A clinical comparison of image quality and patient exposure reduction in panoramic radiography with heavy metal filtration.

Laboratory and clinical studies with the use of rare earth intensifying screens and four different forms of heavy metal elements serving as additional beam filtration were performed for panoramic radiography to identify the most efficacious system. Balanced density images were evaluated for contrast indices, resolution, relative dose reduction, and subjective image quality. Clinical studies were performed with a standard calcium tungstate imaging system and the four most promising experimental imaging systems that showed improvement over the standard system. Dosimetric studies were performed with the use of ionization chambers and thermoluminescent dosimetry (TLD) dosimeters. Exposure reductions of 34% to 79%, depending on the anatomic site and the imaging system used, were achieved. Subjective image quality was evaluated and analyzed statistically. This study concluded that the use of a Kodak Lanex regular screen/T-Mat G film with either Lanex screen or yttrium added beam filtration results in reduced patient exposure in panoramic radiography while image quality is maintained or improved.