Evaluation of Common Diagnostic Errors in Panoramic Radiographs and Interobserver Agreement in Error Identification

Abstract

Aim: Panoramic radiography is frequently used in dental practice as an imaging technique that provides an extensive view of facial anatomical structures. Achieving high-quality radiographic images requires precise positioning and technique. This study aims to evaluate the quality of panoramic radiographs, to identify common errors that compromise diagnostic adequacy, and to analyze interobserver agreement levels concerning these errors. Material and Method: A study analyzed 947 panoramic radiographs from the archive of Ordu University based on nine specific error criteria. Four research assistants evaluated the diagnostic quality of each image, classifying them as “excellent,” “diagnostically acceptable,” or “unacceptable.” Inter-observer agreement was measured with kappa statistics, and overall agreement was evaluated using the Fleiss ? test. Results: The rate of incorrect radiographs was 66.1% to 78.8%, with the most common error criterion differing for each observer. The least common error was the chin tipped too low for observers 1 and 2, and the patient positioned forward for observers 3 and 4. The highest inter-observer agreement was observed regarding the presence of foreign objects on the radiographs, while the lowest agreement occurred in cases where the patient was positioned too far back. Overall, the diagnostic quality of the panoramic radiographs was rated as “acceptable,” with scores ranging from 60.5% to 69.5%. The Fleiss Kappa analysis indicated fair agreement among the four observers in assessing radiographic quality (k=0.252). Conclusion: This study demonstrates that errors in panoramic radiography significantly impact image quality and diagnostic accuracy, highlighting the need for standardization, the use of various imaging models, and enhanced training in radiographic education.