National Orthodontics Programme Module 11 - Radiology

British Orthodontic Society 1

National Orthodontics Programme

British Orthodontic Society

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Radiology

About the National Orthodontics Programme

The National Orthodontics Programme was launched in December 2004 following a successful British
Orthodontic Society Foundation Award application. A primary aim of the project was to develop a modular
learning resource housed in a Virtual Learning Environment for postgraduates in orthodontics
(www.ole.bris.ac.uk). This consists of 40 online modules and a series of online assessments. The resource
aims to maximize the use of academic staff time and significantly reduce the amount of traveling to teaching
bases by Specialist Registrars.
The resource has been developed by all UK dental schools as authors or coauthors. It is at the discretion of
each dental school as to how the resource is best used in their courses.
We hope you enjoy using this unique and pioneering resource.
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Personal Welcome
This Module is intended to improve and update your knowledge on the justification, optimization and
limitations of dental radiographs.
The main objective of this Module is to discuss the new legislation and its importance to Orthodontists.
However it will also include the principles of radiation physics, risks of ionising radiation and various imaging
techniques.
As such we deal with the topics at a high level, focusing on tasks which will stimulate thinking and assist in
gaining personal experience in the subject. You will need to read widely around the subject and references
for further reading are given in each section.
For module content support and guidance, please refer to the discussion board for this module available on
Blackboard.

Module Author
Jane Luker

Module Contributors
Amelia Smith

Peer Reviewer
John Rout

What You Will Learn

The Module will include the following sections:
1. Ionising regulations
2. Selection criteria/ Justificaiton
3. Optimisation and Limitation
4. Principles of radiation physics
5. Risks of ionising radiation
6. Quality assurance
7. Imaging techniques

Timing
• The total time required for the Module and assessment is 25 hours.
• The discussion board for this module is available on Blackboard (www.ole.bris.ac.uk)

Introductory References
• Essentials of Dental Radiography and radiology (3rd edition).
• Eric Whaites. 2003 Churchill Livingstone.
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Assessment

Discuss the role of radiographs in orthodontic clinical practice.

Section 1: Ionising regulations

Recent new legislation includes:

• Ionising radiation regulations 1999:(IRR 1999)
• Ionising Radiation (medical exposure) regulations 2000: (IR(ME)R 2000)

Ionising radiation regulations 1999

• The aim of these regulations was to establish a framework for ensuring that exposure to ionising
radiation arising from work activities is kept as low as reasonably practicable and does not exceed
specified limits.
• There are no dose limits for patients undergoing a medical/dental exposure but each exposure must
be justified.
• The new dose limits associated with exposure arising from work activities have been reduced and
are as follows:

EFFECTIVE DOSE/
YEAR
Employee >18 years <20mSv
Trainee <18 years <6mSv
Carer /Comforter Exempt
General Public 1mSv

New regulations include:

• Notification of equipment – to Health and Safety Executive.
• Prior risk assessment.
• Restriction of exposure (Limitations).
• Maintenance of equipment (recorded).
• Contingency plan in place to deal with accidents.
• Radiation Protection Adviser (RPA) – for every dental practice and required to give advice on:
o Optimisation
o Dosimetry
o Quality assurance
o Radiation protection
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• Information, instruction and training for all staff (recorded). This should include the updating of
staff development.
• Designation of controlled area (exclusion area around patient) – 2m distance around the tube
and anywhere in the main beam until a barrier/wall is reached.
• Local Rules.
• Radiation Protection Supervisor – Their role and knowledge.
• Duties of employees.

Risk assessment should be performed and incorporated in the Radiation Protection File:
o Identify sources of X-rays
o Identify people at risk
o Record predicted dose rates
o Identify steps to prevent accidents
o Document steps to reduce dose (ALARA)
o Record local rules

Ionising radiation (medical exposure) regulations 2000

Regulations devised by the BDA and National Radiation Protection Board (NRPB). They are aimed towards
patient protection.
All personnel involved have dedicated titles and the regulations define new positions of responsibility as
follows:
Employer (Legal person) – Person or body corporate with legal responsibility for a
radiological installation. This could be a practice owner or a NHS Trust.
Referrer – A medical, dental or other health professional entitled to refer to a practitioner for
a radiographic exposure. Responsible for giving suitable information to justify an exposure.
Practitioner – Medical, dental or other health professional entitled to take responsibility for a
medical exposure. Adequately trained to take decisions and must justify on grounds of:
o Specific objectives of the exposure
o Total benefit to the patient
o Anticipated detriment to the patient
o Efficacy, benefits and risks of alternative techniques.

