Digital radiography and the endodontic practice

Got a flash drive? How about a pocket data storage device that can be worn as a wrist watch? Or an automated, software-driven messaging system for patient recalls?

Arthur "Kit" Weathers, DDS

Got a flash drive? How about a pocket data storage device that can be worn as a wrist watch? Or an automated, software-driven messaging system for patient recalls?

If you answered "yes" to any of these questions, you're ahead of the technology curve. If you answered "no," don't worry. You still have plenty of time to put these useful gadgets to work for you.

But here's another more serious question for you: Are you currently performing endodontic procedures such as root canals but haven't installed a digital radio-graphy system in your office? Or are you still stuck performing root canals with your old film X-ray system? If so, then you're definitely behind the technology curve. And with endodontic procedures, digital radiography is one area where you simply cannot afford to lag behind.

Using digital X-rays greatly improves a dentist's ability to do efficient, single-visit root canal procedures. If you haven't made the switch to digital, here are some tips that will help you make the right decision. Some of the ideas are just common sense. Others will help you understand the technology. Still others might be downright surprising.

Let me start with the last category first. You might be surprised to learn that the two things you can safely ignore when shopping for digital are price and image quality. That's right. Don't even factor the price into your decision. First, you're choosing a product and a technology that will not only change your practice for the better in ways you haven't imagined, and you're also making a decision that will affect the long-term health and comfort of your patients. Saving a few dollars a month by purchasing an inferior product is not a good trade-off.

The fact is that no matter which digital radiography system you install, you're going to save money over the film-based X-ray system currently in your office. And not just pennies a day, either. If your office takes an average of 50 X-rays a day, you'll easily save $20,000 a year in the cost of consumable supplies you no longer need and in wasted staff time spent processing X-ray film, even if you choose the most expensive system on the market.

Image quality falls into the same category. The images produced by the top digital radiography systems are all vastly superior to film. This means that, for practical purposes, you don't have to educate yourself about "line pairs" and how a digital image gets displayed to make the right choice. And with image quality, any of the top systems will deliver results that are superior to film.

But there is an important image quality issue to consider. With digital radiography, you can enhance an image to highlight certain aspects of the X-ray for diagnosis and patient education; therefore, you need to make sure that the product you choose allows you to tailor the image enhancement to your specialty. If you're an endodontist, make sure that the system you choose is capable of display- ing images to specifically enhance root structure. Periodontists should ask if their digital system has a function that allows them to focus on bone structure. General dentists need to be sure that decay and root structure can be specially highlighted. Don't even consider a digital system that does not allow you to tailor image enhancement to your specialty.

There are other serious issues to consider. Even before you choose a product, you'll need to make some computer hardware decisions. Are you going to install your digital radiography system on a networked computer system, or are you selecting a stand-alone system installed on a laptop or tablet PC? If you're choosing a network, is the network already installed, or will you need to install one from scratch when you switch to digital radiography? If this is the case, who will do the hardware installation? If you already have a computer network installed, will you need a hardware upgrade or additional workstations before you install your digital X-ray system?

Hire a professional to install or upgrade a network that meets the specifications provided by your digital radiography sales and technical team. While your digital X-ray vendor will install the necessary cards in your network workstations and install and configure the digital radiography software, your network specialist must configure the hardware portion of the installation.

Another key hardware component of the digital radiography system is the digital X-ray sensor. The sensor takes the place of film in a digital X-ray system. In my opinion, the highest quality and most reliable sensors utilize CCD (Charged Coupled Device) technology, and I would recommend that you steer away from a system that uses any other type of sensor. Many systems provide two different sizes of sensor — one for adults and one for children. However, this may create more problems than it solves, if, for example, the incorrect sensor is used and the X-rays must be retaken. Look for a system which features a single size CCD sensor for optimum efficiency.

Along with selecting the best sensor, you'll also need to look at the software. It's the software — the computer program and user interface that enables you to display, enhance, catalog, and store images — that you'll find is one of the most important variables in your choice of digital radiography systems. Some of the questions you'll want to ask about software as you're selecting a system are:

Does the system automatically display images as they are captured in exactly the position you want?

Is this capability configurable? You've developed your own way of taking X-rays over years of practice. You generally take a full mouth series in a particular order, and your assistants mount and display the film X-rays in a way that you're comfortable with. Make sure that the digital X-ray system you choose enables you to configure the order in which you take X-rays and the way you like to see them mounted and displayed so that it exactly matches your current procedure.

The best systems don't require that you change the way you do things to suit them; they can be configured to suit your preferences.

How good is the user interface? Does it allow you and your staff to point the cursor at an image or an area of the image and enlarge it, or increase its contrast, or add color to it to enhance diagnostic capability with a single mouse click? Or do you have to wade through a series of pulldown menus every time you want to modify the image on screen?

I can't tell you how important single point-and-click capability will be to your satisfaction with your new digital radiography system. Over the course of even a single year, you'll save a tremendous amount of time and low-level irritation if you don't have to click through a series of pulldown menus every time you want to change an image.

One of the most important choices you'll make when switching to digital radiography is the vendor or manufacturer. Choose a company that's been in business a decade or more that offers a product with a proven track record. You don't want to make a call to the vendor's sales office six months after you've installed your new system, only to find that their offices are closed.

After choosing a reputable vendor who's in the business for the long haul, you'll want to ask questions about the company's service, after-the-sale support, training, and product reliability.

With digital radiography, I've found that the most important aspect of service and after-the-sale support can be summed up with this question: "Does the vendor offer overnight replacement of the digital sensor if it malfunctions?" Not 48 hours, and not even 24 hours. "Next morning" is the operative phrase, because your practice can't afford to go a day or more without taking X-rays. Don't settle for less than guaranteed overnight sensor replacement.

That said, I hasten to add that I've never experienced sensor failure. The digital sensors I've used have all performed flawlessly, and I've never had to call for an emergency sensor replacement due to failure. Nonetheless, caution is paramount. Like any other device, sensors can fail, and you don't want an equipment problem to compromise the services you provide to your patients.

Make sure the vendor you choose offers in-office training for your staff, and be sure to discuss training costs. Is training free? Since not all of your staff will be available for training at the same time (for obvious reasons), will the vendor offer multiple sessions so that all your staff can be properly trained? Does the package include videotapes or DVDs that you can use to train staff members who are hired later?

While training can be very important, especially to a staff that doesn't have extensive computer experience, I want to add that the best digital radiography systems are so intuitive anyone used to working with computers will quickly learn to use them with little or no training. Nonetheless, good training support is one of the indicators of a good vendor, and you'll want to investigate the training offered as part of your purchasing decision.

Finally, a question I'm asked frequently: What are the best sources of the information that dentists need to make a sound decision? Trade shows are good places to compare products of different vendors, with this caveat: Write down a list of questions and get satisfactory answers from the vendors you're considering. Beware the hype, but take advantage of the wealth of information available at trade shows.

Seminars are another excellent way to gather information about digital radiography. We think that hands-on experience with digital radiography is so important that at our C. E. Magic! Endodontic Root Camp seminars, we provide a chance to use a DEXIS™ digital system, which is the one I selected for my own office, as part of our training. Seminars are also an excellent place to ask tough questions and get unbiased answers.

Finally, consult with your colleagues. Find out what they like and dislike about their digital radiography systems and factor their opinions into your decision. They'll often be your best sources of information for this purchase that will define the service you provide to your patients for the next several decades

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