Principles of Dental Imaging
Exam Solutions
Course Introduction
Principles of Dental Imaging introduces students to the foundational concepts and techniques involved in capturing, processing, and interpreting dental radiographic images. The course covers the physics of X-ray production, image formation, and factors affecting image quality, as well as safety protocols to minimize radiation exposure for both patients and operators. Students explore various types of dental imaging modalities, including intraoral and extraoral radiography, and gain an understanding of digital imaging advancements. Emphasis is placed on indications for imaging, anatomical landmarks, and the role of imaging in diagnosis, treatment planning, and patient education within dental practice.
Recommended Textbook
Essentials of Dental Radiography for Dental Assistants and Hygienists 10th Edition by Evelyn Thomson
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Chapter 1: Dental Radiography: Historical Perspective and Future Trends
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Q1) Pointed cones should be used to direct radiation from the x-ray tube to the patient. A)True
B)False
Answer: False
Q2) What is the technique of choice for intraoral radiography?
Answer: The paralleling technique is the technique of choice because it is less complicated and more consistently produces better radiographs than the bisecting technique
Q3) Who was awarded the first Nobel Prize for physics in 1901, for his experimental work with radiation?
A) W. J. Morton
B) O. Walkhoff
C) W. D. Coolidge
D) W. C. Roentgen
Answer: D
Q4) The bisecting technique is the technique of choice for intraoral radiography. A)True
B)False
Answer: False
Page 3
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Chapter 2: Characteristics and Measurement of Radiation
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Q1) X-rays make the materials they pass through radioactive.
A)True
B)False
Answer: False
Q2) What are the positively charged particles in the nucleus of an atom called?
Answer: Protons. Positively charged protons and neutral neutrons make up the nucleus of atoms.
Q3) Matter is defined as the ability to do work and overcome resistance.
A)True
B)False
Answer: False
Q4) Kinetic energy is the internal energy within the atom that holds its components together.
A)True
B)False
Answer: False
Q5) People living on the Colorado plateau receive a higher dose of what type of radiation than people living in Philadelphia?
Answer: back ground
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Chapter 3: The Dental X-Ray Machine: Components and Function
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Q1) The collimator is a lead diaphragm that restricts the dimensions of the useful beam.
A)True
B)False
Answer: True
Q2) The step-down transformer corrects fluctuations in the current flowing through the x-ray machine.
A)True
B)False
Answer: False
Q3) Primary beam refers to a high-energy, short wavelength x-ray beam.
A)True
B)False
Answer: False
Q4) If the tube head is properly sealed, the port is the only place through which x-rays can escape.
A)True
B)False
Answer: True
Page 5
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Chapter 4: Factors Affecting Radiographic Quality
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Q1) The quality of the beam of radiation is determined by which exposure factor?
Q2) What types of tissues or structures appear radiolucent on radiographs?
Q3) Sharpness/definition refers to the detail and clarity of the structures on a radiograph.
A)True
B)False
Q4) What is long-scale contrast?
Q5) Which kVp setting produces long-scale image contrast?
A) 65 kVp
B) 75 kVp
C) 85 kVp
D) 95 kVp
Q6) Radiographic image unsharpness is generally caused by movement of the patient, image receptor, or tube head during exposure.
A)True
B)False
Q7) Increasing the kVP results in a more penetrating x-ray beam.
A)True
B)False
Q8) What is radiographic density?
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Chapter 5: Effects of Radiation Exposure
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Q1) When radiation affects any cells of the body except the reproductive cells, the effect is called indirect.
A)True
B)False
Q2) In addition to x-radiation, list other causes of changes to the genetic material of cells.
Q3) Erythema is a stochastic effect of exposure to radiation.
A)True
B)False
Q4) The Law of Bergonié and Tribondeau states that cells are most sensitive to radiation injury during mitosis (cell division).
A)True
B)False
Q5) Scientists do not know whether low levels of radiation exposure carry health risks.
A)True
B)False
Q6) Can dental x-rays cause cataracts in the lens of the eye?