Operator – A person responsible for the practical aspect of the exposure including processing
of radiographs.

Essential legal requirements:

• Operators and practitioners MUST have received adequate training - All personnel involved are
required to undergo training which should be updated and documented.
• Operators and practitioners are recommended to have undertaken continuing education - As
required by the General Dental Council all dentists are required to carry out Continued
Professional Training (1 whole day course/5 hours verifiable every 5 years).
• All doses to be kept as low as reasonably practicable (Optimisation) - A written comment in the
notes about each exposure along with factors relevant to the patients dose. Sufficient
information should be recorded to allow the dose the patient received to be calculated if
necessary
• Justification of all medical exposures - No person shall carry out a medical exposure unless:
o It has been justified by the practitioner
o The benefit to the patient outweighs the risks
o It has been authorised by the practitioner
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• Quality assurance and clinical audit is mandatory and should form part of a quality assurance
programme. By 3 years:
o Not less than 70% of radiographs taken should have a quality rating of 1.
o Not greater than 20% should have a quality rating of 2.
o Not greater than 10% should have a quality rating of 3.
• Clinical audit
• Equipment inventory
• “Written procedures” for medical exposures.
• Correct identification of patients
• Clinical evaluation of each radiograph should be recorded in the patients note

Adequate Training:
1. Practitioner – Should complete the Core Curriculum in dental radiology and imaging as part of the
undergraduate dental degree as specified by the GDC and the British Society of Dental and
Maxillofacial radiology 2002. Also to partake in CPD.
2. Operators – Dentists should complete formal training as above. Dental nurses must possess
Certificates in Dental Nursing and Dental Radiography.

What have you learnt from Section 1?

As a practice principle which roles would you legally be

responsible for in accordance
with new regulations IR (ME)R 2000?

Section 2: Selection criteria/ Justification

Justification - “Description of clinical conditions derived from patient signs, symptoms and history that
identify patients who are likely to benefit form a particular radiographic technique.”
The British Orthodontic Society have published new guidelines to help the implementation of the new
regulations.

Isaacson and Thom. Orthodontic Radiographs: Guidelines (2001). British Orthodontic Society.

Developing dentition/ Diagnosis

A CLINICAL EXAMINATION MUST ALWAYS BE CARRIED OUT BEFORE REQUESTING

RADIOGRAPHS
A Dental Panoramic Tomogram (DPT) is usually the film of choice in order to gather as much information as
possible with one exposure.
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There is no scientific evidence to support any benefit from radiographic screening for the purpose of
assessing the malocclusion and timing of treatment.
The DPT has the benefit of dose reduction by the use of rare earth screens and selective collimation if
necessary.
An anterior occlusal is only justified for the:
o Localisation of unerupted teeth
o Suspected pathology
o Unsatisfactory image quality on a DPT
Where available, further films should only be taken if they do not provide sufficient information.
A single lateral cephalogram should not be taken for use in the prediction of facial growth.

End of active treatment

The need for radiographic records to be taken on the day the appliance is removed should be discouraged.
If required radiographs should be taken a couple of visits prior to debond to enable the results of the film to
be addressed e.g. Torque expression to improve the edge-centroid relationship in a Class II division 2 case.

During retention
Radiographs may be required at the end of retention to provide a baseline from which to assess further
changes, particularly in cases where long term stability is less certain.

Post retention
There is no justification for further radiographic exposure.

Skeletal Development
• Hand /wrist radiographs to determine the stages of skeletal development are not sufficiently
reliable for predicting the growth spurt.
• There is evidence to suggest that predicting the growth spurt is reliable by examining cervical
spine maturation on lateral cephalogram, which is a useful tool already utilised in orthodontic
diagnosis.

Limitations of radiographs
1. 2D representation of a 3D object.
In certain cases may need to take a view from another angle e.g. parallax
2. Geometric accuracy
3. Exposure factors
4. Processing
5. Visual perception
o Partial images
o Contrast
o Context
o Individual variation

What other methods are available to us as orthodontist in order to measure facial growth? In
what areas of Orthodontics would this information be useful to us?
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Section 3: Principles of radiation physics

X-rays and γ- rays form ionising radiation and are part of the electromagnetic spectrum. They are wave
packets of energy of electromagnetic radiation and have short wavelengths. The X-ray beam consists of
multiple wave packets or photons of varying energies. They are produced from an X-ray tube (Figure 1).

