Veterinary Dental Radiographic X-Ray Positioning in dogs and cats is very frustrating to learn unless you learn the proper technique. Learn the quickest technique for full mouth radiographs in this example in a small dog.
We will look at, really quickly, how to take full mouth radiographs and do it quickly and efficiently. We’re not going to spend a lot of time on this but I want to drive the point home that this is really important and this is the way to do this. No matter what way you’re doing this now, you need to switch gears and switch to this modality because there is nothing any quicker than how we recommend doing this.
When we’re intubating the patient, we induce the patient, they’re in sternal recumbency. What we’re going to do in a case like this, we’re going to go ahead and place a little towel underneath the patient so that the palate is parallel to the table and that removes a lot of variables.
We’ve got a parallel patient that we can now utilize what is on all radiograph units. Whether they’re human or whether they’re veterinary, and that is this little number designation on the right side on the tube head that tells you what angle that tube head is set at.
If you’re not aware of that on your machine, look at it when you go back in to your office and start to use that to determine how to take radiographs. You don’t have to do that bisecting angle technique where you try to figure out based on where the tooth is, where the tube head is, and where the film or sensor is. You don’t have to use that, all you need to do is set that angle as long as that patient is in sternal recumbency parallel to the table.
Let me give you an example, this is a page out of my book. This is the standard for veterinary dental radiography in the veterinary profession now. This will guide you through how to position the tube head, where to put your sensor, what angle to use for every single position that you will encounter when you’re taking your radiographs in whatever size patient that you have. I’m going to give you guys an opportunity to grab a digital copy of this after we get done here. I’ll tell you about that as one of the bonuses for further education but, let’s go through quickly and we’ll show you kind of how to use this.
The first thing we’re going to do is we’re going to not only standardized the positioning, we’re also going to standardize the sequence that we take these radiographs. We set up our template in our software, depending on your software, so that it is numbered exactly as I’m going to take you through the sequence. We always, always, always start off our full mouth series on the right maxilla just like Annie is showing you right there. We’re using a Nomad, which is a handheld.
Annie is using that 60 degree designation there but, she knows that based on where 45 degrees is and she’s giving a reasonable guess with that handheld versus being pretty much exact if you’re using the floor mount or wall mount generators like most of us have. We use this for travel and it’s much quicker for us so, we like that.
She would be doing the caudal to rostral oblique method here with the tube head at that angulation with the sensor where you see it and then shooting that at 60 degrees. Then those radiographs at the bottom are demonstrating what it’s supposed to look like if you do that correctly on size 2 sensors, which is what most of us have, or if we have CR units on a size 4 sensor if that’s what you have.
That’s the first shot always, I recommend you do this as well.
Second shot we move rostral. In a small dog, we’re going to be doing the canine and premolars and then that’s going to be a lateral shot. The rostral to caudal oblique at about 70°.
Then there’s the incisor shot at about 45 to 55 degrees.
Then we’re going to be doing the same exact thing, there would be the mirror image of the canine and premolar shot and then we back around to the caudal maxilla on the left side.
Then once we’re done with that, we’re going to use that same concept of minimizing the variable to put that patient in dorsal recumbency and make the mandible parallel to the table. We just put a little towel underneath the neck and that will normalize that parallelism to the table and it will allow us to use the angles for that as well.
The first thing we’re going to do, we’re going to go to the exact same side of the table which is now the left side of the patient. We’re going to take the image there which is actually a parallel image. We just put that sensor parallel to the mandible and shoot straight at it just like you would if you were taking an abdomen or a chest rad on your dental machine. You’ve got the tube head, you’ve got the patient sandwiched between the tube head and the plate then you just shoot straight on.
Same thing for the caudal mandible, which we can do but, then we have to use our angles as we go forward because the symphysis is going to be in our way and we cant put that sensor parallel to the mandible. That would be the next shot.
This would be the following.
Here again at about 70 degrees and then parallel back on that side.
Here again at about 70 degrees and then parallel back on that side.
That is every single patient. That takes Annie about 4 minutes to go through that whole patient. You guys should be taking full mouth small dogs in 8 minutes or less. If you’re not, number one, you’re probably not using this. If you are using this, you need to practice some more because it is totally doable to do a small dog in 8 minutes or less. A large dog in 15 minutes or less, more like 12. Annie is going to do this in about 7-8 minutes. Then huge dogs, 20 minutes or less so, that gives you some guidelines.
Now, what that whole process does, and again this is giving you a general idea. The X-ray guide and further training is needed to really, really fine-tune all the stuff. We can’t possibly address all of it in an online training but, this is what you end up with. If you take a line and draw it right down the center of that image, all of the patient’s right teeth on the right side of their mouth is on your left side. It’s on the left side of the screen. All of the left is on your right just like you are looking at the patient. Guess what, that makes it really, really easy to quickly identify where in the mouth you’re working on. Double click on those images so that they come up as one image on your laptop screen and that way you can see exactly what you’re doing when you’re doing your procedure. I always have the x-ray image of where I’m working on the screen at the same time that I’m actually working on that individual area on each patient. Extremely important to keep that in mind and again, the book outlines how to setup templates, it outlines how to do a lot of the angulation and the positioning that you need to do to do these quick and easy and then once you get through that, it’s so intuitive and so self conscious that you don’t need the book after a couple weeks. You can go through here and blow these things out really quickly.