Table of Contents

1 Introduction ........................................................................................... 2
2 Panoramic Patient Positioning Methods ............................................ 4
2.1

Panoramic Imaging Position..........................................................................4

2.2

Sinus Imaging Position ..................................................................................9

2.3

TMJ (Temporomandibular Joint) Imaging Position....................................14

3 Patient Positioning Methods for CT imaging ................................... 20

4 Cephalometric Patient Positioning Methods.................................... 24
4.1

PA projection (Posterior to Anterior) ...........................................................24

4.2

Lateral Projection Mode ...............................................................................27

4.3

SMV Projection (Submento Vertical) Mode.................................................30

5 Image Quality Checkpoints and Solutions ....................................... 33

1 Introduction
This manual provides a guide to achieve correct patient positioning on the panoramic and
cephalometric imaging systems.
This manual is only intended for PaX-500, PaX-Uni3D, PaX-Reve3D, PaX-Primo (Basic model)
and Picasso-Trio which all have the same type of chinrest.
However, the positioning can sometimes vary depending on the patients unique anatomical
structure.
The canine beam adjustment is not required, depending on the equipment model involved.
In that case, please skip the step of adjusting the canine beam.
So, please use thins manual as a base reference only.

Accessories for positioning

VATECH provides 4 different kinds of bite blocks/chin supports for proper patient positioning that
will be used for the various imaging modes your unit provides.

Bite block & Chin support (Nomal)

Chin support (Toothless)

Chin support (TMJ)

Chin support (Sinus)

2 Panoramic Patient Positioning Methods

2.1 Panoramic Imaging Position
Maxillary Sinus

Nasal septum

Head of mandible

Hard plate

Articular eminence

Mandibular canal

Articular fossa

Mandible angle

Styloid process

Hyoid bone

Zygomatic arch

Incisive foramen

Coronoid process of mandible

Mental foramen

Orbit

Panoramic Imaging Process

1. Have the patient remove all jewelry and metallic objects, such as earrings, hair pins,
spectacles, dentures, and orthodontic appliances. These items can cause shadow
images that may obscure diagnosis.
2. Insert the normal chin support and bite
block in the units chinrest receptacle.
Place a hygienic cover over the bite
block.

3. It is recommended that the patient wear a lead apron for protection against any possible
scatter radiation.
4. Have the patient stand upright at the
center of the machine with their chin in
line with the chinrest. Ask the patient to
grip both handles on either side of the
unit firmly.

5. Adjust the height of the system using

the column up/down switch until the
patients chin is resting on the chinrest.
Position the patients chin on the
normal chin support.

6. Ensure that the patients shoulders remain level and their neck is relaxed. The cervical
spine should be straight and upright. To prevent magnifications on the left and right
sides of the final image, make sure that the vertical laser beam is positioned at the
center of the occipital bone.

7. Have the patient bite the bite block along the grooves using their upper incisor. Ensure
that the chin is in good contact with the chin support.

8. Have the patient smile to properly position the canine laser beam at the center of the
patients canine tooth. Rotate the thumb wheel, located under the patient support rest,
forward and backward to properly align the beam.

9. Position the head of the patient to

properly align their Frankfort plane with
the horizontal laser beam. For proper
positioning, adjust in which way the
patients head is tilted by adjust the unit
slightly upward or downward using the
column up/down switch. The Frankfort
plane is the line from the infra-orbital
point to the superior edge of the External Auditory Meatus (E.A.M).
10. The horizontal laser beam, located at
the side of the column, can be adjusted
up or down to accommodate different
head sizes. This is done by manually
moving the horizontal laser beam lever
up or down.

11. Using the temple support wheel button,

adjust the temple supports to fit snugly
on either side of the patients head.
The

patients

head

should

be

immobilized. The temple support wheel

button is located at the front of the
patient support rest.

12. Have the patient close their lips and keep their tongue positioned towards the palate
throughout the exposure cycle.
13. For a patient with no teeth, the vertical laser beam should be positioned on the patients
mid-sagittal line. The horizontal laser beam should be aligned along the Frankfort plane.
Align the canine beam on the fold on the side of the nose.

14. Ensure that the patients eyes are

closed. Press and hold the exposure
switch button until image acquisition is
complete.

2.2 Sinus Imaging Position

Nasal septum
Sphenoid sinus
Orbit
Maxillary sinus
Coronoid process

Sinus Imaging Process

1. Have the patient remove all jewelry and metallic objects, such as earrings, hair pins,
spectacles, dentures, and orthodontic appliances. These items can cause shadow
images that may obscure diagnosis.
2. Insert the Chin support (Sinus).

3. It is recommended that the patient wear a lead apron for protection against any possible
scatter radiation.
4. Have the patient stand upright at the
center of the machine with their chin in
line with the chinrest. Ask the patient to
grip both handles on either side of the
unit firmly.

