Incidental Findings on Large-Field-of-View Cone Beam Computed Tomography Scans: Prevalence, Anatomical Distribution and Predictors of Clinical Relevance in a Retrospective Analysis of 203 Patients

Objectives: This study aimed to assess the prevalence, anatomical distribution, and clinical relevance of incidental findings in large-field cone beam computed tomography (CBCT) scans and to identify patient-related predictors associated with their occurrence. Methods: We conducted a retrospective analysis of 203 patients in a single center who were undergoing CBCT (June 2020–January 2022; field of view: 11 cm × 10 cm) for routine diagnostics or preoperative planning. Findings were categorized by clinical relevance, mapped relative to the primary region of interest (ROI), and analyzed via logistic/Poisson regression for demographic/clinical associations. Results: Incidental findings occurred in 79.3% of the patients, with 89.6% outside the ROI. Dental/sinusoidal airway findings were the most common. Increasing age (OR = 1.11; p < 0.001) and reduced dentition compared to full dentition (>24 teeth vs full dentition IRR = 1.91; p < 0.001 and ≤24 teeth vs full dentition IRR = 2.17; p < 0.001) were significant predictors for relevant incidental findings. Other clinical factors showed elevated but non-significant risk estimates. CBCT indication did not predict the occurrence of incidental findings. Conclusions: Incidental findings in large-volume CBCT scans are common and frequently located outside the primary ROI. Age and reduced dentition were identified as potential predictors. While these findings may support a more individualized approach to CBCT volume selection, any expansion of the field of view must adhere to established radiation protection principles. Prospective studies are needed to further define risk-adapted imaging strategies.