치과위생사의 방사선 촬영업무의 확대에 대한 문헌적 고찰

최영숙,장종화,김진경,박용덕 한국치위생학회 2009 한국치위생학회지 Vol.9 No.2

This study analyzes through the review of literature and laws the exposure time, clinical frequency, and radiation exposure of intraoral and extraoral radiography as well as of panoramic radiography performed by dental hygienists in dental clinics, compares the dental radiology curriculums of radiological science and dental hygiene departments, and proposes the expansion of dental hygienists' radiography operations. The radiology curriculums were compared between the radiological science and dental hygiene departments of colleges. For new analysis by radiography for dental diagnosis, the exposure time, radiation absorbed dose, effective dose, and number of days of natural radiation were compared by the type of oral radiation films and radiographical techniques proposed by domestic and international studies. The exposure time of panoramic radiography is 15 seconds and it takes about two minutes for completion, whereas the exposure time of the standard radiography is 0.2 ~ 0.8 seconds and it takes 10 times longer for completion of the radiography of full mouth than the panoramic radiography. The standard radiography can cause distortions of radiation at severely curved parts of dental arch and palatopharyngeal reflex. However, panoramic radiography can be performed even for lock jaw patients, causes less inconvenience to patients and is much simpler than the standard radiography. The percentage of dental clinics where radiography is performed by dental hygienists was 92.0%, and the percentage of standard film radiography by dental hygienists was 98% whereas the percentage of panoramic radiography by dental hygienists was 92%. For the absorbed dose which is an indicator of radiation exposure, the When the effective dose which is an indicator of the danger of radiation exposure was converted to the number of days of natural radiation, it was 3.3 days for panoramic radiography, but 13.9 days for the full mouth standard radiography by bisecting angle technique which was 4.2 times longer than the panoramic radiography. There were two colleges that had a dental radiology course with two credits in the departments of radiological science. The credits for dental radiology courses in the department of dental hygiene ranged varied by college, ranging from 3 to 8; on average, the theory course was 2.2 credits and the practice course was 2.02 credits. To summarize the above results, the percentage of dental clinics where panoramic radiography is performed by dental hygienists under the guidance of dentists is high. Panoramic radiography has become an essential facility for dental clinics. It is faster than standard film radiography and less dangerous due to low radiation exposure. Panoramic radiography is a simple mechanical job that does not require training of oral radiography by radiotechnologist. Because panoramic radiography is one of major operations which must be performed at all times in dental clinics, it must be designated as intraoral technique rather than extraoral technique, or legalized for inclusion in the scope of operations of dental hygienists.

Panoramic radiography can be an effective diagnostic tool adjunctive to oral examinations in the national health checkup program

Helen Hye-In Kweon,Jae-Hong Lee,Tae-mi Youk,이보아,Young-Taek Kim 대한치주과학회 2018 Journal of Periodontal & Implant Science Vol.48 No.5

Purpose: We investigated correlations between the findings of oral examinations and panoramic radiography in order to determine the efficacy of using panoramic radiographs in screening examinations. Methods: This study included patients who visited dental clinics at National Health Insurance Service (NHIS) Ilsan Hospital for checkups during 2009–2015 and underwent panoramic radiographic examinations within 1 year prior to the oral examinations. Among the 48,006 patients who received checkups, 1,091 were included in this study. The data were evaluated using the Cohen kappa and interrater agreement coefficients. Accuracy, sensitivity, and specificity were calculated using data from the panoramic radiographs as true positive diagnoses. Results: The interrater agreement coefficient for occlusal caries was 28.8%, and the Cohen kappa coefficient was 0.043 between the oral and panoramic radiographic examinations. Root caries and subgingival calculus were only found on the radiographs, while gingival inflammation was found only by the oral examinations. The oral examinations had a specificity for detecting occlusal dental caries of 100%, while their sensitivity for proximal dental caries and supragingival calculus was extremely low (14.0% and 18.3%, respectively) compared to the panoramic radiographic examinations. The oral examinations showed a relatively low sensitivity of 66.2% and a specificity of 43.7% in detecting tooth loss compared with panoramic radiography. Conclusions: Panoramic radiography can provide information that is difficult to obtain in oral examinations, such as root caries, furcation involvement, and subgingival calculus, which are factors that can directly affect the survival rate of teeth. It therefore seems reasonable and necessary to add panoramic radiography to large-scale health checkup programs such as that provided by the NHIS.

