歯科放射線

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Objectives: The purpose of this study was to develop a digital imaging and communications in medicine (DICOM) file for intraoral radiographic images and to develop a universal viewer system for the new DICOM file.
Methods: Three kinds of intraoral digital systems were involved: an imaging plate using photostimulable phosphor (IP), a charge-coupled device (CCD) sensor and a film digitizing system. Three types of projections were involved: periapical, bitewing and occlusal. The images obtained by intraoral radiography were mapped to a template for 14 series by a newly developed DICOM file for intraoral radiographic images. The DICOM file for intraoral radiographic images, which was developed in cooperation with healthcare industry companies, had a newly defined tag with template code for image mapping and a location code in addition to the conventional tags. The images mapped were sent to an image server for PACS through networks and could be viewed in each terminal display by using a newly developed dental viewer.
Result: The periapical images could be viewed as the same pattern of the mapping, and bite-wing and occlusal images could be arranged to be easily viewed on each terminal display based on the new tag information. The new DICOM file for intraoral radiographic images corresponded in the three digital systems and the three projection types.
Conclusion: The newly developed DICOM file will be useful as a universal DICOM file for intraoral radiographic image.

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We report a patient with actinomycotic osteomyelitis of the mandible presenting with paresthesia of the lower lip. Actinomycosis is caused by Actinomyces israelii, and its clinical features include trismus, boardlike mass and multiple abscesses. A 51-year-old female noticed pain and paresthesia of the left lower lip extending to the buccal area 6 months before presenting at our hospital with increasing pain. Gingival swelling and some mobility of the lower left molars were found, and panoramic x-ray showed radiolucency with sclerotic change around the roots of 38. On CT, the diffuse sclerotic change extended from the roots to the left mandible with periosteal reaction, suggesting chronic osteomyelitis of the mandible. Biopsy revealed that isolated necrotic bone and lumps of bacteria surrounded the tooth roots of 38, and we diagnosed actinomycosis of the mandible. During surgery, granulation tissue was found to extend into the lower part of the mandibular canal, and an excised specimen showed osteonecrosis with multinucleated giant cells. Complications were prevented with antibiotics. This case suggested that careful examination is required to identify the disease and determine the treatment strategy.

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