Panoramic Imaging Errors

Question 1

Answer 1

Ghost Image

• It is a radiopaque artifact seen on a panoramic image
• Thick, dense object is located outside of the focal plane and close to the x-ray source (which is behind the head)
• Found on the opposite side of the image, is larger, higher, and indistinct
• May also be caused by normal anatomic structures, such as the ramus of the mandible or hard palate

Question 2

Answer 2

Lead Apron Artifact

• If the lead apron is incorrectly placed on the patient, a radiopaque cone-shaped artifact results that obscures diagnostic information
• If a lead apron with a thyroid collar is used during the exposure of a panoramic projection, a bilateral radiopaque artifact results that obstructs the mandible

Question 3

Answer 3

Incorrect Positioning of Lips and Tongue

• Patient’s lips not closed on the bite-block: a dark radiolucent shadow results that obscures anterior teeth – a dark radiolucent shadow results that obscures anterior teeth
• Tongue is not in contact with the palate: a dark radiolucent shadow results that obscures the apices of the maxillary teeth

Question 4

Answer 4

Chin Tipped Up

• Condyles may not be visible, or appear near the lateral edge of the image
• The hard palate and floor of the nasal cavity appear superimposed over the roots of the max teeth
• The max incisors appear blurred and magnified
• A loss of detail occurs in the max incisor region
• A reverse smile line (curved downward)

Question 5

Answer 5

Chin Tipped Down

• Condyles are positioned higher on the image
• Hyoid bone forms a single widened line
• Mandibular incisors appear blurred; roots may appear short
• A loss of detail occurs in the anterior apical region

Question 6

Answer 6

Teeth Anterior to the Focal Trough

• If the patient’s teeth are too far forward on the bite-block, or anterior to the focal trough, anterior teeth appear “narrow” and out of focus on the image
• Overlap of the premolars may be seen

Question 7

Answer 7

Teeth Posterior to the Focal Trough

• If the patient’s anterior teeth are aligned too far back on the bite-block or posterior to the focal trough, the teeth appear widened” and out of focus on the image
• The roots of the anterior teeth may appear cut off

Question 8

Answer 8

Head Turned

• The ramus and posterior teeth on one side of the image appear larger than those on the other size of the image
• The farthest from the receptor appears magnified and the side closest to the receptor appears smaller

Question 9

Answer 9

Slumped Posture

• When the patient is slouched, slumped, or not standing with the shoulders back, the x-ray beam passes through more of the cervical spine because the beam is angled upward at a negative vertical angulation (-10 degrees)
• The cervical spine appears as a radiopacity in the center of the image and obscures diagnostic information