직.간접디지털 파노라마 방사선촬영시 흡수선량과 유효선량

이근선,김진수,김재덕,Lee, Gun-Sun,Kim, Jin-Soo,Kim, Jae-Duk 대한영상치의학회 2010 Imaging Science in Dentistry Vol.40 No.1

Purpose : We evaluated the absorbed doses to the organs and calculated the effective doses when using the digital panoramic radiography. Materials and Methods : The absorbed dose averages in major organs of oral and maxillofacial region were measured using the Dental head phantom (CIRS Co., USA), $^nLi_2B_4O_7$ TLD chip and UD-716AGL dosimeter (Matsushita Electric Industrial Co., JPN) when performing indirect and direct digital panoramic radiography. Effective doses were calculated from correspond to ICRP 2007 recommendations for two panoramic radiography. Results : The absorbed dose average on indirect and direct digital panoramic radiography was highest in parotid glands as measured 1259.6 mGy and 680.7 mGy respectively. Absorbed dose average in another organs were high in order of esophagus, submandibular gland, tongue and thyroid gland on both types of digital panoramic radiography. The absorbed dose average was higher on indirect type than direct one (p<0.05). The effective dose was higher on indirect type than direct one as measured 13.28 mSv and 8.70 mSv respectively. Conclusion : The absorbed doses in salivary gland and oral mucosa were high. However, thyroid gland also demands the attention on radiography due to high tissue weighting factor in spite of the low absorbed dose.

Panoramic radiography can be an effective diagnostic tool adjunctive to oral examinations in the national health checkup program

Kweon, Helen Hye-In,Lee, Jae-Hong,Youk, Tae-mi,Lee, Bo-Ah,Kim, Young-Taek Korean Academy of Periodontology 2018 Journal of Periodontal & Implant Science Vol.48 No.5

Purpose: We investigated correlations between the findings of oral examinations and panoramic radiography in order to determine the efficacy of using panoramic radiographs in screening examinations. Methods: This study included patients who visited dental clinics at National Health Insurance Service (NHIS) Ilsan Hospital for checkups during 2009-2015 and underwent panoramic radiographic examinations within 1 year prior to the oral examinations. Among the 48,006 patients who received checkups, 1,091 were included in this study. The data were evaluated using the Cohen kappa and interrater agreement coefficients. Accuracy, sensitivity, and specificity were calculated using data from the panoramic radiographs as true positive diagnoses. Results: The interrater agreement coefficient for occlusal caries was 28.8%, and the Cohen kappa coefficient was 0.043 between the oral and panoramic radiographic examinations. Root caries and subgingival calculus were only found on the radiographs, while gingival inflammation was found only by the oral examinations. The oral examinations had a specificity for detecting occlusal dental caries of 100%, while their sensitivity for proximal dental caries and supragingival calculus was extremely low (14.0% and 18.3%, respectively) compared to the panoramic radiographic examinations. The oral examinations showed a relatively low sensitivity of 66.2% and a specificity of 43.7% in detecting tooth loss compared with panoramic radiography. Conclusions: Panoramic radiography can provide information that is difficult to obtain in oral examinations, such as root caries, furcation involvement, and subgingival calculus, which are factors that can directly affect the survival rate of teeth. It therefore seems reasonable and necessary to add panoramic radiography to large-scale health checkup programs such as that provided by the NHIS.

