Reduction of cervical vertebra ghost images in panoramic radiography using vertical dual exposure

Purpose: To evaluate the image quality of vertical dual-exposure panoramic radiography (PR), which merges two PR images taken at different focus heights to reduce ghost images of cervical vertebrae (CV) and intervertebral spaces (IVS) in the incisor region. Methods: PR images of an aluminum block, a CV phantom and a human head phantom were taken at 0 mm and merged with and subtracted from PR images taken at other heights (0, 5, 10, 15, and 20 mm) to create new images, e.g., Merg_{0 + 15 mm} and Sub_{0 − 10 mm}. The subtracted images were analyzed subjectively according to the uniformity on the line profile. Merged images were evaluated subjectively by six raters to determine the influence of the ghost images. Results: Objective evaluation revealed a positional shift in the ghost images according to the height of the focus for both phantoms. In the subjective evaluation, the normal PR (Merg_{0 + 0 mm}) showed the worst score, indicating strong influence of CV and IVS ghost images. Conclusion: The vertical dual-exposure PR method, which merges PR images taken at the normal position and a higher X-ray focus, can reduce CV and IVS ghost images in the incisor region.