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Possibilities of dose reduction in lateral cephalometric radiographs and its effects on clinical diagnostics

¹ Department of Oral Radiology, School of Dental Medicine, University of Tübingen, Germany; ² Department of Medical Biometry, University of Tübingen, Germany; ³ Department of Oral and Maxillofacial Plastic Surgery, University of Tübingen, Germany

*Correspondence to: Priv.-Doz. Dr Gabriele Kaeppler, Zentraler Röntgenbereich, Zentrum für ZMK, Osianderstrasse 2-8, Universität Tübingen, D-72076 Tübingen, Germany; Email: gabriele.kaeppler{at}med.uni-tuebingen.de

Received 16 August 2005; revised 6 February 2006; accepted 2 March 2006

Objectives: The aim of the present study was to determine (1) the absorbed and the exit radiation doses for cephalometric exposures on a phantom head with various exposure settings and image receivers, and (2) the diagnostic image quality for various modalities assessed on cephalometric radiographs of patients.

Methods: The dose measurements for lateral cephalometric radiographs were performed with a semiconductor detector, and also with thermoluminescent detectors and an Alderson phantom. Both the integral and the effective doses were determined. Two radiographs of each patient (n=119) were taken at two different times, one at a low tube potential setting, 75±5 kV, and one with a decreased dose. Film–screen systems with speed class 400 and one storage phosphor plate were used. Five observers assessed the radiographs for the visualization of six cephalometric reference points on a three-point scale with –1, 0 and 1. Twenty-seven image pairs were rescored to determine inter- and intrarater reliability. The statistical analysis was done using analysis of variance and Tukey's HSD (honestly significant difference) post hoc test.

Results: Increasing the tube potential setting led to an average dose reduction to 83% (integral dose) or to 87% (effective dose). Instead of taking the radiograph at a low tube potential setting (75 kV), a dose reduction of about 15% was feasible at a high tube potential setting (90 kV). A significant difference in reference point visibility existed between film radiographs at low tube potential settings (mean score 0.984) and at high tube potential settings (90 kV, mean score 0.958). For the storage phosphor plates, there was no significant difference to the film–screen combinations at low tube potential and halved milliampere seconds settings. In the second assessment, there was a high degree of agreement (96.6%) compared with the first assessment (unadjusted for random agreement).

Conclusions: As there is only minimal dose reduction at increased tube potential settings, for a dose reduction, it seems to be more useful to use storage phosphor plates at unchanged tube potential and halved milliampere seconds settings compared with the film–screen combination.

Keywords: lateral cephalometric radiography; tube potential setting; intensifying screens, storage phosphor radiography