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牙科放射線學 (2)

牙科放射線學 (2). Dental Digital Radiography. 牙科數位攝影術. 陳玉昆副教授 : 高雄醫學大學 口腔病理科 07-3121101~2755 yukkwa@kmu.edu.tw. 學 習 目 標. Understanding: 1. Overall knowledge on digital image 2. Dental digital radiographic systems 3. Advantages & disadvantages of dental

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牙科放射線學 (2)

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  1. 牙科放射線學(2) Dental Digital Radiography 牙科數位攝影術 陳玉昆副教授: 高雄醫學大學 口腔病理科 07-3121101~2755 yukkwa@kmu.edu.tw

  2. 學 習 目 標 Understanding: 1. Overall knowledge on digital image 2. Dental digital radiographic systems 3. Advantages & disadvantages of dental digital imaging 4. Cone beam computerized tomography 5. Fraudulent management of digital images 6. 資料及影像數位化的優點

  3. 參考資料 References: 1. Parks ET, et al. J Contemp Dent Pract 2002;4:23-39 2. White & Pharoah: Oral radiology: principle & interpretation, 5th edition, Chapter 12, p. 227-244 3. 境祐司 Quick Master of web design. Part 6, Lesson 2, p.178-189 4. Schleyer TKL et al. The technologically well-equipped dental office. JADFA 2003;134:30-41 5. Adkeniz BG & Guneri P. Int Endod J 2004;37:214-220 6. Brooks SL, Miles DA. Advances in diagnostic imaging in dentistry. Dent Clinic North Am 1993;37:91-111 7. http://www.learndigital.net 8. Kaohsiung Medical University, Oral Pathology 9. Chen SK & Macdonald R. Chin Dent J 2003;22:1-8 10. Van der Stelet PF. Dent Clin North Am 2000;44:237-48 11. Cha YJ et al. Incidental findings in the maxillofacial area with 3-dimensional cone-beam imaging. Am J Orthod Dentofacial Orthop 2007;132:7-14.

  4. Classification of Digital Image Digital Image Bitmap Image (點 陣 圖) Vector Image (向 量 圖) 牙科大都使用點陣圖像 格狀排列的 像素(pixel) 以數學函數描述幾何圖形，具有線條寬度、控制點與填色等屬性 每個像素(pixel)記載圖像的顏色資料

  5. Classification of Digital Image Bitmap Image (點 陣 圖) Vector Image (向 量 圖) • 解析度較低 • 邊緣鋸齒狀 • 儲存圖像長度、粗細、 • 方向、顏色 • 2. 圖像再如何擴大與變形都 • 不影響圖像的畫質 • 檔案比較少 • 不適合用來表現出寫實或相片風格的圖片 Ref. 3

  6. Classification of Digital Image Ref. 3

  7. 常 用 檔 案 格 式 Digital Imaging & COmmunication in Medicine (DICOM) National Electrical Manufacturers Association/American College of Radiology

  8. 醫 用 數 位影 像 專 有 名 詞 縮 寫 Ref. 9

  9. Film-based imaging Digital imaging Density - Brightness - Latitude - Dynamic Range - Film Speed - Linearity - Contrast - Contrast Resolution - Terminology Ref. 1

  10. Film-based imaging Digital imaging Resolution- Spatial Frequency - Modulation Transfer Function - Radiographic Mottle (Noise) - Background Electronic Noise - Sharpness - Signal to Noise Ratio - Terminology Ref. 1

  11. Analog signal 256 Signal A Time A B Digital signal 256 Signal C D B 每一小方格代表pixel Time 6 units What is a digital image ? Analog signal converter Refs. 1, 6, 10

  12. What is a digital image ? More effective use of radiation Digital Information Conventional X-ray Dose Ref. 10

  13. 口內攝影 X光攝影 多媒體病歷管理系統架構圖 電子病歷 檢查紀錄 前檯作業 (掛號、預約) 後檯作業 (保險、庫存) 多媒體病歷管理系統 Ref. 1

  14. Solid State Detector, SSD: Charge-Coupled Device (CCD) The first system (1984): RadioVisioGrapy (RVG) - Invented by Dr. Frances Mouyens Manufactured by Trophy Radiologie (Vincennes, France) 600dpi Ref. 1

