Pesawat Panoramic-

tomografi
Setio Adi Saputro, SST.,M.Pd.,M.K.K.K
 Introduction
Panoramik disebut juga Orthopantomografi atau Rotografi.
Secara etimologis orthopantomografi berasal dari kata :

• Ortho berasal dari bahasa Yunani yang berarti normal atau lurus.
• pan berasal dari bahasa Inggris yang berarti menyeluruh.
• Tomos berasal dari bahasa Yunani berarti potongan atau irisan.
• Graphic berasal dari bahasa Yunani berarti gambaran atau catatan.

Jadi dari asal kata tersebut dapat disimpulkan bahwa orthopantomografi (OPG) berarti
pemeriksaan radiologis dari gigi beserta rahangnya yang berbentuk melengkung sehingga
terlihat gambaran yang lurus dari film dengan menggunakan prinsip tomografi.
 Tomografi
Teknik radiografi khusus dengan cara mengaburkan bayangan struktur
objek yang superposisis untuk menampakan secara lebih jelas struktur yang
diperiksa (principles od Radiographic Imaging An Art And Science, 1992)

Nama Lain: Planigraphy, stratigraphy, laminography, Tomografi (ICRU 1962)

Andre Edmond Marie Bocage (bapak

anatomy sectional imaging)
Dertmatologis yang menemukan teknik ini (1916) dan
dipatenkan pada tahun 1921

Tabung sinar x dan kaset bergerak berlawanan arah

dalam bidang pararel, dengan objek tidak bergerak
 Theory
Untuk menghasilkan gambar yang lebih jelas dari suatu
lapisan objek tubuh dengan cara menggerakan 2
diantara 3 komponen melalui satu titik sumbu yang
dikenal dengan istilah isocenter/pivot/fulcrum

Pencitraan dengan irisan objek, dengan menggerakkan

sumber sinar-x dan film ke arah yang berlawanan
selama pemaparan.

Pemerlukan pergerakan kepala tabung sinar X dan film

yang terkontrol dan akurat

Objek yang berada di pusat rotasi (setinggi titik

fulcrum) akan tampak fokus, sedangkan objek lainnya
akan tampak buram atau tidak fokus.
 Panoramic
Radiografi panoramik gigi adalah teknik radiografi yang
menghasilkan gambaran kedua rahang dan masing-masing gigi
pada satu film radiografi ekstraoral.
Perkembangan peralatan radiografi panoramik mewakili sebuah
inovasi besar dalam bidang pencitraan gigi karena,
sebelumnya, gambar radiografi gigi hanya terdiri dari proyeksi
lateral intraoral dan miring dari rahang yang diambil
menggunakan perangkat rontgen gigi konvensional.
Saat ini peralatan radiografi panoramik ditemukan secara rutin
di sebagian besar departemen radiologi rumah sakit dan di
sebagian besar praktik kedokteran gigi umum.
 Perkembangan Teknik

1898 1933 1951

Bouchacourt 1922 Numata

1943 Dr. Walter Ott & Sydney
Blackman
Bouchacourt pertama Pada awal tahun 1930-
an, beberapa peneliti aktif Swiss Dr. Walter Ott
kali mengusulkan mengembangkan peralatan
dalam mengejar dan
kemungkinan panorama intraoral dan Sydney
mengembangkan metode
penggunaan sumber pencitraan struktur Koch dan Sterzel Blackman, seorang ahli radiologi
radiasi intraoral untuk 'melengkung' seperti perusahaan Jerman Koch Inggris, memodifikasi prinsip-prinsip
menggambarkan dan Sterzel yang diusulkan oleh Dr. Ott, yang
AF Zulauf rahang. Numata
mengusulkan dan mengembangkan mengarah pada pengembangan
rahang pada awal Paten peralatan sinar-X
komersial peralatan panorama
rotasi ekstraoral membahas prinsip-prinsip peralatan panorama
tahun 1898 'Panograph' oleh Watson and Sons
dikeluarkan untuk AF teknik panorama sejak intraoral
tahun 1933 Ltd
Zulauf pada tahun 1922
di amerika
 Perkembangan Teknik

1
Gambar 1 Paten diberikan kepada Koch dan Sterzel Aktiengesellschaft di Düsseldorf, Jerman, untuk
peralatan x-ray yang mampu menggambarkan rongga tubuh. Horst Bergen dinobatkan sebagai penemu
peralatan tersebut. 2 Unit panorama intraoral panograf yang dikembangkan Watson and Sons Ltd, 3. Paten
peralatan sinar-X rotasi dikeluarkan untuk AF Zulauf pada tahun 1922
 Pesawat Panoramic Intraoral
Peralatan panorama intraoral menggunakan anoda berbentuk konus yang terletak di ujung batang tipis
dengan titik fokus (sumber sinar x-ray) yang sangat kecil (kira-kira 0,1 mm) dibandingkan dengan
peralatan konvensional.

