Many practices report that they experience very different image quality from their sensors than they had seen at a trade show or on a manufacturer's website before they purchased. The reality is that there are many factors which affect the quality of the image returned from your intraoral sensors. Luckily, you and your staff can optimize image quality by following these three steps, none of which are particularly difficult.
Step 1: Start with correct exposure settings on your X-ray head:
In general, we have found that upper posterior PAs require twice the exposure of anterior PAs. BWs and lower posterior PAs require the same exposure. Position the sensor to take an upper posterior PA, and start with a time that is half of what you are currently using for film. Expose. If the image is light and grainy, increase the exposure by one increment (~.025s). Conversely, if the image is overly dark, decrease the exposure by one increment (~.025s). Retake without changing position and evaluate for correct exposure. Take another image if necessary until correct exposure is obtained.
Once the upper posterior PA exposure is correct, take an anterior PA at half of the exposure level and a BW at 3/4 of the exposure level. Evaluate the results. For the premolar BW, pull the tube back 1/2"-3/4" from the position of the molar BW. This will prevent cervical burnout in the premolar region. It is better practice to drop the exposure one increment for the premolar BW than moving the tube back, but many hygienists do not want to have to change the timer setting during BWs. When the correct values are determined, type them up and print them off for each different head in your office. The following is an example of a setting reminder to be posted by the x-ray control unit which was developed from a training with the Suniray.
Progeny (X-Ray Head)
65 KV 7ma
Upper Posterior PAs - .125s (timer setting)
Bite Wings Lower Posterior PAs - .10s (pull back one inch for premolar)
Upper Anterior PAs- .063s (at ring notch) Troll Byte holder
Lower Anterior PAs - .063s (1/2 inch from ring notch) Troll Byte holder
If light and grainy-- come closer with head (to notch)
If burnout or blooming-- increase distance from cheek by 1/2in
Denser bone patient, up one increment (~.25s)/ Less density, down one increment (~.25s)
Below are images taken with the settings above using the Suniray sensor. Both images are native with no post processing.
Step 2: Use a positioning device (e.g. TrollByte Kimera or Rinn XCP Fit) that securely orients the sensor so that the exposure beam is perpendicular to the active side of the sensor.
Have your staff watch the training video that accompanies either of the above systems (or whichever system your office chooses to utilize) and make sure that they parallel the X-ray holder alignment bar with the cone and maintain consistent distance for all areas of the mouth. Remember, if distance is not consistent, the quality of the X-rays will not be consistent.
Step 3: Understand post-processing enhancements such as brightness, contrast, gamma, and sharpness, and how to use them to better visualize decay and bone levels.
Correct exposure levels should result in images that require little to no "tweaking." A sharpening filter such as Apteryx's "real-time filter" set to a low level provides sharpening without creating artifacts. Lowering gamma values on a bite-wing helps to more clearly define the DEJ as well as decay shape and depth.
SuniRay with correct exposure and no enhancement. Taken with a 30 year old SS White X-ray head.
SuniRay with a low level of sharpening with Apteryx "real-time" filter.
Ensure your staff is well versed in the 1-2-3's of X-rays, and you will enjoy consistent quality! As always, Dental TI is happy to assist our clients in training and troubleshooting to address any of your imaging scenarios. Feel free to give us a call at 1-800-672-5733, or email us at info@dentalti.com.
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