Trail showed that distant feedback improved quality of panoramic radiographs in short term.



Panoramic radiographs are regularly used in dental practice and a number of studies have highlighted that the quality of these films is often less the optimal.T he aim of this trial was to assess the value of a quality improvement programme for panoramic radiography.

40 volunteer dental practices were randomly allocated to active (n=20) or control (n=20). Active practices were asked to submit 5 consecutive radiographs following which their received feedback, which all members of the team were asked to act upon.  They were then asked to submit two further batches of 5 and then 10 films for assessment.  Control practice submitted 20 consecutive radiographs and received feedback.   At 2 months a follow up assessment of 12 active and control practice was undertaken.  Processing and technical faults were identified.

  •  All practice submitted the required number of films for assessment.  The majority were taken by dentists (58.5%) the remainder by dental nurses
  •  The ‘active’ practices, showed significant reductions in the technical and processing faults compared with the ‘control’ practices after both rounds of feedback.
  • At the two-month follow-up there were still significant differences between the two groups.

The authors concluded

This cluster randomised controlled trial showed that distance feedback is an effective method in instructing dental practitioners to correct technical and processing errors experienced in producing panoramic radiographs. This intervention was effective in the short term whilst the practitioners were actively receiving feedback and for 8 weeks afterwards.


With the widespread use of panoramic films and dental radiography accounting for a significant proportion of radiation that patients are exposed to it is important that the radiographs are taken appropriately and are of sufficient diagnostic quality.  This study highlights that a simple feedback exercise was sufficient to improve radiograph quality at least for a period of up to 2 months.  Whether we should be taking as many panoramic films as we do is another question as these  in a previous study two of these  authors  published in 2012 noted

The study found that there was no support for the use of panoramic radiographs in routine screening as there was no net diagnostic benefit to the patient.


Rushton MN, Rushton VE, Worthington H. The value of a quality improvement programme for panoramic radiography: A cluster randomised controlled trial. J Dent. 2013 Jan 18. doi:pii: S0300-5712(13)00005-5. 10.1016/j.jdent.2012.12.009. [Epub ahead of print] PubMed PMID: 23337088.

Rushton MN, Rushton VE. A study to determine the added value of 740 screening panoramic radiographs compared to intraoral radiography in the management of adult (>18 years) dentate patients in a primary care setting. J Dent. 2012 Aug;40(8):661-9. doi: 10.1016/j.jdent.2012.04.018. Epub 2012 Apr 27. PubMed PMID: 22542499.

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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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