한국인 남성 무치악환자에서 파노라마 방사선사진상의 치조골 높이 왜곡에 대한 후향적 연구

백주현,송영균 대한구강악안면임플란트학회 2018 대한구강악안면임프란트학회지 Vol.22 No.2

Purpose: The purpose of this study was to analyze the mean residual alveolar bone height according to various measuring points of male edentulous patients. And to compare the residual alveolar bone height differences observed in panoramic and computed tomography images for analyzing the predictable distortion trends in panoramic radiography. Materials and Methods: The study used 40 images of the maxilla and mandible, excluding computed tomography and panoramic images. Based on the anatomical indices, the measurement values of each image were obtained by setting 7 measuring points of the maxilla and 9 measuring points of the mandible. The significant difference was statistically analyzed by paired t test comparing the measurement values observed on computed tomography and panoramic radiography (p <0.05). Results: The mean residual alveolar bone height was more than 15.5 mm in the maxillary anterior part, 8.2 mm in posterior part, 27.7 mm in the mandibular anterior part, and the mandibular posterior part was 11.1 mm. The result of paired t-test comparing the computed tomography and panoramic images showed that the maxillary right central incisor position, maxillary left second premolar, maxillary right second premolar, mandibular left first premolar, mandibular right first premolar, mandibular left second premolar, mandibular right second premolar, mandibular left first molar, mandibular right first molar positions of residual alveolar bone height were significantly different between two images.(p <0.05). Conclusion: It is considered that the reliability of the panoramic radiography is low because there is a significant difference in the residual alveolar bone height observed on computed tomography and panoramic radiography images. Ⅰ. 서론 : 임플란트와 연조직에서 일차 지지를 얻는 보철은 환자의 심미, 기능, 안정, 발음 등에 관한 요구를 만족시켜야 한다. 임플란트 수술 시 보철치료의 필요에 맞는 임플란트의 직경, 수, 위치를 정해야 하며 잔존 치조골의 상태가 중요한 요인으로 작용한다1. 임플란트의 성공에 영향을 미치는 주요 요인은 정확한 수술과 보철 치료계획이며, 치료 계획 중 방사선학적 평가는 필수적인 요소이다2,3. 잔존 치조골의 상태를 방사선학적 평가하는 방법에는 측방 두부규격방사선사진(lateral cephalometric radiography)과 파노라마 방사선사진(panoramic radiography) 같은 다양한 방법이 있다4-8. 이중 잔존치조골 높이 측정 방법에는 파노라마 촬영술과 전산화 단층 촬영술(computed tomography/CT)이 있으며 파노라마 촬영술은 가장 보편적 방법이지만, 이차원 이미지 영상으로 협설 방향의 정보가 부족하고 수평적, 수직적 영상의 확대가 나타날 수 있다9-11. 또한 다양한 확대율을 가진 영상으로 해부학적 구조물의 왜곡이 나타날 수 있으며 촬영 중 환자의 머리 위치에 따라 길이가 달라지는 등 기준을 잡기 어려운 한계가 있다12,13. 전산화 단층 촬영술은 3차원 영상으로 수직적, 수평적 위치 확인이 가능하며 파노라마 촬영에 비해 정확한 해부학적 구조물의 관찰이 가능하나 높은 비용과 방사선 노출량으로 인한 단점이 있다. 임플란트 수술 시 전산화 단층 촬영술 뿐만 아니라 기본 방사선사진을 포함한 검사가 모두 실시되어야 하는데 파노라마 촬영술은 무치악과 유치악 환자 모두에서가장 보편적으로 사용되는 방법이다14,15. 임플란트 수술 시 주의해야 할 해부학적 구조물은 상악동, 이공, 하 치조 신경관 등 다양하며, 특히 신경혈관계는 임플란트 수술 중 침범시에 위험을 초래할 수 있으므로 수술 전 우선적으로 고려해야한다16. 이번 연구의 목적은 한국인 남성 전부 무치악 환자의 다양한 위치에 따른 평균 잔존 치조골 높이를 파노라마 촬영술과 전산화 단층 촬영술 영상에서 비교분석하여, 파노라마 촬영술에서 예측할 수 있는 왜곡경향을 분석함으로써, 파노라마 영상만을 통해 임플란트 수술 시 주의해야 할 해부학적 구조물을 파악하고자 하는 것이다. Ⅴ. 결론 : 본 연구를 통해 전산화 단층 촬영술과 파노라마 촬영술 영상에서 관찰되는 잔존치조골 높이를 비교분석한 결과, 상악에 경우 정중선, 좌측 중절치, 좌측 제1대구치, 우측 제2대구치 위치에서, 하악에서는정중선, 좌측 중절치, 우측 중절치위치에서 파노라마 영상이 신뢰할 수 있을 것으로 사료되며, 그 외 위치에서는 파노라마의 측정 수치가 실제 수치보다 더 높게 나타나는 경향이 있어, 주의가 필요할 것으로사료된다.

Assessment of panoramic radiography as a national oral examination tool: review of the literature

Choi, Jin-Woo Korean Academy of Oral and Maxillofacial Radiology 2011 Imaging Science in Dentistry Vol.41 No.1

Purpose : The purpose of this review is to evaluate the possibility of panoramic radiography as a national oral examination tool. Materials and Methods : This report was carried out by review of the literatures. Results : Panoramic radiography has sufficient diagnostic accuracy in dental caries, periodontal diseases, and other lesions. Also, the effective dose of panoramic radiography is lower than traditional full-mouth periapical radiography. Conclusion : Panoramic radiography will improve the efficacy of dental examination in national oral examination. However, more studies are required to evaluate the benefit, financial cost, and operation time and also to make selection criteria and quality management program.

