|Figure 1. “That x-ray’s in here somewhere!” If the procssor didn’t eat it and the insurance company didn’t lose it, when you finally find the x-ray you want, it won’t be nearly as good an image or contain as much diagnostic information as a digital x-ray.|
General Electric has a clever TV ad showing the advantages of new technology. It opens by showing the faces of a hot, sweaty, struggling boat crew straining at the oars to propel a primitive ship. The captain provides the necessary “motivation” with a lash. Suddenly, a similar ship powered by a sail instead of human muscle overtakes their ship. The oarsmen’s faces reflect awe as they see that the crew on the sail-powered ship is relaxing at a party on the deck, and the captain is water-skiing behind this faster, “new technology-enhanced” ship!
Digital radiography is very much like a sail. An integral part of the paperless practice, it is probably the most expensive single component and requires some thought and planning to prevent it from “capsizing” a practice. The purpose of this article is to discuss some of these considerations.
FOUR TYPES OF DIGITAL X-RAY
Direct digital sensors are what most dentists think of when they hear “digital x-ray.” Instead of conventional x-ray film, an electronic sensor is placed in the patient’s mouth. The x-ray image is captured in a series of individual “cells” on the sensor and then transmitted by a wire (or now wirelessly) to a computer for processing. The number of cells on the sensor determines the number of pixels (the dots that make up a digital image) available at the computer. As with a digital camera, the more pixels, the higher the resolution of the image. But more pixels cost more money to manufacture and more computer speed and memory to process. However, additional pixels do not necessarily translate into additional diagnostic image quality or the ability to see more “line-pairs.”
WHICH DIGITAL X-RAY?
|Table 1. Advantages and disadvantages of digital radiography modalities|
So, which of these wonderful modalities is right for you? Table 2 lists some of the “environmental” considerations, such as the type of procedures you do, your office computer infrastructure, and—probably most importantly—your staff. I think every office should purchase a flatbed scanner with transparency adapter. This is a great way to immediately start benefiting from digital technology. Duplicating chemical films and using the associated software is a great way to introduce “computer-allergic” staff to some of the labor-saving advantages offered by paperless dentistry. It also allows you to send patients home with a very graphic 8- x 10-inch image of their tooth. The patient and other family members can easily see the big, black cavity about to pounce on the poor little gray pulp. With apologies to my endodontic colleagues, no patients want to have the “nerve pulled out of their tooth.” A nice printout not only is worth a 1,000 words but helps prevent both root canals and failed appointments!
|Table 2. “Environmental” considerations for digital radiography modalities|
*The last column, staff considerations, is probably the most important. Digital radiography, like paperless dentistry, requires training and experience. You are unlikely to find replacement staff or “fill-in” who already knows how to operate in such an office environment.
In addition to the sensor modalities you select for your office, you also need dental imaging software. The benefits provided by this software are at least as important as the sensors themselves. This software is usually sold with direct or phosphor plate x-ray systems. When you purchase sensors, you are pretty much “stuck” with them until you decide to buy new ones. There is usually no way to “upgrade” a sensor. With software, however, upgrades are common, expected, and usually fairly inexpensive, so features not offered by your specific software today may be added tomorrow.
Any discussion of dental computers—and especially digital x-ray—needs to at least mention the importance of backup. I hope you don’t go out in your boat without your life preserver, and I hope you don’t attempt digital x-ray or paperless dentistry without valid, tested backup systems. The means and media to do the backup are less important than the end result. Think of it this way: if your office burned to the ground tomorrow, what would you need to do to restore all your patient records, including x-rays and all of the critical practice information required to resume the care of your patients? The only correct answer I can see is this: you would go home and retrieve the “backup computer” that was configured with all your office software and contained all of your current data. If you cannot do this, you should not, in my opinion, be doing either digital x-ray or paperless dentistry.
RUN UP THE SAILS!
Water skiing behind a sail-powered boat may be an exaggeration, but the advantages of sail power over oar power are undeniable. Likewise, the advantages of digital radiography and its contributions to paperless dentistry are profound. It is better, easier, and ultimately less expensive and more reliable than chemical, plastic, and paper-based systems. You see things you simply could not see before, and you can make better decisions on behalf of your patients.
Dr. Stephenson participates in a paperless and wireless restorative dental practice in San Leandro, Calif. You can obtain information about his seminars by visiting paperlessdentistry.com. He can be reached at firstname.lastname@example.org.