Improved disease detection
By Dale A. Miles, D.D.S., M.S., F.R.C.D.
If issues such as cost, learning curve and concerns about the technology itself are getting between you and your purchase, read on. Here are some answers to common misconceptions.
Since Dr. Francis Mouyen introduced the first digital X-ray system using CCD-based technology to dentistry in 1988,
more than a dozen different systems have been brought to the dental market. During this time, manufacturers have been
adopting different strategies to compete for what has been, up until now, a very small share of the imaging market.
The dental community's curiosity is clearly sparked by digital radiography. In survey after survey, dentists have
continued to express their interest and desire to "go digital." Still, judging by the number of dentists who
actually own systems, there appears to remain some reluctance.
Why?
Many of the reasons dentists are reluctant to adopt digital radiography in their practices are based on perception, not fact. Below, I will show how these perceived hurdles can be overcome and why I, like many of my dental colleagues, believe that digital imaging is inevitable in dental practices. We'll start by first taking a look at the systems themselves.
Obviously, there is no shortage of choices for digital X-ray technology in dentistry. With 10 intraoral solid-state systems, three intraoral phosphor systems and five panoramic systems, the dentist has many options (see "Choices in intraoral digital X-ray imaging systems" in Related Links).
With manufacturers planning even more systems, you may be asking, "When do I buy?" There is no single answer. You may be ready now. You may have been reading about the systems for many months, but lacked the background information to become an educated consumer. Regardless, if you're even considering the switch, you are ready! In this article, I hope to bridge the gap between the dentist and the vendor, to raise your comfort level and to make you the educated consumer you need to be to make the decision.
When I lecture at regional or national meetings, I poll the audience to find out who owns the various digital technologies. Typically, among an audience of about 200 dentists, only about 10 to 12 actually own a digital X-ray system. I ask these doctors two simple questions. The first is, "Do you use it every day?" The invariable, unhesitant answer from all who own them is "yes." I am gratified that they come to the program, because this supports my contention that they bought the units without first having the "education" that is such an important component of successful adoption.
The second question I ask is, "Is the wire a problem?" Nine of the 10 doctors invariably say "no," "not really" or a similar retort. The 10th doctor often says "yes." So I ask him or her, "Are you using the positioning instruments that came with the system?" The usual reply: "No."
My point is that often what the doctor perceives to be an obstacle is not. It's a perception. While many doctors may perceive the wire as being cumbersome, it's not–if the proper technique is used. Let's face it, we practice what we were taught in our dental programs many years ago.
In reality, all of the systems are good, some excellent, and all work pretty much the way they are supposed to work. Yes, doctors have encountered problems (we'll discuss these later), and, yes, some vendors have failed to provide a level of service we expect. But all of the vendors are attempting to train their sales and service people to sell you imaging systems they believe are excellent. Remember, it's a learning curve for them also. This is an "imaging paradigm shift!" The shift is not necessarily in the way we acquire the image you still need good positioning, an X-ray device and some education or clinical experience but in the way the image is displayed and can be processed. And that's a good thing! But, it's also a "change," and few of us like that.
What are the advantages to digital radiography?
You've probably heard this before, but let's summarize the advantages of digital X-rays:
| Less exposure to radiation |
| Faster image acquisition |
| Larger image display |
| Improved patient education |
|
Improved disease detection |
| Improved clinical decision-making |
| Image-processing capability |
| Inexpensive image storage |
| Remote consultation capability |
| No darkroom errors |
| No darkroom mess |
| Consistent image quality |
| More environmentally friendly. |
What are the perceived obstacles?
In summary they are: cost, training, lack of education in the imaging modality, technique and “the wire.”
I have already dismissed the perception about the wire. But let's look at the other perceptions or misconceptions one
more time. We'll start with cost.
