06-MAY-2009

Panoramic Imaging
Common Positioning Errors, Reason and Correction

Reference Guide to Proper Panoramic Images

1 Jalan Kilang Timor #05-04, Pacific Tech Centre S(159303) TEL +65 6376 0002 .FAX +65 6376 2002.

Guidelines to Proper Positioning

Things to Do and Ask

1. Ask all female patient if they are Pregnant 2. To remove all metal artifacts on them 3. If they are having metal fillings or crowns in their mouths 4. Ensure their safety and make sure they are calm 5. Lastly, be confident of positioning the patient

Physical checks
Lead aprons are to be worn when exposing patients. But to note that the apron does not goes too high up the shoulder as it may cause reflection too

Remove all earrings and necklaces As they causes shadows in the images

Positioning of Patients
1. Make sure the patient hold on to the handles 2. The patient is tilted alittle towards the machine 3. Both legs are firmly onto the ground

Positioning of Patients
These are very important lights help guide users to position every patient properly

Frankfurt light Mid-Sagital light Canine light

Ideal Panoramic Radiograph

(a)

(c)

(d) (b)

a. Anterior teeth should be in the middle of image b. Slight upward or smile line occlusal curve. c. The condyles are at the same level. d. Premolars overlapping is normal.

PANO - Common Positioning Errors

Patient bites too far forward

1.Anterior teeth are blurred and minimized. 2.Spine is superimposed over condyles, Focal through too far backward This is a common error with edentulous patients because they have no teeth to bite on the pin. Use edentulous bite block for edentulous patients.
Normal bite block & Edentulous bite block

Ask patient not to bite too far forward and align canine beam exactly.

Patient bites too far backward

1.Anterior teeth are magnified and unclear 2.White out caused by ghost image of cervical spine in the middle and mandible burn out. Focal through too far forward Ask patient not to bite too far backward and align canine beam exactly.

Patients head tipped downwards (Chin-down)

1.Upward curvature of occlusal plane. 2.Anterior mandible is distorted and blurred. 3.Mandible is out of focal through. Up chin rest and align canine beam exactly.

Patients head tipped upwards (Chin-up)

1.Occlusal plane flattened. 2.Anterior part is blurred. 3.Shadow of the Palate is more prominent. Down chin rest and align canine beam exactly.

Patients head tilted

1.Magnification ratio of right and left side looks different. Patients head tilted up on one side. Adjust mid sagittal beam correctly.

Patients head rotated

1.Patients left side is enlarged compared to right. The patients head was rotated towards the one side. Adjust mid sagittal beam correctly.

Patients tongue dropped from palate

1.Large airway shadow directly over the roots of the maxillary teeth Patients tongue is not being placed on the hard palate during the exposure.

Patients head projected

1.White tapered opacity in middle of image. It is the effect of the spine on the anterior of the image with slumping of the patient. Ask patients head to be straightened.

Patients movement

1.Portions of radiograph are blurred. The patient moves during an exposure. Instruct the patient to remain still.

Lead apron artifact

1.Wedge-shaped artifact that also obscures diagnostic information associated with the mandible The apron shall not be placed too high up the patients back prior to exposure.

Too bright image

1.Image is too bright Under-exposed. Increase kVp and mA.

Too dark image

1.Image is too dark Over-exposed. Decrease kVp and mA.

Summary
With references to the common mistakes we have seen, we know that it is very important to know that positioning affects a lot on the image quality. So with the information given, users are able to eliminate such common mistakes. Therefore Vatech & E-Woo emphasizes on proper training and promises to deliver its specialize training to all users around the world.