Digital Radiography in Dental Practice

Save time and money while protecting your patient records

Allan G. Farman, BDS, PhD, MBA, DSc

Suppose you are unlucky enough to have your dental practice irreparably damaged by a natural disaster—what is the key to success in continuing your business? Given adequate insurance coverage, the building and equipment are replaceable in relative short order. Your practice is not the building or your compressors, handpieces, dental chairs, x-ray machines, or consumables, such as filling materials and gloves, but rather your patients and their records. If these records are preserved, your business can be rebuilt. Preserving records is easiest if they are digital so they can be conveniently and securely backed up off-site. Radiographs form an important part of the patient record and their backup, storage, and retrieval are facilitated by acquisition using digital radiography. Secondary digitization of film radiographs is time-consuming and also reduces image quality so it is an inefficient way to manage backup.

In an age where almost everything is digital, it is perhaps surprising that up to 40% of dentists in the United States are reported to still use film radiography in their dental practice. If the security reasons and convenient backup of radiographs were not sufficient cause to use digital radiography, let’s consider some of the other reasons:

1. Digital images can be securely transferred for second opinions or for administrative purposes including prior approval of treatment. Unlike film images that have been digitized, copies of digitally acquired images are perfect clones of the original.

2. Film radiographs and digital images have been shown to be diagnostically equivalent when optimally acquired. In the case of analog film images, reports have indicated that up to 70% of radiographs submitted to insurance companies are not of diagnostic quality, largely because of processing errors.

3. Film images do not provide “instant“ evidence of quality and so correction in positioning is less readily achieved.

4. Film is single use whereas digital sensors are reused.

5. Film requires chemical processing and processors either with a daylight loader or darkroom that take space. In addition to the consumable costs of film, there are also the costs of processing solutions, and removal of used processing solutions and lead foils. Film is not an environmentally friendly medium. Silver in used fixer can negatively impact recycling liquid waste. Hence, the disposal of used fixer by flushing is often not an option.

6. Film processing takes time. First there is someone arriving early to turn on the processor so that it can heat up to the operating temperature, then there is the time spent cleaning processors and replacing used chemistry, and there is also time spent processing radiographs. Further, there is preventive maintenance for the processor.

7. Even film that is labeled “soft” is not comfortable when used for intraoral radiographic imaging. Further, film is flexible and if bent during exposure, it causes a distorted image.

8. It is difficult to explain disease shown on a passport size piece of processed film, whereas a zoomed image viewed on a high-resolution monitor is readily explained to the patient.

9. With digital radiography, the patient record can be entirely digital for radiography and records, saving on storage space and easing retrieval of images.

10. Digital images are almost immediate and are helpful in operative radiology.

For all dentists who use intraoral radiography, digital imaging has definite advantages over analog film. Most new graduates will be using digital imaging and many will not have experienced film imaging during their dental studies. A high proportion of dental schools in the United States are now entirely digital for radiographs and records. For dentists trained in analog film radiography, there may be a fear of a learning curve and the consideration of investment perhaps not so many years prior to retirement. For these dentists, the learning curve is not as difficult as one would think because of instant feedback. Moreover, if you are going to retire, it is pertinent to keep your practice up-to-date, as it can facilitate eventual sale. If you never intend to retire, digital radiography is a wise investment for security of patient records. It is also a wise investment as processors’ upkeep, film and processing solution purchases, and associated waste removal can be costly over time. Some years ago, all photography used film and this was readily available in many different types of stores. Photographic film is no longer readily available because the declined market share made the modality a less attractive market for potential sellers. It is likely that a similar tipping point will occur for dental radiography film at some time in the near future.

About the Author

Allan G. Farman, BDS, PhD, MBA, DSc, is an oral and maxillofacial radiologist and an independent consultant in maxillofacial imaging science. He has doctorates in both oral pathology and oral maxillofacial radiology. He is part of the ISO DICOM Standards Committee and ADA Code’s Maintenance Committee for the American Dental Association. He has published over 400 peer-reviewed articles and books.