SUBJECT TITLE

LESSON 1: Lesson Title

FACULTY OF DENTISTRY
DDS YR 3
DENTAL RADIOLOGY (Code: 1304)
2/19/2019
By: Dr Shobha Naik ([email protected])
Dr Shobha Naik 1
 SUBJECT TITLE
DENTAL RADIOLOGY
Ultrasound
LESSON 1: Lesson Title

Ultrasound Imaging

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 SUBJECT TITLE
DENTAL RADIOLOGY
Ultrasound
LESSON 1: Lesson Title

Contents
• Introduction

• Interaction of ultrasound and matter

• Ultrasonic transducer

• Indications

• Advantages and disadvantages of Ultrasonography

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 SUBJECT TITLE
DENTAL RADIOLOGY
Ultrasound
LESSON 1: Lesson Title

Learning outcome
1. Should have the knowledge of principle of ultrasound
imaging.

2. Able to apply the indications of USG in dentistry

3. Should understand the advantages, disadvantages and

limitations of USG.

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 SUBJECT TITLE
DENTAL RADIOLOGY
Ultrasound
LESSON 1: Lesson Title

Introduction
• A sound beam is similar to x-ray beam – waves transmitting
energy.

• Important difference is that x–rays readily passes through a

vaccum whereas sound requires a medium for its transmission.

• Velocity of sound depends on the nature of medium.

• In physics, the term "ultrasound" applies to all acoustic energy

with a frequency above the audible range of human hearing.

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 SUBJECT TITLE
DENTAL RADIOLOGY
Ultrasound
LESSON 1: Lesson Title

Sound travels through

 Air – 330 m/sec

 Fat – 1459m/sec

 Water – 1480 m/sec

 Muscle- 1580 m/sec

 Bone – 4080 m/sec

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 SUBJECT TITLE
DENTAL RADIOLOGY
Ultrasound
LESSON 1: Lesson Title

HISTORY
• 1912- sunken Titanic Ship

• 1940’s- SONAR

• Dussik (1942) in Austria – Medical use.

• Prof. Lan Donald (1960) – Father of modern ultrasound.

• Day and Wheeler (1971)- Dental soft tissues.

• Nieman (1976) – Parotid masses.

• Pickrell KL (1978)- Localization of parotid gland calculus.

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 SUBJECT TITLE
DENTAL RADIOLOGY
Ultrasound
LESSON 1: Lesson Title

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 SUBJECT TITLE
DENTAL RADIOLOGY
Ultrasound
LESSON 1: Lesson Title

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 SUBJECT TITLE
DENTAL RADIOLOGY
Ultrasound
LESSON 1: Lesson Title

ULTRASOUND MACHINE

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 SUBJECT TITLE
DENTAL RADIOLOGY
Ultrasound
LESSON 1: Lesson Title

Transducer : it is the device that can convert one form of energy into
another.
Ultrasonic
transducer

Electric signal

Ultrasonic energy
back from the Ultrasonic energy
tissues

Transmitted into
tissues
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 SUBJECT TITLE
DENTAL RADIOLOGY
Ultrasound
LESSON 1: Lesson Title

PRINCIPLE OF ULTRASOUND
Ultrasound waves are created by a vibrating crystal within a ceramic
probe.
Waves travel through the tissue and are partly reflected at each tissue
interface.
“Piezoelectric “ principle- electric current causes crystal to vibrate,
returning waves create electric current.
Following phenomenon occur when ultrasound propagates through
matter
Reflection
Refraction
Diffraction
Attenuation
Scattering

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 SUBJECT TITLE
DENTAL RADIOLOGY
Ultrasound
LESSON 1: Lesson Title

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 SUBJECT TITLE
DENTAL RADIOLOGY
Ultrasound
LESSON 1: Lesson Title

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 SUBJECT TITLE
DENTAL RADIOLOGY
Ultrasound
LESSON 1: Lesson Title

• The most important component is a thin piezoelectric crystal element

located near the faces of the transducer.

