Podcast
Questions and Answers
What is the primary purpose of panoramic radiography?
What is the primary purpose of panoramic radiography?
Which factor does NOT influence the focal trough in panoramic radiography?
Which factor does NOT influence the focal trough in panoramic radiography?
What is a consequence of structures being distorted in panoramic radiography?
What is a consequence of structures being distorted in panoramic radiography?
What type of beam is used in panoramic radiography to enhance image quality?
What type of beam is used in panoramic radiography to enhance image quality?
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How is the rate of movement of the receptor managed during a panoramic radiograph?
How is the rate of movement of the receptor managed during a panoramic radiograph?
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What aspect of panoramic radiography minimizes scattered radiation?
What aspect of panoramic radiography minimizes scattered radiation?
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Which statement about the panoramic x-ray machine's design is accurate?
Which statement about the panoramic x-ray machine's design is accurate?
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What characterizes the focal trough in panoramic radiography?
What characterizes the focal trough in panoramic radiography?
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What type of image is formed when structures are intercepted by the X-ray beam twice?
What type of image is formed when structures are intercepted by the X-ray beam twice?
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Which component is NOT part of a panoramic machine?
Which component is NOT part of a panoramic machine?
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What is the primary advantage of panoramic radiography in terms of jaw visualization?
What is the primary advantage of panoramic radiography in terms of jaw visualization?
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Which of the following best describes the orientation of teeth in panoramic images?
Which of the following best describes the orientation of teeth in panoramic images?
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For which patient scenario is panoramic radiography particularly beneficial?
For which patient scenario is panoramic radiography particularly beneficial?
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What is the angle at which the X-ray tubehead is typically positioned in panoramic machines?
What is the angle at which the X-ray tubehead is typically positioned in panoramic machines?
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Which benefit of panoramic radiography helps in treatment follow-ups?
Which benefit of panoramic radiography helps in treatment follow-ups?
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How does the radiation dose of panoramic radiography compare to full mouth intraoral evaluations?
How does the radiation dose of panoramic radiography compare to full mouth intraoral evaluations?
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What is one of the purposes of imaging prior to surgical procedures like extraction of impacted teeth?
What is one of the purposes of imaging prior to surgical procedures like extraction of impacted teeth?
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What specific aspect of patient positioning is essential during the imaging procedure?
What specific aspect of patient positioning is essential during the imaging procedure?
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Which of the following factors should be considered when selecting exposure factors for imaging?
Which of the following factors should be considered when selecting exposure factors for imaging?
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What is the recommended kV range for exposure factors in imaging for dental procedures?
What is the recommended kV range for exposure factors in imaging for dental procedures?
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What should patients be instructed to do with their tongues during the imaging procedure?
What should patients be instructed to do with their tongues during the imaging procedure?
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Which of these items should NOT be removed from the patient before the imaging procedure?
Which of these items should NOT be removed from the patient before the imaging procedure?
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What is a crucial step in the preparation of equipment before imaging?
What is a crucial step in the preparation of equipment before imaging?
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What is the approximate duration of the exposure cycle during the imaging process?
What is the approximate duration of the exposure cycle during the imaging process?
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What is a significant disadvantage of panoramic imaging compared to intra-oral films?
What is a significant disadvantage of panoramic imaging compared to intra-oral films?
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In what circumstance might panoramic imaging be preferred over full mouth intraoral radiographs?
In what circumstance might panoramic imaging be preferred over full mouth intraoral radiographs?
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Why might a patient with facial asymmetry result in a poor diagnostic image in panoramic imaging?
Why might a patient with facial asymmetry result in a poor diagnostic image in panoramic imaging?
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Which factor contributes to the poor visualization of certain teeth in panoramic images?
Which factor contributes to the poor visualization of certain teeth in panoramic images?
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What inherent issue is associated with panoramic imaging that affects image interpretation?
What inherent issue is associated with panoramic imaging that affects image interpretation?
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What is a primary concern regarding the use of panoramic imaging due to its convenience?
What is a primary concern regarding the use of panoramic imaging due to its convenience?
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What common issue occurs with tooth images in the premolar area during panoramic imaging?
What common issue occurs with tooth images in the premolar area during panoramic imaging?
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What disadvantage does inherent magnification of panoramic imaging introduce?
What disadvantage does inherent magnification of panoramic imaging introduce?
