Clinical indications and determinants of field-of-view selection in cone-beam computed tomography among pediatric patients: a two-center cross-sectional study

Cone-beam computed tomography (CBCT) is increasingly used in pediatric dentistry, but field-of-view (FOV) selection should be carefully optimized to minimize radiation exposure in young patients. This study aimed to describe the distribution of clinical indications, region of interest (ROI), and FOV selection in CBCT examinations of pediatric and adolescent patients, and to examine associations with age group, sex, referral department, and study center. This retrospective, two-center, cross-sectional study included 3,439 archived CBCT examinations from two university dental faculties. Patients aged 6–18 years were grouped into 6–9, 10–12, and 13–18 years. Data on sex, referral department, main indication, sub-indication, ROI, and FOV were recorded. Statistical analyses included chi-square tests, Cramér’s V, adjusted standardized residual analysis, Spearman correlation, and multivariable logistic regression. Dental anomalies were most frequent in children aged 6–9 years (54.65%), whereas bone pathologies predominated in adolescents aged 13–18 years (37.20%). Smaller FOVs (8 × 5 cm and 8 × 9 cm) were more common in younger children, whereas 12 × 5 cm and 12 × 10 cm FOVs predominated in adolescents (all p < 0.001). Bilateral maxillary imaging was the most common ROI overall, whereas combined maxilla-mandible imaging became more frequent with increasing age. Age showed a weak but significant positive correlation with FOV size ( r = 0.122, p < 0.001). In multivariable analysis, patients aged 10–12 years (OR 1.808; 95% CI 1.353–2.416; p < 0.001) and 13–18 years (OR 2.647; 95% CI 2.055–3.411; p < 0.001) had higher odds of selecting a large FOV than those aged 6–9 years. CBCT indications, ROI distribution, and FOV selection patterns in pediatric and adolescent patients varied significantly by age group, clinical indication, and referral context. These findings underscore the importance of age- and referral-context-sensitive CBCT decision-making and may inform future efforts to optimize radiation protection for young patients.