Panoramic x ray

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Panoramic x ray

  1. 1. Panoramic x-ray Islam Kassem Level 6 ikassem@dr.com
  2. 2. ikassem@dr.com2D panoramic imaging
  3. 3. High Quality Images, Effortlessly• ikassem@dr.com
  4. 4. Concepts of Panoramic Radiography Introduction Dr.walaa ikassem@dr.com
  5. 5. Introduction to Panoramic Radiography• Commonplace in dental practice• Considered essential in radiographic diagnosis• 30% of dental units sold are panoramic ikassem@dr.com
  6. 6. Introduction to Panoramic Radiography• “Panorama” means unobstructed view of a region in any direction• Panoramic radiograph show greater coverage than periapical and bitewing radiographs ikassem@dr.com
  7. 7. Introduction to Panoramic Radiography• New technique• Introduced in 1959• Employs scanography (slit beam) & curved surface rotational tomography ikassem@dr.com
  8. 8. Client Dose from Panoramic Radiography• 10 times less radiation than a complete intraoral survey using long, round PID & E+ film• 4 time less radiation than a bitewing survey using long, round PID and E+ film ikassem@dr.com
  9. 9. Indications for Panoramic• Pathology-cysts, tumors• Trauma-fractures• Growth & development• Client management• Edentulous• Localization: anatomy, objects, implant placement• Carotid artery condition ikassem@dr.com
  10. 10. Advantages of Panoramic Radiography• Field size• Quality control• Simplicity• Time & rapidity of the procedure• Client cooperation• Dose• Minimal infection control• Gross anatomy & pathology visible ikassem@dr.com
  11. 11. Disadvantages of Panoramic Radiography• Image quality• Focal trough limitations• Equipment costs• Overuse ikassem@dr.com
  12. 12. Disadvantages of Panoramic Radiography• Image quality – Magnification – Distortion – Poor definition compared to intraoral – Overlap – Superimposition & ghost images ikassem@dr.com
  13. 13. Disadvantages of Panoramic Radiography• Poor image quality due to – Tomographic process – Increased object-film distance – Use of intensifying screens – Faster film with larger crystals ikassem@dr.com
  14. 14. Disadvantages of Panoramic Radiography• Focal Trough (Image Layer) – Areas outside are not visible – Size & shape limits imagery to those structures which “fit” into the image layer – Size & shape not adjustable so not all client’s arches image equally well ikassem@dr.com
  15. 15. Disadvantages of Panoramic Radiography• Distortion – Vertical & horizontal distortion with variations causes uneven magnification ikassem@dr.com
  16. 16. Disadvantages of Panoramic Radiography• Superimposition & Ghost Images – All objects in the field of the beam, even those outside of the image layer are projected onto the film but most are not seen. – Objects with the greatest density are projected in two places on the film • Intended (useable image) • Ghost image (reversed, higher, blurred) ikassem@dr.com
  17. 17. Disadvantages of Panoramic Radiography• Superimposition & Other Imaging Quirks – Ghost images may hide pathosis – Soft tissue shadows may mimic pathosis ikassem@dr.com
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  19. 19. Focal Trough• An imaginary, three-dimensional curved area that is horseshoe shaped.• This is a very important concept because many technique errors are caused by improper positioning of the patient’s jaws within the focal trough.• When the jaws are positioned within this area, the radiograph will be clear.• When the jaws are positioned outside of this area, the images on the radiograph will appear blurred or indistinct. ikassem@dr.com
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  21. 21. Components of the Panoramic Unit• Panoramic x-ray tubehead• Head positioner• Exposure controls ikassem@dr.com
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  23. 23. The Head Positioner• Each panoramic unit has a head positioner used to align the patient’s teeth as accurately as possible.• Each head positioner consists of a chin rest, notched bite-block, forehead rest, and lateral head supports or guides.• Each panoramic unit is different, and the operator must follow the manufacturer’s instructions on how to position the patient in the focal trough. ikassem@dr.com
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  27. 27. Positioning of the Teeth• Posterior to focal trough • If the patient’s anterior teeth are not positioned in the groove on the bite-block and are either too far back on the bite-block or posterior to the focal trough, the anterior teeth appear “fat” and out of focus on the radiograph.• Anterior to focal trough • If the patient’s anterior teeth are not positioned in the groove on the bite-block and are either too far forward or anterior to the focal trough, the teeth will appear “skinny” and out of focus. ikassem@dr.com
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  32. 32. Positioning of the Spine If the patient’s spine is not straight, the cervical spine will appear as a radiopaque artifact in the center of the film and obscure diagnostic information. ikassem@dr.com
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  43. 43. Common Errors• Patient preparation errors • Ghost images: A ghost image looks like the real object except that it appears on the opposite side of the film. • Lead apron artifact: If the lead apron is placed too high, or if a lead apron with a thyroid collar is used, a cone-shaped radiopaque artifact results.• Patient seating errors • Chin too high • Chin too low ikassem@dr.com
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  46. 46. Thank you ikassem@dr.com

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