Digital Dinosaur X-rays

Sept. 30, 2014
Waaayyyy back in 2008, I decided to give digital X-rays a try in my practice. I remember purchasing the boxes, sensors, software, and even the new computer monitors to ensure I was getting the best image possible.

By Kent W. Stapley, DMD

Waaayyyy back in 2008, I decided to give digital X-rays a try in my practice. I remember purchasing the boxes, sensors, software, and even the new computer monitors to ensure I was getting the best image possible. Unfortunately, on the first day of using this exciting new diagnostic equipment, I found it to be anything but diagnostic. The images were fuzzy. They couldn't be adjusted to look much better with the limited tools available in the software. Even after experimenting with the various exposure settings on my X-ray machine, I wasn't able to get images from which I could make a diagnosis - unless they were very small on the screen.

I had been so excited to be able to enlarge an image and show a patient what needed to be done for their tooth, but the image just wouldn't be clear enough when I did. Sadly, I sent everything back to the vendor and went back to squinting at my little films for another three years until I finally found the sensors that would do everything I wanted, for a price I could afford.

My DentiMax sensors, which I use today, have served me well since then. I diagnose more because I identify problems so much earlier. I am able to show my patients what needs to be done, and case acceptance is much better! "Seeing is believing," as they say.

Still, it is frustrating when I get those new patients who transfer to my office with what I call "digital dinosaur X-rays" from their previous offices. The images are so difficult to read and diagnose from. I can't help but wonder how a dentist can use that sort of an image day after day and feel like they are catching all that needs to be diagnosed.

Like anything else in the world of electronics, technology improves and needs to be upgraded. I recently asked Jim Ramey, the director of digital imaging at DentiMax, why many of the digital X-ray sensors out there are so inferior and why they still get used. Jim enlightened me. In his own words:

Jim: The inferiority of all of these older sensors is due to the CCD technology they are built upon. These sensors have a pixel size which is much larger, the bit depth is smaller, and as a result the resolution of the image is not nearly as high.

To put things into perspective, some of those older CCD sensors had an "actual line pair measurement" of 12 to 14, a bit depth of 8 to 12 bits, and a pixel size over 32 microns! The new CMOS DentiMax Dream sensor, in comparison, has an actual line pair measurement of >20, a bit depth of 16 bits, and a pixel size of 19 microns (for pixel size, smaller is better)!

This means that you have a much, much higher resolution image to start with. This allows you to use filters such as "sharpen" to make the images crystal clear without becoming pixilated. It allows you to zoom incredibly far into the image without it becoming so pixilated to the point that you can no longer tell what you are looking at. The CMOS technology actually allows a dentist to see it as clearly as if it were an actual film, and to make it as large as the entire monitor screen. You can still clearly see what you are looking at diagnostically - no more need to squint or use those 8x loupes!

As for why dentists continue to use this inferior technology, the answer is twofold. First, they have already made a significant investment, and it would require completely replacing everything they spent so much on not too terribly long ago. I have talked to doctors who even look to places like Craigslist to buy used sensors that will work with their existing setup rather than invest in new sensors. Second, they don't know what they're missing! Unless they see a side-by-side comparison of what they're missing, they may feel they are doing just fine with the older technology.

Thank you, Jim. Sometimes it's nice to know why things work the way they do. I think most of us are just glad the newer CMOS digital X-ray sensors and software work so well and so reliably day after day after day!

Kent W. Stapley, DMD, resides and maintains his private dental practice in Mesa, Ariz., where he and his wife are raising their nine children. He has been a solo general practitioner his entire career and has started and sold several satellite offices over the years in the Mesa area.

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