Image Evaluation

An ideal panoramic radiograph should be free from errors related to technique or film manipulation.

Figure 61.
fig61
Ideal Panoramic Radiograph.

However in reality many panoramic films are not ideal and present minor but acceptable errors.

Figure 62.
fig62
Panoramic with acceptable error. Patient is twisted or rotated as evidenced by the discrepancy in dimension between left and right ramus width and dentition. However, this does not interfere with its diagnostic acceptability and does not require a retake.

However there are certain specific critical errors that result in images that fail to fulfill the criteria for an acceptable panoramic image. These errors are critical because they usually necessitate re-exposure of the patient.

The principle technical criterion for acceptance of a panoramic radiograph is that it should adequately image all of the structures of the maxillofacial region. If any of the structures are not present, either because it is not covered or obscured, then it should be re-taken. It should be remembered that the patient pays for the interpretation and subsequent diagnosis generated from the panoramic and not the procedure itself.

Specific exclusionary criteria include the inability to visualize any of the following either due to the structure not being imaged on the film or obstruction of the structure from view:

  • Condyle of the TMJ
  • Mandibular/maxillary anterior region
  • Mandibular ramus

Figure 63 demonstrates three of the most common reasons for retakes – neither the condyle of the TMJ, the mandibular anterior region nor the mandibular ramus are visualized on this radiograph. In this particular case it is because the patient’s head is tilted too far down during exposure.

Figure 63.
fig63

Figure 64 demonstrates three further reasons for retakes; poor visualization of the maxillary anterior region, coverage of structures due to the presence of ghost images and/or labels. In this particular case the patient is positioned too far backward and has their head tilted too far up (as evidenced by the reverse or frown occlusal plane). These positioning errors place the maxillary anterior region out of the focal trough and produces excessive ghosting of the amalgam restorations of the opposite side.

Figure 64.
fig64