Q7) Do scientists believe that radiation damage to reproductive cells is cumulative?
Page 7
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Chapter 6: Radiation Protection
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Q1) Thermoluminescent dosimeters (TLDs) contain crystals that absorb energy when exposed to radiation.
A)True
B)False
Q2) What undesirable effect does collimation reduce?
Q3) Should the patient wear a thyroid collar during panoramic radiography?
Q4) Guidance for deciding when, what type, and how many radiographs to expose on a patient have been developed and should be followed.
A)True
B)False
Q5) The National Committee on Radiation Protection principle to keep exposure down, based on the idea that all radiation, no matter how small the dose, may cause adverse biological effects, is called "ALARA."
A)True
B)False
Q6) The sum of inherent and added filtration is called .
Q7) What are the three categories of methods for protecting oral health care personnel from radiation exposure?
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Chapter 7: Dental X-Ray Film and Processing Methods
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Q1) The purpose of the lead foil in the film packet is to absorb back-scattered x-rays to reduce film fog.
A)True
B)False
Q2) Each of the following statements regarding dental x-ray film speed is true EXCEPT one. Which one is the EXCEPTION?
A) E-speed film is the fastest film speed currently available.
B) Film speed is printed on the back side of each individual film packet.
C) Trademark names like "Super" or "Ultra" are not film speeds.
D) Film speeds slower than D are no longer used.
Q3) A pedodontic film is any film used to radiograph a child's teeth.
A)True
B)False
Q4) Which of the following statements regarding extraoral film is FALSE?
A) It is used outside the mouth.
B) It comes individually wrapped in protective paper.
C) It is called a "screen film."
D) It uses intensifying screens.
Q5) Silver halide crystals suspended in gelatin form which part of dental x-ray film?
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Chapter 8: Digital Radiography and Image Acquisition
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Q1) At a minimum, how often should manual processing solutions be changed?
A) Every week
B) Every 2 weeks
C) Every 3 weeks
D) Every month
Q2) The purpose of the washing step in film processing is to:
A) shrink and harden the emulsion.
B) remove any residual chemistry remaining on the emulsion.
C) neutralize alkaline and/or acidic chemistry.
D) reduce the exposed silver halide to metallic silver.
Q3) The optimum developing temperature for manual time-temperature film processing is:
A) 58 degrees F.
B) 68 degrees F.
C) 78 degrees F.
D) 88 degrees F.
Q4) It is safe to read a radiograph under white-light conditions after only 2 or 3 minutes of developing.
A)True
B)False
Page 10
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Chapter 9: Infection Control
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Q1) Which requires less radiation to produce an image, digital or conventional film-based radiographs?
Q2) Digitization converts radiographs obtained with traditional film-based radiography to digital images.
A)True
B)False
Q3) There are two methods of acquiring a digital image.
A)True
B)False
Q4) What determines the quality of a digital image?
A) Gray scale
B) Spatial resolution
C) Combination of pixels
D) All of the above
Q5) Which of these is used in indirect digital imaging?
A) Photostimuable phosphor
B) Complementary metal oxide semiconductor
C) Charge-coupled device
D) Artificial intelligence
Q6) What are the advantages of digital radiography?
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Chapter 10: Legal and Ethical Responsibilities
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Q1) The Centers for Disease Control and Prevention (CDC) does not enforce infection control regulations.
A)True
B)False
Q2) Using standard precautions, infection control protocols are carried out only if the patient is known to be infectious.
A)True
B)False
Q3) Which of the following gloves are recommended for cleaning and disinfecting radiographic operatories and equipment?
A) Heavy-duty utility gloves
B) Plastic overgloves
C) Latex treatment gloves
D) Vinyl treatment gloves
Q4) Taking a thorough medical history and performing an oral examination will not always identify potential infected patients.
A)True
B)False
Q5) What is the definition of "disinfect"?
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Chapter 11: Patient Relations and Education
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Q1) Providing the radiographers with a radiation monitoring device is good risk management.
A)True
B)False
Q2) In malpractice cases, the dentist may be sued for the actions of the radiographer.
