Document Type: Original Research


1 MD, Department of Prosthodontics, Faculty of Dentistry, Mazandaran University of Medical Sciences, Mazandaran, Iran

2 PhD, Department of Radiation Medicine, Shahid Beheshti University, Tehran, Iran

3 MD, Department of Prosthesis, Faculty of Dentistry, Mazandaran University of Medical Sciences, Mazandaran, Iran

4 PhD, Obesity and Eating Habits Research Center, Endocrinology and Metabolism Molecular–Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran

5 PhD, Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran

6 MD, Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran



Background: Panoramic imaging is one of the most common imaging methods in dentistry. Regarding the side-effects of ionizing radiation, it is necessary to survey different aspects and details of panoramic imaging. In this study, we compared the absorbed x-ray dose around two panoramic x-ray units: PM 2002 CC Proline (Planmeca, Helsinki, Finland) and Cranex Tome (Soredex, Helsinki, Finland).
Materials and Methods: In this cross-sectional study, 15 thermoluminescet dosemeters (TLD-100) were placed in 3 semi-circles of 40cm, 80cm and 120cm radii in order to estimate x-ray dose. Around each unit, the number of TLDs in each semi-circle was 5 with equal intervals. The center of semicircles accords with the patient’s position. Each TLD was exposed 40 times. These dosemeters were read out with a Harshaw Model 4000 TLD Reader (USA). The calibration processing and the reading of dosemeters were performed by the Atomic Energy Organization of Iran.
Results: The mean absorbed dose in three lines of PM 2002 CC Proline was 123.2±15.1, 118.0±11.0 and 108.0±9.1 µSv, (p=0.013). The results were 140.4±15.2, 120.2±10.4 and 111.6±11.2 µSv in Cranex Tome (p=0.208), which reveals no significant difference between two systems.
Conclusion: There are no significant differences between the mean absorbed dose of surveyed models in panoramic imaging by two units (PM 2002 CC Proline and Cranex Tome). These results were less than occupational exposure recommended by ICRP, even at the highest calculated doses.


