Özlem Büşra DOĞAN, Hatice BİLTEKİN
Clinical Dentistry and Research - 2026;50(2):138-147
Background and Aim: Accurate identification of panoramic radiographic artifacts is essential for improving diagnostic reliability and reducing unnecessary repeat imaging. This study aimed to classify panoramic radiographic artifacts by their formation mechanisms and evaluate image quality using the cumulative artifact burden based on total artifact count. Materials and Methods: This retrospective study included 500 panoramic radiographs. Images were classified into eight artifact categories, and the cumulative artifact burden was calculated from the total artifact count. Inter-observer agreement was assessed using Cohen's kappa( kappa), and reliability of the total artifact count using the intraclass correlation coefficient (ICC). Results: A total of 500 panoramic radiographs were evaluated. At least one artifact was identified in 92.0% of radiographs, whereas only 8.0% were artifact-free. According to the predefined image quality classification, 8.0% of radiographs were classified as excellent, 62.6% as acceptable, and 29.4% as unacceptable. Air space-related soft tissue artifacts were the most frequent findings, with improper tongue positioning observed in 43.6% of images. Transverse and vertical positioning artifacts were also common, whereas motion artifacts were relatively infrequent (3.0%). Inter-observer agreement demonstrated substantial to almost perfect reliability, with Cohen's kappa values ranging from 0.80 to 0.92 and excellent agreement for total artifact count assessment (ICC = 0.958). Conclusion: A mechanism-based classification combined with an artifact count-based burden assessment may provide a structured approach for evaluating panoramic image quality, although further validation is needed to determine its relationship with diagnostic acceptability.
