Achieving diagnostic consistency

Over the past few months, I've emphasized the capability of digital radiography to improve diagnosis. I'd like to continue to explore that subject, but from a slightly different perspective than before.

Steve Lynch, DMD

Over the past few months, I've emphasized the capability of digital radiography to improve diagnosis. I'd like to continue to explore that subject, but from a slightly different perspective than before. I want to talk about the diagnostic consistency that you can realize by installing digital radiography in your practice as opposed to continuing to use film X-rays.

Any number of factors can contribute to inconsistent image quality when you're working with film. For instance, when you take the first X-rays of the day, you have to ask several questions. Is the developer fully warmed up? Are the chemicals fresh? Are you sure the film you're using has been stored under the proper conditions, not just in your office, but in the facility where it was housed until it was shipped to you?

As the day goes on, you also need to make sure your chemicals haven't lost their potency. Every set of X-rays you take means that your developer is performing slightly differently than it was before. Over the course of a day, when more than 100 X-rays might be processed, that can mean a significant difference in quality from morning to late afternoon.

Differences in film X-ray image quality that become apparent during a single workday can become magnified even more over time. If, for instance, film X-rays are not developed completely, they will become cloudy quite quickly, often within a matter of months. Even perfectly developed film X-rays deteriorate over longer periods of time. What this boils down to is that, in many cases, a year after you've taken a set of film X-rays, you literally don't have the same X-rays stored in your filing cabinet. Simply put, their quality has been degraded, perhaps only somewhat, perhaps more significantly. But film X-ray quality does degrade over time. There's no way around it!

That's why, when my office made the transition to DEXIS® digital radiography several years ago, we began to notice significant differences in the quality and consistency of our X-ray images. First, and most obvious, there was no degradation whatsoever in the quality of the digital X-ray images during the day. The same crystal clear images appeared on the 17-inch monitor late in the day as they had earlier. My team members also didn't have to be constantly checking to make sure developer chemicals were up to par, because, of course, there are no chemicals with digital radiography.

Another thing we realized immediately was that it was much easier to get patients to accept treatment by using digital radiography. The patients could actually see very clearly any problems we identified, and they immediately felt as if they were part of the diagnostic process, rather than mere onlookers. The fact that we always get consistent image quality with our digital X-rays also means no time-consuming retakes. If a second take is necessary, it appears immediately on the computer screen, and the patient (not to mention the dental team) does not need to wait 7 to 10 minutes to see the image.

But where digital image consistency is so important — and where its advantages over film become so obvious — is in the case of comparing images over time. With endodontic procedures, it is particularly important that we monitor progress. Film radiography makes that difficult, and in some cases, impossible. As I mentioned, film X-rays deteriorate in quality over time. Add to that the fact that the original film images you're comparing might have been of different quality, even when they were newly developed, and you've got a recipe for diagnostic problems.

On the other hand, since digital images do not degrade over time, you know that the image you took a year ago will be just as clear and sharp as when it was taken. You'll be able to display past images side by side with current images instantly on the large screen monitor. You won't have to go searching through a file cabinet for tiny 2-inch x 2-inch film images that then might prove unusable when you actually put them on the light box.

You owe it to yourself and your patients to provide the best and most consistent diagnosis possible.

Steve P. Lynch, DMD, is in private practice in Oxford, Ala. Since 1995, he has been teaching dentists, team members, dental students and faculty the applications of lasers and digital radiography.Contact Dr. Lynch by email at or visit his Web site at www.lynch for more information.

More in Science & Tech