A)True
B)False
Q3) Each of the following statements regarding risk management is correct EXCEPT one. Which one is the EXCEPTION?
A) An attempt should be made to obtain duplicate copies of a new patient's radiographs.
B) The fastest film speed currently available should be used for all radiographs.
C) Unless required by law, personnel monitoring devices should be discouraged.
D) All intraoral radiograph exposures should use an image receptor holding device.
Q4) Generally, how frequently must x-ray machines be inspected?
Q5) Who owns a patient's dental radiographs?
Q6) When does the statute of limitations begin to run for children?
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Page 13
Chapter 12: Introduction to Radiographic Examinations
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Q1) Each of the following statements regarding communication is correct EXCEPT one. Which one is the EXCEPTION?
A) Patient questions must be answered honestly to develop trust.
B) Communication is the process by which information is exchanged between two or more people.
C) Establish how you will communicate with the patient prior to putting on the mask required for radiographic procedures.
D) In an uncomfortable discussion, avoid eye contact with the patient.
Q2) How should the radiographer greet the patient?
Q3) Which of the following statements is correct?
A) The measurement term "gray" indicates comparisons between different types of radiation.
B) Exposures are recorded with the term "sievert."
C) The amount of radiation absorbed by the tissue is referred to as the dose.
D) mSv stands for one-hundredth of a sievert.
Q4) Nonverbal communication includes gestures, facial expressions, body movement, and listening.
A)True
B)False
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Chapter 13: The Periapical Examinationparalleling Technique
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Q1) The bitewing survey may consist of two to eight radiographs.
A)True
B)False
Q2) The periapical examination is sometimes referred to as an <BOLD>interproximal radiograph.
A)True
B)False
Q3) Why is the paralleling technique the technique of choice over the bisecting technique for intraoral radiographs?
Q4) Which of the two techniques for obtaining intraoral radiographs is considered the technique of choice?
A)True
B)False
Q5) Which of the following statements is correct?
A) Vertical angulation is usually described in millimeters.
B) Vertical angulation of the tube head and PID begins at 90 degrees.
C) To change vertical angulation, the tube head is swiveled from side to side.
D) When the open end of the PID is tilted toward the floor, the vertical angle is positive.
Q6) Have film holders always been used in dental radiography?
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Chapter 14: The Periapical Examinationbisecting Technique
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Q1) Incorrectly aligning the point of entry will result in what type of error?
Q2) Image receptor holders designed for use with the paralleling technique usually have a short bite block.<KT>
A)True
B)False
Q3) An image receptor holder with an external aiming device can make radiographic errors less likely.
A)True
B)False
Q4) Image receptors with an external aiming device eliminate radiographic technique errors.
A)True
B)False
Q5) What is the most likely reason that overlapping occurs even if the image receptor is correctly positioned parallel to the teeth of interest and the central ray is accurately directed through the appropriate embrasure?
Q6) How is the correct point of entry achieved when using the paralleling technique?
Q7) With the paralleling technique, where is the central ray directed?
Page 16
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Chapter 15: The Bitewing Examination
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Q1) Explain how the bisecting technique relates to the rule of isometry.
Q2) How does the central ray of the x-ray beam intersect with the image receptor and the teeth of interest when using the bisecting technique?
Q3) The two planes that can be visualized by the radiographer are the estimated long axis of the tooth and the plane of the image receptor.
A)True
B)False
Q4) Which of the following statements regarding patient preparation for dental radiography is NOT correct?
A) The patient should be protected with a lead/lead-equivalent apron and thyroid collar.
B) The patient's occipital protuberance should be against the headrest during exposure.
C) The patient's eyeglasses may be left in place to protect the eyes.
D) Objects in the mouth such as dentures, partials, and retainers should be removed prior to exposure.
Q5) Why is it important for the radiographer to know how to apply both the paralleling and bisecting techniques?
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Chapter 16: The Occlusal Examination
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Q1) Bitewing radiographs are especially useful in detecting caries on which of the following tooth surfaces?
