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Practical Panoramic Radiography

William C. Scarfe, BDS, FRACDS; Gail F. Williamson, RDH, MS

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  1. Which selection below correctly describes the image distortion produced when the patient’s midsagittal plane is not centered?

    • The occlusal plane forms a frown-like configuration.
    • The entire image is magnified and does not fit on the receptor.
    • A triangular-shaped radiopacity is produced in the midline.
    • One side of the image is narrowed and the other side is widened.
  2. Examine this panoramic image carefully.  What correction does the clinician need to make to improve the diagnostic quality of the image?

    Panoramic image.
    Panoramic image
    • Realign the dental midline.
    • Adjust the vertical placement of the patient’s head.
    • Instruct the patient to bite end-to-end in the biteblock groove.
    • Straighten the patient’s cervical spine.
  3. A variety of artifacts can be produced on panoramic images when the clinician does not pay attention to technical details.  Which of the following scenarios would produce radiopaque artifacts?

    • Head and neck jewelry not removed prior to exposure.
    • Patient's tongue was not placed flat against the hard palate.
    • X-ray head or receptor contact with the shoulder during exposure.
    • Improper closure of the cassette allowing light leaks onto the film.
  4. Which of the following selections is NOT an accurate description of the focal trough?

    • Predetermined layer of structures.
    • Sometimes referred to as the image layer.
    • Located between the film cassette and x-ray source.
    • Trough is narrower in the posterior and wider in the anterior.
  5. When the patient’s head is positioned too far backward, the clinician will observe all of the following manifestations except one.  Which one is the exception?

    • Image is too large and does not fit on the film.
    • Anterior teeth on both arches are involved most often.
    • The structures on one side will be narrower than the other.
    • Structures appear wider and very blurred compared to normal.
  6. Which of the following phrases is NOT consistent with production of panoramic ghost images?

    • Magnified and unsharp appearance.
    • Same general shape as original object.
    • Location is higher than original object.
    • Appear on same side as the original object.
  7. What type of distortion will the clinician observe if the patient’s head is positioned too far upward?

    • The hard palate is superimposed over maxillary teeth apices.
    • The occlusal plane will display a grin-like configuration.
    • The posterior teeth will appear narrowed and blurred.
    • The hyoid bone will superimpose over the mandible.
  8. Which of the following selections is NOT an accurate description of panoramic x-ray machines?

    • X-ray source is aligned at a -10º angulation.
    • Operator can adjust time but not the kVp and mA.
    • Aperture of the x-ray source is a very narrow vertical slit.
    • Cassette rotates in front of the patient's face during exposure.
  9. What error would cause of the production of a wedge-shaped radiopaque artifact near the midline in panoramic radiography?

    • The patient did not place his/her tongue against the hard palate.
    • The lead apron was placed too high up on the back of the patient's neck.
    • The operator let go of the exposure switch momentarily during the procedure.
    • The patient’s spinal column was slumped and obscured the image in the midline.
  10. Which of the following is NOT an accurate description of intensifying screens?

    • Located on the internal surfaces of an open film cassette.
    • Composed of phosphor crystals that fluoresce upon x-ray exposure.
    • Film size and sensitivity is paired with screen size and fluorescence.
    • Reflecting layer directs the light produced toward the screen base.
  11. Which of the following problems would produce a high-density panoramic image?

    • Low processing temperature.
    • White light leaks in the darkroom.
    • Inadequate solution replenishment.
    • Underestimation of patient size & stature.
  12. When determining ideal panoramic image density, which of the following is the best region to examine to assess adequate density?

    • Dentinoenamel junction on molars.
    • Mandibular parasymphyseal area.
    • Maxillary sinus cavity anatomy.
    • Gonial angle of the mandible.
  13. When the patient’s head is positioned too far downward, which of the following manifestations will the clinician observe on the radiographic image?

    • The occlusal plane will display a big grin or jack-o-lantern configuration.
    • The maxillary and mandibular anterior teeth will appear blurred and widened.
    • One side of the arches will appear widened and the other side will be narrowed.
    • A pyramid-shaped radiopacity appears superimposed over the patient's midline.
  14. Which of the following selections is NOT correct about panoramic imaging?

    • Unit requires pre-cleaning, disinfection and barrier placement.
    • A thyroid collar is used to protect the neck during film exposure.
    • The object-receptor distance is greater compared to intraoral radiography.
    • Objects like earrings can produce ghost images on the panoramic film.
  15. Of the following criteria which one is NOT associated with a diagnostic panoramic radiographic image?

    • Slight smile or downward curve of the occlusal plane.
    • Clear view of the interproximal surfaces of all of the teeth.
    • Symmetrical display of the anatomic structures right to left.
    • Entire maxilla, mandible and temporomandibular joints displayed.
  16. What type of error is produced when the head plane is tilted to one side?

    • Excessive ghosting of the cervical spine and ramus occurs.
    • The mandibular anterior teeth are blurred and foreshortened.
    • The maxillary and mandibular anterior teeth are blurred and widened.
    • The occlusal plane is canted and the size of the teeth is reduced on one side.
  17. Which of the following selections is NOT correct about panoramic imaging?

    • The side closest to the receptor is the one recorded in focus on the image.
    • The x-ray beam rotates behind the patient's head as the receptor rotates in front.
    • The x-ray beam travels in a labial to lingual direction just like in intraoral imaging.
    • The operator aligns the patient's head according to specific anatomical planes.
  18. A number of visual features of the dentition can be used to assess whether the teeth are positioned correctly within the focal trough.  Which of the following is NOT a visual assessment feature?

    • Anterior teeth shape "normal" in width.
    • A grin or pronounced upward curve of teeth.
    • No tooth size discrepancy on left or right side.
    • Anterior teeth in focus with pulp canal clearly seen.
  19. Panoramic radiographic images are recommended in all of the following clinical situations except _______________.

    • evaluation of the mixed dentition
    • examination of edentulous alveolar ridges
    • evaluation of periodontal furcation involvement
    • evaluation of third molar teeth development and position
  20. What is the anatomic structure identified by the arrow on this panoramic image?

    Anatomic structure.
    anatomic structure
    • maxillary sinus
    • hard palate
    • orbit of the eye
    • nasal fossa





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