A panoramic radiograph shows a ghost image of a radiopaque object projected near the opposite mandibular angle. What should you instruct the patient before retaking the image?

Correct answer: C. Remove all jewelry, earrings, and metallic appliances from the head and neck

• A. Chin raised too high produces a flat or REVERSE (inverted) smile line and superimposition of the hard palate over the maxillary roots.
• B. Chin tucked too far down produces an exaggerated (excessive) smile curve with the anterior teeth blurred and the condyles crowded at the edges — an error of positioning, not a ghost image.
• C. CORRECT. A GHOST IMAGE is produced when a dense radiopaque object (earring, necklace, removable partial denture clasp, hearing aid) lies BETWEEN the X-ray source and the center of rotation. It appears on the OPPOSITE side, HIGHER (more superior), and MAGNIFIED and blurred horizontally. The remedy is simply to remove all metallic objects before exposure.
• D. Bite block position controls anteroposterior positioning, causing magnification or narrowing of anterior teeth — not ghosting.

Note: Ghost image rule: opposite side, higher, larger, blurred.