Introduction: In dental medicine, patient doses are low, but due to the stochastic nature of the effects of ionizing radiation (IR), they still increase the risk of developing malignant and hereditary diseases. Therefore, dental examinations using IR must be justified and optimized. Optimization ensures diagnostically adequate radiographs with the lowest possible patient exposure. One of the tools for optimization is the use of diagnostic reference levels (DRLs). Purpose: Optimization of existing imaging protocols for panoramic dental X-ray imaging on the NewTom GiANO HR X-ray unit at the Health Center Ravne na Koroškem. Methods: We divided the study into five parts. In the first part, we analyzed patient doses from retrospectively obtained radiographs before optimization. The second part involved X-ray imaging of a head and neck phantom to determine CNR values to assess quality and reproducibility of the radiographs. Additionally, we conducted a subjective review of the image quality depending on the dose. In the third part, dentists evaluated quality of retrospectively obtained radiographs. Based on their assessments, we determined the best combination of program and settings for optimization. In the fourth part we carried out optimisation and determined new exposure parameters for the chosen combination. For the optimized protocols, we determined the average dose loads by gender. Finally in the fifth part, dentists assessed the quality of the radiographs after optimization. Results: Through optimization, we reduced the average dose loads for males from 182 mGy cm² to 148 mGy cm² (a decrease of 19 %), and for females from 144 mGy cm² to 128 mGy cm² (a decrease of 11 %). In both cases, this reduction represents a statistically significant difference (p=0.001). We also analysed the scores of the radiographs and found that in 17 criteria out of 20 quality criteria, there were no statistically significant differences between the radiographs taken before and after optimization. For the remaining three criteria where differences were detected, after consulting with the dentist, we confirmed that these differences were not clinically significant. Discussion and conclusion: Through optimization, we significantly reduced dose loads for both genders while maintaining the quality of the radiographs. Despite optimization, the dose loads for male and female patients remained above the national DRL (Diagnostic Reference Level) of 100 mGy cm². However, the results of the image quality analysis after optimization suggest that further reduction in dose loads is feasible with continued optimization. Additionally, optimization could potentially be enhanced by post-processing of radiographs.
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