My answers to the $10,000 question are Dr. Leah Patrick, the Dexis niche, and ScanX

By Jeff Carter, DDS

Many months ago, we decided to analyze the viability of digital radiography as a total replacement for film-based radiographs in dentistry. After all, according to trade publications, high-tech experts, and marketing efforts by manufacturers, thousands of practitioners have thrown away all film and processing equipment in their offices and successfully made the switch to digital radiography. And, according to some "experts," if you are not taking digital radiographs and do not have immediate plans to make the switch, you are behind the times and on the verge of practicing substandard dentistry.

In the last issue of Dental Equipment & Materials, we asked for referral lists from vendors that fit our criteria for just such digital radiographic usage with a focus on general practitioners. Our criteria were established by Dr. Marty Lipsey in his quest to successfully digitize radiographs in a large group practice. This was our request of any and all vendors of CCD or CMOS sensors:

Please send us a referral list of six practices that utilize your sensors to take all bitewings and periapical radiographs on adults and children. Please note if any of the listed practices are also utilizing digital CCD or CMOS panoramic sensors.

In the last issue of DE&M, we also made this request:

Any practitioners that meet the criteria of utilizing CCD or CMOS sensors to take all bitewings and periapical radiographs on adults and children and would like to be a resource for other dentists, send us your contact information. Please note if you are also utilizing digital CCD or CMOS panoramic sensors.

The answers to our two requests are in and they are highly illuminating.

Dr. Leah Patrick

Of the responses received from any source, Dr. Leah Patrick of Dickson, Tenn., is the one and only practitioner who I have been able to locate in nine months who fulfills what I consider to be the prototypical digital radiography usage in a busy and successful dental office. Thank you Leah for sharing your experience and background with us in the following e-mail.

I recently read your article in Dental Equipment & Materials asking if anyone is using digital radiography exclusively. I wanted to write you and give you a brief description of my office. You may contact me if you would like more info!

I am a solo practitioner in Dickson, Tenn., and I opened my office in January 2001. This was a brand new practice and I made the decision to go "paperless" on the front end to avoid eventually having to convert. We do not have a dark room or X-ray film in the office! So, yes, we do all our X-rays digitally; it is the only choice we have. We love it. A small learning curve and we were off to the races and unable to fall back on "regular X-rays." We have EagleSoft for our dental software and Schick for our X-rays. When I opened this office, I did not know of another like it (technology-wise) and have since become a model for others. We love what we do and we love our technology. It makes our life simple. When we opened, we had two sensors (one adult and one child) and no pan. We grew very fast and added a digital pan in June 2001, and two more sensors in April 2002 along with a second hygienist.

I hope this information is helpful. We are a family practice in a small town with a very fun and colorful office. We love our computers and our X-rays and with technology there are always ups and downs, but the ups far outweigh the downs!

Why do I consider this example prototypical? The implementation of four Schick CCD sensors of at least two different sizes allows the simultaneous taking of bitewings and periapicals on adults and children. The use of one sensor in a busy five-operatory practice with two hygienists is not a viable option in my opinion, no matter how intricately you schedule.

Leah's addition of a digital panoramic unit five months into a new practice is telling and exemplary of her success. Leah and I agree on the highly diagnostic value of panoramic images in a general practice facility, not as a replacement for FMX but as an adjunct. In addition, panoramic image-taking is a very justifiable and valuable profit center for any practice. Obviously, panoramic or panoramic-cephalometric images are indispensable in many specialty practices.

Leah's investment breakdown to acquire the prototypical digital radiography hardware and software for a general practice facility included:
√ Four Schick CCD sensors and accessories — $33,000
√ Schick panoramic CCD sensor (retrofitted to a Soredex panoramic unit) — $17,995
√ Additional image management software cost beyond EagleSoft's basic package to manage and store captured digital radiographs — $8,000 to $10,000

Leah invested approximately $60,000 in Schick sensors and additional EagleSoft image software. This investment does not include items such as computers, monitors, servers, switches, networking cables, networking software, mounting solutions, data-entry devices, and system support services. Leah's success is also due in part to the collaborative efforts of the Schick-Patterson-EagleSoft team in the Nashville area. Dr. Leah Patrick can be reached at (615) 446-7878.

You may recall from the last article we described a practice with a system very similar to Leah's. That example was the practice of Dr. Benjamin Young, which was not prototypical from an investment standpoint. He was fortunate enough to purchase three Schick sensors and a panoramic retrofit kit for $21,000, a purchase price you won't be able to duplicate. Regardless, Dr. Young would also highly recommend his system to you and can be reached at (801) 352-8288 or (866) DRBEN YOUNG.

In summary, we found two general practices that highly recommend CCD sensors for taking all bitewings and periapical radiographs on adults and children. In addition, both of these practices utilize digital panoramic units.

The Dexis niche

I have communicated with several highly satisfied users of Dexis CCD sensors. Most of these practices are three- to four-operatory facilities and these same practices take most, if not all, bitewing and periapical radiographs on adults and children with the same-sized Dexis sensor. Most of these Dexis practices do not utilize a digital panoramic unit and, until recently, Dexis did not offer a CCD panoramic sensor option.

