Choosing Digital Sensors
A practical guide for integrating this imaging technology
Aniket Jadhav, BDS, MDS, MSHA
Digital sensors can be a very helpful technology for most aspects of general dentistry, and especially for endodontics, dental implants, surgery, and immediate postoperative assessment. Digital sensors can be classified as direct or indirect digital (photostimulable phosphor plates, or PSPs).
Typically direct sensors are attached to the computer via a cable and either utilize CCD or CMOS technology. Regardless of hardware technology used, image resolution is similar. The latest generation of direct digital sensors can achieve resolution similar to the film-based imaging. Resolution varies by sensor and depends on the hardware specifications and technique used.
PSPs are not connected to computers directly by cable or wirelessly, but rather they need a dedicated scanner to process the image. PSP are similar to film and therefore represent a more comfortable transition to digital imaging for some clinicians. They are more flexible and cheaper, but offer slightly lower resolution than direct sensors.
Digital sensors replace film and processing chemicals with scanners and computers. This saves lot of space for the dark room and maintenance of the processing solution and equipment. There is also no need for physical file storage.
Digital sensors are also timesavers for clinicians. Images can be accessed easily and stored along with a patient’s health record, as well as securely shared with other providers when needed. Radiographic images can be stored in different formats (eg, jpeg, tiff), which varies among vendors. It is highly recommended to have a system that is DICOM conformant. DICOM images are not merely the radiographic images, but also contain patient information and offer seamless sharing among health care professionals. Although it is beyond the scope of this article, HIPAA compliance must always be ensured when sharing patients’ protected health information.
Regardless of type of imaging used, clinicians should utilize the lowest possible radiation dose to acquire diagnostically acceptable images as per the ALARA (As Low As Reasonably Achievable) principle. Digital sensors require a lesser radiation dose as compared to film, but patient exposure may actually increase especially with direct sensors due to the ease of making an exposure.
If you are considering adopting digital sensors in your office, here are some important factors to consider:
Software compatibility. The very first thing is to determine if digital sensors would be a good fit for the practice. Integrating a new technology means making changes to the current workflow. Before deciding on any imaging system, it is important to see if the system can be bridged to the current practice management/electronic health record system. This will make the job of the assisting and administrative staff easier, allowing them to seamlessly adjust to a new workflow and help them share patient health records and images with specialists or patients.
Patient comfort. A common concern about direct digital sensors is patient discomfort due to their thickness, as well as the difficulty in using them for patients with limited opening or a strong gag reflex. Training assisting staff and clinicians is key to minimizing discomfort. Paralleling technique (sensor and teeth are aligned parallel while x-ray beam is directed perpendicularly using XCP sensor holders) is widely used in dentistry. When patients experience a gag reflex or have a limited opening, however, bisecting angle technique (sensor is placed close to teeth and x-ray beam is directed at the imaginary line dividing the long axis of the tooth and the sensor) can be used instead. The majority of vendors have specific sensor holders designed for their system to acquire images using either of the techniques, which can be used with PSPs and film-based imaging as well.
Design is another important consideration for patient comfort. Some direct digital sensors are thicker or have sharper margins than others. Some manufacturers offer sensors with rounded edges that might be more comfortable for these patients. It is beneficial for clinicians to perform a test run before deciding on a system.
Staff training and support. Training staff on placement of the sensors and handling of the imaging software is critical to providing the best possible images for successful implementation. The effective size of a direct digital sensor is smaller than the external dimensions, which means that positioning is very important to ensure one captures the area of interest perfectly. Proper positioning helps reduce the radiation exposure of retakes and keeps the practice running efficiently.
The vendor can provide training for administrative and assisting staff to acquaint them with the new system and its workflow at the initial phase of the transition. In addition to learning the most effective placement of the sensors and how to manage the software, a team effort will be required to implement quality assurance protocol and comply with the state regulations on radiation safety. Discuss maintenance and support of the product with the vendor before making a purchase.
Networking. The number of sensors needed is one more consideration, and also goes hand in hand with the networking within the office. Direct digital sensors can be hooked up to any chairside computer due to their portability, although it is important to store patient data on a centralized protected server so that the images can be accessed at multiple desktops or workstations within the office. Having enough file storage space to accommodate digital images is also important.
Final Thought
The key to making integration painless is assessing the needs of your practice to make sure digital sensors will fit your working environment. In addition to considering the advantages and disadvantages presented here, talk to colleagues who own the system you are considering. Their practical experiences of integration can provide invaluable insight that can make the process as smooth as possible.
About the Author
Aniket Jadhav, BDS, MDS, MSHA, is an assistant professor of oral and maxillofacial radiology in the department of diagnostic and biomedical sciences at the University of Texas School of Dentistry at Houston. His areas of interest include cone-beam computed tomography, radiographic assessment of maxillofacial pathology, implant treatment planning, volumetric assessment, MRI studies for temporomandibular joint disorders, and temporal bone imaging.
Before You Buy: Direct Digital Sensors
Reasons to Invest
• Short acquisition time
• Images available instantly
• Lower radiation needed
• Good patient educational tool
• Ideal for endodontics, implants, surgery, restorative procedures
Pre-Purchase Considerations
• Thickness of the sensors
• Hardness makes them inflexible
• Special positioning devices needed
• Initial cost of implementation is much higher
Active surface area is smaller than external dimensions
Keys to Integration
• Ensure compatibility with existing practice management software
• Be mindful of the hardware, networking, and security requirements
• Get long-term training and product support
• Be aware of the up-front investment and cost to maintain