A) Mesial
B) Occlusal
C) Facial
D) Lingual
Q2) The term used to describe the contact point between teeth in the same arch is "proximal surface."
A)True
B)False
Q3) Periapical radiographs image the alveolar bone crest better than bitewing radiographs.
A)True
B)False
Q4) The name bitewing is descriptive.
A)True
B)False
Q5) What size image receptor is used for bitewing radiographs on a child with primary teeth?
Q6) Which two angulations are critical to producing quality bitewing radiographs?
Page 18
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Chapter 17: The Panoramic Examination
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Q1) The cross-sectional technique produces an occlusal radiograph that resembles a large periapical radiograph.
A)True
B)False
Q2) The thyroid collar may be in the path of the primary beam during which occlusal technique?
A) Maxillary posterior topographical
B) Mandibular anterior topographical
C) Mandibular posterior topographical
D) Mandibular cross-sectional
Q3) Determining the vertical angulation for exposure of a cross-sectional occlusal radiograph is assisted by positioning the open end of the PID parallel to the external aiming device of the image receptor holder.
A)True
B)False
Q4) What is the purpose of the occlusal radiographic exam?
Q5) Can a thyroid collar be used during the occlusal radiographic exam?
Q6) Do occlusal radiographs display dimensional distortion?
Q7) What are the recommended exposure settings for occlusal radiographs?
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Chapter 18: Identifying and Correcting Undiagnostic
Radiographs
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Q1) What term is used to describe images other than anatomy or pathology that do not contribute to a diagnosis of the patient's condition?
A) Artifacts
B) Cone cuts
C) Double images
D) Pressure marks
Q2) A black film indicates accidental exposure to white light.
A)True
B)False
Q3) Can fluorescent watch faces and dials fog film?
Q4) White spots on the film are caused by premature contact with the developer solution.
A)True
B)False
Q5) Light (thin) images may result from each of the following EXCEPT one. Which one is the EXCEPTION?
A) Placing the image receptor (film) in the mouth backward
B) Not depressing the exposure button for the duration of the cycle
C) Using an mA setting that was too high
D) Developing in weak processing solutions
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Chapter 19: Quality Control and Environmental Safety in Dental Radiography
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Q1) The expiration date manufacturers place on radiograph film boxes indicates that films:
A) should not be used for patient exposures after this date.
B) may be safely used for one additional month after this date.
C) may be safely used for a 6-month period after this date.
D) may be used safely after performing a quality control test.
Q2) Which of the following statements regarding dental x-ray machine output consistency testing is correct?
A) It should be performed by a qualified expert only.
B) Multiple images that are identical in density and contrast indicate a failed test.
C) Each test film should be processed immediately after exposure.
D) It uses a step wedge.
Q3) Assessing the radiographic equipment and systems in use, and developing a written plan for quality control are the first steps in establishing a quality administration program.
A)True
B)False
Q4) What is the key to peak performance of an automatic processor?
Q5) What is a reference film?
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Chapter 20: Image Orientation and Introduction to Interpretation
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Q1) Switching from film-based radiography to a digital imaging system will eliminate the need for managing each of the following EXCEPT one. Which one is the EXCEPTION?
A) Disinfectant
B) Developer
C) Fixer
D) Lead foils
Q2) What happens if fixer chemicals are accidentally mixed with developer?
Q3) Which of these is the name of the synthetic rubber used in utility gloves that protect the radiographer when handling chemicals?
A) Vinyl
B) Neoprene
C) Nitrile
D) Latex
Q4) A chemical manufacturer may not have to reveal ingredients of a product unless:
A) another manufacturer used the same ingredient in their product.
B) a medical emergency arises when a radiographer is using the chemical.
C) the chemical is known to produce a hazardous waste.
D) OSHA mandates that all chemicals be revealed on the MSDS.
Q5) Describe the appropriate use of an emergency eyewash station.
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Chapter 21: Recognizing Normal Radiographic Anatomy
Intraoral Radiographs
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Q1) Each of the following is an advantage of film mounting EXCEPT one. Which one is the EXCEPTION?
