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Diagnostic accuracy of in vitro panoramic radiographs depending on the exposure

¹ Department of Oral Radiology, School of Dental Medicine, University of Tübingen, Tübingen, Germany; ² Department of Medical Biometry, University of Tübingen, Tübingen, Germany; ³ Department of Oral and Maxillofacial Plastic Surgery, University of Tübingen, 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 28 July 2005; revised 8 January 2006; accepted 1 February 2006

Objectives: The aim was to evaluate the effect of dose reduction on diagnostic accuracy in panoramic radiographs with increased tube potential and reduced milliampere settings.

Methods: Panoramic radiographs of 12 dried human skulls prepared with lesions in the bone, teeth and peri-implant bone in ascending size were taken. Medium and regular film–screen combinations and a storage phosphor system were used for imaging. All systems were exposed at a low and a high tube potential level. To compare the dose at different tube potential settings, dose length product was measured at the secondary collimator. Five observers assessed the presence (response: 1) or absence (response: 0) of lesions. Sensitivity, specificity and diagnostic accuracy were evaluated and 36 000 ratings were made in all. All settings were repeated once. Intrarater agreement was expressed by Cohen's kappa coefficient.

Results: There was no significant difference in diagnostic accuracy between a medium and a regular film–screen combination at a low tube potential level (70 kV; 0.935 and 0.930) and the medium film–screen system at a high tube potential level (85 kV; 0.926). Compared with this group, the regular film–screen combinations at high tube potential level (85 kV, 0.906) and all digital radiographs were significantly different (0.886 and 0.866), irrespective of the tube potential level. The digital panoramic radiograph was only comparable with the best film–screen combinations with an exposure for a medium film–screen system and at a low tube potential level. Sensitivity was 89.9% and specificity 93.7%. The kappa coefficient for intrarater agreement was high (0.81).

Conclusions: The medium intensifying screen can be used at high tube potential settings instead of low tube potential settings, or the regular intensifying screen can be used at low tube potential settings with the same diagnostic value. A dose reduction of about 40% is possible. The storage phosphor plates should be exposed at least like a regular film–screen system and at a low tube potential level.

Keywords: radiography, panoramic; tube potential (kV) setting; intensifying screens; storage phosphor radiography