What is the most common cause of a ghost image in a panoramic radiograph?

A ghost image in a panoramic radiograph is primarily caused by the presence of objects that are not removed prior to imaging, such as jewelry or dentures. These items can create reflections or shadows on the film, resulting in the distinctive "ghost" appearance seen in the final image.

When a patient has any foreign objects in or on their body during the exposure, such as earrings, necklaces, or removable dental appliances, these items can lead to artifacts that can mimic anatomical structures but are not actually present. This can confuse the interpretation of the radiograph and lead to misdiagnosis.

Improper positioning can also lead to issues in the radiograph, but it typically results in distortion or blurring rather than ghost images. Incorrect exposure settings primarily affect the overall quality and contrast of the image, and faulty film processing might cause issues such as streaks or spots but not specifically ghost images. Therefore, the presence of unremoved jewelry or dentures is the most accurate cause for ghost images in a panoramic projection.