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Digital X-rays: Some Strong Points about the Low Rays!

Yes, the digital age is upon us. About 8 months ago we decided to go digital with our X-rays. This is almost the last step towards our goal of getting rid of patient paper charts. We still have panorex x-rays that need to be put in our patients charts and we are considering scanning these so we would be totally digital. We have not made that last step as of yet, because we are still adjusting to the digital x-rays. Yes, adjusting! I will try to summarize some benefits, some of the problems we have encountered and some of our solutions.

The initial setup is somewhat of a shock. You will need to make sure your computers are up to the task and your X-ray heads also. The digital X-ray requires very precise exposure because it is so sensitive to even a small deviation in exposure. The computer can and does adjust for some of the deviation between shots but good equipment makes for a far less frustrating experience. A Pentium processor with at least windows 3.11 and 16 megs of ram is recommended. Your X-ray head should ideally be a 70KV machine although mine are (4 of 5) 90KV machines. My next purchase will be new 70 KV machines.

Installation was not easy. If you are not familiar with interrupts and memory addresses make sure you include setup in your purchase agreement! Once we handled the first computer --the rest were easy. (We installed the boards in 3 of our operatories. Both hygiene ops have individual setups. The three doctor ops share one central computer x-ray capture card by utilizing a long cord for the sensors). Every computer in the office can access the radiographs via the network, we have computers in all six opertories, two at the front desk, one consultation, one in business office and one in my private office. We store the data on one central computer hard drive that all computers can access. The network software version required a few calls to tech support to make it work properly.

Digital x-rays required some new technique learning by all staff members. We had to experiment to determine the correct exposure and placement technique. We found that the smallest sensor was basically useless. We utilize the two larger sensors for PA's and Bitewings. We have found that on young children the lack of bendability usually requires the use of traditional film on the little ones. The film holders that come with the digital equipment are very helpful in holding and aligning the film. You will need to order extra sets of the sensor holders. If you already have Rinn kits for regular x-rays you can use these and only order the sensor holders they will fit on your traditional Rinn alignment tools.

It is imperative that your computer monitors are of good quality and your video cards must have at least 1meg of video ram.

Initially, we were skeptical that we could see all the same things we see on regular radiographs. With our current equipment I seem to have a harder time discerning small incipient carious lesions. This may be more a function of some of our current monitors and 90KV machines. Digital x-rays are wonderful for Endo treatment! It saves tons of time and takes much of the frustration out of determining length and fill. You can take multiple pictures without removing the sensor and get good angle views that are very time consuming and frustrating with regular film. No implant dentist should be without this as well. The rapid x-ray and measurement features are awesome tools to help with implant placement. Emergency treatment of patients is enhanced with digital x-ray. You can seat the patient, take the x-ray, and diagnose in usually 3 or 4 minutes instead of 7-10 minutes. You save even more time if you happen to miss what you want to see on one of the x-rays. You also impress the emergency patient with the new technology!

I would estimate that time saving in the typical week (less time on emergency endo) will save the doctor about 1 to 2 hours a week. At a $200 per hour production rate, that's $400 per week and, at 48 weeks per year, $19,200 per year. You will also save staff time for developing and mounting x-rays. If they save 4 hours per week at $10 per hour and 48 weeks per year we save $1920 per year. Add to this less wear and tear on your x-ray heads (you shoot for 80% less time) the film cost and developing costs and I would conservatively estimate that you can save between $22,000 to $30,000 per year. I ask you, Why wouldn't anyone buy one right now?

This year I will buy two more boards for my last two doctor's computer opertories so we won't have to drag our long cord between opertories. I will also buy some new 70KV x-ray equipment and some better computer monitors for some of my rooms. The way I look at it, my initial investment of around $17,000 has been paid back already.

Now remember not the least benefit is the reduced dose to your patients!

Storing the X-rays will become somewhat of a problem. I expect to be able to store about 1 year on a 2gig hard drive. We archive the x-rays to a writeable CD drive for permanent storage quarterly. Of course we back up to a removable media every other day. We like the Iomega Jaz drive. It is very fast and holds 1gig. I made a simple backup "bat" file that only copies the files from a certain date onward. I change the date once a month. This shortens the backup time for my front desk person to about 5 minutes per backup. With new larger cheaper hard drives coming along storage is not going to be an expensive problem.

So far, insurance companies have not given us any grief about sending them printed x-rays. We just use our laser printer and attach them to the insurance forms. This is so much better that sending out your x-rays and not having them when you need them for reference because they are out at the insurance company. Also having access on the computer solves the run around looking for the emergency patient's x-rays syndrome. The computer doesn't misfile them!

What improvements would I like to see? The computer image can supposedly capture and determine much more data than we can see with our eyes. Someone needs to make that data apparent to us via better color rendition of the different shades of gray. I recently saw some software that predicts the probability of decay in areas on the picture where I really can't see a definite lesion. How much easier our diagnosis could become!

In general, I and my office are very enthusiastic about our entry into the digital X-ray age. Join us and send your comments about your experience.

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