Digital imaging - yes!

April 1, 2000
The benefits and advantages of digital radiography made the author go from detractor to supporter of this new technology.

The benefits and advantages of digital radiography made the author go from detractor to supporter of this new technology.

Mike Maroon, DDS

When I was asked to write an article on the "pros" of digital radiography, my initial reaction was, "Why me?" You see, for years, I had been hesitant about making the move to digital radiography. In fact, in my seminars I hesitantly cautioned people about purchasing digital radiography. I don`t know what my main reason was, although there were several potential problem areas that I perceived to be important enough to make me hesitant about recommending digital imaging.

One of my areas of concern was the cost of the computers, the sensors, and the software. Another was the fear of change or, as many of you might call it, the fear of computers. Also, for some strange reason, I felt uncomfortable not having a hard copy of film (probably some kind of Freudian thing), and I even felt weird about trusting computers for storage! As you can see, I had many of the same concerns that some of you reading this article may have or have had.

I think the thing that really turned me around on this technology was when I decided to look at this from an entirely new perspective. I decided to examine it from a reverse viewpoint and see if my feelings about digital radiography were justified. To do this, I asked myself this simple question: "If digital radiography were the "standard of care" and film was trying to be introduced into the profession, would it be accepted?" The only answer I could come up with was "not a chance!"

The benefits and advantages of digital radiography make film pale in comparison. The main problem with film is that there are too many variables. For example, if you miss the right spot, you need to take a new film. If you develop the film too long or not long enough, you lose clarity. Once the process is finished, nothing will make the end product any better. Even under the best of circumstances, trying to make a diagnosis from a small X-ray film is less than ideal.

So, let`s take a look at what I believe the benefits and advantages of digital radiography are.:

(1) Digital radiography systems capture dental X-ray images in "real time," directly into the computer. There is no need for film, hassles, or delays. There is a significant decrease in radiation compared to the use of film. In many cases, the amount of radiation can be reduced by as great as 90 percent! This is probably the single most beneficial "marketing" aspect of digital radiography. Patients are really concerned about radiation. Some patients in my practice were so vehemently opposed to having radiographs taken at the appropriate time intervals, it interfered with my ability to to practice the "standard of care" that would be acceptable by my peers. Digital radiography solves the problem, because even the slowest digital image is faster than the fastest speed film.

(2) Digital radiography allows superior image enhancement. With film, what you see is what you get. With digital radiography, what you see can be enhanced! This allows for superior diagnosis. Most of the systems on the market today have a tremendous dynamic range compared to film.This allows you to have blacker blacks, whiter whites, and better definition of intermediary gray tones. It also allows you to magnify the image without losing much resolution. Several of the programs even have a "clear vu" or "spot magnifier" that will allow you to emphasize a certain area or the entire selection for superior clarity and sharper detail.This increases your likelihood of making a proper diagnosis. So many things show up well on digital images that just can`t be seen on film.

Some of the other features that you can use to enhance diagnosis are inverting the image to make the whites black and the blacks white. The contrasting features of inversion make it easy to gain a different perspective about the image.

You also can colorize the image so the light areas of a standard image appear blue, the black areas appear red, and the gray areas are green. This allows you to view soft tissue more clearly and easily spot any abnormalities.

You also can adjust the brightness and contrast, as well as view a preview of the image. The preview capability helps you determine if you want to accept the new image or revert to the original. Some system also have hue, saturation, and lightness adjustments.

Most of the systems allow you to smooth and sharpen images to your preference. Some even have edge enhancement, which allows you to get a more definitive view of the edges of the film. All of these tools allow you to increase your accuracy and to diagnose problems better, giving you the opportunity to more clearly explain and treat these problems while increasing practice profitability!

Another significant benefit of digital radiography is measurement and calibration. This allows you to trace non-linear objects, such as a root canal. You do this by selecting a point of the tooth while depressing the mouse button and continuing on to another point. These approximate measurements then can be turned into calibrated images. Although there may be some minor inaccuracies, due to the image angle, these measurements are typically more accurate than measurements obtained on film. This is extremely useful in endodontic therapy and also in diagnosing any pathology.

Ease of use

Most of the digital radiography systems are easy to use. Oh sure, there is a short learning curve where you`ll need to sit down with the manual or a trainer to understand the basics of the program. However, once you do this, you`ll be amazed at how quickly and easily it is to maneuver around these programs. The technology has to be easy to use - otherwise, people wouldn`t use them!

