Digital Radiography in General Practice: Is It Time to Convert?
The benefits of digital imaging in dentistry are numerous, yet many practitioners are hesitant to expand into this technology. Various strategies can be used to incorporate digital intraoral radiology into a practice. The payoff is typically improved efficiencies and better patient care.
Without continual growth and progress, such words as improvement, achievement, and success will have no meaning.” This quote from Benjamin Franklin speaks to the core human condition—as well as dentistry, where imaging has been a cornerstone of dental practices for more than a century. Today, digital imaging, first introduced by Francis Mouyen1 in 1987, is approaching critical mass in utilization due to the significant benefits it offers both practices and their patients.A study by iData Research in 20102 indicates that digital radiology is a global trend that is dramatically driving the rapid adoption of digital technology. Digital imaging systems are projected to double from 2009 to 2016, and annual sales of digital sensors in the United States are expected to increase at a compound annual growth rate (CAGR) of 9.2% by 2016. However, analog film is still dominant in the US, especially with some dentists reluctant to change because of costs or being comfortable with their analog systems. Nonetheless, now that the diagnostic quality of digital intraoral radiology is unquestioned,3-6 the majority of new offices are “going digital” or planning to. The exclusive distribution agreements between digital sensor manufacturers and major distributors (eg, DEXIS® with Henry Schein [www.henryschein.com]; Schick Technologies with Patterson Dental [www.pattersondental.com]) are a driving force for digital sensor radiology adoption. The two dental distribution conglomerates are engaging in aggressive marketing campaigns to further promote their lines of digital sensors.
Numerous articles7-11 confirm the benefits of digital imaging, but the decision to move into this technology should be made individually. Total cost beyond dollars must take into account staff and doctor time spent selecting, learning, and otherwise making the transition to the new system. Commonly, a major secondary event—like preparing the practice for sale, bringing in an associate, remodeling, or moving to a new location—is the impetus for making the change.
The first step is to realistically appraise the practice environment—that is, weigh what should change and what should not. Then, examine specific goals in keeping with financial resources and timelines. This involves considering existing and future needs for intraoral, extraoral, and 3-dimensional (3-D) radiographic imaging technologies.
Essentially, there are three methods for incorporating digital intraoral radiology into a practice:
• Digitizing intraoral x-ray films. This can be accomplished with a backlit scanner, placing film on a view box, and taking a digital photo or intraoral video of it, then importing these images into practice management software. This approach, however, does not eliminate the expenses of film and processing.
• Purchasing a photostimulable phosphor plate (PSP) system such as ScanX® (Air Techniques, Inc., www.airtechniques.com) or DIGORA® Optime (Soredex, www.soredex.com). This is less expensive than purchasing intraoral sensors and, because it is similar to the traditional protocol for taking x-rays, involves a minimal learning curve. In seconds, an image receptor captures and scans the image into the management software.
• Purchasing a direct digital sensor system that comes with image management software that, depending on the system, integrates or bridges with a practice’s existing practice management system. Sensor systems require a steeper learning curve, as the medium is rigid, wider, and not as flexible as film or phosphor plates.
Because most dentists already use practice management software, a useful starting point for the process of incorporating digital radiology is to contact the existing vendor to determine the sensor system that best integrates with the current program and request a demonstration of that system on existing hardware for evaluation. For dentists who are satisfied with the integration and image quality, building onto the existing platform by simply adding an application to the current base is easiest. However, an unsatisfactory result may indicate inadequate hardware or limitations with software, suggesting that the optimal solution may be a complete system overhaul.
Dentists should keep in mind that technology integration is a process, so the goal must be continually refined, incorporating new information as it is encountered. An example of this is the growing trend toward web-based practice management solutions. While the cloud’s ability to accommodate digital imaging has at this time some limitations, this should not deter those considering a move to a web-based system; however, be aware that such an imaging solution may not be as complete as an in-office system today. The compass for the practice should always be its vision and goals, not the transient limitations of technology, which is continually evolving.
Starting with a blank page—that is, with no existing computer or software infrastructure—simplifies the process immensely. The starting point should be software selection. Both dental supply houses mentioned previously—Henry Schein and Patterson Dental—can offer a one-stop solution of practice management software and the necessary technology components, along with set-up, training, financing, and support.
Those practices with practice management software that has only administrative workstations will need to add digital intraoral radiology. This can be most efficiently accomplished by adding clinical workstations to be networked with a dedicated server and integrated with the practice management and image management software programs. This allows each operatory within a practice to function independently, so that the hardware infrastructure is available for all functions. This provides greater utilization of the practice management program, increasing efficiency and saving time.