Figure 1: The X-ray tube

X-rays are produced by electron bombardment of a tungsten target from a heated electrical filament. The
incoming electrons collide with target atoms and cause the ejection of an alternative electron from the outer
orbit of the atom. The reorganisation of electrons within the atom causes energy to be admitted as x-ray
photons with specific energies. High-energy photons can penetrate at a great distance. Low-energy photons
are less useful as have little penetrating power and are removed by filtration.
These X-rays can affect film emulsion to produce an image. Alternatively they can cause certain salts to
fluoresce and to emit light as found with intensifying screens.
X-ray production is described below:
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Figure 2: The components of an X-ray tube

B: Focusing cup-
to ensure that most
electrons will hit the
anode at the target.
C: Lead casing to
absorb unwanted X-
rays

D: Copper block
and oil to allow
efficient removal
of heat.
F: The cathode
(negative) consists of
E: The anode (positive)
a heated tungsten
consists of a tungsten target
filament that
produces a source of
electrons

o A cloud of electrons are produced by the current (mA) passing through the tungsten
filament at the cathode.
o The potential difference across the x-ray tube (kV) between the cathode and anode
causes migration of the electrons across to the positive anode.
o The speed with which the electrons cross to the anode is dependent upon the kV of the
x-ray tube.
o The electrons collide with the tungsten target on anode and 99% of their energy is
converted into heat which is dissipated by the Copper in the anode and the oil
surrounding the x-ray tube.
o 1% of the energy of the electrons bombarding the anode is converted into x-rays by one
of two processes:

• Bremsstrahlung Radiation (Continuous spectrum):

Slowing of the electron by the electrostatic attraction of the positive nucleus of the tungsten atoms.
As the electron slows the loss in energy produces x-rays of variable energies producing a wide
continuous spectrum. The photons are generally of low energy and often harmful as do not
contribute to the useful X-ray beam. They are removed by an Aluminium filter.
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Figure 3: The effect of an electron on the tungsten

atom

Characteristic Spectrum
• An incoming electron displaces a bound electron on the inner shells of the tungsten atom. The
electrons from higher shells cascade inwards to fill the gaps emitting a defined energy X-ray
photon. The incoming electron must have an energy above 70kV in order to have sufficient
energy to displace an inner shell electron of a tungsten atom. The energy of the electron is
directly related to the potential difference (kV) across the tube (see later).

X-ray set variables

Factors that can affect the intensity and /or the quality of the beam are often found within the x-ray set.
Kilovoltage (kV)
Refers to the potential difference applied across an x-ray tube and determines the speed at which electrons
travel across the tube and impact the tungsten target. Modern intra-oral x-ray sets produce 65-70kV as this
increases the number of high energy photons.
• Determines QUALITY of X-ray beam i.e. energy of the photons and thus the penetrating
power.
• The higher the kV the more likely the x-ray photon will pass through the patient.
• However it also affects film contrast. Increasing kV decreases the contrast.Higher kV x-ray
photons produce films with less contrast between dental tissues such as enemel and dentine
but are diagnostic for caries assessment. They also reduce the dose to the patient as more x-
ray photons pass through the patient reducing the exposure time.
• Higher kV tubes produce x-ray beams which penetrate bone and teeth better and thus produce
less contrast with the soft tissues.

Milliamperage (mA) and time (secs)

Refers to the current flowing through the tube and determines the number of electrons flowing from the
filament to the tungsten target. Most sets operate at 7-12mA. The length of time of the exposure is also
important.
• Determines QUANTITY of the x-ray photons
• Affects degree of blackening of film (optical density). An over-exposed film is too black
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Interactions of x-rays with matter

As the x-ray beam interacts with the patient there are four possible
fates:

1-Transmitted unchanged
2-Pure scatter
3-Absorbed
PHOTOELECTRIC EFFECT
4-Scatter and absorption
COMPTON EFFECT

Figure 4: The effects of X-rays

Energy absorbed from the x-ray beam by the tissues may lead to harm.
Scattering – change in direction of a photon with or without a loss of energy. Pure scatter results in no loss
of energy.
Absorption – deposition of energy i.e. removal of energy from the beam.
The only two interactions of importance are the Photoelectric effect and the Compton effect.

