Panoramic and cephalometric extraoral dental radiograph systems
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PRODUCT NAME AND MANUFACTURER
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Orthopantomograph OP100 and Orthoceph OC100 Dental X-Ray System, Instrumentarium Imaging Inc., 300 W. Edgerton Ave., Milwaukee, Wis. 53207, 1-800-558-6120, "www.usa.instrumentarium.com"
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DATE OF ADA ACCEPTANCE
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Received ADA Seal of Acceptance in September 2002
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SUMMARY
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The basic unit is the Orthopantomograph OP100, which is a computer-controlled extraoral imaging system capable of producing panoramic radiographs using either film or digital technology. This unit has automatic exposure control, automatic spine compensation, a patented V-shaped X-ray beam and a built-in quality assurance program. The OP100 is available with cephalometrics (the OC100 model), linear tomography (the Ortho Trans model), identification film marking (the Ortho ID model) and imaging software (the Ortho Zone and Ortho TMJ models). The addition of a cephalometric arm to the Orthopantomograph makes the unit an Orthoceph.
The image receptor sizes are as follows:
- – Panorama OP100: cassette 15 x 30 centimeters;
- – Cephalometric image receptor OC100: 24 x 30 cm, 18 x 24 cm, 8 x 10 inches;
- – Panoramic image receptor OP100D: CCD camera, image pixel size 90 x 90 micrometers;
- – Cephalometric image receptor OC100D: CCD camera, image pixel size 90 x 90 µm.
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CONSIDERATIONS FOR ACCEPTANCE: SAFETY AND EFFICACY DATA
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The Orthopantomograph met the criteria set forth in the ADA Acceptance Program Guidelines.1 One of the requirements in the guidelines is measurement of the focal spot. A smaller focal spot enhances detail in the radiographic image. A larger focal spot allows greater heat dissipation, but with less detail in the radiographic image. The Orthopantomograph has a small focal spot, 0.35 x 0.5 millimeters, which was determined using the International Electrotechnical Commission. or IEC, standard for focal spots.2 The IEC standard is used for X-ray tube assemblies and describes methods and requirements for testing the specified characteristics of focal spots.
The Orthopantomograph was evaluated by the U.S. Air Force Dental Investigation Service, or USAF DIS, in 1998.3 This evaluation included a radiation survey and clinical-user testing. The radiation survey was conducted at the Department of Radiology at Wilford Hall Medical Center, Lackland Air Force Base, Texas, and the clinical evaluation was conducted at the Dental Processing Center at Lackland Air Force Base. A questionnaire was used to obtain the USAF dental radiology consultants’ opinions regarding the unit’s design, reliability, image quality and ease of use. The consultants rated all these features "excellent" or "good." DIS concluded that this system is versatile and user-friendly. The system was found to be easy to use, producing consistent, high-quality films. The small focal spot resulted in consistent image quality with high density, resolution and contrast. The computer-controlled radiation (the automatic exposure control feature) was found to balance the best image with the lowest exposure.
A study by Eraso and colleagues4 evaluated the influence of automatic exposure control on panoramic image quality. They found significant improvements in quality with automatic exposure control compared with manual exposure control.
A study by Farman and Farman5 evaluated the quality of the digital images compared with film. The objective of this study was to evaluate the perceived clinical efficacy of a charge-coupled device detector for digital panoramic radiography in comparison with conventional film/screen radiographs using the same machine and patient population. The assessments included area of coverage; clarity of dental structures; clarity of bony outlines; specific anatomical details such as the maxillary sinus floor, mandibular canal and mandibular condyle; and region-by-region assessment of the dentition. The study found that the digital images were clinically equivalent to conventional film/screen images for panoramic dental radiographs. Additionally, Farman and colleagues6 found that digital imaging resulted in a 70 percent reduction in radiation dose compared with conventional film used with the OP100.
A study by Potter and colleagues7 evaluated the Orthopantomograph and the Planmeca 2002CC (Helsinki, Finland) panoramic imaging systems for their ability to produce cross-sectional images with accurate vertical dimensions of the posterior mandible. After the images were acquired, the mandibles were sectioned and measured. The study’s conclusion was that both systems were useful for vertical measurements of a potential implant site in the posterior mandible. In addition, Scarfe and colleagues8 found that the Orthopantomograph provides a focal trough that conforms well to the geometry of the dental arch, as well as adequate spatial resolution.
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REFERENCES
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- American Dental Association, Council on Dental Materials, Instruments and Equipment. ADA acceptance program guidelines for panoramic X-ray units. Chicago: American Dental Association; 1992.
- International Electrotechnical Commission. X-ray tube assemblies for medical diagnosis: Characteristics of focal spots. IEC publication 60336 (1993–02). Geneva: International Electrotechnical Commission; 1998.
