Are children's dental panoramic tomographs and lateral cephalometric radiographs sufficiently optimized?

Objectives: Children are especially vulnerable to harmful effects of ionizing radiation. Cutting down the dimensions of the X-ray beam is the most effective way to reduce the patient dose. We evaluated the appropriateness of field-size in the most frequent radiographs, dental panoramic tomographs (DPTs) and lateral cephalometric radiographs (LCRs) among 7- to 12-year-olds. Materials and methods: The image field-size of 241 DPTs and 118 LCRs was analysed. The image field was considered appropriate when it did not include anatomic structures beyond the area of clinical interest. The image field was compared with factors such as the age of the patient, the radiographic equipment used and the programme selected. Moreover, we assessed the use of thyroid shield in LCR. Results: The field-size was too large in 70% of the DPTs horizontally and in 96% vertically. None of the DPTs were segmented. Every LCR showed appropriate limitation anteriorly, but the image field was too large in 54% posteriorly, in 86% superiorly, and in 76% inferiorly. A thyroid shield had been used in only 71% of cases. Conclusion: Most DPTs and LCRs had been performed sub-optimally. An abundancy of DPTs had been taken using an adult programme, and the field-size had not been sufficiently adjusted in LCRs, possibly for technical reasons. To facilitate adherence to radiological best practice the equipment used for DPTs and LCRs should facilitate the adjustment of field-size in both the vertical and horizontal planes. In addition, those involved in taking radiographs should maintain their skills through regular update courses.