The economics of digital radiography

Sept. 1, 2004
What would you say if I told you converting from film to digital radiography would give you a positive return on investment in less than a week?

Arthur "Kit" Weathers Jr., DDS

What would you say if I told you converting from film to digital radiography would give you a positive return on investment in less than a week? You'd probably challenge me on that assertion, and I'd welcome the challenge. Let me show you how it's true.

Much has been written about the ROI dentists can realize by installing digital radiography equipment. I want to review some of the arguments and correct a few misconceptions. I also want to focus on endodontics and explain why the ROI associated with digital radiography for dentists performing a lot of endodontics in their practices is greater than that for dentists not doing a lot of endodontic work.

First, you've heard it can take a couple of years or more to realize a positive return on an "investment" in digital radiography equipment. This misperception most frequently focuses on the purchase price of a digital radiography system and on amortizing its value during the life of the equipment. And it often fails to take into account that you're going to be jettisoning some expenses associated with film radiography, and that getting rid of them is part of your ROI as well.

What is the ROI on the film, chemicals, and staff time associated with taking film radiographs? You never get a return on these items. They're overhead expenses, and as long as you're taking film X-rays, you're going to have to pay for them.

They're not insignificant, either. For every day you put off converting to digital, you're paying for consumable supplies you don't need. I'm talking about X-ray film and the chemicals needed to process them. If your office takes 50 to 100 X-rays a day, your cost for these consumable supplies is $25 to $50 a day at the generally accepted industry standard of about 50 cents an X-ray. If you're like the majority of dentists who still use film, you're wasting between $400 and $800 each month on film, chemicals, and mounting. The dollar figure for your practice will depend on the number of X-rays you take in an average day.

Now factor in the cost of staff time for taking film X-rays. While it takes six to eight minutes to process a single X-ray, the best way to calculate the cost of staff time is by the number of trips to the darkroom staff members make, because multiple X-ray films often are processed in a single trip. Time spent in the darkroom can range from the six to eight minutes I've mentioned for a single X-ray to as long as 12 to 15 minutes to develop and mount a full-mouth series. To calculate this number, I generally take the average number of trips to the darkroom multiplied by 10 minutes, which is a comfortable average.

This means that wasted staff time for 15 to 30 darkroom sessions can range from two and a half to five hours every day. At $20 an hour, this comes to between $50 and $100 a day. Using these numbers, the range of your daily cost for expenses and salaries that cannot be recouped will run at the low end about $75, and at the high end $150. For an office open four days a week, that translates to $300 to $600 a week, depending on the volume of X-rays processed.

The typical lease or purchase price of the DEXIS™ digital radiography equipment installed at our C.E. Magic! Endodontic Root Camp seminars is about $400 a month. That means that in the overhead and expense savings you realize by converting from film to digital, you'll begin realizing an ROI in fewer than six days. That's if you take an average of 50 X-rays a day. If you're at the high end, you'll begin to realize a positive return in fewer than three days. If your lease payment is $400, you begin realizing a positive return each month after you've taken some 275 X-rays — again, less than a week's worth in many offices.

Digital radiography is something no dentist who performs a lot of endodontic procedures can do without these days. Fortunately, the ROI in these practices is even more impressive. Whether you specialize in endodontics or endodontic work is a significant part of your general practice, digital radiography will give you a positive ROI, sometimes in ways that are a bit more difficult to quantify, but which nonetheless are important to you and your patients.

At our Root Camp seminars, I recommend you take two radiographs from two angles before beginning a root canal, and take multiple images as you're performing a procedure. The benefits to the dentist are obvious — better visualization throughout the procedure and better case diagnosis. Benefits to the patient also are obvious — less exposure to radiation (up to 90 percent less, depending on the type and speed of film used), and reduced time spent waiting while X-rays are being developed and mounted.

We think digital radiography equipment is so important for endodontic procedures that during our two-day, hands-on endodontic Root Camps, we provide the attendees with hands-on opportunities to use a digital radiography system.

In addition to these benefits, there are some measurable ROI benefits to endodontists. At six to eight minutes per film developed, you could easily waste as much as 25 to 30 minutes during one endodontic procedure — and that's not counting retakes. You can calculate the value of your time based on your annual earnings, but I'm betting that your positive ROI is likely to begin on about day two, even if you only factor the cost of your time saved into the equation.

I've also heard the argument that while you're waiting for film to be developed during an endodontic procedure, you can check other patients who are in for routine cleaning and examination, but this is not an efficient use of your time. To interrupt the flow of a root canal procedure to examine another patient while X-ray film is being developed means you'll have to take off your gloves, go into another operatory, wash your hands, put on another pair of gloves, perform the examination, take off your gloves again, go back into the operatory where you were working, wash your hands again, and put on another pair of gloves to resume the procedure.

Of course, there are going to be occasions when you'll have to deal with interruptions. But it makes far more sense — and this is the way we recommend doing it — for you to arrange your schedule where possible so you can complete your endodontic procedure without interruption, then make your routine examinations. It's far more efficient and less bothersome to all concerned.

Whether you're a general dentist who performs endodontic procedures or an endodontic specialist, when you install digital radiography equipment you're going to generate an almost immediate ROI. In fact, by the time your second monthly lease payment is due, you'll be far enough ahead that you'll still have a positive ROI, even after making the payment. Digital radiography delivers positive cash flow through savings on overhead and expenses within the first week it's installed in virtually any dental practice, and the ROI just keeps increasing with each passing month.

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