Teknik intraoral mempunyai beberapa masalah fundamental.

1. sangat memakan waktu,
2. memerlukan pemaparan terpisah untuk rahang atas dan rahang bawah
3. Teknik ini juga mengakibatkan distorsi geometrik yang parah
4. Paparan radiasi dosis tinggi ke jaringan mulut, terutama lidah.

Paradoksnya, faktor-faktor ini tampaknya tidak menghalangi pengembangan unit panorama intraoral yang
mengandalkan isotop radioaktif sebagai sumber radiasinya. Untungnya, eksperimen lebih lanjut dengan
peralatan panorama intraoral jenis ini dengan cepat dibatasi, bukan hanya karena risiko radiasi yang nyata
namun juga biaya isotopnya.
 Indikasi Pencitraan Panorama
Indikasi pencitraan panoramik terbatas pada situasi dimana pencitraan intraoral
tidak praktis dan tidak realistis
Radiografi panoramik tidak boleh digunakan sebagai alat skrining untuk pasien
baru
Indikasi pencitraan panoramik berikut ini diambil dari Kriteria Seleksi Radiografi Gigi,
sebuah dokumen yang diterbitkan oleh Fakultas Dokter Gigi Umum (UK):

 Dimana lesi tulang atau gigi yang belum erupsi tidak dapat terlihat pada radiografi
intraoral.
 Pada pasien dengan pertumbuhan gigi yang terbengkalai dimana secara klinis terdapat
beberapa gigi karies dan terdapat penyakit periodontal lanjut yang menyeluruh secara
bersamaan.
 Sebagai bagian dari penilaian ortodontik dimana terdapat kebutuhan klinis untuk
mengetahui keadaan gigi dan ada tidaknya gigi. (Selain itu, British Orthodontic Society
telah mengeluarkan pedoman tentang penggunaan radiografi dalam ortodontik.)
 Dalam penilaian gigi molar ketiga sebelum ekstraksi bedah.
 Komponen Pesawat panoramik
1. Kepala tabung sinar-X. Menghasilkan sinar x-ray. Sinar diarahkan
sedikit ke atas, menuju slot pada tempat kaset.
2. Diafragma. Berkas sinar X dikolimasi oleh diafragma sehingga
membentuk berkas berbentuk celah vertikal. Lebar sinar x-ray tidak
boleh lebih dari 5 mm.
3. Tempat kaset. Memiliki lembaran logam di bagian depan yang
mencegah hamburan foton sinar-X mencapai kaset, yang dapat
menurunkan kualitas gambar. Terdapat celah vertikal sempit pada
dudukannya yang berhadapan langsung dengan sumber sinar-X. Hal
ini memastikan bahwa hanya sejumlah kecil film yang diekspos pada
satu waktu.
 Komponen Pesawat panoramik
4. Kereta kaset. Memindahkan kaset ke belakang tempat kaset selama
pemaparan.
5. Blok gigitan. Digunakan untuk menemukan lokasi gigi seri atas dan
bawah dalam hubungan tepi-ke-tepi pada lapisan fokus. Ini juga
memisahkan gigi atas dan bawah untuk mencegah tumpang tindih.
6. Penanda berkas cahaya. Digunakan untuk memposisikan pasien
dengan benar, untuk memastikan gigi berada pada lapisan fokus.
7. Peralatan penahan kepala. Memungkinkan kepala pasien tidak
bergerak setelah diposisikan secara akurat.
8. Holder. Minimalkan pergerakan pasien
Pesawat Panoramic
ekstraoral
Pesawat pamoramic
Prinsip Panoramic / Tomografi

Gerakan rotasi simultan dari sumber sinar-X, kaset, dan tempat kaset pada
bidang horizontal menghasilkan lapisan fokus berbentuk U pada gigi dan
rahang
Gambar diperbesar antara 10 - 30%. Perbesaran pada bidang vertikal dan horizontal sama, hanya untuk
struktur yang berada di tengah lapisan fokus (fulcrum).
Struktur di luar lapisan fokus terdistorsi, kabur, dan seringkali tidak dapat dikenali. Beberapa penelitian
menunjukkan bahwa lapisan fokus dapat menyempit jika ditangkap secara digital, sehingga posisi pasien menjadi
lebih penting.
Waktu pemaparan 12-20 detik untuk orang dewasa. Sangat penting bagi pasien untuk tetap tidak bergerak
selama pemaparan, untuk mencegah pergerakan artefak pada gambar.
GAMBAR Pengaruh posisi suatu benda terhadap ukuran
radiografinya.
A. Mandibula menopang cincin logam yang
ditempatkan di tengah fokus (fulcrum). Mandibula
diposisikan di tengah-tengah fokal palung dengan
menempatkan tepi insisal gigi seri tengah pada
lekukan di ujung alat pemosisian batang gigitan.
B. Hasil radiografi panoramik menunjukkan distorsi
minimal pada cincin logam.
C. Mandibula dan cincin diposisikan 5 mm dari fulcrum.
D. Hasil radiografi panoramik menunjukkan perbesaran
horizontal pada gigi cincin dan gigi mandibula.
E. Mandibula dan cincin diposisikan 5 mm di depan
takik pada bite-block.
F. Hasil radiografi panoramik menunjukkan minifikasi
horizontal pada gigi cincin dan gigi mandibula.
Gambaran skematis tentang hubungan antara sumber sinar-X, pasien, kolimator, dan Kaset. Ketika tabung sinar-X
bergerak mengelilingi satu sisi pasien, kaset bergerak pada sisi yang berlawanan. Kaset bergerak melewati
kolimator secara simultan untuk merekam gambar.
Citra Radiografi Panoramic
Gambaran Panoramic Normal

