By Lorin Berland, DDS, FAACD
At the time I bought it, I looked at competing systems very carefully. I was looking for clarity of image, number one. I was also looking for an intuitive, easy-to-use software interface. And I was looking for reliability and versatility as far as networking within my office's computer systems.
Every other expensive piece of equipment I've bought — with the exception of my digital radiography system — is now outdated. I wouldn't even think of using the curing lights I bought six years ago, and curing lights are relatively expensive. I wouldn't use the camera I bought eight years ago. Eight years ago there were no digital cameras to speak of in dentistry. At that time digital cameras still did not compete with film cameras. I'm now on my third or fourth digital camera.
I'm still using the first digital radiography system I ever purchased. It's been upgraded, I won't deny that, but it's by far the most important and economical piece of equipment I ever purchased. Once I began to really get into using digital radiography, I discovered many more reasons why it was absolutely the right thing to do at the time and remains so to this day. Let me give you some of the reasons why.
First, there's the critical matter of diagnostic capability. I don't care what other dentists might say who are still trying to convince themselves they should stick with film technology, you can improve your diagnostic capability significantly using digital radiography. With digital, you're looking at an image that fills a 19-inch computer screen and not a film image the size of a postage stamp. Using the software-based digital radiography's image enhancement functions such as magnification, brightness control, and heightened contrast, you can bring out aspects of the X-ray that simply aren't visible on film, including such things as tiny fractures and imperfections that you might very well miss on film. Once you begin to practice using magnification for vision, you wouldn’t practice without it. It’s the same with the digital x-rays.
The ability to instantly display a large-screen X-ray image also means that you're able to involve your patients in diagnosis and treatment planning in a way that's just not possible with film. My patients appreciate it, and I'm pretty sure yours will too. I want to make it clear that I'm not advocating that you run out and buy the first digital radiography system you see. In fact, there are some digital radiography systems that will actually not allow you to capture certain images you can with film, and there are others whose design features make them clumsy and difficult to use, and in some cases uncomfortable for patients. Here are some of the things you need to be looking for and some tips to help you avoid making a mistake.
The heart of a digital radiography system is the sensor, and there are several things to look for in a sensor when selecting a digital system. The first is sensor comfort. You need to choose a system that has a comfortable sensor for your patients.
And in doing this, I'd recommend that you not simply take a sales rep's word that his or her product is comfortable. Sharp edges on the sensor are a big problem. Have your team members try out each sensor and determine which one they think is most comfortable. If a sensor hurts them, it will also hurt your patients. In terms of convenience, I recommend a system with a single sensor rather than two different sensors. Several of my colleagues have reported that having to switch between two sensors often means several retakes when they discover that the smaller sensor hasn't captured the entire X-ray image they need. This in turn means that they have to switch out the sensor and capture the image again, wasting time, needless exposure to radiation, and trying their patients’ patience.
Top: Image Enchancement using ClearVU
Bottom: Image Enchancement using the Relief Mode
You also need to make sure that you can capture all of the necessary images you need. Some systems, for instance, will not allow you to take vertical bitewing X-rays. Others, because of the way in which the cord is attached to the sensor, make it very difficult to position the sensor for capturing the third molars. If the sensor is the heart of a digital radiography system, the software is the brain. And it helps enormously if youbuy a really smart system. By smart I mean one that will enable you to set in advance exactly the order in which you want to take your full mouth series and just how you want them “mounted,” that is, displayed on the screen. You want to “set it and forget it,” so the system knows every time just how you want the X-rays captured and you don't have to specify it for every patient.
And by smart I mean a system that doesn't require you to go through a series of pulldown menus every time you want to do a routine software operation, such as magnifying an image. Look for a system that has incorporated software procedures into singleclick operations. Selecting one from column A and one from column B might be OK if you’re out to dinner, but it's no good when you're taking X-rays. One-click software procedures will save you time and aggravation.
A third area where choosing the right digital radiography vendor is important is image management. The first thing that digital radiography does is store X-ray images on the computer, so you no longer need to go fumbling through file folders and retrieving film images every time you want to send an X-ray to an insurance company or to another dental specialist. The best digital radiography systems have automated these procedures to a very high degree, even to the point where they enable you to send images to specific insurance providers as part of their procedures. This saves a tremendous amount of time and work on the part of your administrative team.
In the not-too-distant future, I'm confident that all dental imaging will be digital, as it is now in many offices, my own included. You want a system that will enable you to display all types of digital images, including intraoral X-rays, extraoral (panoramic and cephalometric) X-rays, intraoral photographic images, and extraoral photographic images. And you need to be able to display similar X-rays taken at different times side-by-side on the computer screen, so you can compare progress over time.
I've often said that I don't see how you can practice dentistry today without converting to digital radiography, and I stand firm in that conviction. Given what digital radiography will do for a practice in the areas of enhanced diagnostic capability, patient appreciation and involvement, as well as image management, I think it's incumbent on every dentist to do the homework and install the best digital radiography system available. It’s no longer a “nice-to-have.” In the current environment, it's a necessity.