구강검진에서 임상검사와 비교한 파노라마방사선사진의 유용성

안서영,안창현,최갑식 대한구강악안면방사선학회 2007 Imaging Science in Dentistry Vol.37 No.2

Purpose : To evaluate the efficacy of panoramic radiography by comparing the results of clinical examination with radiographic findings. Materials and Methods : We studied 190 patients (20 men and 170 women; mean age, 40 years; range, 22 to 68 years) who visited the health promotion center of Korea Medical Science Institute and were examined both clinically and by panoramic radiography. We compared results from both examinations. Treatment options by clinical examination were described as “no treatment indicated”, “treatment of dental caries”, “removal of calculus”, “treatment of periodontal disease”, “prothodontic treatment” and “extraction of the third molar”. Findings taken from the panoramic radiography were: dental caries, periapical lesion, alveolar bone loss, calculus deposition, retained root, impaction of the third molar, disease of maxillary sinus, bony change of mandibular condyle, etc. Results : The prevalence of panoramic findings were: 37.9% of dental caries, 17.4% of periapical lesions, 44.7% of alveolar bone losses, 62.6% of calculi deposition, 7.9% of retained roots, 26.8% of third molar impactions, 6.3% of diseases of maxillary sinus, 2.1% of bony changes of mandibular condlye and 35.8% of miscellaneous lesions. Abnormal conditions revealed by panoramic radiography which had not been discovered on clinical examination were: 24.2% of the patients had dental caries, 17.4% had periapical lesions, 7.4% had calculi deposition, 5.3% had retained roots, 15.3% had third molar impactions. The opposite cases were: 5.2% had dental caries, 12.6% had calculi deposition, and 9.5% had third molar impactions. Conclusion : The use of panoramic radiography as a supplement to the clinical examination might be a valuable screening technique.

Assessment of panoramic radiography as a national oral examination tool: review of the literature

최진우 대한영상치의학회 2011 Imaging Science in Dentistry Vol.41 No.1

Purpose : The purpose of this review is to evaluate the possibility of panoramic radiography as a national oral examination tool. Materials and Methods : This report was carried out by review of the literatures. Results : Panoramic radiography has sufficient diagnostic accuracy in dental caries, periodontal diseases, and other lesions. Also, the effective dose of panoramic radiography is lower than traditional full-mouth periapical radiography. Conclusion : Panoramic radiography will improve the efficacy of dental examination in national oral examination. However, more studies are required to evaluate the benefit, financial cost, and operation time and also to make selection criteria and quality management program.

Common positioning errors in panoramic radiography: A review

Rafael Henrique Nunes Rondon,Yamba Carla Lara Pereira,Glauce Crivelaro do Nascimento 대한영상치의학회 2014 Imaging Science in Dentistry Vol.44 No.1

Professionals performing radiographic examinations are responsible for maintaining optimal image quality for accurate diagnoses. These professionals must competently execute techniques such as film manipulation and processing to minimize patient exposure to radiation. Improper performance by the professional and/or patient may result in a radiographic image of unsatisfactory quality that can also lead to a misdiagnosis and the development of an inadequate treatment plan. Currently, the most commonly performed extraoral examination is panoramic radiography. The invention of panoramic radiography has resulted in improvements in image quality with decreased exposure to radiation and at a low cost. However, this technique requires careful, accurate positioning of the patient’s teeth and surrounding maxillofacial bone structure within the focal trough. Therefore, we reviewed the literature for the most common types of positioning errors in panoramic radiography to suggest the correct techniques. We would also discuss how to determine if the most common positioning errors occurred in panoramic radiography, such as in the positioning of the patient’s head, tongue, chin, or body.

Common positioning errors in panoramic radiography: A review

Rondon, Rafael Henrique Nunes,Pereira, Yamba Carla Lara,do Nascimento, Glauce Crivelaro Korean Academy of Oral and Maxillofacial Radiology 2014 Imaging Science in Dentistry Vol.44 No.1

Professionals performing radiographic examinations are responsible for maintaining optimal image quality for accurate diagnoses. These professionals must competently execute techniques such as film manipulation and processing to minimize patient exposure to radiation. Improper performance by the professional and/or patient may result in a radiographic image of unsatisfactory quality that can also lead to a misdiagnosis and the development of an inadequate treatment plan. Currently, the most commonly performed extraoral examination is panoramic radiography. The invention of panoramic radiography has resulted in improvements in image quality with decreased exposure to radiation and at a low cost. However, this technique requires careful, accurate positioning of the patient's teeth and surrounding maxillofacial bone structure within the focal trough. Therefore, we reviewed the literature for the most common types of positioning errors in panoramic radiography to suggest the correct techniques. We would also discuss how to determine if the most common positioning errors occurred in panoramic radiography, such as in the positioning of the patient's head, tongue, chin, or body.