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Study Notes
Panoramic Radiography
- Panoramic radiography is an extra oral imaging technique that captures a single image of both the maxillary and mandibular arches and their supporting structures in a curved focal trough.
- Developed independently by Dr. Numata and Dr. Paatero, this technique utilizes a rotating receptor and x-ray tube to capture a wide field of view.
- The focal trough, where structures are sharply defined, is created by the synchronized movement of the x-ray source and receptor.
- The focal trough's shape and position are determined by the type of equipment, imaging protocol, receptor and x-ray beam path and velocity, and collimator width.
- Structures outside the focal trough are distorted—structures close to the x-ray source are magnified, and those on the opposite side of the patient are out of focus.
- Three types of images are formed: Real image within the focal trough; a double image of structures behind the rotation center; and a ghost image of structures between the center of rotation and the x-ray source.
- Components of a panoramic machine:
- X-ray tube head produces a narrow fan-shaped beam angled upwards at approximately 8 degrees.
- Control panel for machine operation.
- Patient positioning apparatus with chin rest area, temple supports, bite peg, and light beam markers (mid-sagittal, canine guidance, and Frankfort plane).
- An image receptor (digital or film) with an associated carriage assembly.
Advantages of Panoramic Radiography
- Provides a broad coverage area encompassing both jaws, supporting structures, the mid-orbit and inferiorly to the chin and neck.
- Anatomical structures are identifiable in their correct relationship.
- Relatively simple and requires minimal patient effort.
- Less time-consuming compared to full mouth radiography.
- Useful for patients unable to open their mouths or those with gag reflex.
- Aids in overview, treatment follow-up, case presentation and patient education.
- Lower radiation dose compared to conventional full-mouth intraoral radiographic evaluation.
- Helps visualize fractures.
- Useful for assessing mixed dentition status and eruption patterns in pediatric patients.
- Provides a general overview of periodontal disease.
- Standardized images are reproducible for comparative and research purposes.
Disadvantages of Panoramic Radiography
- Lower image resolution, magnification, definition, and geometric resolution compared to intraoral films.
- Inherent magnification and distortion of structures outside the focal trough.
- Areas outside the focal trough are poorly visualized.
- Proclined or retroclined anterior teeth are visualized poorly.
- Superimposition of real, double, and ghost images can create radiopaque and radiolucent areas due to soft-tissue shadows and air spaces.
- Facial asymmetry or jaws not conforming to the rotational curvature can lead to poor image quality.
- Patient positioning errors cause variable vertical and horizontal distortion.
- Ease and convenience may encourage indiscriminate use.
- Overlapping of teeth; particularly in the premolar region.
- Equipment expense.
- Artefacts are easily misinterpreted.
Indications for Panoramic Radiography
- Substitute for full-mouth intraoral radiographs.
- Assessment of developmental anomalies and tooth development in children and TMJ dysfunctions.
- Evaluation during orthodontic treatment.
- Determining the size and location of lesions like cysts and tumors.
- Monitoring pathology and postoperative bone healing.
- Pre-surgical evaluation for extractions, cyst enucleation, etc.
- Detecting fractures of the middle third and mandible after trauma.
- General overview of alveolar bone levels in periodontal disease.
- Assessing alveolar bone height prior to implant placement.
Patient and Equipment Preparation for Panoramic Radiography
- Patients should remove jewelry, piercings, hairpins, glasses, dentures, and orthodontic appliances.
- Explain the procedure and equipment movement to reassure the patient.
- Perform a test exposure to demonstrate machine movements.
- Insert the cassette containing the phosphor plate or film into the assembly.
- Cover the control panel with cling film.
- Wear suitable protective gloves.
- Set the collimation to the required field size.
- Adjust exposure factors based on the patient's size, typically 70-90 kV and 4-12 mA.
Patient Positioning for Panoramic Radiography
- Position the patient with a straight spine, ensuring they hold any stabilizing supports or handles provided.
- Instruct the patient to bite on the bite peg edge-to-edge with their upper and lower incisors, ensuring chin contact with the support.
- Immobilize their head with the temple supports.
- Align the midsagittal plane vertically, Frankfort plane horizontally, and the canine light between the upper lateral incisor and canine.
- Instruct the patient to close their lips, press their tongue against the hard palate, and remain still throughout the exposure (approximately 15-18 seconds).
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