Transitioning from film to digital: sensors and suggestions

Nov. 1, 2009
Many longstanding aspects of dentistry are currently in transition to the next generation of technology and opportunity.

For more on this topic, go to and search using the following key words: digital radiography, dental imaging, dental X–rays, Dr. Bradley A. Dykstra.

Many longstanding aspects of dentistry are currently in transition to the next generation of technology and opportunity. Filing cabinets full of paperwork are being replaced by electronic medical records. Billing statements are moving from the U.S. Postal Service to the Internet. Film–based X–ray images are becoming a tool of the past as the dental profession embraces digital radiography.

Digital radiography systems like the KODAK RVG 6100 Digital Radiography System provide doctors with unprecedented opportunities to make more confident diagnoses, observe and treat dental diseases at earlier stages, boost productivity, and avoid the recurring costs associated with using film.

Film's limitations

While film has long been considered the gold standard in dental imaging, it has several functional limitations. First, film images necessitate the use of materials that must be frequently replaced or carefully disposed of. Film supplies must be regularly replenished. Developing film requires the use of hazardous chemicals, many of which are carcinogenic and/or harmful to the environment. The legal requirements and ramifications for procuring and discarding these chemicals vary by state.

While your state may not impose a specific disposal fee, disposing of hazardous chemicals requires at the very least an investment of valuable time. That's time spent away from the office and patients. Digital radiography requires no such complications.

Second, and related to the logistics of supply management and disposal, using film creates variable costs. The amount of film a practice must purchase is directly proportional to the number of patients who require film–based X–rays. While a practice capturing film X–rays may have an established profit margin on each image captured, such a practice is missing an opportunity to increase revenue.

With a digital radiography system, the costs are essentially fixed at the system's purchase price — either a monthly installment payment or the amortization of the fully paid purchase price over the life of the system. Thus, particularly for practices that capture a relatively high volume of images, implementing a digital radiography system represents an opportunity to increase profits: the more digital radiographs taken, the higher a practice's revenue.

Third, film's relatively lengthy acquisition time — roughly five to 10 minutes — builds unproductive time into a practice's schedule. In the time spent over the course of a day waiting for film images to be acquired, a practice could be serving additional patients.

Assuming that there is suitable patient demand, the use of film effectively limits a practice's productivity. This situation is further exacerbated in cases where images need to be retaken: a doctor or hygienist must wait to find out that he or she needs to capture another image, then wait on that new image to be acquired. Digital radiographs are acquired in seconds; using a digital system thus awards a practice the ability to accommodate additional patients each day. This advantage allows a speedier return on investment.

Fourth, while film produces detailed, high–quality images, those images are not created in a versatile form. Film images must often be duplicated or resized — a process that effectively requires a doctor to capture a derivative image of the original.

The derivative image will inevitably be of lower quality, even if the variation is slight. Regardless, duplicating or resizing a film image into a usable form is a process that takes time and expensive equipment, cutting into a practice's efficiency. In contrast, you can create a perfect “clone” or resize of a digital image — with no degradation in quality — with a simple mouse click. Digital images are also generated near–instantaneously, much faster than film images.

Fifth, digital images are far more versatile. They can be stored electronically alongside your other image files, promoting a paperless office environment. They can be easily exported into a wide variety of image formats and transmitted via e–mail or removable flash drive. If necessary, they can be printed. Easy transmission can be especially useful for practices with multiple office locations or in cases involving collaboration. Film images must be processed and physically transmitted. For practices that scan film images into their office computers or servers (which often leads to at least some degradation in quality), digital images remove a time–consuming step.

Finally, the absence of preset customized image filters imposes restrictions on how film may be used to diagnose particular conditions when compared with digital images. Other than its generally high resolution, film has many shortcomings.

Selecting the right sensor

When selecting a digital radiography system, there are many criteria a practice should consider. A practice ought to seek a system that is not only free of film's limitations, but which brings positive, productivity–boosting benefits.

First and foremost, the system needs a good sensor. From the perspective of a practice, there are many considerations when looking for the right sensor. Of course, the sensor needs to be capable of capturing high–resolution images; ideally, a sensor should capture film–quality images. After all, if the sensor cannot capture images identical in quality to film, there is potential for a dental practitioner to sacrifice some of the clinical and financial benefits afforded by digital imaging.

Sensors should be durable — they will likely be bitten, dropped, stepped on, or struck over the course of their use — and should retain their ability to capture high–quality images. Sensors should also be easy to use, and if possible should connect directly to practice computers through the USB port. The more components, adaptors, interfaces, and the like involved with linking a sensor to a computer, the higher the costs and potential for malfunction.

A sensor's size is also important on several levels. From the clinician's perspective, a sensor should have a sufficiently large active portion (the portion of the sensor which captures the radiograph). The active areas of some sensors do not extend the full length and width of the sensor base; for instance, the corners might not be active. This requires additional precautions when positioning the sensor to ensure that the radiograph contains all the appropriate anatomical features.

While at first glance this may nudge practices toward purchasing the largest sensors available, it raises the important issue of patient comfort. Some patients, especially children, have small mouths, which cannot comfortably accommodate a large sensor, if any at all. Thus, depending on the type of applications for which the sensors are routinely used, it is generally advisable to have multiple sensors of different sizes.

Patient comfort is not only significant in maintaining positive doctor–patient relations, it can also impact image quality and practice efficiency. If a sensor is sitting uncomfortably in a patient's mouth, the patient may attempt to move it.

Even a slight change in the sensor's position can lead to the omission of important anatomical detail. This in turn often requires the radiograph to be recaptured. To minimize the risk of recapture, it is prudent to select a sensor that uses comfortable positioners which hold it in place, as well as one with a short image generation time.

Sometimes utilizing the right tool can enhance your abilities as a clinician. The differences between film and digital images directly translate to improved patient care and productivity. Shorter image acquisition times mean that you can make faster diagnoses. The image generated does not need to be printed or resized; it appears on your computer screen, large enough for both you and your patient to view.

Large, clear images lead to more confident diagnoses and more predictable outcomes. Digital images provide a persuasive visual aid that can accompany a proposed treatment plan, often leading to increased instances of case acceptance. Ultimately, digital radiography systems like the RVG 6100 System reduce the time occupied by many types of consultations, leaving you with more time to care for other patients. The transition from film to digital imaging is probably inevitable, but such does not lessen the need to consider the relevant factors to maximize the system's benefits to your practice.

Dr. Bradley Dykstra is a general dentist in private practice in Hudsonville, Mich. He is a graduate of the University of Michigan's dental school and received his MBA from Grand Valley State University. Dr. Dykstra speaks on integrating technology into the dental office, and consults through his company, Anchor Dental Consulting. Reach him at (616) 669–6600, or send an e–mail to [email protected].

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