Photoelectric effect
A pure absorption interaction predominating with low-energy photons. The x-ray photon interacts with an
inner bound electron. The photon energy needs to be equal, or greater than the binding energy of the
electron in order to be able to eject it. The photon gives up all its energy to the electron and disappears
(total absorption). The electron is ejected and is known as the photoelectron. The photoelectron goes on
to interact with other electrons within the tissues and is the cause of harmful ionizations. Atomic stability is
achieved by the capture of a free electron.
As the atomic number increases, the number if inner bound
electrons also increases. The photoelectron effect is directly
proportional to the atomic number (Z) cubed. Lead has an
atomic number of 82 and is therefore a good absorber of x-rays.
It is often used for radiation protection.
The atomic number of soft tissues is 7 (Z3 =343) and for bone is
12 (Z3 = 1728). This obviously gives a difference in the radio-
opacity due to the variation in degree of absorption.
The photoelectric effect is also inversely proportional to the
voltage of the X-ray machine 9(kV) cubed. Low kV machines will
produce greater proportion of low-energy photons thus a
greater probability of the photoelectric interactions, greater
contrast radiographs but increased dose to the patient.

Figure 5: The variation in absorption of X-ray

photons depending on the atomic number resulting
in varying contrast.
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Thus:
• Responsible for producing contrast between different tissues of different atomic numbers.
• Pure absorption, therefore contributes to the dose received by the patient.

Compton effect
This results in absorption and scattering of high-energy photons. The energy of the x-ray photon is much
greater than the binding energy of the electron. The x-ray photon interacts with a loosely bound electron.
The electron is ejected as the Compton recoil electron with some of the energy of the incoming photon
(partial absorption). This electron then undergoes further ionization within the tissues. The remaining energy
is scattered as a scattered photon. The scatterd electron can travel in any direction and may go on to:
o Undergo further Compton interactions within the tissues
o Undergo photoelectric interactions within the tissues
o Escape from the tissues and is of concern in the clinical environment.

This interaction is not dependent on the atomic number, so will occur in all tissues equally. There is,
therefore, little discrimination between different tissues on the final radiograph. As this interaction is
dependent on high-energy photons this explains why high kV machines will result in low contrast films.

Mechanism of damage (see risks of ionising radiation)

X-rays cause damage by ionization. Mechanisms for harm are via:

1. Direct damage to DNA/RNA.
Approximately one-third of biological effects of x-ray exposure result from direct hits and may lead
to:
o Cell death
o Abnormal replication
o Failure of transfer of information

If somatic cells are affected Radiation induced malignancy

If genetic cells are affected Congenital abnormality

2. Indirect damage
This results in the ionisation of water with the release of free radicals leading to damage.
Approximately two-thirds of the biological effects of x-ray exposure result from indirect effects.

Dose units:
1. Radiation absorbed dose (D)
Measure of the amount of energy absorbed from an x-ray beam by the soft tissues. (Joules /Kg)
2. Equivalent dose (H)
A measure of the radiation dose that takes into account the effectiveness or ability to do damage of
different types of radiation. X-rays have a radiation weighting factor of 1, whereas neutrons have a
weighting factor of 10. This produces a common unit.
= D x radiation weighting factor (Sieverts)
3. Effective dose (E)
A measure which allows doses from different investigations of different parts of the body to be
compared, by converting all doses into an equivalent whole body dose. The most radiosensitive
tissues such as the reproductive organs are given the highest tissue weighting factor – 0.2. Skin has
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a weighting factor of 0.01. If the associated tissue is involved the equivalent dose is multiplied by
the tissue weighting factor. This dose can be used to compare doses from other investigations of
other parts of the body.
= H x tissue weighting factor (Sieverts)

What is the effective dose of a thyroid examination?

Radiation absorbed dose = 10J/Kg
Radiation weighting factor = 1
Tissue weighting factor = 0 .05

Section 4: Risks of Ionising Radiation

***THERE IS NO SAFE DOSE***

1. Somatic Certainty (Non-stochastic) or Deterministic Effects

The severity of the effect is proportional to the amount of radiation received. These effects are
usually associated with high levels of radiation exposure and each has a THRESHOLD beneath which
the effects are prevented. Protection measures are designed do that these effects are prevented.
o Acute – Radiation sickness
Death > 10Sv total body irradiation
o Chronic – hair loss, sterility.

