Panoramic Radiography - Errors

6.43 Error in this Radiograph is:

• Chin is tipped too low

• Patient is slumped

• Patient is turned or twisted

• Patient is positioned too far forward in the machine

• Chin is tilted too far upward

Answer explanation

1. Error:

Chin is tipped too low.

2. Features:

Excessively curved “smile line” of the teeth.

Hyoid bone is projected as a horizontal, radiopaque band across the anterior mandible.

3. Correction:

Raise chin up a little.

Check Frankfort plane light is parallel to the ala-tragus line.

6.44 Error in this Radiograph is:

• Chin is tipped too low

• Patient is slumped

• Patient is turned or twisted

• Patient is positioned too far forward in the machine

• Chin is tilted too far upward

Answer explanation

1. Error:

Patient is “slumped” or “stooped.”

2. Features:

Lower anterior teeth are obscured.

V-shaped radiopaque ghost image of the spine is seen in the midline.

3. Correction:

Make sure patient is standing upright with back and neck

straight.

6.45 TWO Errors in this Radiograph:

• Chin is tipped too low

• Patient is slumped

• Patient is turned or twisted

• Patient is positioned too far forward in the machine

• Chin is tilted too far upward

Answer explanation

1. First error:

Patient is “turned” or “twisted” in the machine.

2. Features:

Molars are wider on right than on left.

Ramus is wider on right than on left.

3. Correction:

Make sure patient is facing straight forward in the machine.

Close side guides firmly against patient’s head.

Check anterior vertical midline light; make sure it is aligned

with middle of nose and rest of face.

1. Second error:

Patient is “slumped” or “stooped.”

2. Features:

Anterior left teeth are slightly obscured by radiopaque shadow.

Ghost image of spine is seen on left midline, only as patient is turned in the machine.

3. Correction:

Make sure patient is standing upright with back and neck

straight.

6.46 TWO Errors in this Radiograph:

• Chin is tipped too low

• Patient is slumped

• Patient is turned or twisted

• Patient is positioned too far forward in the machine

• Chin is tilted too far upward

Answer explanation

1. First error:

Patient is positioned too far forward in the machine.

2. Features:

Excessively narrowed anterior teeth

Spine is superimposed on ramus on both sides.

3. Correction:

Make sure patient is biting in groove in bite block.

Check that the canine light is aligned with middle of lower canine.

1. Second error:

Patient is slightly twisted.

2. Features:

Upper right molar is a little wider than upper left molar.

Right ramus is a little wider than left ramus.

Spine overlaps right ramus more than left ramus.

3. Correction:

Close side guides firmly against patient’s head.

Check anterior midline light.

COMMENT: The lower anterior teeth are missing so the

patient could not properly bite in the groove in the bite block, as indicated by the lack of an interocclusal space between the upper and lower teeth. Because the patient was not biting in the groove, he ended up too far forward and possibly contributed to the twisted position as well. A couple of cotton rolls in the edentulous space and careful attention to technique would have taken care of the problem.

6.49 Error in this Radiograph:

• Chin is tipped too low

• Patient is slumped

• Patient is turned or twisted

• Earrings were not removed

• Chin is tilted too far upward

Answer explanation

1. Error:

Hoop and stud earrings were not removed on each side.

2. Features:

Real and ghost images of earrings

3. Correction:

Be sure to check for this in both men and women, especially

those with long hair obscuring the ears.

6.50 TWO Errors in this Radiograph:

• Tongue is not against palate

• Patient is slumped

• Patient is turned or twisted

• Patient is positioned too far back

• Chin is tilted too far upward

Answer explanation

1. First error:

Tongue is not against palate.

2. Features:

Dark shadow is obscuring apices of maxillary teeth.

3. Correction:

Instruct patient to place tongue on palate; if this fails, ask

patient to suck on his or her cheeks while still biting on the

bite block.

1. Second error:

Patient is positioned too far back.

2. Features:

Normally we would expect to see widened teeth, but sometimes this feature is missing, as is the case here.

Ghost image of the ramus on both sides. This is easy to see

because a horizontal line is dividing the ramus from the

body; above this line the ramus is excessively radiopaque,

and below the line the body is of normal density. The radiopaque shadow is the ghost image of the ramus on the other side and happens only when the patient is too far back.

3. Correction:

Make sure patient is biting in groove in bite block.

Check canine light.

6.52 TWO Errors in this Radiograph:

• Chin is too high

• Patient is slumped

• Patient is turned or twisted

• Patient is positioned too far back

• Chin is too low

Answer explanation

1. First error:

Chin is too high.

2. Features:

The occlusal plane is flat. Also when the chin is up, the head

goes back causing a ghost image of the ramus on both sides.

3. Correction:

Make certain the ala-tragus positioning light on the side of the face is parallel with the floor and is in the middle of the ala of the nose and on the tragus of the ear; this will ensure the chin is at the correct down angle on the chin rest.

1. Second error:

Patient is slumped in the machine.

2. Features:

There is a light radiopaque shadow in the mandibular midline, and as a result of the slumping, the machine rubbed against the neck causing the patient to move slightly as seen by the wavy outline of the mandibular cortex in this area.

3. Correction:

Have the patient stand “tall” with the neck straight and vertical.

6.57 TWO Errors in this Radiograph:

• Neck chain is left on

• Patient is slumped

• Patient is turned or twisted

• Patient is too far forward

• Chin is tilted too far upward

Answer explanation

1. First error:

Neck chain is left on.

2. Features:

Ghost image of the neck chain in the mandibular midline.

Real image seen on right spine identifies the chain as jewelry vs. a napkin chain.

3. Correction:

Be sure to remove all extraoral items.

1. Second error:

Patient is too far forward.

2. Features:

Narrow anterior teeth

Shadow of spine overlaps the ramus on both sides.

3. Correction:

Make sure the patient is biting in bite block groove.

Check canine light

6.64 Error in this Radiograph:

• Patient is slumped

• Patient is turned or twisted

• Patient is too far back

• Chin is tilted too far upward

Answer explanation

Features:

The only sign of this error is that the nasal turbinates are spread across the sinus above the hard palate on both sides.

Correction:

Some machines have a special chin rest for edentulous patients.

6.66 Error in this Radiograph:

• Patient is slumped

• Patient is tilted or tipped in machine

• Patient is too far back

• Chin is tilted too far upward

Answer explanation

Features:

One condyle is lower than the other.

Correction:

Check midface vertical light.