A reduced-cost option would be a mobile digital radiography solution in which a single sensor is connected to a laptop that is shared throughout the office. With this option, both the technology and data are available only to one person at a time, limitations that suggest this might be most appropriate as an interim solution enabling a practice to incrementally add this technology.
The focus of this article has been on intraoral radiographic sensor digital imaging. In the US market, sensor technology outpaces PSP 7 to 1. As for extraoral digital radiography, the entry of many companies into this market has significantly reduced costs. Multiple companies now offer digital panoramic/cephalometric/cone beam computed tomography (CBCT) units for less than a conventional full-size CBCT unit. These hybrid units with a small field of view (FOV) CBCT are excellent for general dentists who do single-implant placements.
Digital radiology is a critical asset to dentistry, where x-rays are used daily to make the diagnostic and treatment decisions that are the foundation of clinical practice. Having the ability to capture an image in any treatment room within a matter of seconds and view that image from any workstation enables dental teams to be more efficient and effective in rendering care. The time savings are extraordinary, as is the ability to show patients images in real-time and in an enlarged size viewable on a monitor; this, in turn, allows practitioners to educate and validate their recommendations in a more compelling manner than by holding a dental film against the operatory light or a view box. Reduced radiation exposures, as well as the lack of chemical waste, are significant benefits to the patient and to the environment. The overriding benefit of digital imaging technology is that it is a growing platform of applications that will continue to provide additional solutions for patients.12 Building a digital platform is essential for tomorrow’s dentist.
In short, digital imaging is one essential piece of the technology puzzle. The computer infrastructure, whether in the office or in the cloud—or in both—is the key element to making dental offices more productive and serving patients with today’s technology.
1. Mouyen F, Benz C, Sonnabend E, Lodter JP. Presentation and physical evaluation of RadioVisioGraphy. Oral Surg Oral Med Oral Pathol. 1989;68(2):238-242.
2. Gart C, Zamanian K. Global trends in dental imaging: the rise of digital [iData Research website]. July 27, 2010. www.idataresearch.com/global-trends-in-dental-imaging-the-rise-of-digital. Accessed May 30, 2013.
3. Van der Stelt PF. Modern radiographic methods in the diagnosis of periodontal disease. Adv Dent Res. 1993;7(2):158-162.
4. Wenzel A, Pitts N, Verdonschot EH, Kalsbeek H. Developments in radiographic caries diagnosis. J Dent. 1993;21(3):131-140.
5. Sanderink GC, Huiskens R, van der Stelt PF, et al. Image quality of direct digital intraoral x-ray sensors in assessing root canal length. The RadioVisioGraphy, Visualix/VIXA, Sens-A-Ray, and Flash Dent systems compared with Ektaspeed films. Oral Surg Oral Med Oral Pathol. 1994;78(1):125-132.
6. Farman AG. Fundamentals of image acquisition and processing in the digital era. Orthod Craniofac Res. 2003;6 suppl 1:17-22.
7. Levato CM. Technology integration: a journey, not a destination. Compend Contin Educ Dent. 2002;23(10 suppl 2):4-10.
8. Schleyer TK. Why integration is key for dental office technology. J Am Dent Assoc. 2004;135 suppl:4S-9S.
9. Farman AG, Levato CM, Gane D, Scarfe WC. In practice: how going digital will affect the dental office. J Am Dent Assoc. 2008;139 suppl:14S-19S.
10. Levato CM. Intraoral digital radiology: a safe, cost-efficient imaging solution. Compend Contin Educ Dent. 2011;32 spec no 4:48-50.
11. Levato CM. Putting technology in place successfully. J Am Dent Assoc. 2004;135 suppl:30S-37S.
12. Levato CM. Imaging in dentistry: a clinical perspective. Cosmetic Dentistry. 2010;3:14-20.
ABOUT THE AUTHOR
Claudio M. Levato, DDS
Private Practice, Bloomingdale, Illinois; Fellow, American College of Dentists, International Academy of Dental Facial Esthetics, Odontographic Society of Chicago, and International Congress of Oral Implantologists
CONTINUING EDUCATION Resources
Using Digital Technology to Enhance Restorative Dentistry: dentalaegis.com/go/cced433
Digital Radiography: A Valuable Tool for the Dental Team: dentalaegis.com/go/cced434
Intraoral Digital Radiography: Elements of Effective Imaging: dentalaegis.com/go/cced435