• The front and back faces of the crystal are coated with the thin
conducting film to ensure good contact with the electrodes that will
supply electric field used to strain the crystal.

• Strain refers to deformity of the crystal caused when a voltage is

applied.

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 SUBJECT TITLE
DENTAL RADIOLOGY
Ultrasound
LESSON 1: Lesson Title

• The surfaces of the crystal are coated with gold and silver electrodes.

• The outside electrode is grounded to protect the patient from

electric shock, its inside electrode abuts against a thick backing block
that absorbs sound waves transmitted back into the transducer.

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 SUBJECT TITLE
DENTAL RADIOLOGY
Ultrasound
LESSON 1: Lesson Title

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 SUBJECT TITLE
DENTAL RADIOLOGY
Ultrasound
LESSON 1: Lesson Title

• Transducer is both transmitter and receiver, but cannot send and

receive at the same time.

• Long continuous sound is unsatisfactory, because the associated

vibrations in the crystal produce continuously fluctuating voltages
between the electrodes.

• As the sound pulses passes through the body, echoes reflect back
toward the transducer from each tissue interface.

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 SUBJECT TITLE
DENTAL RADIOLOGY
Ultrasound
LESSON 1: Lesson Title

• These echoes carry energy & they transmit their energy to the
transducer, causing a physical compression of the crystal element.

• This will change their orientation which induces a voltage between

the electrodes. The voltage is amplified & serves as ultrasonic signal
for display on the monitor.

• Compression force & associated voltage are responsible for name

piezoelectricity- pressure electricity.

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 SUBJECT TITLE
DENTAL RADIOLOGY
Ultrasound
LESSON 1: Lesson Title

• Commonly used artificial piezoelectric materials are

Barium titanate

Lead zirconate titanate(PZT)

Great advantage of piezo electric ceramic is that they can be formed

into different shapes depending on the application for which they are
intended.

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 SUBJECT TITLE
DENTAL RADIOLOGY
Ultrasound
LESSON 1: Lesson Title

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 SUBJECT TITLE
DENTAL RADIOLOGY
Ultrasound
LESSON 1: Lesson Title

Interactions B/W Ultrasound and Matter

• In x-ray imaging, transmitted radiation will blacken the film and
creates a image while scaterred radiation will fog the film.

• With USG, image is produced by reflected portion of the beam.

Transmitted sound contributes nothing to the information. But
transmission must be strong enough to produces echoes at deeper
levels.

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 SUBJECT TITLE
DENTAL RADIOLOGY
Ultrasound
LESSON 1: Lesson Title

• Adjacent tissues with different speeds of sound create an acoustic

interface.

• The No. of interfaces and the degree of difference in speed of sound

between media is acoustic mismatch.

• It determines how much sound is reflected at any given interface and

therfore how much sound is transmitted through to the next tissue.

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 SUBJECT TITLE
DENTAL RADIOLOGY
Ultrasound
LESSON 1: Lesson Title

Interaction of Ultrasound with tissue

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 SUBJECT TITLE
DENTAL RADIOLOGY
Ultrasound
LESSON 1: Lesson Title

Absorption depends on viscocity of the conducting medium

• Liquids  low viscosity  little absorption

• Soft tissues  higher viscosity  medium absorption

• Bone  highest viscosity  high absorption of ultrasound

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 SUBJECT TITLE
DENTAL RADIOLOGY
Ultrasound
LESSON 1: Lesson Title

Image display
• The ultrsonic image is an electronic representation of data generated
from returning echoes and displayed on a TV monitor.

• The image is assembled, one bit of data, and many bits together form
the electronic image.

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 SUBJECT TITLE
DENTAL RADIOLOGY
Ultrasound
LESSON 1: Lesson Title

Ultrasound terms

Tissue that do not produce signals,

such as fluid filled cyst, air, are said
to be anechoic and appear black.