A) Aids viewing and interpretion
B) Prevents unnecessary retakes
C) Facilitates storage of radiographs
D) Provides meaningful patient education
Q2) Which of these statements regarding viewing equipment is FALSE?
A) A magnifying glass may be used to aid the viewer.
B) Clear plastic film mounts help reduce glare and enhance the detail of the images.
C) Subdued room lighting is best for viewing radiographs.
D) Viewbox lighting must be of uniform intensity and evenly diffused.
Q3) Radiographs may be best interpreted by holding the film up to the overhead room light.
A)True
B)False
Q4) What type of film mount is preferable?
Q5) The placement of radiographs in a film holder is called ________________.
Page 23
Q6) How long should dental radiographs be retained?
Q7) Which is the preferred method of mounting films?
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Chapter 22: Recognizing Normal Radiographic Anatomy
Panoramic Radiographs
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Q1) Which of the following soft tissues may be imaged on an intraoral dental radiograph?
A) Eyelid
B) Ear lobe
C) Tip of the nose
D) Cheek
Q2) What is a bony growth extending out from the lingual surface of the mandible called?
Q3) How does cortical bone appear on a radiograph?
Q4) Each of the following is a structure of the mandible EXCEPT one. Which one is the EXCEPTION?
A) The ramus
B) The condyle
C) The coronoid process
D) The hamulus
Q5) What is the round radiolucency often observed near the apices of the mandibular premolars called?
Q6) Radiographs taken on a 5-year-old child will most likely image 20 primary teeth.
A)True
B)False Page 24
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Chapter 3: Radiographic Appearance of Dental Materials and Foreign Objects
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Q1) Which of these will appear radiopaque?
A) An abscess
B) A cyst
C) A granuloma
D) Osteosclerosis
Q2) A torus is a bony growth projecting outward from the surface of a bone.
A)True
B)False
Q3) The dentigerous cyst is an odontogenic cyst that develops at the apex of a nonvital tooth.
A)True
B)False
Q4) What is the name of the process characterized by root-end resorption in which the roots of the teeth appear shorter than normal?
Q5) Which of these restorative materials will appear the most radiopaque on a dental radiograph?
A) Post and core
B) Composite
C) Porcelain
D) Gutta-percha
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Chapter 24: The Use of Radiographs in the Detection of Dental Caries
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Q1) Nonmetallic radiolucent restorations may mimic decay radiographically. A)True
B)False
Q2) It is the superimposition of the buccal and lingual cusps of the posterior teeth that hinders recording incipient occlusal caries on a radiograph.
A)True
B)False
Q3) Recurrent caries appears as a radiolucency adjacent to the restoration. A)True
B)False
Q4) Proximal caries occur on the buccal and lingual surfaces of the teeth. A)True
B)False
Q5) A caries grading system establishes a baseline from which to track the progression and/or remineralization of the carious lesions at future appointments.
A)True
B)False
Q6) What is the radiographic appearance of moderate occlusal decay at the DEJ?
Q7) What is the name for severe, unchecked caries that affect multiple teeth?
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Chapter 25: The Use of Radiographs in the Evaluation of
Periodontal Diseases
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Q1) How does the two-dimensional nature of radiographs limit their utility as a diagnostic aid?
Q2) Which periodontal disease case type demonstrates early bone loss, up to 30 percent?
Q3) Radiographs may assist in determining the distribution of periodontitis.
A)True
B)False
Q4) What is triangulation?
Q5) Can gingivitis be detected radiographically?
Q6) Vertical bone loss is the same diagnosis as </KT><KT>angular bone loss.
A)True B)False
Q7) Radiographs may assist in making the diagnosis of gingivitis.
A)True B)False
Q8) Periodontal diseases affect both soft tissues (gingiva) and bone around the teeth. A)True
B)False
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Chapter 26: Describing Radiographic Anomalies, Lesions, and Opportunistic Screening
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Q1) How many radiographs should be included in a full mouth survey of a child with transitional dentition?
Q2) The radiographer should place the image receptor and take the exposure without showing the child.
