CBCT indications, imaging protocols, and field-of-view selection in pediatric patients: a multicenter retrospective study

This study aimed to evaluate the indications for cone-beam computed tomography (CBCT), field of view (FOV) selections, and imaging protocols from the perspective of the ALADAIP principle — As Low as Diagnostically Acceptable, being Indication-oriented and Patient-specific — proposed by the DIMITRA Project, and to determine the intercenter variability of these practices. In this multicenter retrospective cross-sectional study, the records of 240 patients aged 18 years or younger who underwent CBCT imaging between 2020 and 2024 were reviewed from the archives of three university faculties of dentistry. Demographic characteristics, indications for CBCT imaging, FOV selections, imaging protocols, departments requesting CBCT examinations, and technical imaging parameters were retrospectively evaluated. The imaging practices were evaluated according to the ALADAIP principle. Data were analyzed using Pearson’s chi-square test and the Fisher–Freeman–Halton exact test, with statistical significance set at p < 0.05. The mean age of the patients was 13.05 ± 3.51 years, and 53.3% were female. The most common indication for CBCT imaging was impacted teeth (36.3%), followed by other indications (27.1%), bone pathologies (16.3%), dental anomalies (10.4%), and dentoalveolar trauma (10.0%). Significant differences were observed among the centers in terms of indications for CBCT imaging ( p = 0.015), FOV selections ( p < 0.001), imaging protocols ( p < 0.001), and the distribution of departments requesting CBCT examinations ( p < 0.001). In addition, FOV selection differed significantly according to both clinical indication ( p < 0.001) and age group ( p = 0.010), whereas no significant association was found between clinical indication and imaging protocol selection ( p = 0.079). In CBCT practice, imaging decisions should be planned not solely according to the indication, but also on a patient-specific basis by considering patient age, the anatomical region to be imaged, and diagnostic requirements. The observed intercenter differences in FOV selection and imaging protocols, together with the limited use of low-dose protocols, support the need for more effective implementation of the patient-specific and indication-oriented imaging approach proposed by the DIMITRA Project in clinical practice.