Th 144924

Sensors and Sensibility

March 1, 2004
Do the math. Digital radiography makes sense ...

Digital radiography is one of the top additions to the high-tech office. Besides the efficiency within the office and with patients, many busy dentists find that digital radiography has a positive return on investment. The companies promoting these products have excellent spreadsheets showing cost per film; personnel time used for taking, processing, and mounting radiographs; and spared chemicals. These numbers do add up — do your own simple math.

Digital radiographs might also have advantages for emergency visits and endo. Currently, most dentists have the assistant seat the patient, take a film, and run off to develop it. The doctor then strolls in, goes over the same information again with the patient, and waits impatiently for the wet film. With instant digital X-rays, the film is taken and within seconds the patient is ready for a treatment explanation, anesthetic, and treatment. What a time-saver!

Here are other factors to consider:

(1) Is digital providing better diagnosis? Look at a digital film and see if you can diagnose more easily. Is it better or more difficult? With today's computer-adjusted images, you can now look at a film 10 times the original size, which makes it easier (although in some cases more difficult initially) to see things. Software adds value above film, because you can tweak the images to see things more clearly. Adjustments in brightness and contrast are only the tip of the iceberg of what you can do to enhance your digital image.

Click here to enlarge image

(2) Be aware of compatibility and specifications. Consider your current and future computer needs. Enhanced imaging from one company's software may not work with your planned or current system. Some companies bombard you with technical specifications about types of sensors (CCD, CMOS), lines of resolution, etc. Although important, the final decision should be made on what you can see on the screen and how your diagnosis will be impacted. Sensor size and shape are also factors in terms of information as well as patient comfort. You might find that although two sensors are the same size, the actual exposed areas are different. This, and the technique of the operator, will have an impact on the position of the sensor when taking an image.

While the common perception of digital radiography is wired or wireless instant sensors that cost more than $4,000 each, there is a digital alternative — phosphor plate sensors. These are small flexible "plates" that are actually the thickness of the film itself (sans packet) and are used just like traditional film. They are "developed" through a digital processor called a scanner. Although initial costs of these systems are comparable to wired sensors, the annual maintenance is much lower. If a plate is damaged, a new one costs less than $50. There is also no change in technique from your traditional film-taking, and all of your current film positioners are usable. In fact, the bitewings can be taken with tabs, and verticals present no problems, noting that the images and software are comparable with sensors. All of the software enhancements available to the wired sensors are available with the phosphor plates. In an ideal situation, both systems would co-exist: phosphor plates for routine films and wired sensors for emergency and endo procedures. Some companies are now bundling these systems in cost-effective packages.

Click here to enlarge image

null

3D X-ray using digital radiography
photo courtesy of Trophy

Click here to enlarge image

(3) Factor in the "wow" from patients for instant imaging. Patients can finally see what you are trying to show them as you look together and, in many situations, co-diagnose.

Whether a new patient is in your office for a full-mouth series or a recall patient is in for bitewings, the ability to produce instant images is a powerful educational tool.

One myth about digital radiographs is that the wire is in the way. If you typically take films using a positioning device, the patient's mouth is already partially opened to bite on the plastic device. The wire runs along the device. If you are used to seeing bitewings with a tab, the wire will have an impact on that positioning. Vertical bitewings also present a challenge. This is one area where the new wireless sensors and the phosphor plates have an advantage.

The lower radiation advantage of digital radiographs has been touted from the beginning; however, you should note that Kodak has done an admirable job reducing exposure with its Insight film. Digital radiography may make it necessary to update your older X-ray heads. You will note that the newer units are much lighter, easier to manage, and have controls that are more user-friendly. The timers are also more precise and give better quality with both film and digital radiographs.

(4) Digital radiography merges with chartless offices. If your goal is to become chartless, you will find that retrieval of these images from a computer is far faster than rummaging through a chart with multiple mounts and little envelopes. One misconception is that once you go digital you have to go back and scan all of the existing films. This is not true, nor is it really feasible. Older practices will still depend on that chart for archival information, but after a time you will use your computers exclusively for retrieval.

There will be some instances where scanning and digitizing certain X-rays will be desired and helpful. If that becomes an issue, you will need a scanner with a special cover called a "transparency adapter." You will find that the units compatible with our needs are more expensive than typical scanners, because the lighted cover must be at least 8" x 10" in order to copy a full series of radiographs, a pan, or ceph. The better units also have the light moving along with the scanning bar, giving a brighter, more uniformly illuminated image. The budget models usually have an area of about 2" x 4", which would only copy two or three films at a time. Some of the digital radiography software products have scanning input capabilities, but two excellent stand-alone systems can be found at tigerview.com and apteryxware.com.

(5) Digital communication helps simplify communication with others. In addition to showing patients their mouth, you can send a picture to a specialist instantly for evaluation. The images can be emailed or sent to a secure Web site if the specialist has that capability. Colleagues who are online can be of help with second opinions, and there are also several online dental resource groups that accept digital and photographic images for case studies and discussions. Many insurance companies will also allow you to send digital images with electronic claims, with no chance of a lost film.

(6) Make a choice based on your practice. The point of this discussion is that digital radiography is here and ready for your practice. Plan to attend a dental meeting to gather more information, or call any of the companies for an in-office demo. Take a look at the images and see what interproximal caries, bone levels, PDLs, etc., look like. Be certain that all costs are spelled out including installation, training, software, updates, initial warranty, and most important, the maintenance contract. When evaluating contracts on the wired (and wireless) hard sensors, be sure you understand what is and is not covered, any costs for replacement sensors, and the procedure and time necessary to get a replacement sensor.

(7) Involve your team. One final note — be sure your team is involved in this transition. This is a radical change of procedure, and your team members are the ones who will be using this the most. They must be convinced that it is better than the old system — not only for themselves, but for the patients. Be sure to contact other offices who have made this transition and ask if they would ever go back to film.

Readers: Please let Woman Dentist Journal know your experiences so we can follow up on this article with further advice for the multitasking woman dentist.

Paul Feuerstein, DMD
Dr. Feuerstein is a general practitioner in North Billerica, Mass. He installed one of dentistry's first computers in 1978, and has taught courses on technology throughout the country ever since. He maintains a Web site at www.computers indentistry.com. You may contact him at drpaul@com putersindentistry.com.