A)True
B)False
Q3) Should a thyroid collar be used when exposing radiographs on children?
Q4) By how much should adult exposure times be reduced for a 6-year-old child patient?
A) One-half the exposure time used for the adult patient
B) One-third the exposure time used for the adult patient
C) One-fourth the exposure time used for the adult patient
D) One-fifth the exposure time used for the adult patient
Q5) Are panoramic radiographs acceptable substitutes for intraoral radiographs if a child cannot tolerate intraoral placement of the image receptor?
Q6) Exposures on children between the ages of 10 and 15 should be the same as those used for adult patients.
A)True
B)False
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Chapter 27: Pediatric Radiographic Techniques
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Q1) Which of the following conditions or circumstances would contraindicate necessary dental radiographs for the patient?
A) Pregnancy
B) Hearing or visual impairment
C) Wheelchair confinement
D) Recent dental radiographs at another practice
Q2) For patients with motor disorders and conditions of involuntary movement, which of the following can be adjusted to help avoid blurry images?
A) Increase milliamperage and decrease exposure time.
B) Decrease milliamperage and decrease exposure time.
C) Increase milliamperage and increase exposure time.
D) Decrease milliamperage and increase exposure time.
Q3) If the patient mentions gagging, the radiographer should dismiss his or her concern as all in the mind.
A)True
B)False
Q4) Should the radiographer expose the anterior or posterior projections first?
Q5) What are some examples of distraction techniques the radiographer can use to help the patient control the gag reflex?
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Chapter 28: Radiographic Techniques for Patients With Special Needs
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Q1) Which of the following results in a fuzzy duplicate radiographic image?
A) Setting the exposure timer too short
B) Setting the exposure timer too long
C) Leaving the viewbox light on when opening the box of duplicating film
D) Leaving the original radiographs in the film mount when duplicating
Q2) Duplicating film, like radiographic film, has double-sided emulsion.
A)True
B)False
Q3) Localization methods provide a way for the radiographer to read a third dimension into two-dimensional radiographs.
A)True
B)False
Q4) Which of these is NOT a method of localization?
A) The tube-shift method
B) The working radiograph method
C) The definitive evaluation method
D) The right-angle method
Q5) What is a duplicate radiograph?
Q7) What is the principle behind the tubeshift method of localization? Page 31
Q6) When tori are present, where should the image receptor be placed?
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Chapter 29: Radiographic Techniques for Specific Oral Conditions
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Sample Questions
Q1) Which of the following determines the exposure factors for extraoral techniques?
A) Intensifying screen-film combination
B) The patient's size and tissue density
C) Target-film distance
D) All of the above
Q2) The radiographic technique that uses simultaneous movement of the x-ray source and the image receptor to record images of structures located within a selected plane of tissue while blurring structures outside the selected plane is called "tomography."
A)True
B)False
Q3) Each of the following statements regarding extraoral film is correct EXCEPT one. Which one is the EXCEPTION?
A) Handle by the edges only.
B) Remove from the box slowly.
C) Slide across the intensifying screens when placing it in the cassette.
D) Load into the cassette just prior to use.
Q4) Latex or vinyl treatment gloves should be used to handle extraoral films.
A)True
B)False
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Chapter 30: Radiographic Techniques
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Sample Questions
Q1) Each of the following statements regarding principles of panoramic radiography is correct EXCEPT one. Which one is the EXCEPTION?
A) The patient stands or is seated in a stationary position.
B) The x-ray beam is directed toward the stationary cassette.
C) The x-ray tube head moves around the front of the patient.
D) The radiation beam passes through the patient toward the cassette.
Q2) Each of the following will appear radiolucent on a panoramic radiograph EXCEPT one. Which one is the EXCEPTION?
A) The orbit
B) The maxillary tuberosity
C) The zygoma
D) The lingula
Q3) The technique used to show detailed images of structures located within a predetermined plane of tissue while eliminating or blurring those structures in the planes not selected is called "tomography."
A)True
B)False
Q4) What happens to the radiographic image if intensifying screens and film are not in tight contact?
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