Does dose optimisation in digital panoramic radiography affect diagnostic performance?
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ORIGINAL ARTICLE
Does dose optimisation in digital panoramic radiography affect diagnostic performance? Luciano Augusto Cano Martins 1 & Danieli M. Brasil 1 & Laís A. Forner 2 Francisco Haiter-Neto 1 & Deborah Q. Freitas 1 & Matheus L. Oliveira 1
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Cassiana Viccari 2
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Received: 20 April 2020 / Accepted: 17 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
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. Keywords Panoramic radiography . Diagnostic imaging . Radiation protection . Thermoluminescent dosimetry
Introduction Panoramic radiography is a diagnostic imaging modality that allows broad visualization of dentomaxillofacial anatomical structures and the detection of bone lesions and impacted teeth
* Luciano Augusto Cano Martins [email protected] 1
Department of Oral Diagnosis, Division of Oral Radiology, Piracicaba Dental School, University of Campinas (UNICAMP), Av. Limeira, 901-Areião, Piracicaba, SP, Brazil
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
[1, 2]. Although film-based and digital panoramic imaging systems are equivalent for many purposes [3], digital radiographs have been used for more than 20 years and the radiation dose to
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