10

5. Adjust the height of the system using

the column up/down switch until the
patients chin is resting on the sinus
chin support.

6. Ensure that the patients shoulders remain level and their neck is relaxed. The cervical
spine should be straight and upright. To prevent magnifications on the left and right
sides of the final image, make sure that the vertical laser beam is positioned at the
center of the occipital bone.

7. Position the head of the patient to

properly align their Frankfort plane with
the horizontal laser beam. For proper
positioning, adjust in which way the
patients head is tilted by adjust the unit
slightly upward or downward using the
column up/down switch. The Frankfort
plane is the line from the infra-orbital
point to the superior edge of the External Auditory Meatus(E.A.M)

11

8. The horizontal light should fall on the tip of patients nose. Therefore, you have to tilt the
patients head 10~15 degrees upward.

9. Have the patient smile to properly position the canine laser beam at the center of the
patients premolars tooth. Rotate the thumb wheel, located under the patient support
rest, forward and backward to properly align the beam.
.

10. Adjust the horizontal laser beam along

the patients Inferior Orbital Fissure.
The horizontal laser beam, located at
the side of the column, can be adjusted
up or down to accommodate different
head sizes. This is done by manually
moving the horizontal laser beam lever
up or down.

12

11. Using the temple support wheel button,

adjust the temple supports to fit snugly
on either side of the patients head.
The

patients

head

should

be

immobilized. The temple support wheel

button is located at the front of the
patient support rest.

12. Have the patient close their lips and keep their tongue positioned towards the palate
throughout the exposure cycle.
13. Ensure that the patients eyes are
closed. Press and hold the exposure
switch button until image acquisition is
complete.

13

2.3 TMJ (Temporomandibular Joint) Imaging Position

EAM(External Auditory Meatus)
Head of mandible
Articular fossa
Articular eminence
Mandible angle

14

TMJ Imaging Process

1. Have the patient remove all jewelry and metallic objects, such as earrings, hair pins,
spectacles, dentures, and orthodontic appliances. These items can cause shadow
images that may obscure diagnosis.
2. Insert the chin support (TMJ).

3. It is recommended that the patient wear a lead apron for protection against any possible
scatter radiation.
4. Have the patient stand upright at the
center of the machine with their chin in
line with the chinrest. Ask the patient to
grip both handles on either side of the
unit firmly.

15

5. Adjust the height of the system using the column up/down switch until the patients chin
is resting on the chin rest. The top of the TMJ support should be in contact with the
patients acanthion point.

6. Ensure that the patients shoulders remain level and their neck is relaxed. The cervical
spine should be straight and upright. To prevent magnifications on the left and right
sides of the final image, make sure that the vertical laser beam is positioned at the
center of the occipital bone.

7. Position the head of the patient to properly align their Frankfort plane with the horizontal
laser beam. For proper positioning, adjust in which way the patients head is tilted by
adjust the unit slightly upward or downward using the column up/down switch. The
Frankfort plane is the line from the infra-orbital point to the superior edge of the External
Auditory Meatus (E.A.M)

16

8. The horizontal laser beam, located at

the side of the column, can be adjusted
up or down to accommodate different
head sizes. This is done by manually
moving the horizontal laser beam lever
up or down.

9. Have the patient smile to properly position the canine laser beam at the center of the
patients canine tooth.

Rotate the thumb wheel, located under the patient support rest,

forward and backward to properly align the beam.

10. For TMJ Open imaging, the patients mouth should be opened as wide as possible.
The top of the TMJ support and the patients acanthion point must remain in contact.

11. Have the patient close their eyes and rest their tongue at the bottom of their mouth
throughout the exposure cycle.

17

12. Using the temple support wheel button,

adjust the temple supports to fit snugly
on either side of the patients head.
The

patients

head

should

be

immobilized. The temple support wheel

button is located at the front of the
patient support rest.

13. Ensure that the patient does not move

during image acquisition. To expose,
press and hold the exposure switch
until TMJ Open image acquisition is
completed.

14. To subsequently take the TMJ Closed

image, the patients mouth will now
remain closed.

The upper lip must

make contact with the TMJ support.

18

15. Have the patient smile to properly position the canine laser beam at the center of the
patients canine tooth.

Rotate the thumb wheel, located under the patient support rest,

forward and backward to properly align the beam.

16. Have the patients close their lips and rest their tongue at the bottom of their mouth
throughout the exposure cycle.
17. Position the head of the patient to
properly align their Frankfort plane with
the horizontal laser beam. For proper
positioning, adjust in which way the
patients head is tilted by adjust the unit
slightly upward or downward using the
column up/down switch. The Frankfort
plane is the line from the infra-orbital
point to the superior edge of the External Auditory Meatus (E.A.M)
18. Ensure that the patients eyes are closed. Press and hold the exposure switch button
until image acquisition is complete.