- Bartoloni JA. 55-07 Orthopantomograph OP 100 (Project 97-24). Dent Items Significance 1998;55. Available at: "www.brooks.af.mil/DIS/DIS55/sec3.htm#DIS55007". Accessed Oct. 29, 2002.
- Eraso FE, Ludlow JB, Platin E, Tyndall D, Phillips C. Clinical and in vitro film quality comparison of manual and automatic exposure control in panoramic radiography. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;87:518–23.[Medline]
- Farman TT, Farman AG. Clinical trial of panoramic dental radiography using a CCD receptor. J Digit Imaging 1998;11:169–71.[Medline]
- Farman TT, Kelly MS, Farman AG. The OP 100 Digipan: evaluation of the image layer, magnification factors, and dosimetry. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997;83:281–7.[Medline]
- Potter BJ, Shrout MK, Russell CM, Sharawy M. Implant site assessment using panoramic cross-sectional tomographic imaging. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997;84:436–42.[Medline]
- Scarfe WC, Eraso FE, Farman AG. Characteristics of the Orthopantomograph OP 100. Dentomaxillofac Radiol 1998;27:51–7.[Abstract]
Panoramic imaging
Panoramic radiographic systems are commonly used in dental offices. It is important that any diagnostic radiography be used only after clinical examination, consideration of the patient’s history and consideration of both the dental and the general health needs of the patient.1 The following should be considered when using panoramic imaging.
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QUALITY CONTROL
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It is important to monitor the quality of images produced in the dental office. Proper exposure and processing optimizes an image’s density and contrast. Panoramic images should demonstrate both condyles, the inferior rim of the orbits and the anterior inferior border of the mandible.2
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GROWTH AND DEVELOPMENT
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Panoramic or periapical radiographs are useful for assessing early growth and development of a child’s transitional dentition.3 During a patient’s late adolescence, these radiographs are useful for examination of the third molars.3
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TEMPOROMANDIBULAR JOINT EVALUATION
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A position paper issued by the American Academy of Oral and Maxillofacial Radiology4 stated that panoramic radiography should be used to evaluate the temporomandibular joint when the goal is identification of gross osseous changes. The advantage of panoramic images is that, in addition to the joint, the teeth and other parts of the jaw can be visualized; however, superimposition of other structures reduces the image quality.
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DENTAL IMPLANTS
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Panoramic radiographs are used for preoperative assessment of implant sites and for following implant success over time. Tyndall and Brooks5 described the advantages of panoramic images: they allow visualization of many anatomical features, they are relatively inexpensive, and panoramic systems are becoming more commonplace in dental offices. Tyndall and Brooks also described the disadvantages: panoramic images’ nonuniform horizontal magnification, the possibility of positioning artifacts and lack of cross-sectional information.
Below is a comparative table
of radiation sources and doses.6–8
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SCREENING
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Panoramic radiographs should not be used to screen for pathology without historical or clinical signs. Radiographs, in general, were not found to be efficacious for detecting occult tumors in asymptomatic patients.9 The U.S. Food and Drug Administration guidelines on the use of dental radiography state that the diagnostic need for radiographic examinations to detect occult lesions should be based on "the prevalence of such lesions, the probability of the lesion being present with no clinically detectable signs or symptoms, the potential consequences if the lesions were not detected, and the effects of the radiographic findings on the patient’s treatment."2
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REFERENCES
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- ADA Council on Scientific Affairs. An update on radiographic practices: information and recommendations. JADA 2001;132:234–8.[Free Full Text]
- White SC, Heslop EW, Hollender LG, Mosier KM, Ruprecht A, Shrout MK. Parameters of radiologic care: an official report of the American Academy of Oral and Maxillofacial Radiology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;91:498–511.[Medline]
- Joseph LB. The selection of patients for X-ray examinations: Dental radiographic examinations. Rockville, Md.: U.S. Department of Health and Human Services; 1987.
- Brooks SL, Brand JW, Gibbs SJ, et al. Imaging of the temporo-mandibular joint. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997;83:609–18.[Medline]
- Tyndall AA, Brooks SL. Selection criteria for dental implant site imaging: a position paper of the American Academy of Oral and Maxillofacial Radiology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;89:630–7.[Medline]
- Frederiksen NL. X-rays: what is the risk? Texas Dent J 1995;112:68–72.
- Cohnen M, Kemper J, Mobes O, Pawelzik J, Modder U. Radiation dose in dental radiology. Eur Radiol 2002;12:634–7.[Medline]
- Visser H, Hermann KP, Bredemeier S, Kohler B. Dose measurements comparing conventional and digital panoramic radiography. Mund Kiefer Gesichtschir 2000;4:213–6.[Medline]
- Zeichner SJ, Ruttimann UE, Webber RL. Dental radiography: efficacy in the assessment of intraosseous lesions of the face and jaws in asymptomatic patients. Radiology 1987;162:691–5.[Abstract/Free Full Text]
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PRODUCT NAME AND MANUFACTURER
DATE OF ADA ACCEPTANCE
