Identifying Panoramic Errors

Panoramic radiographic imaging is technique sensitive. The clinician must attend to all aspects of machine and patient preparation, patient positioning, patient instruction and exposure to produce a quality image. A number of authors indicate that the quality of panoramic radiographic images taken either in an institutional setting,13-15,18-20 in general dental practice or submitted to third party insurance providers16,17 is low. In most instances, a low percentage of panoramic images were found to be error free and many panoramic images demonstrated multiple errors.13-20

In 2014, Rondon et al.18 conducted a review of the literature to determine the most common types of patient positioning errors. The most common positioning errors that resulted in a retake or repeated panoramic radiographic examination were respectively: 1. Head positioned too far forward, 2. Head turned right or left, 3. Head tilted down, and 4. Head positioned too far backward.18

Asha et al. conducted a review of 560 digital panoramic radiographs in 2018.20 They found the most common errors in order by percentage of occurrence were: 1. Chin tipped too high, 2. Head twisted, 3. Chin tipped too low, 4. Head too far backward, 5. Tongue not on palate, 6. Slump spine, and 7. Head too far forward.20

Table 5. Panoramic Patient Positioning Errors.
Rondon et al. 201418
1. AP Head Plane - Too Far Forward
2. Horizontal Head Plane - Turned
3. Vertical Head Plane - Chin Down
4. AP Head Plane - Too Far Back
Asha et al. 201820
1. Vertical Head Plane - Chin Up
2. Horizontal Head Plane - Twisted
3. Vertical Head Plane - Chin Down
4. AP Head Plane - Too Far Backward
5. Tongue Not on Palate
6. Spine Slumped
7. AP Head Plane - Too Far Forward