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Does dose optimisation in digital panoramic radiography affect diagnostic performance?

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Abstract

Objectives

To compare the overall diagnostic performance of digital panoramic radiographs obtained with low-dose protocols and to estimate the absorbed dose in the head and neck.

Materials and methods

Forty-eight panoramic radiographs were obtained from eight imaging phantoms using six exposure protocols of progressively lower tube voltages (kVp) and currents (mA), as follows: (1) 70 kVp and 12.5 mA, (2) 66 kVp and 10 mA, (3) 66 kVp and 8 mA, (4) 66 kVp and 5 mA, (5) 66 kVp and 4 mA and (6) 66 kVp and 3.2 mA. Five oral radiologists independently evaluated the images and reported all detectable radiographic findings. Intra-examiner reproducibility was assessed by re-evaluation of 25% of the images. The data were analysed using the McNemar and weighted Kappa tests. Absorbed doses of the six protocols were obtained from thermoluminescent dosimeters placed inside a Rando phantom and compared using one-way ANOVA with post hoc Tukey (α = 0.05).

Results

The overall diagnostic performance of panoramic radiographs obtained with low-dose protocols did not differ from that of panoramic radiographs obtained with the highest dose (p > 0.05). Moreover, substantial agreement was observed between all protocols. Protocol 1 resulted in the highest absorbed dose and protocols 4, 5 and 6 in the lowest absorbed doses, with the difference being significant (p ≤ 0.05).

Conclusion

Although digital panoramic radiography is considered a relatively low-dose examination, the radiation dose can be further reduced without negatively affecting its overall diagnostic performance.

Clinical relevance

Considering the risks associated with X-rays, digital panoramic radiographs can be obtained at even lower exposure levels.

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Funding

This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brazil (CAPES) – Finance Code 001.

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Authors and Affiliations

  1. Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP), Av. Limeira, 901-Areião, Piracicaba, SP, Brazil

    Luciano Augusto Cano Martins, Danieli M. Brasil, Francisco Haiter-Neto, Deborah Q. Freitas & Matheus L. Oliveira

  2. Faculty of Philosophy, Sciences and Letters of Ribeirão Preto (FFCLRP/USP), Centro de Instrumentação, Dosimetria e Radioproteção (CIDRA), University of São Paulo, Av. Bandeirantes, 3900 - Vila Monte Alegre, Ribeirão Preto, SP, Brazil

    Laís A. Forner & Cassiana Viccari

Authors
  1. Luciano Augusto Cano Martins
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  2. Danieli M. Brasil
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  3. Laís A. Forner
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  4. Cassiana Viccari
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  5. Francisco Haiter-Neto
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  6. Deborah Q. Freitas
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  7. Matheus L. Oliveira
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Contributions

All authors contributed to the study conception and design. Preparation of the materials and data collection were performed by LACM, MLO, DMB and FHN. Preparation of the thermoluminescent dosimeters and radiation dosimetry analysis were performed by LAF and CV. Statistical analysis was performed by DQF. The first draft of the manuscript was written by LACM and all authors reviewed it. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Luciano Augusto Cano Martins.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors. Our sample (dry skulls, mandibles, hyoid bone and cervical vertebrae) was obtained from the biobank of the Piracicaba Dental School, University of Campinas (UNICAMP), subjected to the local Ethics Research Committee, and approved (approval #: 3.235.082).

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For this type of study, individual formal consent is not needed.

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Martins, L.A.C., Brasil, D.M., Forner, L.A. et al. Does dose optimisation in digital panoramic radiography affect diagnostic performance?. Clin Oral Invest 25, 637–643 (2021). https://doi.org/10.1007/s00784-020-03535-7

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  • DOI: https://doi.org/10.1007/s00784-020-03535-7

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