19

3 Patient Positioning Methods for CT imaging

1. Have the patient remove all jewelry and metallic objects, such as earrings, hair pins,
spectacles, dentures, and orthodontic appliances. These items can cause shadow
images that may obscure diagnosis.
2. Insert the normal chin support and bite
block in the units chinrest receptacle.
Place a hygienic cover over the bite
block.

3. It is recommended that the patient wear a lead apron for protection against any possible
scatter radiation.
4. Have the patient stand upright at the
center of the machine with their chin
in line with the chinrest. Ask the
patient to grip both handles on either
side of the unit firmly.

20

5. Adjust the height of the system using

the column up/down switch until the
patients chin is resting on the chinrest.

6. Ensure that the patients shoulders remain level and their neck is relaxed. The cervical
spine should be straight and upright. To prevent magnifications on the left and right
sides of the final image, make sure that the vertical laser beam is positioned at the
center of the occipital bone.

7. Have the patient bite the bite block along the grooves using their upper incisor. Ensure
that the chin is in good contact with the chin support.

21

8. Using the temple support wheel button,

adjust the temple supports to fit snugly
on either side of the patients head.
The

patients

head

should

be

immobilized. The temple support wheel

button is located at the front of the
patient support rest.

9. For CT imaging, the horizontal light should be aligned the patients occlusion. But the
beam cannot be adjusted.
So, to properly align the patients occlusion along the horizontal beam, adjust the height
of the column and chin rest using the up/down control switch and up/down control
buttons of the touch pad screen panel.

< Tip 1 >

< Tip 2 >

< Sample touch screen image >

Tip: Automatically the horizontal beam located on the center of CT image. If you want
to take a clear image of a particular area, adjust the chin rest using up/down buttons
of the touch pad screen panel, so that the horizontal beam focuses on the area.
1. To focus on the maxillary area, the horizontal light should be aligned at 1.5cm alone the
patients occlusion.
2. To focus on the mandible area, the horizontal light should be aligned at 1.5cm below the
patients occlusion.

22

10. Have the patient close their lips and keep their tongue positioned towards the palate
throughout the exposure cycle.
In order to get quality images, the patient is not allowed to swallow saliva or make
tongue movements during x-ray exposure of the imaging process.
11. Ensure that the patients eyes are
closed. Press and hold the exposure
switch button until image acquisition is
complete.

23

4 Cephalometric Patient Positioning Methods

4.1 PA projection (Posterior to Anterior)
Sagittal suture

Innominate line

Occipital bone

Atlanto-occipital joint

Frontal sinus

Maxillary sinus

Orbit

Mandible angle

Crista pyramidis

Incisive foramen

Mastoid air cells

Sphenoid sinus
Nasal septum

24

Cephalometric PA Imaging Process

1. The nasal positioner should be flipped upward to prevent image obstruction.
2. Adjust the distance between the ear
rods, as shown in the illustration.

3. Have the patient remove all jewelry and metallic objects, such as earrings, hair pins,
spectacles, dentures, and orthodontic appliances. These items can cause shadow
images that may obscure diagnosis.
4. It is recommended that the patient wear a lead apron for protection against any possible
scatter radiation.
5. Guide the patient to the Cephalometric Unit.
6. Ask the patient to stand upright. Ensure
that the patients shoulders are level
and the neck is relaxed.

25

7. Use the column up/down switch to

adjust the height of the machine until
the ear rods are adjacent to the
patients ears.

8. As a positioning checkpoint, ensure

that the patients Frankfort plane is
parallel to the floor.

9. Ensure that the patients eyes are closed. Have the patient remain still. Press and hold
the exposure switch button until image acquisition is complete.

26

4.2 Lateral Projection Mode

Lambdoid suture

Sphenoid sinus

Occipital bone

Maxillary sinus

Mastoid air cells

Head of mandible

Coronal suture

EAM(External Auditory Meatus)

Frontal sinus

Mandible angle

Dorsume sella

Hyoid bone

Nasal bone

Nation point

Orbit

16

27

Acanthion point

Cephalometric Lateral Imaging Process

1. Have the patient remove all jewelry and metallic objects, such as earrings, hair pins,
spectacles, dentures, and orthodontic appliances. These items can cause shadow
images that may obscure diagnosis.
2. Flip the nasal positioner down and rotate the ear rods to position the patient laterally.
Adjust the distance between the ear rods.

3. It is recommended that the patient wear a lead apron for protection against any possible
scatter radiation.
4. Guide the patient to the Cephalometric Unit.

28

5. Use the column up/down switch to adjust the height of the machine until the ear rods
are adjacent to the patients ears. Ensure that the ear rods have a comfortable yet firm
fit in the patients ears.

6. For proper positioning, the patients

Orbitomeatal

Line(OML)

should

be

parallel to the floor. Adjust the nasal

positioner on the patients soft tissue
nasion point.

