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Purpose: To study the application value of digital tomosynthesis(DTS)examination in the diagnosis of atlanto-axial subluxation of children comparing with CT or DR.Methods:Local ethics committee approval was obtained,and all participants provided informed written consent.One hundred and fifty nine consecutive patients who suspected with atlanto-axial subluxation were recruited prospectively(mean age,7 years; M: F=1.7∶1).All of them were children and then were randomly divided into group digital radiography(DR,n=53),DTS(n=53)and CT(n=53).Radiation dose of DR,DTS and CT were respectively measured and compared.Image qualities were evaluated by two senior radiologists using a qualitative 5-point scale.Results:The mean value of radiation dose of DR,DTS and CT were respectively 14.64 ± 8.70mSv,16.92 ± 0.62mSv,1892 ± 152mSv.There were no significant differences(P=0.06)between group DR and DTS,but there were significant differences between group DR/CT or DTS/CT.(P<0.01,P<0.01).The DR and DTS radiation dose were much lower than CT,only accounting for 0.8%and 0.9%of it.Through image quality analysis,we found that quality of group DTS and CT were significantly better than DR.To dostatistical analysis with Mann-Whitney U test on the results of image quality score.Two observers found that all aspects of group DTS and group CT were significantly better than DR(P<0.00; P<0.00).Although there was no significant difference between quality of CT and DTS image(P=0.81; P=0.71).Two observers uniformity was considered well(Kappa = 0.91).Conclusion:In pediatric atlanto-axial rotatory subluxation diagnosis,DTS can replace DR wholly.CT has the advantages in the post processing,which can clearly display the sagittal and coronal details of joint,but its radiation dose is far more than DTS.Therefore,in consideration of the radiation and injury to children,on the basis of the premise strict physical examination,DTS may berecommended preferred.Certainly the experience of clinicians is important.