gambar panorama dibagi menjadi 9 area yang membentuk 6 zona yang

harus dipelajari untuk membayangkan setiap radiograf atau gambar
panorama
Pembagian zona panoramik
Zona 1: Gigi-geligi. Bidang oklusal harus sedikit melengkung ke atas untuk membuat garis seperti senyuman. Akar gigi
anterior ada pada gambar, dan gigi posterior berukuran sama di setiap sisi tanpa lebih banyak kontak yang tumpang tindih
di satu sisi dibandingkan sisi lainnya.
Zona 2: Hidung-sinus. Turbinat harus tetap berada di hidung, dan bayangan langit-langit keras harus melintasi sinus di atas
apeks gigi posterior rahang atas.
Zona 3: Mandibula. Di sini korteks inferior harus berbentuk kurva halus dan tulang hyoid serta bayangan tulang belakang
tidak boleh bertumpuk.
Zona 4: TMJ. Kedua kondilus harus berada di tengah zona. Tidak ada kondilus yang lebih tinggi atau lebih besar dari
kondilus lainnya. Kondilus tidak boleh keluar dari bagian atas atau samping gambar.
Zona 5: Ramus & tulang belakang. Di banyak mesin panorama, gambar ganda nyata dari tulang belakang tidak terlihat di
bagian tepinya. Jika terlihat, tulang belakang tidak boleh bertumpukan pada ramus dan harus berada pada jarak yang sama
dari ramus di kedua sisi. Gambar tulang belakang harus vertikal dan tidak miring. Ramus harus memiliki lebar yang sama di
setiap sisinya dan tidak ada bayangan ramus di kedua sisinya.
Zona 6: Hyoid. Gambaran hyoid dapat dilihat di kedua sisi. Mereka harus menjadi bayangan cermin satu sama lain dan
tidak ada satupun yang lebih besar, lebih tinggi, atau lebih tersebar dari yang lain. Hyoid tidak boleh menyebar ke seluruh
mandibula. Jarak dari badan hyoid ke mandibula harus sama di kedua sisi.
 Gambaran error panoramic

Pasien diposisikan terlalu jauh ke depan

Cek:
1. Gigit pada alur di bite-block.
2. Periksa lampu posisi caninus (canine positioning light) : harus sejajar di tengah gigi taring
bawah
 Gambaran error panoramic

Pasien diposisikan terlalu jauh ke belakang

Cek:
1. Gigit pada alur di bite-block.
2. Periksa lampu posisi caninus (canine positioning light) : harus sejajar di tengah gigi taring
bawah
 Gambaran error panoramic

Posisi Dagu tidak pada sandaran dagu

Cek:
1. Posisikan dagu pada sandaran, dan sesuaikan ketinggian sandaran dagu.
2. Pastikan pasien berdiri tegak dengan leher dan punggung lurus.
3. posisikan dagu ke bawah sekitar 5 derajat.
4. Periksa lampu posisi bidang Frankfort (IOML).
5. Periksa Canine positioning light untuk memastikan sesuai posisi.
Gambaran error panoramic

Pasien merosot atau membungkuk

Gambaran error panoramic

Dagu miring terlalu rendah

Gambaran error panoramic

Dagu miring terlalu tinggi

 Keuntungan

• Ditoleransi dengan baik oleh pasien

• Waktu pemaparan yang minimal bila
dibandingkan dengan radiografi intraoral
• Cakupan anatomi yang luas
• Dosis pasien yang relatif rendah
 Kerugian
• Resolusinya tidak sebaik film intraoral.
• Detail tidak sebaik film intraoral
• Superimposisi bayangan nyata/ganda
• Hanya objek pada titik fokus yang terlihat jelas
• Distorsi gambar
-Gigi yang tumpang tindih
- Pembesaran
- Objek di luar fokus terdistorsi dan kabur.
THANK YOU
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