7. Ask the patient to stand upright. Make sure that the patients shoulders are level and the
neck is relaxed.
8. Have the patient remain still. Press and hold the exposure switch button until image
acquisition is complete.

29

4.3 SMV Projection (Submento Vertical) Mode

Zygomatic bone
Teeth
Nasal septume
Mandible angle
Mastoid air cells
Sphenoid sinus
Great formamen
Odontoid process

30

Cephalometric SMV Imaging Process

1. The nasal positioner should be flipped
upward to prevent image obstruction.

2. Adjust the distance between the ear rods for head positioning.
3. Have the patient remove all jewelry and metallic objects, such as earrings, hair pins,
spectacles, dentures, and orthodontic appliances. These items can cause shadow
images that may obscure diagnosis.
4. It is recommended that the patient wear a lead apron for protection against any possible
scatter radiation.
5. Guide the patient to the Cephalometric Unit.
6. Ask the patient to stand upright, facing
the machines rotating unit.

31

7. Use the column up/down switch to

adjust the height of the machine until
the ear rods are adjacent to the
patients ears. Ensure that the ear rods
have a comfortable yet firm fit in the
patients ears.

8. For proper SMV positioning, the patients Frankfurt plane must be perpendicular to the
floor, as shown below.

9. Have the patient remain still. Press and hold the exposure switch button until image
acquisition is complete.

32

5 Image Quality Checkpoints and Solutions

Case 1. Patient Stepped too far into the Imaging Device

Anterior Enlargement

<Situation>
Anterior teeth area looks hazy
Premolar teeth look overlapped
<Cause>
The patient bit the bite stick beyond its grooves.
Canine laser beam was not correctly aligned.
The patient stood too far into the machine.
<Solution>
Ensure that the patients incisors are properly aligned on the grooves of the bite block.
Have the patient smile to properly align the canine laser beam with the center of the
patients canine tooth.

33

Case 2. Patients Head is Angled in a Downward Position

<Situation>
Roots of the anterior teeth area are hazy, while the premolars look overlapped.
<Cause>
The patients head was tilted in a downward position.
<Solution>
Properly align the horizontal laser beam along the patients Frankfurt plane by adjusting
the column slightly upwards using the up/down switch.
If situation persists despite adjustments, the dentition of the patient is not normal.

34

Case 3. Patients Head is Angled in an Upward Position

<Situation>
Roots of the anterior teeth area are hazy.
<Cause>
The patients head was tilted in a downward position.
<Solution>
Properly align the horizontal laser beam along the patients Frankfort plane by adjusting
the column slightly downwards using the up/down switch.

35

Case 4. Patients Head is Tilted

<Situation>
Hazy image in which the patients head appears to lean to the right or left.
Differing magnification on the right and left sides of the image.
<Cause>
The patients head was tilted to the left or right during image acquisition.
<Solution>
Align the sagittal beam properly along the patients Mid-Sagittal plane.
The vertical beam should be positioned at the center of the occipital bone.

36

Case 5. Patients Head is Turned

<Situation>
Differing magnifications on the right and left sides of the image.
A part of chin looks much wider than normal.
<Cause>
The patient turned their head.
<Solution>
Align the sagittal beam properly along the Mid-Sagittal plane of the patient.

37

Case 6. Upper Jaw is Dark

<Situation>
Upper jaw looks dark.
<Cause>
The patients tongue was not positioned towards the palatal area.
<Solution>
Ensure that the patient keeps their tongue against their palate while taking the image.

38

Case 7. Patient Movement

<Situation>
Whole image is hazy with undefined lines
Blurry image
<Cause>
Patient moved during image capture.
<Solution>
If the patient is nervous, try to calm them.
Ask the patient not to move during image acquisition.

39

Case 8. Inappropriate Patient Posture

<Situation>
A pyramid shaped ghost (white) image appears in the middle of the image.
<Cause>
Patients posture is bent.
<Solution>
When positioning the patient, ensure that their spine is straight.
Keep the shoulders down so that the tip of the chin does not reach the nape.
Adjust the vertical carriage slightly upwards to properly position the patients head and
to straighten the spine.

40

Case 9. Metal Objects

<Situation>
Ghost images (reflections) of the metal objects appear in the image.
<Cause>
Patient did not remove all metal objects.
<Solution>
Have the patient remove all jewelry and metallic objects, such as earrings, hair pins,
spectacles, dentures, and orthodontic appliances.

41

Case 10. Image is too Bright

<Situation>
Image is too bright.
<Cause>
The x-ray dose is too low.
<Solution>
Increase the kVp and mA exposure values.

42

Case 11. Image is too Dark

<Situation>
Image is too dark.
<Cause>
The x-ray dose is too high.
<Solution>
Decrease the kVp and mA of exposure values.

43