Positioning errors and quality assessment in panoramic radiography

PURPOSE: This study was performed to determine the relative frequency of positioning errors, to identify those errors directly responsible for diagnostically inadequate images, and to assess the quality of panoramic radiographs in a sample of records collected from a dental college. MATERIALS AND METHODS: This study consisted of 1,782 panoramic radiographs obtained from the Department of Oral and Maxillofacial Radiology. The positioning errors of the radiographs were assessed and categorized into nine groups: the chin tipped high, chin tipped low, a slumped position, the patient positioned forward, the patient positioned backward, failure to position the tongue against the palate, patient movement during exposure, the head tilted, and the head turned to one side. The quality of the radiographs was further judged as being 'excellent', 'diagnostically acceptable', or 'unacceptable'. RESULTS: Out of 1,782 radiographs, 196 (11%) were error free and 1,586 (89%) were present with positioning errors. The most common error observed was the failure to position the tongue against the palate (55.7%) and the least commonly experienced error was patient movement during exposure (1.6%). Only 11% of the radiographs were excellent, 64.1% were diagnostically acceptable, and 24.9% were unacceptable. CONCLUSION: The positioning errors found on panoramic radiographs were relatively common in our study. The quality of panoramic radiographs could be improved by careful attention to patient positioning.