Panoramic Errors, Anatomy Review and More

Errors in Panoramic radiology mostly related to the steps in acquiring the image:

• Have patient remove denture, removable appliance/retainer, jewelry, glasses, coat, hearing aids, etc.

• Patient bites on bite stick – proper anterior-posterior position.

• Adjust the chin rest/tilt as needed – __________ plane

• Position the side guides to keep head secure.

• Ask the patient to stand up completely _________.

• Neck extended but not slumped forward.

• Ask the patient to place tongue in the roof of the mouth and holds still.

Errors in Panoramic radiology mostly related to the steps in acquiring the image:

• Have patient remove denture, removable appliance/retainer, jewelry, glasses, coat, hearing aids, etc.

• Patient bites on bite stick – proper anterior-posterior position.

• Adjust the chin rest/tilt as needed – Frankfort plane

• Position the side guides to keep head secure.

• Ask the patient to stand up completely straight.

• Neck extended but not slumped forward.

• Ask the patient to place tongue in the roof of the mouth and holds still.

Image Formation Concepts:

• Structures are flattened out and ________ out.

• Adjacent areas to the maxilla and mandible are seen.

• Midline structure may project as single or __________ images.

• Ghost images are formed.

• Air spaces are seen.

• Soft tissue shadows sometimes seen.

Image Formation Concepts:

• Structures are flattened out and spread out.

• Adjacent areas to the maxilla and mandible are seen.

• Midline structure may project as single or double images.

• Ghost images are formed.

• Air spaces are seen.

• Soft tissue shadows sometimes seen.

Identify The Zones.

Zone 1: Dentition

Zone 2: Nasal Cavity and Maxillary Sinuses

Zone 3: The Mandible

Zone 4: Temporomandibular Joints (TMJs)

Zone 5: Spine and Ramus

Zone 6: Hyoid Bone

What Zone Is This?

Zone 1: Dentition

What do we see in Zone 1?

• supernumerary teeth/impacted tooth

What Zone Is This?

Zone 2: Nasal Cavity and Maxillary Sinuses

What do we see in Zone 2?

What do we see in Zone 2?

What Zone Is This?

Zone 3: The Mandible

What do we see in Zone 3?

What Zone Is This?

Zone 4: Temporomandibular Joints (TMJs)

What do we see in Zone 4?

What Zone Is This?

Zone 5: Spine and Ramus

What do we see in Zone 5?

What Zone Is This?

Zone 6: Hyoid Bone

What do we see in Zone 6?

Identify The Structures On The Maxillary, Temporal & Zygomatic Structures.

Identify The Structures On The Mandible.

Errors in patient preparation

Errors in patient preparation

• Image 1: Ghost image of a necklace/chain. Also jaw surgery.

• Image 2: Lead apron

What error is this?

Error: patient too far foward

What error is this?

Error: patient too far back

What errors are these?

What error is this?

Error: slumped position/vertical spine shadow

What error is this?

Error: improper tongue position

• radiolucency: palatoglossal air space b/c tongue was not positioned to the roof of the mouth.

What error is this?

Error: movement

What should you have asked this patient prior to exposing?

Ask patient to remove maxillary partial denture before exposure.

What error (s) do we see here?

A. Head rotated or twisted to right more

B. Head rotated or twisted to the left more

C. Chin too high

D. Chin too low

A. Head rotated or twisted to right more

What error is shown in each photo?

Which error is most significant in the way the patient was positioned?

A. Head is turned too much to right

B. Head too far back

C. Head too far forward

D. Head turned to the right too much

C. Head too far forward

What is the most prominent error depicted in positioning of the patient by the radiographer?

A. Chin a bit too far down

B. Chin a bit too high up

C. Head too far forward

D. Head too far back

B. Chin a bit too high up

Name the errors

• Palatoglossal space

• earring ghost image

What errors do we see?

A. Chin too high and forward

B. Pt. is laughing

C. Chin too low and head too far back

D. Chin too low and head is too far forward

D. Chin too low and head is too far forward

What caused this?

A. Pt. moved

B. Pt. head slumped forward

C. Pt. has thyroid collar on

D. Pt. has a mandibular fracture

B. Pt. head slumped forward

What is the most obvious error and how do we correct it?

A. We see palatoglossal air space; tongue needs to be up

B. Pt. has developed a very large cyst over time; needs biopsy

C. Pt. has significant resorption of all maxillary teeth; needs extractions

A. We see palatoglossal air space; tongue needs to be up

What errors can you see?

What is the issue with this image?

A. Head too forward

B. Pt. has multiple fractures of jaw

C. Patient motion; talking during exposure

C. Patient motion; talking during exposure

What is the most likely cause?

A. Pano hit pt. shoulder and dragged

B. Pt. started talking

C. Pt. had surgery to right side of face

D. Pt. has surgery on left side of face

A. Pano hit pt. shoulder and dragged

What is this?

A. Lead apron/thyroid collar too high and bunched up in the back

B. Static electricity

C. Head movement

D. Pt was vomiting during exposure

A. Lead apron/thyroid collar too high and bunched up in the back

What do we see?

Earring ghost artifacts and a necklace

What do we see here?

Glasses

What is the yellow arrow pointing to?

What are the arrows pointing to?

Ghost image of mandible

Pano. hit shoulder and dragged

Must check for shoulder clearance; walk around the patient, look from each side.