Radiology · patient case question
The right side of the panoramic image appears magnified and the left appears narrowed. What positioning error occurred?
Patient case: Reading the panoramic film
demo: Series of radiographic interpretation items
chief: Assorted radiographic findings and technique errors from a single clinic session.
history: Several patients imaged the same morning; the films are reviewed together at the end of the day.
meds: Not applicable.
findings: One panoramic film shows the right ramus and posterior teeth appreciably wider than the left. Another shows two ring-shaped radiopacities superimposed over one maxillary sinus and three over the other, in a patient wearing earrings. A third shows a curved radiopacity in the lower field. An occlusal film shows a soft tissue shadow over the incisal edges of the anterior teeth.
Show answer and explanation
Correct answer: D. The patient's head was rotated to the left
- A. Excessive chin depression produces an exaggerated downward curve of the occlusal plane, the so-called frown, with the anterior teeth blurred and the condyles displaced to the edge of the film, but the two sides stay symmetrical.
- B. Rotating to the right would produce the mirror image, magnifying the left side.
- C. Positioning too far forward narrows the anterior teeth and blurs them, but again it does so symmetrically.
- D. Correct. In panoramic imaging the side placed further from the film and closer to the source is magnified. Turning the head to the left carries the right side away from the receptor, so the right structures widen while the left, now closer, narrows. The rule is that the side that appears wider is the side that moved away.