Digital Radiography
Most new digital radiographic sensors now use CMOS chips versus CCD chips. This is an advantage for manufacturers because they are less expensive, require less energy, and offer the advantage of a broader dynamic range. This means CMOS technology is more tolerant to overexposure; increasing x-ray exposure improves signal-to-noise ratio, thus reducing noise perception. CCD technology has a narrow dynamic range that will saturate with increased radiation, so blooming occurs (ie, black image). One downside is that CMOS sensors do require more radiation because they are less sensitive, with 25% more exposure needed.
A related benefit with CMOS technology, however, is that the electronic interface components can be built into the CMOS chip directly, which allows the sensor to plug directly into a USB2 port. There are currently two new sensors with that capability, DEXIS Platinum (www.dexis.com) and e2v (www.e2v.com). Note that the size of the intraoral sensor limits the amount of built-in electronics. Most manufacturers place a small electronics control box along the USB cable to perform image processing and speed up the image transfer.
Digital radiology systems are now more user friendly. An example of this is the X-pod from MyRay (www.my-ray.com), which is a completely self-contained hand-held unit. For someone who wants to have intraoral digital x-rays and does not have computers in the operatories, or for someone just beginning a practice, this is a very cost-effective and portable solution.
The market for digital panoramic units seems to have segmented into two major categories: the entry-level, simple digital panoramic unit and the high-end, multifunctional digital panoramic units. With some entry-level panoramic units coming in under $25K, the market for retrofit kits has all but gone away. The trend has been to allow add-on features to the high-end market, which can bring the cost up to $60K. These features include:
- Cephlametric units
- Tomographic features
- Cross-sectional volumetric features (static or dynamic)
Only two pan units have cross-sectional volumetric imaging that can browse dynamically, the Instrumentarium OP200 (www.instrumentariumdental.com) and MyRay Hyperion (www.my-ray.com). Other high-end pans have static cross sections.
Another category combines digital panoramic and CBCT applications. These hybrid “CBCT and pan” units have both technologies with separate sensors, for example, the Kodak 9300 (www.kodakdental.com); Sirona XG3D (www.sirona.com); Instrumentarium OP 300 (www.instrumentariumdental.com); and VaTech Picasso DUO (www.vatech.co.kr).
How dentists purchase technology has more to do with the trend toward digitizing dental records than technological innovation. After more than 20 years, dentistry has reached critical mass where a majority of dentists have invested in the technology infrastructure and are on a path toward digitizing their practice. Digital radiography is a cornerstone of the patient record, and it is no longer a matter of “if” you incorporate digital radiology, but rather a question of “when.”
Currently, the major obstacle is the proprietary nature of current technology integration of intraoral sensors into the existing practice management software programs. Because 85% of current practice management desktops are controlled by three major dental corporations (Henry Schein Practice Solutions, Dentrix, and Easy Dental [www.henryschein.com]; Patterson Dental, Eaglesoft [www.pattersondental.com]; and Carestream Health, Practiceworks, and SoftDent [www.carestreamdental.com]). These five programs function seamlessly and best with their primary digital radiology partner and require bridges or less optimal integration with other sensors. To incorporate other sensors, usually a bridge or “name grabber” program is needed to take x-rays and link them to the specific patient. This is usually done transparently and requires a few additional clicks, even though it is bridging two software programs and may have separate databases.
My recommendation has always been to keep it as simple as possible for the dentist and minimize potential conflicts by choosing the digital radiology solution best suited to your existing practice management company. If you are using Eaglesoft, your best choice would be to choose Schick sensors; if you are using Dentrix or Easy Dental, your best choice would be DEXIS; if you are using PracticeWorks or Softdent, your best choice would be Kodak sensors. If you are using any other practice management software, you will probably need to use a bridge to access your x-ray features, so you can choose any sensor system. However, it would still be prudent to ask them which system they integrate with most efficiently.
The downside to choosing the easy path is the cost of the sensors, which can range from $5,000 to $12,000 apiece. The least expensive sensors are usually from smaller manufacturers and usually use a third-party imaging software program (eg, Apertyx, www.apteryxware.com/dental/) that has the ability to work with virtually all sensors on the market.
There is another piece of new technology that will impact intraoral radiology whether you use sensors, phosphor plates, or film. The Tru-Align, by Interactive Diagnostic Imaging (www.idixay.com) is an LED laser alignment system that attaches directly over any 2.5-inch to 3-inch round x-ray cone to drastically reduce scatter radiation by collimating the x-ray beam to perfectly align the target receptor. This system will reduce the patient exposure radiation by approximately 60%, as well as producing clearer and crisper images.
Incorporating technology without a plan and a willingness to work through the learning curve can be disastrous and counterproductive. Predictable care is best accomplished when sound principles and systems are in place and followed. Technology can facilitate, organize, and execute the diagnosis, planning, and the predictable completion of procedures.
The benefits of incorporating digital radiology have been significant for all parties: the dentist, staff, patient, insurance companies, and the environment. It is also a technology that replaces costs in chemistry, film, and maintenance, as well as saving enormous staff time in processing, filing, and copying conventional x-rays. This technology does eventually pay for itself in real cost savings, but the real advantage is having images immediately available to view on a monitor, so that you can be most effective at what your core function is: treating patients.
Because technology is constantly evolving, we should always start with a little homework before making any major purchase or change. The very first step is an objective assessment of where we currently are. We need to determine what is working well and what is not with our current systems and applications. We also must determine what exactly we want as an end result.
Once we have a plan, we can begin the process of finding the best fit. For some of us, we may find that creating a complete web-based solution for our information technology (IT) may be our ultimate goal, whereas some of us are looking for an expedient exit strategy and want the office to look, feel, and function as a contemporary and up-to-date practice. There is a broad range of practice environments that function efficiently and profitably. It is your responsibility to find your ideal practice setting and make it happen.
About the Author
Claudio M Levato, DDS
Private Practice
Bloomingdale, Illinois
