What is the most likely cause of cervical spine ghosting on an OPG?

Cervical spine ghosting on an orthopantomogram (OPG) typically occurs when the patient's neck is extended or positioned too far forward during the imaging process. This positioning can cause the cervical spine to appear in the image as a ghost-like shadow, which can obscure important diagnostic details.

When the neck is extended, the cervical vertebrae may project onto the image in such a way that they create an artifact rather than a clear representation of the anatomy. Proper positioning of the patient's head is crucial in obtaining a clear OPG; it should neither be too far back nor too far forward. This ensures that the cervical spine is captured appropriately without distortions that could lead to misinterpretations by the dental or medical professional reviewing the X-ray.

In contrast, while tilting the head or having poor neck posture can create various other imaging artifacts, they are less likely to specifically cause cervical spine ghosting compared to the improper positioning described. Alignment issues with the film may affect overall image quality but do not specifically result in the characteristic ghosting of the cervical spine.