Acta Radiológica 37 (1996) 441^45 Copyright © Acta Radiológica 1996

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ACTA RADIOLÓGICA
ISSN 0284-1851

HISTORY OF PANORAMIC RADIOGRAPHY

D. HALLIKAINEN

Department of Diagnostic Radiology, University Hospital, Helsinki, Finland.

Abstract
The first attempts to image the whole jaw were made with intraoral radiation sources Key words: Radiography, panoramic;
at the beginning of this century. The narrow-beam principle was described in 1922. Ex­ history.
perimental work and development of equipment in the 1950s resulted in commercially
available machines in the early 1960s. The panoramic technique originated from the Correspondence: Dorrit Hallikainen,
need to image the jaws, but it was also applied to other anatomic regions, before CT Sampsantie 33, FIN-00610 Helsinki,
became available. Panoramic radiography is an essential element in oral radiology to­ Finland. FAX *358-0-77 72 115.
day.

The anatomic complexity of the dentomaxillofacial
region makes diagnostic imaging a complicated
task. Panoramic radiography provides an "unob­
structed view" of the upper and lower jaw and denti­
tion. Its use has developed into a well-established
method in oral radiology. The panoramic technique
was also applied to other parts of the head and neck
before the era of axial imaging and multiplanar re­
construction.
The history of panoramic radiography has been
described in Principles and practice of panoramic
radiology by O. LANGLAND et al. (10). Since the pub­
lication of PAATERO'S first article in 1946, Scandina­
vian authors have contributed to the body of re­
search on the physical aspects of panoramic imag­
ing. Four Finnish manufacturers of panoramic
equipment still account for a notable segment of the
world market.
Development of extraoral rotational
panoramic radiography
The first attempts to image the whole jaw in one ex­
posure were made at the beginning of this century.
Several publications and patents involved tech­
niques using an intraoral radiation source.
A. F. ZULAUF (USA) described a method whereby
a narrow beam scanned the upper or lower jaw, and
the technique was patented in 1922 (35). He called
his device "the panoramic x-ray apparatus". H.
NUMATA (Japan) constructed a device suitable for
clinical examinations, calling the method "parabolic
radiography" and published his first results in 1933
(14).
The general principle of using a narrow beam for
curved objects was presented by K. HECKMANN
(Germany) in 1939. He was also granted a patent on
the method (7).
In 1946, Y. V. PAATERO published a paper on the
narrow-beam method and the basic requirements for
panoramic radiography (15), not being aware of the
earlier publications on this method. PAATERO placed
the film inside the patient's mouth, and this caused
practical problems (16, 17) (Figs 1, 2).
In 1949, PAATERO published papers on the basic
principles of panoramic radiography using extraoral
film (18).
The early 1950s witnessed a notable event in the
development of extraoral rotating panoramic radio­
graphy in Finland. Y. V. PAATERO, Professor of Clin­
ical Dental Science at the University of Helsinki,
visited the Finnish company Lääkintäsähkö with a
dry mandible in his hand, explained his ideas about
panoramic radiography, and asked for help. He was

