SUMMARIES A study of panoramic in adult patients Screening panoramic radiology of adults in general dental practice: radiological findings by V. E. Rushton, K. Horner and H. V. Worthington Br Dent J 2001; 190: 495-501

Aim of patients’ radiographs (56.3%) had no radiological findings of To identify the radiological findings from routine screening relevance to treatment. panoramic radiographs taken of adult (≥18 years) patients in general dental practice. Conclusions The choice of radiographic examination for the majority of Method patients in the study did not follow current guidelines. Dentists Forty-one general dental practitioners (GDPs) who routinely diagnosed fewer abnormalities than did experts. While many took panoramic radiographs of all new adult patients were radiological findings are revealed by panoramic radiography, these recruited. In total, they submitted 1,818 panoramic radiographs may either duplicate information from bitewing radiographs or are of consecutive patients along with basic patient information, often of no significance to treatment planning. This study did not radiological reports and treatment plans. The radiographs were provide evidence to support the practice of routine panoramic also reported by ‘experts’ (consensus of two dental radiologists). radiography of all new adult patients. Radiological findings were recorded from the GDP assessments (dentist RY), the experts (expert RY), after exclusion of findings that would have been seen on posterior bitewing radiographs (MRY) and after exclusion of findings of no relevance to In Brief treatment (MRYT). • This study in a general dental practice setting looked at the diagnostic yield from routine panoramic radiography of Results new adult patients There was no significant difference in age profile between the • Many of the dentists involved in the study did not follow study sample and Dental Practice Board population figures (P = current guidelines on the choice of radiographic 0.26). No radiographs other than the panoramic radiograph had examination for new patients been taken for 57.1% of patients. For the GDP assessments, only • Radiological abnormalities were identified on the 4.6% of patients had radiographs with no radiological findings, overwhelming majority of radiographs, but many of these while for the experts this proportion was 3.1%. With the would have duplicated findings available on more accurate exception of the assessment of periodontal loss, the experts posterior bitewing radiographs diagnosed significantly greater proportions of cases as having • When the treatment plans of the dentists were taken into positive radiological findings. Agreement between dentist and account, the majority (56.3%) of radiographs made no expert assessments varied greatly. When findings from bitewing contribution to patient management radiographs were excluded, no radiological findings were • The routine use of panoramic radiography on new adult recorded on the radiographs of 17.2% of patients. When patients is not supported by the findings of this study proposed treatment plans were taken into account, the majority

Comment his paper is the latest from Rushton and In order to assess the potential radiolog- stage in this study is to identify any possi- Ther colleagues exploring the use of ical findings the investigators first exclud- ble clinical indicators and is, therefore, panoramic radiography in general dental ed those which would have been found on awaited with interest. practice. They showed in a previous paper posterior bitewings, since these are by gen- This paper raises one other issue of cur- that 42% of GDPs practised routine eral agreement the radiograph of choice rent concern. There was a wide disparity panoramic screening of all new patients. for the new patient, and then those of no between the dentists and the radiologists This practice breaches a fundamental pre- relevance to treatment. In less than 5% of in their radiological findings. IR(ME)R cept of the Ionising (Medical cases, there were no relevant radiological 2000 requires as part of optimisation that Exposure) Regulations (2000) which state findings, rising to 17% if the findings from all radiographs must be reported. It is that all radiographs must be justified so bitewing radiographs were excluded, and important to appreciate that observer that they are of positive benefit to a patient’s over 55% when the proposed treatment variation is not the same as observer error. management or prognosis. plans were taken into account. Written radiology reports are already part The present paper examines whether These results confirm previous reports of some third party quality assurance pro- such screening radiography can in any way that the significant diagnostic yield from grammes. They should be included in be justified in terms of the actual radi- screening panoramic radiography is low every practitioner’s risk management ographic findings. The GDPs taking part in but are novel in that they relate to a wider, strategy and integral to the undergraduate the study provided the basic clinical infor- general dental practice population. They curriculum. mation with each radiograph together with also provide sound evidence to confirm a radiological report and treatment plan. current guidelines: there is no justification P. N. Hirschmann The radiological findings were compared for the practice of routine panoramic Consultant Dental Radiologist, with those of two dental radiologists. screening of new dental patients. The next Leeds Dental Institute

BRITISH DENTAL JOURNAL, VOLUME 190, NO. 9, MAY 12 2001 491