You should always calculate the cost of your new “digital” purchase before you buy it. Questions to ask yourself
(and maybe your accountant as well) are:
| What is the best price? |
| Should I lease it? |
| What is the warranty? |
| What is the service experience of others who purchased it? |
| Can I get a "money-back" guarantee? |
| How much training is required to use it? |
| Is that training available, and at what cost? |
|
Are there any special office modifications required for adoption? |
| Will I need to purchase any other pieces of equipment or software separately? |
| Will it make me more efficient? |
| Will it make my staff more efficient? |
| Will the staff accept it? |
| How much income will it generate? |
| When will it pay for itself? |
These questions and others have been asked (and in some cases answered) by practice management speakers and clinicians many times before. I will not answer them all here, but I will offer some observations.
First, you need to know if you're ready to adopt the technology. If you've considered it, looked at it, read about it, attended lectures on it, asked salespeople and colleagues about it, then you're ready.
I've said it many times at many meetings: the question is not should you go digital, but how soon can you go digital. You need to train on the equipment. You need to make other staff members as proficient with it as you are. There's no escaping the training.
If you haven't budgeted for the purchase, you may need to lease. You should always ask for a "money-back" guarantee; it will make you and your staff more efficient, and it will make your practice money and pay for itself in the first year.
Digital radiographic imaging systems are just another peripheral to add to your other digital devices, video cameras, fax machines, periodontal probes and voice activation charting. All practice management software manufacturers know this. That's why they've built in integration programs for the various digital X-ray systems. If your current patient management software is not capable, you may have to upgrade. If your office computer system is not networked, you may have to wire them together. These are examples of additional costs not included in the digital X-ray system direct cost.
On the other hand, many digital X-ray systems are "stand-alone" systems, capable of working in the operatory independent of the your patient database. Computer systems with huge, inexpensive hard drive storage are available if you want to keep your image database separate. However, you will want to integrate these image records with your chart records eventually, so it's probably wiser to do it now, even if it means a patient management software upgrade or complete overhaul.
What equipment do I need to go digital?
The first assumption is that you already have computers in your office. If they are networked as a LAN (local area network), then you are ready to add imaging devices and to share those images between operatories and the "front desk." Maybe you're even ready to begin to move toward an all-electronic record. At minimum, your computer should have the following configuration for digital X-ray imaging:
| The fastest processor you can afford_700 MHz or better |
| At least 128 MB of RAM (you can never have too much.) |
| 30 GB of storage |
| A CD-RW drive (rewritable) |
| Network card (if you plan to link your computers, and you'll need one for each computer) |
| Desktop scanner with transparency adapter |
Here's a system I recently configured on Hewlett Packard's online site. It had a 750 MHz Athlon processor, 256 MB RAM (added for $215), 30 MB of hard drive storage (added for $70), a CD-RW internal drive (added for $199) and a network card (added for $29). This configuration, starting with a base price of $1,231, came to $1,744. If we add a scanner with a transparency adapter (which is required to scan X-ray films and 35mm slides) at $899, our total cost is $2,643. These costs may be even lower by the time this article is printed! Kodak has just introduced a low-cost, digital inkjet printer–the DMITM 1200 that will make high-resolution paper or X-ray film prints. As of this writing, it retails for $894. Film for the printer is $71 for a box of 100, 8" x 10" sheets. The printer also prints high-quality images on DMI inkjet paper ($59 per 100, 81/2"x 11" sheets).
Now all you have to do is make sure that the digital vendor's software and hardware interface will work with this computer. Some companies have specific graphics cards and resell specific computers at a reduced cost to offer you a "complete" system. You should always check with the vendor to see if the computer system you're considering will be appropriately configured. You can also check with the digital X-ray vendor to see if they will order the computer configuration you think you'll need to see if they will upgrade the type of system they resell. If their "base system" doesn't match your needs, they will usually reconfigure the system to accommodate you.
There has never been a better time to go digital. Costs for high-end computers are low, digital systems are vastly improved, and dental software companies have integrated the image databases. All you need is the system and a little training to become part of the future of dentistry–the digital future.
Posted by dentalprodcts.net. Originally published in the December 2000 Dental Practice Report. Copyright 1999-2001 Medec Dental Communications.
Reprinted with permission. For more information on digital imaging visit Dr. Miles' Web sites: www.learningdigital.net www.edts.net
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