  1. Lurie GA. Panoramic imaging. Oral radiology: principles and interpretation. Louis: Mosby; 2004. p. 191.
  2. Piedra I. The Levandoski Panoramic Analysis in the diagnosis of facial and dental asymmetries. J Clin Pediatr Dent. 1995;20:15-21. PubMed PMID: 8634190.
  3. Mattila M, Kononen M, Mattila K. Vertical asymmetry of the mandibular ramus and condylar heights measured with a new method from dental panoramic radiographs in patients with psoriatic arthritis. J Oral Rehabil. 1995;22:741-5. PubMed PMID: 8606331.
  4. Osman F, Scully C, Dowell TB, Davies RM. Use of panoramic radiographs in general dental practice in England. Community Dent Oral Epidemiol. 1986;14:8-9. PubMed PMID: 3456878.
  5. Rushton VE, Horner K, Worthington HV. Aspects of panoramic radiography in general dental practice. Br Dent J. 1999;186:342-4. PubMed PMID: 10333640.
  6. Tugnait A, Clerehugh V, Hirschmann PN. Radiographic equipment and techniques used in general dental practice: a survey of general dental practitioners in England and Wales. J Dent. 2003;31:197-203. PubMed PMID: 12726704.
  7. Gijbels F, Jacobs R, Bogaerts R, Debaveye D, Verlinden S, Sanderink G. Dosimetry of digital panoramic imaging. Part I: Patient exposure. Dentomaxillofacial Radiology. 2014.
  8. Gijbels F, Jacobs R, Debaveye D, Bogaerts R, Verlinden S, Sanderink G. Dosimetry of digital panoramic imaging. Part II: occupational exposure. Dentomaxillofacial Radiology. 2014.
  9. American Dental Association Council on Scientific Affairs. The use of dental radiographs: update and recommendations. J Am Dent Assoc. 2006;137:1304-12. PubMed PMID: 16946440.
  10. Wingren G, Hallquist A, Hardell L. Diagnostic X-ray exposure and female papillary thyroid cancer: a pooled analysis of two Swedish studies. Eur J Cancer Prev. 1997;6:550-6. PubMed PMID: 9496457.
  11. Wingren G, Hatschek T, Axelson O. Determinants of papillary cancer of the thyroid. Am J Epidemiol. 1993;138:482-91. PubMed PMID: 8213752.
  12. Arndt D, Lenz U, Konig W. Fatal skin epithelioma in a stomatologist professionally exposed to x-rays. Berufsdermatosen. 1975;23:201-6. PubMed PMID: 1212190.
  13. Foley SJ, Pay A, Howell GP, Holt S. Metastatic squamous cell carcinoma of the hand and review of the literature. J R Army Med Corps. 1995;141:102-4. PubMed PMID: 7562734.
  14. Jacobs R, Vanderstappen M, Bogaerts R, Gijbels F. Attitude of the Belgian dentist population towards radiation protection. Dentomaxillofacial Radiology. 2014.
  15. Mettler FA, Jr., Huda W, Yoshizumi TT, Mahesh M. Effective doses in radiology and diagnostic nuclear medicine: a catalog. Radiology. 2008;248:254-63. PubMed PMID: 18566177.
  16. White, S.C. and M.J. Pharoah, Oral Radiology: Principles and Interpretation. Mosby Elsevier: St. Louis, Missouri; 2009. p. 448-52.
  17. Commission EU. Radiation Protection 136. European Guidelines on radiation protection in dental radiology. Office for Official Publications of the EC. 2004.
  18. Gavala S, Donta C, Tsiklakis K, Boziari A, Kamenopoulou V, Stamatakis HC. Radiation dose reduction in direct digital panoramic radiography. Eur J Radiol. 2009;71:42-8. PubMed PMID: 18448296.
  19. Ludlow JB, Ivanovic M. Comparative dosimetry of dental CBCT devices and 64-slice CT for oral and maxillofacial radiology. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008;106:106-14. PubMed PMID: 18504152.
  20. Brenner DJ, Doll R, Goodhead DT, Hall EJ, Land CE, Little JB, et al. Cancer risks attributable to low doses of ionizing radiation: assessing what we really know. Proc Natl Acad Sci U S A. 2003;100:13761-6. PubMed PMID: 14610281. PubMed PMCID: 283495.
  21. Zielinski JM, Garner MJ, Krewski D, Ashmore JP, Band PR, Fair ME, et al. Decreases in occupational exposure to ionizing radiation among Canadian dental workers. J Can Dent Assoc. 2005;71:29-33. PubMed PMID: 15649338.
  22. In: International Commission on Radiological Protection. ICRP Publication 60: 1990 Recommendations of the International Commission on Radiological Protection. Elsevier Health Sciences; 1991. Available from:
  23. Kim IH, Mupparapu M. Dental radiographic guidelines: a review. Quintessence Int. 2009;40:389-98. PubMed PMID: 19582243.
  24. Ludlow JB, Davies-Ludlow LE, White SC. Patient risk related to common dental radiographic examinations: the impact of 2007 International Commission on Radiological Protection recommendations regarding dose calculation. J Am Dent Assoc. 2008;139:1237-43. PubMed PMID: 18762634.
  25. Yasuda H, Takami M, Ishidoya T. Changes in optical transmission caused by gamma ray induced coloring in photoluminescence dosimeter. Health Phys. 2006;90:565-8. PubMed PMID: 16691104.
  26. Hayakawa Y, Kobayashi N, Kuroyanagi K, Nishizawa K. Paediatric absorbed doses from rotational panoramic radiography. Dentomaxillofac Radiol. 2001;30:285-92. PubMed PMID: 11571549.
  27. Vallo J, Suominen-Taipale L, Huumonen S, Soikkonen K, Norblad A. Prevalence of mucosal abnormalities of the maxillary sinus and their relationship to dental disease in panoramic radiography: results from the Health 2000 Health Examination Survey. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;109:e80-7. PubMed PMID: 20219592.
  28. Devlin H, Yuan J. Object position and image magnification in dental panoramic radiography: a theoretical analysis. Dentomaxillofacial Radiology. 2014.
  29. Nair MK, Nair UP. Imaging of mandibular trauma: ROC analysis. Acad Emerg Med. 2001;8:689-95. PubMed PMID: 11435182.
  30. Persson RE, Hollender LG, Powell VL, MacEntee M, Wyatt CC, Kiyak HA, et al. Assessment of periodontal conditions and systemic disease in older subjects. II. Focus on cardiovascular diseases. J Clin Periodontol. 2002;29:803-10. PubMed PMID: 12423292.
  31. Drozdzowska B, Pluskiewicz W, Tarnawska B. Panoramic-based mandibular indices in relation to mandibular bone mineral density and skeletal status assessed by dual energy X-ray absorptiometry and quantitative ultrasound. Dentomaxillofac Radiol. 2002;31:361-7. PubMed PMID: 12424634.
  32. Cho BH. Diagnostic performance of dental students in identifying mandibular condyle fractures by panoramic radiography and the usefulness of reference images. Imaging Sci Dent. 2011;41:53-7. PubMed PMID: 21977475. PubMed PMCID: 3174461.
  33. Tierris CE, Yakoumakis EN, Bramis GN, Georgiou E. Dose area product reference levels in dental panoramic radiology. Radiat Prot Dosimetry. 2004;111:283-7. PubMed PMID: 15266083.
  34. Nilsson L, Rohlin M, Thapper K. Exposure distribution, absorbed doses, and energy imparted for panoramic radiography using Orthopantomograph model OP 5. Oral Surg Oral Med Oral Pathol. 1985;59:212-9. PubMed PMID: 3856810.
  35. Martin C. Effective dose: how should it be applied to medical exposures? The British journal of radiology. 2014.
  36. Kuroyanagi K, Hayakawa Y, Fujimori H, Sugiyama T. Distribution of scattered radiation during intraoral radiography with the patient in supine position. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998;85:736-41. PubMed PMID: 9638710.
  37. Bankvall G, Hakansson HA. Radiation-absorbed doses and energy imparted from panoramic tomography, cephalometric radiography, and occlusal film radiography in children. Oral Surg Oral Med Oral Pathol. 1982;53:532-40. PubMed PMID: 6954429.
  38. Frederiksen N. Specialized radiographic techniques. Oral radiology; Principles and interpretation, 5th ed. Louis: Mosby; 2004. p. 262-3.