  15. Solid State Detector, SSD: Charge-Coupled Device (CCD) Photoelectric effect Silicon X-ray Conduction band electron Energy 1.26eV Valence band A B hole X-ray capture efficiency increase resolution increase A www.airtechniques.com/products/detailview2.aspx?id=90 B 1pixel utilizes 3 electrodes Basic structure of CCD Ref. 2

  16. The first system (1981): Fuji Corp. (Tokyo, Japan) Digora Densply Air techniques/VistaScan Photo Stimulable Phosphor System (PSP)/(IPS)/(SPS) 600dpi The PSP consists of a polyester base coated with a crystalline halide emulsion [a europium-activated barium fluorohalide compound (BaFBrEu2+)] that converts X-ray radiation into stored energy, which is released as blue fluorescent light when scanned with a helium-neon laser beam. The emitted light is captured and intensified by a photomultiplier tube & then converted into digital data. Ref. 1

  17. Plate prepared Plate exposed Plate processed Photomultiplier tube Scanning laser • PSP plate flooded with • white light to return all e- to • valence band X-ray photon Conduction band F center F center F center Valence band A Eu+2 B C (B) X-ray impart energy to valence e- exciting them to conduction band. Some e- trapped at F center (C) A red scanning laser imparts energy to e- at F-center promoting them to conduction band & then to valence band. Energy is released as green light detected by photomultiplier tube using red filter PSP Image Formation Ref. 2 Photo Stimulable Phosphor System (PSP)/(IPS)/(SPS) Eu+3 Eu+2 Eu+2 Eu+3

  18. Gendex #2 CCD sensor Schick #2 CMOS sensor Kodak #2 film Gendex #2 PSP plate Protective layer Phosphor layer BaFX: Ea2+ Reflection layer Conduction layer Support Backing layer Bar code layer Different intraoral image sensors Ref. 2

  19. Intraoral Receptor Comparison Feature Film CCD PSP Ref. 1

  20. Digital extraoral radio-graphic unit Dental Digital Imaging System Laser scanner Air techniques/VistaScan Image Detectors Photo Stimulable Phosphor System (PSP)/ (IPS) /(SPS) Solid State Detector, SSD: Charge-Coupled Device (CCD) Wireless- latent image Digital intraoral radiographic unit Optic cable Instant image 牙周治療 Ref. 4, manufacturer datasheet

  21. Scan X System Manufacturer datasheet

  22. Scanning times Scan X System Manufacturer datasheet

  23. Disadvantages of drum scanner Manufacturer datasheet

  24. Advantages of VistaScan Manufacturer datasheet

  25. Scan X System Manufacturer datasheet

  26. Intra-oral Scan X System Panorama/Ceph Manufacturer datasheet

  27. Scan X System ScanX Intraoral www.airtechniques.com/ products/detailview2.a spx?id=88 ScanX Duo www.airtechniques.com/ products/detailview2.a spx?id=112 www.airtechniques.com/products/detailview2.aspx?id=86 In-Line Erase Manufacturer datasheet

  28. Scan X System ScanX Cleaning Sheets A quick and convenient way to keep the ScanX dust free. ! Sheets are cut and specially sized for use in each scanner. ! Run through the scanner just like imaging plates. Scan X Scan X IO Scan X Duo www.airtechniques.com/pdf/ScanX_CleaningSheets_Lit_9922_237.pdf

  29. Scan X 高醫牙科數位影像系統 Ref. 8

  30. Commercial available Products Ref. 7

  31. Commercial available Products Ref. 7

  32. Dental Digital Imaging System 牙科治療椅的電腦 治療椅上的液晶螢幕 下 載 醫院醫學影像部High performance主機 High performance server (牙科主機) 上 傳 診間 主機 診間 國外 小港牙科門診部 診間 診 區 間 內 部 網 路 院外第一牙科門診部 Ref. 4, Microsoft Picture Archives

  33. Dental Digital Imaging System 高雄醫學大學 高雄醫學大學 口腔醫學院 口腔醫學院 醫院醫學影像部主機 治療椅電腦 小港牙科門診部 牙科主機 (1) 院外第一牙科門診部 Server X光攝影 國外 Server 牙科主機 (2) 雷射印表機輸出 舊片庫存 Server 掃瞄器 健保申報 Microsoft Picture Archives

