Panoramic ghost images as an aid in the localization of soft tissue calcifications

Mapping of the ghost envelope for an Orth Oralix panoramic x-ray unit (Philips Medical Systems) was carried out with a lead sphere suspended at various locations around a dry mandible. The ghost envelope is a three-dimensional zone within which an object or anatomic structure must lie to produce a ghost image on panoramic radiographs. If the three-dimensional shape of the ghost envelope for a particular panoramic unit is known, information can be gained about the clinical location of objects appearing on radiographs produced with that machine. Objects outside the envelope will not result in ghost image formation. Objects within the envelope will result in characteristic ghost images depending on their position. This article analyzes ghost image characteristics in relation to object position and discusses the limitations of the method. A series of ready reference diagrams is provided, which may aid in the localization of soft tissue calcifications and foreign objects observed on panoramic radiographs.