Tissues that produces weak signal

are hypoechoic appear fairly dark.
Eg muscles, blood vessels

Tissues that produce intense signals

such as cartilages or needles or bone
are hyperechoic and appear white.

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 SUBJECT TITLE
DENTAL RADIOLOGY
Ultrasound
LESSON 1: Lesson Title

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 SUBJECT TITLE
DENTAL RADIOLOGY
Ultrasound
LESSON 1: Lesson Title

Doppler Ultrasound
• The application of the color flow doppler ultrasound to echography
offers an opportunity to evaluate & determine the presence,
direction, velocity of blood flow within the ultrasound image of the
examined tissue.

• Color power doppler gives a color coded representation of the

doppler signal and its time modification.

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 SUBJECT TITLE
DENTAL RADIOLOGY
Ultrasound
LESSON 1: Lesson Title

The direction of blood flow is assigned the color red or blue, indicating flow
toward(red) or away(blue) from the ultrasound transducer.

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 SUBJECT TITLE
DENTAL RADIOLOGY
Ultrasound
LESSON 1: Lesson Title

Real time imaging

• Real- time, 2-D, is a major method for ultrasound imaging.

• Real- time ultrasound permits assessment of both anatomy and

motion. E.g- featal motion, heart valve.

• When images are acquired and displayed at rate of several times per
sec, effect is dynamic.

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 SUBJECT TITLE
DENTAL RADIOLOGY
Ultrasound
LESSON 1: Lesson Title

3-D Ultrasound
• 3-D scanners used for fetal, gynecologic and cardiac scanning may
employ hardware- based image registration, high density 2-D arrays,
or software registration of scan planes as a tissue volume is acquired.

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 SUBJECT TITLE
DENTAL RADIOLOGY
Ultrasound
LESSON 1: Lesson Title

Clinical appliactions of Ultrasound

1. Therapeutic :
 physiotherapy - pain relief

 Accelerating tissue regeneration

 Stimulates capillary circculation

 Thermal and probably non- thermal mechanisms

 5-15 mins, move transducer constantly to avoid hot spots.

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 SUBJECT TITLE
DENTAL RADIOLOGY
Ultrasound
LESSON 1: Lesson Title

• Ultrasonic therapy of about 0.5MHz is used in physiotherapy, the

function here is almost certainly restricted to internal healing of the
tissues and has comfort, beneficial effects.

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 SUBJECT TITLE
DENTAL RADIOLOGY
Ultrasound
LESSON 1: Lesson Title

Diagnostic applications in Oral & Maxillofacial

region

Oral Mucosa
• In evaluation of fibrosis of oral mucosa and observation in systemic
sclerosis shows increased echogenecity due to fibrotic deposits.

• Imaging of the oral mucosa by 20MHz sonography.

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 SUBJECT TITLE
DENTAL RADIOLOGY
Ultrasound
LESSON 1: Lesson Title

Squamous cell carcinoma

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 SUBJECT TITLE
DENTAL RADIOLOGY
Ultrasound
LESSON 1: Lesson Title

Periapical lesions

cystic lesion appears as a hypoechoic well-contoured cavity filled with fluids with no evidence of internal
vascularity on power Doppler imaging, and granuloma as a hyperechoic or mixed hyper- and hypoechoic
areas with a rich vascular supply on power Doppler imaging.

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 SUBJECT TITLE
DENTAL RADIOLOGY
Ultrasound
LESSON 1: Lesson Title

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 SUBJECT TITLE
DENTAL RADIOLOGY
Ultrasound
LESSON 1: Lesson Title

Temperomandibular Joint
• To define the disc and its position as well as the presence of the TMJ
internal derangements.
• Real time sonography of TMJ may be an ideal means of confirming the
position of the condyle within the glenoid fossa.

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 SUBJECT TITLE
DENTAL RADIOLOGY
Ultrasound
LESSON 1: Lesson Title

Salivary glands
• Ultrasonography could detect a mass in parotid gland and in
particular differentiate between intrinsic and extrinsic lesion.