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 D. HALLIKAINEN
Yrjö V. Paatero.
Fig. 1. Drawings presented in 1947. a) The principle of rotating
narrow beam radiography; A marks the recommended beam di­
rection. b) The patient-positioning device. The frontal arch and
intraoral pin served as a centring guide and were removed be­
fore exposure. From ref. 16, with kind permission.
introduced to TIMO NIEMINEN, an engineer, who built
an experimental device with 2 rotating plates (Fig.
3). This was the start of the close collaboration be­
tween PAATERO and NIEMINEN that continued until
PAATERO'S death in 1963.
PAATERO was invited to work in the USA in
1950-51. The material resources were much better
there than in Finland, and there he continued his re­
search on panoramic radiography. PAATERO worked
at the University of Washington, with R. NELSON
and J. KUMPULA. They developed a method using 2
eccentric rotation centres. PAATERO did not like this
442
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solution and therefore continued his own research in
Finland (22). In 1957, D. HUDSON, J. KUMPULA, and
G. DICKSON were granted a patent on the double ec­
centric method (8).
PAATERO introduced the terms "pantomography"
(panoramic tomography) and, later, "orthopantomo-
graphy" (orthoradial panoramic tomography) (Fig.
4) (19). The latter expression is used as a general
term for panoramic radiography in Finland.
In the first experimental device, the tube was sta­
tionary and the patient's chair was rotated. This
equipment was also constructed by T. NIEMINEN.
However, he was not satisfied with this method and
designed a new model in which the tube rotated. In
1957, an orthopantomograph with 3 rotation centres
was constructed and installed at the Dental Clinic of
the University of Helsinki. The clinical tests contin­
ued until 1960. PAATERO'S early publications show
that he approached the problems in a practical, often
experimental, way. He applied his inventions di­
rectly to clinical practice, and several of his publica­
tions include illustrative clinical cases (19, 20, 22-
24).
J. DUCHAMEL (France) was the first to publish pa­
pers dealing with the mathematic background of the
method (4, 5). Around that time, there were several
studies on the narrow-beam method - or slit radio­
graphy (26, 34).
ULF WELANDER and his colleagues later made
unique contributions to the theoretic and mathe­
matic understanding of panoramic radiography (11,
25, 28-33).
H. KASHIMA et al. (Japan) were the first to publish
a paper on computed panoramic radiography (9).
MCDAVID et al. presented the first electronic system
for digital acquisition of rotational panoramic radio­
graphs (12, 13).
Development of commercial equipment
The production of the Orthopantomograph® began
in 1960, starting with the assembly of single units
and developing into large-scale production. The
manufacturer was established under the name Pal-
omex (Panoramic Layer Observing Machine for Ex­
port) in 1965, TIMO NIEMINEN taking charge of both
development and marketing. NIEMINEN collaborated
with the Siemens Company, and especially with P.
OBERLEY, who recognized the great potential of the
device. The tubes and generators were manufac­
tured by Siemens, which for years also marketed the
products.
The production of equipment also began in areas
other than Scandinavia. In the USA, D. HUDSON, J.
KUMPULA, and R. NELSEN continued their work on ·
 HISTORY OF PANORAMIC RADIOGRAPHY

EXCERPTUM EXCERPTUM

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Kebenhavo ZUricli Kaïictilmvn Zllrirli

Editor Editor
GÖSTA FORSSELL GÖSTA FOnSSELL

é é
Yrjô V. Pastero
Yrjö V. Pastero
A NEW T O M O G R A P H I C A L METHOD
THE U S E OF A MOBILE SOURCE OF
FOR RADIOGRAPHING CURVED
LIGHT IN RADIOGRAPHY
OUTER S U R F A C E S

Vol. XXIX. Fase. 3 31:ΙΠ 1948 N:o 169 Vol. XXXII. Fase. 2—3 30 : IX 1949 N:o 186—187

cl Stockholm: P. A. Norstedt& S oner Stockholm: P. A. Norsledt & S ön e ;

Fig. 2. a) and b) PAATERO'S early papers in Acta Radiológica.

the double eccentric method. The clinical tests were
completed in 1958, and the S. S. White company
(Pennwalt Corporation) started production under the
trade name Panorex.
Dr SIDNEY BLACKMAN of the UK visited PAATERO
in Helsinki in 1954. Later, an improved model of the
pantomograph was manufactured in Helsinki and
supplied to BLACKMAN at the Royal Dental Hospital
(2). BLACKMAN collaborated with the UK company
Watson & Sons, which started to manufacture a pan­
oramic unit called the Rotograph. In the late 1960s,
several other manufacturers in the USA, Japan, and
Europe began the production of panoramic equip­
ment.
Technical development continued. Clinical and
scientific research played a minor role in improving
technique: it was the innovations of engineers that
determined progress.
The early models were equipped with AC gener­
ators, most often one-pulse generators. The fact that
it was possible to connect the equipment to 12-pulse
generators in hospitals resulted in improved image
quality. It also allowed the use of tubes with rotating
anodes.
The Soredex Company (Helsinki, Finland) was
the first to produce units (Cranex DC) with constant
potential generators, starting in 1978. High-
frequency generators were small and allowed pre­
cise and fast regulation of the output. Thus, they
were suitable for small, stand-alone equipment such
as panoramic units.
In the early models, the movements were control­
led by mechanical means. The projection geometry
could be varied by changing the location of the im­
age layer and patient. These variations were applied
to image the maxillary sinuses, the temporomandib-
ular joints, the optic foramina, and the cervical
spine.
Technical development continued and stepping
motors and electronic devices replaced the mechani­
cal solutions. This did not necessarily alter the per­
formance of the units, because the mechanical mod-

