Pano errors common in orthodontic imaging
Panoramic radiograph errors are common in young orthodontic patients and could affect the diagnostic value of radiographic exams, according to a study in the European Journal of Orthodontics (August 2012, Vol. 34:4, pp. 452-457).
A team of Swedish researchers set out to evaluate the frequency of errors in panoramic radiographs in young orthodontic patients, register the pathologic and abnormal conditions, and compare them with the patient’s record.
They analyzed 1,287 panoramic radiographs obtained from patients referred for orthodontic treatment during a one-year period (530 boys and 757 girls; mean age 14.2 years). Four observers evaluated the radiographs for 10 common errors, pathologies, and/or anomalies. Five of the errors were divided into clinically relevant or not clinically relevant errors (those influencing diagnosis). Only those pathological findings with a possible influence on orthodontic treatment were compared with the patient’s record.
Of the 1,287 radiographs, 96% had errors, the researchers reported. The number of errors in each image varied between 1 and 5, and in 24% of these images the errors could be of importance for clinical decision-making.
“The present study showed that 315 (25%) out of 1287 radiographs should have been retaken as the radiographs had clinically relevant errors,” the study authors wrote. “If the image is not retaken, the diagnostic value of the radiograph, and thus the radiation dose and benefit for the patient, is questionable.”
The most common error was that the tongue was not in contact with the hard palate. Another common error was that the patient’s head was rotated, more often to the left than to the right, which could be explained by the construction of the panoramic equipment where the positioning aids are on the patient’s left side, the study authors noted.
They found pathologies or anomalies in 558 patients and recorded a total of 1,221 findings. Findings of possible relevance for orthodontic treatment were 63, and 12 of those were registered in the patient records, the researchers noted.
“This study … has shown the frequent occurrence of errors in panoramic radiography, i.e., how difficult it is to take panoramic radiographs without errors that may affect the diagnostic value of the radiographic examination,” they wrote. “Professionals responsible for the interpretation of radiographs have to be aware of the potential of finding symptom-free pathological changes or other anomalies, even though the frequency is low.”
Pathological findings outside the dental arches were low and could be an argument for minimizing the radiation field, they concluded.
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