Initially, I was puzzled about how these Dexis practices remained satisfied with the use of only one sensor for both adults and children. In fact, I discovered the Dexis CCD sensor is equivalent to the traditional #1 film size and is closer in size to a #0 size film than it is to a #2 size film, which explains how the Dexis sensor can be used routinely on children.

On the other hand, the Dexis sensor (#1 size film equivalent) image capture is approximately 25 percent smaller than what is viewable on a #2 sized film. The Dexis sensor image capture is also approximately 17 percent larger than what is viewable on a #0 size film, the smallest film size available. Therefore, as advantageous as the smaller #1 sized sensor with rounded edges is to patient comfort, it may also require more images be taken to capture an adult FMX series. The worst-case scenario is that the exclusive use of the smaller Dexis sensor for FMX on an adult may require two to four additional images captured to duplicate what was previously viewable in an FMX with traditional film using a mix a #2 and #1 sized films.

Conceptually, it would seem you could purchase a #1 size Schick sensor or any other vendor's sensor and duplicate the Dexis approach of "one size fits all" for periapical and bitewing radiographs. However, I do not know of anyone who recommends that solution.

It is worth noting that the Dexis sensor connection to the CPU "floppy" (PCMCIA) port has consistently provided superior image quality in many instances over sensors that rely on connection to USB ports. And for approximately $10,000, you can purchase one Dexis CCD sensor and the required Dexis image-management software.

Ultimately, I believe Dexis has found a niche in the digital radiography market based on the "one size fits all" approach, superior image quality, and the comparatively lower investment cost. Keith Konowitz, Dexis Regional Manager in New York/New Jersey can be reached at (888) 883-3947, ext. 282, if you would like to obtain a list of dentists who could answer your questions on the successful utilization of the Dexis CCD sensor(s) in their practices.

ScanX™

I have previously suggested that phosphor plate scanning systems provide a viable alternative to traditional film. My experience is that ScanX has become the most popular and successful phosphor plate scanning system on the market. Congratulations to Air Techniques, long known for manufacturing high-quality air compressors, for making that happen.

I am not suggesting the phosphor plate systems are problem-free, but they are more easily integrated into dental facilities than their CCD or CMOS counterparts. One obvious negative aspect of ScanX and similar systems is that you do have to expend staff time and energy to scan phosphor plates. Some would make the point that the cost savings in phosphor plate systems is negated over time due to the extra "labor" involved with the scanning process versus direct CCD capture. I do not believe that is the case yet, especially if you include panoramic images. You can purchase the ScanX scanner, accessories, software, and multiple phosphor plates of all film sizes including panoramic, for $20,000 to $23,000. As your office overhead clock ticks, you could also make the point that waiting for your turn to use the one Dexis sensor or taking additional images due to the smaller-sized sensor negates the cost savings in the Dexis niche over time.

Thanks to Kent Searl, vice president of sales and marketing at Air Techniques, for providing this referral list to those of you that would like to learn more about ScanX as a viable replacement for film in your office.

For an alternative view of phosphor plate scanning systems, you may want to contact Dr. Gary Pearl at (203) 281-7722. Gary's comments are as follows:

I read the article in the September/October 2003 issue of Dental Equipment & Materials. I have had a phosphor digital X-ray system in the office for more than two years. The system can work, but my office has had a lot of problems. Film is clearer. Film is faster. Film causes fewer headaches. Film is cheaper. But, patients like digital images better. Call me and I'd be happy to discuss my experience with digital X-rays. We have taken about 30,000 X-rays with our phosphor plate system. I would recommend that a dentist think twice before switching from film to digital X-rays.

In conclusion my opinion is:

Is digital radiography a great technology? Yes!

Are we in a transition period from traditional film-based radiographs to digital radiographs? Yes!

Have thousands of dental practices thrown away all film and processing equipment in their offices and successfully made the switch to digital radiography? No.

If you'd like to contact one of your peers regarding their equipment, here are some suggestions. These numbers were provided to DE&M by the manufacturers.

Dexis

Dr. Weiner — (718) 464-3855
Dr. Maddalena — (631) 698-6161
Drs. Fishman & Roth — (212) 752-6537
Dr. Goldstein — (973) 366-7995
Dr. Gordon Ferguson — (973) 744-3181
Dr. Gerard — (973) 740-1277
Dr. Julie Stelly — (972) 867-2500
Dr. Bruce McArthur — (303) 935-9448
Dr. Jim McCreight — (970) 879-4703
Dr. Jeff Hambrice — (972) 442-2002
Dr. Michael Shields — (719) 634-3204
Dr. Gary Field — (719) 598-0872
Dr. Val Weenig — (719) 599-7453
Dr. Glen Hall — (325) 698-7560
Dr. Randy Yoshida — (808) 949-7333
Dr. Gerry Adachi — (808) 521-4421
Dr. Ian Topelson — (303) 296-8525