Most programs use icons, as well as drop-down menus to allow you to access the features of the software. This is terrific if you have new team members who need to get up to speed quickly. Also, most of the software programs have tutorials with digital images already in them to allow you to practice and learn the features of the program at your own pace.

Digital-radiography software is used with your existing X-ray tubes. There is no need to purchase any additional X-ray equipment. The software programs usually have a calibration step that you must go through when you initially install the software. Once this is completed, you are ready to go.

No chemicals required

Another benefit is that there are no chemicals to be bought, maintained, or disposed of. This means that digital radiography is better for the environment. With the human population growing each year, we put a tremendous strain on our natural resources. The elimination of these chemicals is one small step that we can do to help. There also is a significant savings on the purchase of these chemicals month after month and year after year. Digital radiography actually will save you money and is more cost-effective in the long run!

Digital radiography can be used with laptop, desktop, or tower PCs. Most people are opting for the portability of the laptop computer, which allows them to have all the benefits of digital radiography without a tremendous initial outlay of finances. The images are stored right on the laptop computer`s hard drive.

If you have an existing computer network, it is easy to add digital radiography to the network with either PCMCIA connectors or USB ports. (Note: PCMCIA and USB are computer monikers for the type of connection that different companies use to connect to your existing computers. Most companies will have this information available to you and will instruct you on the easiest connections available for their programs.)

Still another benefit is that most of the digital-radiography software programs are compatible with the major dental-management software programs that are on the market today. This makes integration and record storage quick and easy. You no longer will have overflowing charts that you always seem to drop at the wrong time, coin envelopes that get lost or misplaced, or vinyl film mounts that never seem to hold the films in place properly.

Many digital-radiography software programs are now including security, authenticity, and dating to ensure that the records are secure and properly archived. Once the computers are purchased, the only additional outlay of finances would be for periodic upgrades. With the current storage capacity of hard drives in the gigabyte range, this most likely will be many years from now.

Another benefit is that most companies have developed sensors that are similar in size to what we are used to with film - that is, size #0, size #1, and size #2. These sensors are easily placed with the accompanying positioner, which actually makes it easier for you or your team members to capture the image by properly positioning the X-ray tube at the correct angle to the sensor. This allows you to be comfortable in knowing that you`ll get the image right the first time more often. Covering the sensors with barrier film and wiping them with a bactericidal agent prior to re-using them easily maintains patient protection.

Digital panoramic units have been available for several years. Presently, only one company includes a digital-cephalometric unit. This will change in the near future as more people get involved with the technology. If you want to incorporate an existing panoramic and/or cephalometric film into the computer for ease-of- record storage, this can be accomplished quite easily with a backlit scanner. Once scanned, the image can be imported into the software program to allow it to be enhanced and manipulated similar to other images.

No more lost X-rays!

Digital radiography allows you to integrate digital images into reports that can be printed, faxed, or e-mailed to their final destination. This means that you no longer have to hear those dreaded words that an insurance company has "lost the patient`s X-ray." You can send images electronically, attached to the claim form. You also can e-mail images to colleagues around the world and ask their advice on diagnosis and treatment. You can include images in diagnostic reports for referrals or patients that you create with your word-processor. And, in the event that you really want a copy of an image to hold in your hands, you can print out a beautiful copy with a printer.

Earlier in this article, I alluded to the "marketing" aspect of digital radiography. Well, let`s talk about that for a moment. The benefits that have been outlined in this article are all terrific and the added bonus is the marketing. Patients absolutely love the fact that their dentist is on the leading edge of technology - especially when it comes to their safety! The sensors and the computer-software program - and all the enhancements that can be done with the images - fascinate them. And, here`s the best part - they go home and tell people about it!

I`ve had more new patients come into my office and tell me that they`ve heard about the new X-ray system that I have that is safer for them. This influx of patients and the revenue dollars these patients have generated have allowed me to recoup my investment in digital imaging many times over. This is something you just don`t get with film. Have you ever had a patient tell someone else about the great full-mouth series or bitewings that you did for them?

Your patients will appreciate the difference that digital radiography makes in their lives and you`ll appreciate all the benefits that your practice receives from embracing this technology. That`s why when someone now asks me what I think of digital radiography, I answer, "Digital radiography - yes!"

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