Figure 6: Radiation-induced caries Figure 7: Mucositis and Xerostomia

2. Somatic Stochastic Effects

Theses effects are governed by the rule of probability – every exposure MAY induce a malignancy,
but when levels are low this chance is very small. There is no THRESHOLD beneath which a
malignancy will definitely not occur. There is no link with the amount of exposure and the severity of
harm, only the likelihood of causing harm.
3. Genetic Stochastic Effects
These effects are the chance of inducing a congenital abnormality in future offspring of the patient
undergoing exposure through irradiation of their reproductive organs.

Dental radiography accounts for 25% of radiographic examinations carried out in the UK and is the most
used diagnostic tool. The doses are generally very low but there is still a risk of inducing a somatic stochastic
or genetic stochastic effect.
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RADIOGRAPHIC RISK PER MILLION OF A FATAL

EXAMINATION CANCER
Intra-oral radiograph 0.2
DPT 1.0
Skull 1.7
Barium enema 37
CT chest 198

The risk of ionising radiation varies depending on the age.

AGE GROUP x FACTOR RISK OF

(YEARS) CANCER
<10 x3
10 – 20 x2
20 – 30 x 1.5
30 – 50 x 0.5
50 – 80 x 0.3
80+ negligible risk

The risks of dental radiography are small compared with other medical exposures and overall there is 1 in a
million risk of a fatal outcome.
In 1998 – 1999 2million DPT’s were taken in the GDS (NHS) and represents 24% of investigations. This
excluded those taken in the hospital, community or private sector. In the same time period £18 800 000 of
income was generated for GDP’s by DPT’s.

Are radiographs, DPT’s in particular, over prescribed? How would you go

about being more selective in the use of radiographs personally and on a
departmental level?
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Section 5: Dose Limitation

Optimisation – All exposures should be kept as low as reasonably achievable (ALARA), taking into
account social and economic factors. No practice shall be adopted unless its introduction produces a net
positive benefit.
Limitation – The equivalent dose to individuals should not exceed the limits recommended above in
Section 1. It is not mandatory that dentists have personal monitoring but it is recommended to establish that
dose limits are not being exceeded. Should be considered for those staff whose workload exceeds 100 intra-
oral or 50 DPT’s.

Typical doses from dental radiography:

Film Average effective dose

Intra-oral 0.008-0.01mSv
E speed – 0.004mSV
Rectangular collimation- 0.001mSv
DPT 0.016-0.026mSV
Skull 0.1mSv (non-triangulation)
Chest 0.02mSv
CT skull 2mSv

The effective dose of a DPT is equivalent to the average background radiation received in 3 days, whereas
the effective dose of an intra-oral equals 16 hours of background radiation. The accumulative effect,
however, is very real and every effort should be taken to keep exposure down to the very minimum.

Recommended methods for dose reduction:

Patients
• There are no set limits
• The decision to carry out an investigation should be based on the film influencing the diagnosis
and subsequent treatment of the patient and the clinician having adequate knowledge on the
effects of ionising radiation.
• The number, type and frequency of the requested radiographs is the responsibility of the
clinician. Selection Criteria in Dental Radiography (1998), Orthodontic Radiographs: Guidelines
(2001)
o Clinical judgement
o Equipment
Intra-oral – 60-70Kv– to generate a high potential difference to accelerate the
electrons.
Constant potential – X-ray production is efficient, more high-energy
photons are produced and fewer lower-energy harmful photons
produced
200mm long spacer cone – a device for indicating the direction of the
beam and setting the ideal distance form the focal spot to the target.
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Figure 8: The effect of a long spacer cone to reduce the

exposure.

• Rectangular collimation with film holders (reduced dose by 50%)

• E or F speed film- The faster the film, the less the exposure to the patient however the poorer
the image quality. These films are very sensitive to processing variables
Extra-oral - Effective patient positioning aids
• Rare earth intensifying screens –Absorb x-rays and convert to photons of light. Green light
sensitive films cut the dose by 90%.
• Use of field limitation techniques – 50% reduction of dose if exposure restricted to dentition
o Radiographic technique
Operators adequately trained
Good processing
Use of film holders and beam aiming devices
o Lead protection
No justification in the use of lead aprons (2001).