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 D. HALLIKAINEN
Fig. 3. An experimental panoramic device, constructed for Y. V.
PAATERO by T. NIEMINEN.
Fig. 4. The orthopantomograph, manufactured until 1964.
els were already quite sophisticated. More impor­
tant was the progress made in ergonomics, espe­
cially in patient-positioning devices. The manufac­
turers also concentrated on dental panoramic imag­
ing, and interest in other types of projection dimin­
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ished. It reappeared in the late 1970s, when
electronics made it easy to preprogramme several
image-layer forms within one piece of equipment.
The first sign of this development was the "OP-
4" experimental device (Palomex, Finland), in
which several cylindric image layers of different ra­
dii were electronically stored (1). Tomorex (Penn-
walt, USA) still used mechanical steering, and 2
curved image-layer halves could be combined in
various ways (3). The "OP-6", known and marketed
as Zonarc since 1980 (Instrumentarium/Palomex,
Finland), was the first device to have 7 different,
preprogrammed image-layer forms (Fig. 5) (6). The
2 commercial devices, Tomorex and Zonarc, were
designed for the examination of supine patients.
The preprogramming of image-layer forms re­
quired expertise in dental science. Consequently, re­
searchers now took part in image-layer design (27,
32, 33).
Developments in clinical practice influence the
imaging tasks in oral radiology. For example, im­
plant planning and follow-up require cross-sectional
images of the jaws. The Scanora device (Orion Cor-
poration/Soredex, Finland), on the market since
1988, was the first to combine panoramic radiogra­
phy and multidirectional tomography (27). There
are now several machines that perform both pan­
oramic and tomographic procedures.
Panoramic radiography originated from the need
to image the jaws properly. It was also applied to
other anatomic regions, before CT became avail­
able. Improvements in technology such as digitiza­
tion ensure that the panoramic technique will re­
main an essential element in future oral radiology.
Fig. 5. The Zonarc (Instrumentarium/Palomex) was the first
unit with several electronically programmed image layer tracks.
The patient was examined in the supine position.
 HISTORY OF PANORAMIC RADIOGRAPHY
ACKNOWLEDGEMENTS
I am grateful for highly inspiring and informative discussions
with the following persons: Lie. Tech. Heikki Kanerva; quality
manager (retired) Ensio Koskennurmi, Instrumentarium Imag­
ing; general manager Folke Lindberg, Ph.D.h.c; Timo Niem­
inen; and Professor Erkki Tammisalo. I also thank marketing
manager Erkki Järvinen, Instumentarium, for photographs of
the historical equipment.
REFERENCES
1. ALTONEN M.: Structures of the midface on cylindrical pan-
tomograms. J. Maxillofac. Surg. 4 (1976), 171.
2. BLACKMAN S.: Mass dental radiography. Radiography 22
(1956), 2 1 .
3. CHARLTON O. B., DAFFNER R. H., GEHWEILER J. A., MARTINEZ
S. & PUTMAN C. E.: Panoramic zonography of fractures of
the facial skeleton. AJR 137 (1981), 109.
4. DUCHAMEL J.: Les procédés de radiographie en coupe non
rigoreux. Sei. Indust. Phot. 25 (1954), 129.
5. DUCHAMEL J.: Une forme nouvelle de phototomographie. La
photopantomographie de Y. V. Paatero. Sei. Indust. Phot.
25 (1954), 353.
6. HALLIKAINEN D., PAUKKU P. & TÖTTERMAN S.: Guide to pan­
oramic zonography. Palomex Instrumentarium. Helsinki
1984.
7. HECKMANN K.: Die Ro'ntgenperspektive und ihre Umwand­
lung durch eine neue Aufnahmetechnik. RÖFO 60 (1939),
144.
8. HUDSON D., KUMPULA J. & DICKSON G.: A panoramic x-ray
dental machine. U. S. Armed Forces Med. J. 13 (1957), 46.
9. KASHIMA I., KANNO M., HIGASHI T. & TAKANO M.; Com­
puted panoramic tomography with scanning laser-stimu­
lated luminescence. Oral Surg. Oral Med. Oral Pathol. 60
(1985), 448.
