True Cephalometric Lateral Skull

Patient Positioning
Irrespective of the type of equipment being used, patient
positioning is the same and can be summarized as follows:

1. The patient is positioned within the cephalostat, with the sagittal

plane of the head vertical and parallel to the image receptor and
with the Frankfort plane horizontal. The teeth should generally be
in maximum intercuspation.
2. The head is immobilized carefully within the apparatus with the
plastic ear rods being inserted gradually into the external auditory
meati.
3. The equipment is designed to ensure that when the patient is
positioned correctly, the X-ray beam is horizontal and centred on
the ear rods (see Fig. 14.6 ).

FIG. 14.6 Diagrams and photographs showing similar patient positioning in the
cephalostat when using (A) phosphor plate/film-based one shot or (B) solid-state
scanning equipment.

FIG. 14.7 An example of a digitally captured cephalometric lateral skull radiograph.

Selection Criteria
In the UK, the Selection Criteria for Dental Radiography (third edition)
booklet (updated in 2018) suggests panoramic radiography in
general practice in the following circumstances:

• Where a bony lesion or unerupted tooth is of a size or position

that precludes its complete demonstration on intraoral radiographs

• In the case of a grossly neglected mouth

• As part of an assessment of periodontal bone support often
supplemented with periapical radiographs
• For the assessment of wisdom teeth before planned surgical
intervention; routine radiography of unerupted third molars is not
recommended
• As part of an orthodontic assessment where there is a clinical
need to know the state of the dentition and the presence or absence
of teeth. The use of clinical criteria to select patients rather than
routine screening patients is essential.

In addition, in dental hospitals panoramic radiographs are also

used to assess:

• Fractures of all parts of the mandible except the anterior region

• Antral disease – particularly to the floor, posterior and medial

walls of the antra
• Destructive diseases of the articular surfaces of the
temporomandibular joint
• Vertical alveolar bone height and position of anatomical
structures as part of pre-implant planning.

Technique and Positioning

The exact positioning techniques vary from one machine to another.
However, there are some general requirements that are common to
all machines and these can be summarized as follows.

Patient Preparation
• Patients should be asked to remove any earrings, jewellery, hair
pins, spectacles and dentures or orthodontic appliances.
• The procedure and equipment movements should be explained,
to reassure patients and if necessary a test exposure should be used
to show them the machine’s movements.

Equipment Preparation
• The cassette containing the phosphor plate or film should be
inserted into carriage assembly (if appropriate).

• The exposure control panel should be covered in cling film (see

Chapter 8 ).

• The operator should put on suitable protective gloves (e.g. latex

or nitrile) (see Chapter 8 ).

• The collimation should be set to the size of field required.

• The appropriate exposure factors should be selected according to
the size of the patient – typically in the range of 70–90 kV and 4–12
mA.

Patient Positioning
• The patient should be positioned in the unit so that their spine is
straight and instructed to hold any stabilizing supports or handles
provided (see Fig. 15.15 ).

• The patient should be instructed to bite their upper and lower

incisors edge-to-edge on the bite-peg with their chin in good
contact with the chin support.

• The head should be immobilized using the temple supports. •

The light beam markers should be used so that the mid-

sagittal plane is vertical, the Frankfort plane is horizontal and the

canine light lies between the upper lateral incisor and canine.
• The patient should be instructed to close their lips and press their
tongue on the roof of their mouth so that it is in contact with their
hard palate and not to move throughout the exposure cycle
(approximately 15–18 seconds).

FIG. 15.15 Patient positioned in the Planmeca ProMax panoramic unit. Note the bite-
peg, chin, temple supports and light-beam markers to facilitate positioning.