The use of panoramic radiography in a dental accident and emergency department

Objectives: To determine the rate of appropriate requests for panoramic rad iography (PR) in a Dental Accident and Emergency Department and the implica tions for patient dose. Methods: Two hundred and seventy-one requests for PR during July 1998 were assessed by two dental radiologists and categorised as appropriate or inapp ropriate based on established selection criteria. Incidental findings that might alter patient management were also noted. Results: One hundred and fifty-seven requests (58%) were considered appropr iate and 114 (42%) inappropriate. The most common inappropriate request was to assess disease localised to one or two teeth. Dental students were invo lved in 186 requests and 76 of these (41%) were inappropriate. The estimate d saving in collective radiation dose over the month of the study if approp riate radiographs had been taken, would have been approximately 540 mu Sv, a reduction of 70%. Three out of 114 (3%) inappropriate, PRS showed minor i ncidental findings. Conclusions: A considerable proportion of requests for PR were inappropriat e. In most of these cases, periapical radiographs would have provided more detail with less radiation dose. The lar-e number of inappropriate requests involving dental students has implications for educators. The use of local selection criteria based on currently accepted guidelines would have reduc ed the dose substantially.