10. LANGLAND O. E., LANGLAIS R. P. & MORRIS C. R.: Principles
and practice of panoramic radiology. 1st edn., ch. 1. W. B .
Saunders, Philadelphia 1982.
11. MCDAVID W. D., WELANDER U., KANERVA H. & MORRIS C.
R.: Transfer function analysis in rotational panoramic
radiography. Acta Radiol. Diagn. 24 (1983), 27.
12. MCDAVID W. D., DOVE, B., WELANDER U. & TRONJE G.:
Electronic system for digital acquisition of rotational pan­
oramic radiographs. Oral Surg. Oral Med. Oral Pathol. 71
(1991), 499.
13. MCDAVID W. D., WELANDER U. & TRONJE G.: Preliminary
evaluation of a digital system for rotational panoramic
radiography. Oral Surg. Oral Med. Oral Pathol. 73 (1992),
623.
14. NUMATA H.: Consideration of the parabolic radiography of
the dental arch. J. Shimazu Stud. 10 (1933), 13.
15. PAATERO Y. V.: Sunnittelemastani uudesta hampaiden rónt-
genkuvaustekniikasta. Suomen Hammaslääkäriseuran
Toimituksia 86 (1946), 37. (English summary: A new
radiographie method in dentistry.)
16. PAATERO Y. V.: Liikkuvan valolähteen käyttö hammasrönt-
Downloaded from acr.sagepub.com at MCMASTER UNIV LIBRARY on June 30, 2015
genkuvauksessa. Suomen Hammaslääkäriseuran Toimituk­
sia 86 (1947), 11. (English summary: The use of a mobile
source of light in dental radiography.)
17. PAATERO Y. V.: The use of a mobile source of light in radio­
graphy. Acta Radiol. 29 (1948), 221.
18. PAATERO Y. V.: A new tomographical method for radio­
graphing curved outer surfaces. Acta Radiol. 32 (1949),
177.
19. PAATERO Y. V.: Pantomogramman kuvakerroksen paksuu-
den riipuvuus objectin sijainnista j a pyörimisnopeudesta
sekä röntgensäteiden divergenssistä. Soumen Ham­
maslääkäriseuran Toimituksia 48 (1952), 133. (English
summary: Thickness of layer reproduced on pantomogram
in relation to location of the object, speed of rotation, and
divergence of roentgen rays.)
20. PAATERO Y. V.: Radiography of the temporo-mandibular
joint. A new method. Ann. Chir. Gynaecol. Fenn. 42
(1953), 259.
21. PAATERO Y. V.: Pantomography in theory and use. Acta Ra­
diol. 41 (1954), 321.
22. PAATERO Y. V.: Geometrical study on possibilities of mak­
ing double eccentric pantomograms with a single exposure.
Suomen Hammaslääkäriseuran Toimituksia 50 (1954), 36.
23. PAATERO Y V.: Die Andwendungen der Pantomographie für
klinische Untersuchungen. RÖFO 82 (1955), 525.
24. PAATERO Y V.: Pantomography of spherical layers. Acta
Radiol. 48 (1957), 181.
25. SJÖBLOM A., SÄMFORS K . - A . & WELANDER U.: F o r m distor­
tion in narrow beam rotation radiography. Acta Radiol. Di­
agn. 16 (1975), 565.
26. SOILA P.: General theory of narrow beam rotating tomogra­
phy. Acta Radiol. 55 (1961), 458.
27. TAMMISALO E., HALLIKAINEN D., KANERVA H. & TAMMISALO
T.: Comprehensive oral X-ray diagnosis. Scanora® multi-
modal radiography. A preliminary description. Dentomax-
illofac. Radiol. 21 (1992), 9.
28. WELANDER U.: A mathematical model of narrow beam rota­
tion methods. Acta Radiol. 15 (1974), 305.
29. WELANDER U.: Layer formation in narrow beam rotation ra­
diography. Acta Radiol. 16 (1975), 529.
30. WELANDER U. & WICKMAN G.: Blurring and layer thickness
in narrow beam rotation radiography. Acta Radiol. 18
(1977), 705.
31. WELANDER U. & WICKMAN G.: Image distortion in narrow
beam rotation radiography. A mathematical analysis. Acta
Radiol. 19 (1978), 507.
32. WELANDER U., MCDAVID W. D., TRONJE G. & MORRIS C. R.:
A method of increasing the anterior layer thickness in rota­
tional panoramic radiography. Dentomaxillofac. Radiol. 12
(1983), 133.
33. WELANDER U., TRONJE G. & MCDAVID W. D.: Layer thick­
ness in rotational panoramic radiography. Some specific as­
pects. Dentomaxillofac. Radiol. 18 (1989), 119.
34. VUORINEN P.: The roentgenographic slit methods. Acta Ra­
diol. (1959), Suppl 177.
35. ZULAUF A. F.: Panoramic XZ-ray apparatus. U.S. Patent No
1408559,7.3.1922.
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