Panoramic Radiography

Robert A. Cederberg, MA, DDS

Professor, Dept. of Restorative Dentistry & Biomaterials University of Texas HSC at Houston Dental Branch

Linear Tomography

Panoramic Radiography
Radiographic technique for producing a single image of both maxillary and mandibular arches and their supporting structures. Drs. Paatero and Numata were the first to describe the principles of panoramic radiography.

Historical Development
Panoramic radiographs can be made using two different methods: 1. Use of an intraoral source of radiation 2. Use of an extraoral source of radiation a. Film placement is intraoral b. Film placement is extraoral

Panoramic Radiography Intraoral Source of Radiation

Status-X, Siemens Co., Erlangen, Germany

Development of Extraoral Source of Radiation

Dr. Numata was the first to propose this method in 1933. He placed a curved film in the mouth lingual to the teeth and used a slit beam of radiation which rotated around the patients jaw to expose the film. The patient was stationary.

Parabolography Dr. Paatero

Dr. Paatero in 1946 demonstrated a similar method using a rotating chair.

Parabologram of maxillary teeth

Pantomography (Linear Tomography)

Dr. Blackman collaborated with Dr. Paatero using a pantomographic technique. Watson & Sons, Ltd. in collaboration with Dr. Blackman developed the first commercial model of the pantomograph known as the Rotograph.

Rotary Radiography

Watson & Sons, Ltd., Wembley, England

Rotograph

Development of Orthopantomographic Technique

Limitations of Rotary panoramic technique: rotation of patient and film in circular paths (jaws are not circular but elliptical), overlapping of teeth posteriorly and streak artifacts. Orthopantomograph uses 3 rotation centers producing an elliptical path of rotation. Paatero first prototype 1958.

Orthopantomograph

Panoramic Radiography Advantages:

Broad anatomic coverage Relatively low patient radiation dose Convenience and speed of the exam Easily tolerated by patients - Ex: patients who are unable to open their mouths Easy to explain treatment plans

Panoramic Radiography Disadvantages:

Does not resolve fine detail, consequently additional images (PA, BW) required Magnification Distortion and overlapping of teeth Objects located outside the image layer are distorted, obscured or not seen

Principles of Rotational Panoramic Radiography

Panoramic radiograph is unique in the foci of projection Focus of projection is not the same in the vertical and the horizontal plane Horizontal plane - center of rotation Vertical plane - x-ray source

Central projection:

Principles of Rotational Panoramic Radiography

X-ray source placed intraorally and curved film is placed extraorally, still a central projection, although magnified equally hor. & vert.

Principles of Rotational Panoramic Radiography

If you replace the stationary intraoral x-ray source with an extraoral rotating slit beam x-ray source, magnification will be equal in the rotation or horizontal plane but different in the x-ray source or vertical plane.

Principles of Rotational Panoramic Radiography

Principles of Rotational Panoramic Radiography

The combination of a rotating beam and a moving film changes the horizontal dimension of the recorded image, but the projection of the object remains the same, so that the proportions are restored in the resultant image.

Principles of Rotational Panoramic Radiography

Panoramic Cassettes

Screens

Panorex

Panelipse

Focal Trough

The three-dimensional curved zone or Image Layer in which structures are well defined.

Focal trough size affected by arc path, velocity of the film and x-ray tube, beam alignment, and collimator width.

Influence of Patient Positioning on Image Magnification

As the position of the object is moved within the focal trough the size and shape of the resultant image change.

Influence of Patient Positioning on Image Magnification

Correct Position

Forward Position

Backward Position

Correct Patient Positioning and Head Alignment

Occlusal plane 20 to 30 degrees below horizontal Tragus to outer canthus is parallel to the floor Back and spine erect and neck extended Groove of bite block is positioned inter-incisally and midline is centered Tongue placed in roof of the mouth

Correct Patient Position and Head Alignment

Improper Patient Positioning

Too Far Forward

Improper Patient Positioning

Positioned Too Far Back

Improper Patient Positioning

Chin Too Far Up

Improper Patient Positioning

Chin Tilted Down

Improper Patient Positioning

Slumped Correct

Patient placed in slumped position

Improper Patient Positioning

Rotated Position

Ghost Images

Superimposition of structures from the contralateral side to the side being viewed

Ghost Images

Improper Patient Positioning and Patient Preparation

Improper Patient Positioning and Patient Preparation

Improper Patient Positioning and Patient Preparation

Improper Film and/or Cassette Handling

Improper Film and/or Cassette Handling

Improper Exposure Techniques

hard palate
pterygomaxillary fissure hyoid bone maxillary sinus

tongue shadow
infraorbital canal infraorbital rim

Soft Palate & Uvula Inferior Alveolar Canal Articular Tubercle

Floor of Nasopharynx Cornoid Notch Angle of the Mandible

condyle coronoid process nasal septum lateral wall of nasal fossa

zygoma
zygomatic arch

Panoramic Radiographic Anatomy Hard Tissues

Panoramic Radiographic Anatomy Soft Tissues