  34. Cone Beam CT - KMUOP 牙科用CBCT設計成X光源和感應器面對面排列，繞著被檢查者迴轉的直立式開放裝置，外型類似全口環繞X光機，不像醫科用CT是橫躺的密閉式大型機械，機台大小約2.2公尺2.5公尺 Kaohsiung Medical University, Oral Pathology Department

  35. Principle of Cone Beam CT X-ray source System rotation axis X-ray-Detectors X-ray cone beam Anatomic volume Plane of detector Projection of the volume on the plane of detector Detector element Manufacturer datasheet

  36. Principle of Cone Beam CT 牙科3D錐束電腦斷層是以單束或部份旋轉的 錐狀X光射束穿過組織，將擷取之影像方投射 於後方的一個板狀偵測器上 Manufacturer datasheet

  37. Conventional Spiral CT Cone Beam CT X-ray Source X-ray Source ‘Fan’ of X-ray ‘Cone’ of X-ray Detector Detector 與傳統螺旋型掃描需多次迴轉不同的是： CB-CT只需旋轉1次便可得到被檢體的所有Volume Data。不同於Multi-Slice法，在X軸Y軸Z軸方向解像度均相同，每個Voxel均為正立方體，將此數位化資料處理後重組成各斷面如縱切面，橫斷面，矢狀切面甚至斜切面等的影像，這種功能稱為: 任意斷層面的再構成 (MPR : Multi Planar Reconstruction)，在3D軟體的操作下，也可以作立體影像的觀察 Manufacturer datasheet

  38. FOV – Field Of View Principle of Cone Beam CT FOV – Field of View 12cm 7cm

  39. Principle of Cone Beam CT CBCT攝影條件有四種模式: D (Dental) Mode: FOV為直徑51.2mm，解像力為100m I (Implant) Mode : FOV為直徑102.4 mm，解像力為200m P (Panoramic) Mode : FOV 為直徑150.0mm，解像力為293m F (Facial) Mode : FOV為直徑192.5mm，解像力為376m 圓錐狀的X光線在9.6秒環繞被檢者一周360度 即可得到所有的空間資料(5125l25l2 Matrix) Manufacturer datasheet

  40. Images of Cone Beam CT 2D Image Diagnosis Panoramic Image Periapical Image Manufacturer datasheet

  41. 3D Image Diagnosis Images of Cone Beam CT Manufacturer datasheet

  42. MPR - Multi-Planar Reconstruction Images of Cone Beam CT 冠狀面 (Coronal) 軸向面 (Axial) 矢狀面 (Sagitta) Manufacturer datasheet

  43. Thickness and Interval Images of Cone Beam CT Thickness 10mm Interval 10mm Manufacturer datasheet

  44. Radiation dose of Cone Beam CT

  45. Radiation Dose of Cone Beam CT Comparison of absorbed dose of radiation Absorbed dose of radiation (Sv) Protocol Conventional X-ray Medical CT NewTom 9000 Panoramic 2.9-9.6 12 Lateral cephalogram Not available TMJ (per cut) 1.9-2.0 Implant/tomogram 22.1-52 Not available 48 Submental vertex 33-84 Complete mouth series Low quality 119.9-207.6 300-2426 36.9-50.3 Total dose This type of cone beam CT (NewTom 9000) can produce an image with significantly less radiation than traditional CT because it uses an image intensifier; this is particularly important for children. The absorbed dose from a full volume scan is 36.9 to 50.3 Sv (Ref. 11)

  46. Evaluate and analyze critical anatomy for implants and oral surgery within minutes Principle of Cone Beam CT Manufacturer datasheet

  47. Images of Cone Beam CT More accurate 3-D views of impacted molars Manufacturer datasheet

  48. Send volume data to third-party software for 3-D model replacement Images of Cone Beam CT Manufacturer datasheet

  49. 3-D views of critical structures for complete TMJ analysis Images of Cone Beam CT Manufacturer datasheet

  50. Images of Cone Beam CT Labeling and measurement tools Manufacturer datasheet

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