• Uselful in evaluating sialolithiasis because of its simplicity and being

non-invasive and especially when there is acute infection in the
gland.

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 SUBJECT TITLE
DENTAL RADIOLOGY
Ultrasound
LESSON 1: Lesson Title

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 SUBJECT TITLE
DENTAL RADIOLOGY
Ultrasound
LESSON 1: Lesson Title

Massetric hypertrophy
• To assess asymmetry,muscle dimensions and thickness(helpful in
diagnosis and treatment especially in follow up)
• Inflammatory changes show complete or partial absence of hyperechoic
bands and decreased internal echogenecity.

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 SUBJECT TITLE
DENTAL RADIOLOGY
Ultrasound
LESSON 1: Lesson Title

Lymph nodes
• Systematic neck screening using USG and careful examination of the suspected
nodes is an acceptable diagnostic method for cervical metastatic nodes.

Hilar vascularity or apparently avascularity - Normal and reactive lymph nodes.

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 SUBJECT TITLE
DENTAL RADIOLOGY
Ultrasound
LESSON 1: Lesson Title

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 SUBJECT TITLE
DENTAL RADIOLOGY
Ultrasound
LESSON 1: Lesson Title

Vascular lesions of Head and Neck (Doppler

Ultrasound)
• Colour Doppler US can be used to characterize the flow of head
and neck vascular anomalies and to differentiate hemangiomas
from other vascular malformations which is crucial in
treatment planning.

• The speed and duration at which blood approach and move

away from transducer provide information to US which is
coded red and blue

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 SUBJECT TITLE
DENTAL RADIOLOGY
Ultrasound
LESSON 1: Lesson Title

• Hemangioma during proliferative phase has a high density of

vessels with low resistance as on USG.

Transverse section of the masseter muscle

reveals a hypoechoic, compressible vascular
mass : diagnosis - Hemangioma
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 SUBJECT TITLE
DENTAL RADIOLOGY
Ultrasound
LESSON 1: Lesson Title

Main indications
● Evaluation of swellings of the neck, particularly those involving the
thyroid, cervical lymph nodes or the major salivary glands —

● Detection of salivary gland and duct calculi

● Determination of the relationship of vascular structures and vascularity

of masses with the addition of color flow Doppler imaging.

● Assessment of blood flow in the carotids and carotid body tumours.

●Therapeutically, in conjunction with the sialolithotripter, to break up

salivary calculi which can then pass out of the ductal system.

● Ultrasound-guided fine-needle aspiration (FNA) biopsy.

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 SUBJECT TITLE
DENTAL RADIOLOGY
Ultrasound
LESSON 1: Lesson Title

Advantages

Sound waves are NOT ionizing radiation & are not harmful

Images show good differentiation between different soft tissues and

are very sensitive for detecting focal disease in the salivary glands.

Technique is widely available and relatively inexpensive.

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 SUBJECT TITLE
DENTAL RADIOLOGY
Ultrasound
LESSON 1: Lesson Title

Disadvantages

 Images can be difficult to interpret for inexperienced operators.

Technique is operator dependent.

Real-time imaging means that the radiologist must be present during

the investigation.

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 SUBJECT TITLE
DENTAL RADIOLOGY
Ultrasound
LESSON 1: Lesson Title

Limitations

Sonographic devices have trouble penetrating bone.

Sonography performs very poorly when there is air between

the transducer and organ of interest.

Method is operator-dependent.

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LESSON 1: Lesson Title

References
• White SC, Pharoah MJ. Oral radiology: Advanced imaging, (6th
ed); 2004.
• Eric Whaites; Essentials of Dental Radiography and
Radiology:4th ed Page 237-240
• Sharma, et al. : Ultrasound in Dentistry; International Journal of
Scientific Study | May 2014 | Vol 2 | Issue 2

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