Surface Dose (ESD) of analogue and digital radiography techniques for 14 radiographic examinations from randomly selected medical centres in the central district of Korea. It was that the mean ESD of the digital examinations was 2.84 mGy (range, 0.37-6.38 mGy) and that of the analogue examinations was 1.83 mGy (range, 0.38-4.74 mGy), resulting in a 55.25 % higher ESD for digital technique. Although this survey is not completely representative of Korea, findings of this study indicate a need for closer exposure management in digital radiography to minimise patient dose.

Dentomaxillofacial imaging and interpretation

•. Dental radiography is widely practised and accounts for 26% of all medical exposures in the UK.•. Imaging of a variety of lesions found characteristically in the dental and maxillofacial region is reviewed through the medium of these common radiographic examinations.•. Interpretation in the maxillofacial region is helped by an understanding of dental notation and the development of the dentition, and related dental developmental anomalies are described.•. Prevalent dental conditions such as caries and periodontal disease are explained and radiological features illustrated.•. A strategy for interpretation in the dental and maxillofacial region is introduced.This article introduces radiographic imaging and interpretation in the dental and maxillofacial region. The range of common intra-oral and extra-oral radiographs is illustrated. Dental annotation is central to the clear communication of abnormalities involving the teeth, and the most common conventions are described. An overview of tooth development ...