Diagnostic image quality of digital panoramic radiography of pediatric patients

Background and Aim: Panoramic radiography is an important diagnostic tool in oral health care. This study aimed to evaluate the quality of panoramic images (PIs) of children aged 3 to 12 and to define the correlation between age and frequency of patient positioning and specific operating errors. Materials and Methods: 650 PIs of pediatric patients (276 female and 374 male) were divided into 5 subgroups according to the patients age (3-4, 5-6, 7-8, 9-10, 11-12, nsubgroup=130). The frequency of patient positioning and operating errors was determined. 15 operating errors were distinguished among which: patient too far forward or backward, head turned or tilted, chin tipped too high or too low, chin not on the chin rest, incorrect tongue position/lips open, bite guide not used and patient movement during exposure. Additionally, PIs were categorized into three groups: excellent, diagnostically acceptable and diagnostically unacceptable. For each unacceptable PI the inadequate region was noted. Results: Eight types of errors occurred significantly more often as the child was younger (p<0.05, chi-square trend test); only patient positioned too far back showed an increase with age (p<0.001). Only 3.7% of the PIs were excellent, 60.5% were diagnostically acceptable and 35.8% were diagnostically unacceptable. In the diagnostically unacceptable PIs the anterior region of the jaws was mostly affected. Conclusion: Positioning errors occurred rather frequently when taking PIs in children. For improving the radiographic quality and reducing the number of retakes, attention to PI errors with type and frequencies may contribute possible solutions