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To assess the accuracy of a limited cone-beam volumetric imaging system in detecting incipient proximal caries.Fifty extracted premolars were used. On 100 surfaces examined, 71 proximal carious lesions were found; 47 were limited to the enamel, and 24 penetrated into the dentin. A limited cone-beam volumetric imaging system (CBVI), 3D Accuitomo (J. Morita Mfg. Corp., Kyoto, Japan), was used. Insight films (Eastman Kodak, Rochester, NY) were used for comparison. Seven experienced oral radiologists determined the presence of lesions using a continuous rating scale. The area measure (Az) values were calculated from the receiver operating characteristic curve obtained for each modality and observer.The mean Az-values were 0.63 ± 0.02 for 3D Accuitomo and 0.63 ± 0.03 for film. Analysis of variance showed no statistically significant difference between 3D Accuitomo and film.A limited CBVI, 3D Accuitomo, could not enhance the accuracy in detecting proximal carious lesions.