Dentists and staff

• As long as local rules are followed all dental staff should receive an annual dose limit of
considerably less than 6mSv.
o Distance form source of radiation –controlled area (see section 1)
o Equipment
Warning lights visible
Control panel outside the controlled area
o Monitoring – Not compulsory but personal dosimeters are useful to provide information
on the energy of radiation received. Sensitive and reliable.

General public
o Thickness and material pf partition walls
o Mandatory appointment of a RPA.
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Section 6: Quality Assurance

This is now mandatory and a requirement of the legislation described in Section 1.
Quality assurance is an organised effort by the staff operating a facility to ensure that the diagnostic images
produced are of sufficiently high quality so that they consistently provide adequate diagnostic information at
the lowest possible cost and with the least possible exposure of the patient to radiation.
Aims of quality assurance
• To produce diagnostic radiographs of consistently high standard
• To reduce the number of repeat radiographs
• To determine all sources of error to allow their correction
• To increase efficiency
• To reduce costs
• To reduce the radiation dose to patients and staff.

A quality assurance programme must be written down and include the person responsible for
implementation, frequency of programme implementation and the frequency of formal audits to
assess the programme.

Quality Assurance Measures

The essential quality control measures relate to:
Staff training and updating
• The register should include the name of the member of staff, their responsibility and training
record.

Image quality
• The quality of every radiograph should be compared to a high standard reference film
positioned permanently on the viewing screen. Any deterioration in the quality should be
investigated and the appropriate action to correct this instigated. All the above procedures
should be recorded.

• The NRPB/RCR have produced guidelines to assess the quality of radiographs as follows:
o Rating 1: Excellent
o Rating 2: Diagnostically acceptable
o Rating 3: Unacceptable

The results should be recorded and evaluated against appropriate targets. Ideally not less than 70% of
radiographs should be recorded as rating 1, no greater than 20% recorded as rating 2 and no greater than
10% recorded as rating 3.
Recording of the nature of a film error along with the number of repeat radiographs taken is also essential in
order to calculate the percentage of faulty films.
Working procedures
• These include:
o Local rules – Legal requirement. Includes the procedural and operational elements that
are essential to the safe use of X-ray equipment, including guidance on exposure times
and what is relevant in the maintenance of good standards in quality assurance.
o Operational procedures – Written procedures for all actions that indirectly affect radiation
safety and diagnostic quality e.g. the correct use of processing chemicals.
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X-ray equipment
• Physical checks are required and should be recorded:
o Before any equipment is bought into routine use and is the legal responsibility of the
installer.
o Before the equipment is bought into clinical uses and determines the assessment of the
typical patient dose.
o Every 3 years or after a major maintenance procedure.
o Daily in order to check important features that could affect radiation protection.

Processing
• The darkroom, image receptors including films and cassettes and processing equipment and
solutions require regular checks to ensure effectiveness such as light-tightness, storage
conditions, correct temperature and cleanliness. All results of checks such as frequency of
cleaning procedures should be recorded.

Audits
• This should comprise two independent audits demonstrating effective implementation of the
programme.

Design a quality assurance programme. Include procedures that require daily,

weekly and periodical checks.

Section 7: Imaging techniques

Digital film/ Fluoroscopy

• Sialography
• Digital subtraction
• Interventional techniques

Ultrasound

Advantages Disadvantages
Non-ionsing Operator dependent
Rapid image production Poor visualisation of deep structures
Easy to scan in most planes Limited bony infroamtion
Excellent sensitivity Extent of large masses not always seen
Good soft tissue discrimination

Computerised Tomography
• High dose technique
• Very good for bone
• Good sensitivity for mass lesions but less soft tissue resolution than MRI
• Uses – include inflammatory sinus disease, complicated facial fractures, bony lesions of the jaw.
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Magnetic Resonance Imaging (MRI)

The image is formed by the activity of a radiowave on a patient place in a magnet. The patient emits a
signal that is received and the picture is reconstructed.

Advantages Disadvantages
Non-ionising Poor cortical bone detail
Can reconstruct images in any plane Not tolerated by all patients
Excellent soft tissue discrimination Long scanning times
Non-operator dependent

Radionuclide imaging
Procedure involved in the localisation of regions of activity within a patient resulting from the administration
of one or more radionuclides.

Visit the discussion board to discuss any of the thoughts outlined above

Congratulations -You have now completed Module 11.

Please remember to complete the module assessment so we can keep improving the module content.