What doctors are saying about digital radiography




You Can’t Afford NOT to go Digital

Dr. William Choi, DMD, FICOI


During my first job right out of dental school, I found myself in a small darkroom with that familiar,dense chemical odor and the annoying hum of the developer. While waiting anxiously to see if my film had captured what I needed, I told myself that once I had my own practice, I would never touch film again. Now that I have my practice in San Leandro, California, I have intraoral digital sensors in each operatory, with the computers stored in a neat and tidy place out of view. The countless hours I spent developing and handling film made choosing digital imaging technology very easy. One major concern I hear often about upgrading to digital radiography is cost, but I can tell you that not upgrading will prevent you from maximizing your income. I can tell you firsthand that the benefits of a digital upgrade more than make up for the cost. I can tell you about the many different ways digital radiography reduces my costs, but for now I'll focus on a few of the advantages of digital versus film.

1. Labor — Intrinsic to film radiography is the labor required to process and develop film X-rays. biggest contributions to overhead in my office are the staff and associate dentists. In an office with more dentists than assistants, time spent developing X-rays is time lost from diagnosing and treating the more than 150 new patients that come to our office every month. Compared to the digital sensor that can capture and display an image to both the patient and doctor in two seconds, a film X-ray can take 20 to 30 minutes to develop, which adversely affects the number of patients a dentist can see in a day.

2. Costs — Without factoring in labor, the ADA estimates that every film X-ray costs about $1.11. practice that averages 500 X-rays per month will spend nearly $6,000 a year on film X-rays alone, and that doesn't even include the time wasted in the darkroom developing the film. With digital intraoral sensors starting at around that same price, a practice that switches from film to digital will regain the initial capital costs in just one year.

3. Convenience —The inherent costs of film X-rays extend to the storage and duplication of the original radiographs. Digital X-rays afford the ease and convenience of creating perfect radiographic duplicates that can be sent electronically to specialists and insurance companies, and can accompany referrals. In addition, the ability to manipulate and refine images from a computer to create more contrast or enlarge a particular area eliminates the costs associated with retaking X-rays due to over- or underexposure. My digital intraoral sensors are integrated with the existing practice management software system, making it even easier for me to store and access patients' digital X-rays.

4. Patient consultation —I know that I would not be able to see as many patients with film, largely due to the extra time it takes to consult with patients about treatment plans when showing them film X-rays. Digital imaging, which directly displays an image to the patient on a monitor where a dentist can interact with the X-ray and enhance parts of the image, significantly reduces patient consultation time as well as increases treatment plan acceptance.

5. Safety —With recent studies finding that frequent dental X-rays are linked to an increased risk of brain tumors such as meningioma, the difference in amount of radiation exposure between film and digital X-ray is paramount to a patient's overall health and safety, as well as to the health of the dentists and assistants working in the practice. Film X-rays expose patients to as much as 80% more radiation than digital sensors, but the health concerns are not just limited to radiation exposure. The chemicals used to process and develop film X-rays in darkrooms generate dangerous wastes, to which the dentists and assistants handling the chemicals are exposed.

I have a true commitment to a higher quality of care, and digital radiography is one of the many things that prove this to both my patients and staff.

William Choi, DMD, FICOI, is in full-time practice in San Leandro, Calif., is an Assistant Clinical Professor at UCSF Hospital Dentistry, and is a Fellow of the International Congress of Oral Implantology (FICOI). He has a strong interest in using the latest dental technology, including 3-D imaging (CBCT) for surgical planning and diagnosis. You may reach Dr. Choi at willdmd@gmail.com.





Why Film Radiography Is a Bad Habit

Dr. Joshua Barkhordar


Working with my father for the past four years at his Peninsula Specialty Dental Care endodontic practice, I’ve come to a realization—using film radiography in your practice is a bad habit.

Let me explain. We’ve all heard that humans are creatures of habit. Everyone has their own routines and rituals that help them through the day—a morning cup of coffee, an afternoon jog, an hour in front of the TV at night. Habits allow us to enter into a comfort zone where we’re not as engaged with the task at hand, where we can accomplish something with little conscious attention or deliberate effort.

Of course, some habits are bad for us. Smoking cigarettes, indulging in desserts or unhealthy foods, etc., all provide temporary comfort but at a long-term cost to our health. This is where film radiography comes in. Ever since the advent of digital radiography dental practitioners have been weighing the costs and benefits of adopting the new technology. Is the long-term return on investment worth the purchasing price? Are digital radiographic images comparable to film X-rays? How significant are the reduced radiation exposure levels? And yet often the greatest impediment to making the transition from film to digital is also the simplest one—sometimes dentists are just more comfortable sticking with the technology they’re familiar with. But, like any bad habit, the comfort of abiding by film radiography and resisting the technological advances of digital comes at the cost of the long-term financial success of your practice.

My father has been running his practice successfully out of Belmont, CA for over fifteen years, providing his patients the utmost in quality dental care. When it comes to the question of phasing out his practice’s film radiography equipment and implementing digital technology, my father is hesitant. He’s simply more comfortable with the equipment he’s been using for over a decade and doesn’t think it’s worth it to have to learn how to integrate and operate new technology. He’s wary of the upfront costs of investing in digital imaging equipment. But the true costs of staying with film are hidden by the convenience of sticking with the technology he’s familiar with.

I’ve shared many of the same concerns as my father regarding the transition from film to digital, but as I follow the recent advancements in digital radiography I’m becoming more and more certain of its clear advantages. Switching to digital immediately eliminates ongoing film and chemistry costs and allows you to use the space normally dedicated to developing film for something more productive for your practice. The money saved by ridding your practice of these recurring expenses adds up, and you’d be surprised how quickly it can cover the initial investment. Beyond money saved on supplies, digital imaging can increase your practice’s profits by improve case acceptance rates. The ability to instantly display a digitally enhanced image to patients gets them more involved in the diagnostic process and less hesitant to go ahead with treatment plans. And with the time you save from not needing to develop X-rays, you can see more patients. Significantly reducing costs and seeing more patients with higher case acceptance is a simple yet powerful recipe for your practice’s long-term financial success.

With a growing awareness of the long-term financial impact of hesitating to transition away from film, my father has begun to outfit his practice with digital imaging equipment—a 3D CT cone beam system and intraoral digital sensors. In a year I plan on opening my own practice, and though I’m also more familiar with film radiography, I know that to ensure the financial success of my new practice I’ll have to adopt the technology that reduces costs and increases profits.

When I was earning my D.D.S degree at the University of California San Francisco, I was mostly trained using conventional radiography equipment. Now, five years later, I oversee pre- Doctoral patient care as a clinical instructor at UCSF, and the students I teach have access to a variety of digital radiography equipment—both CCD and PSP versions of the technology—and an EPR system that archives digital radiographic images to be accessible to various clinics and specialty programs. The next generation of dental practitioners is being instilled with the skills of the future. For those of us accustomed to the traditional methods of radiography, I’d suggest seriously considering making the switch from film to digital—the short-term comfort afforded by sticking with film is not worth the true long-term costs. Think of it as kicking a bad habit.





The Benefits of Digital Radiography Flow Both Ways

Dr. Alex Parsi


At its best, the dentist-patient relationship is mutually beneficial. Dentists improve their patients' health, and patients improve their dentists' financial success. A financially successful practice can provide better treatment than a practice that is not financially successful. Dentists' best interests and patients' best interests are not mutually exclusive.

But like any other customer-business relationship, there are tensions and trade- offs, inefficiencies that are detrimental to the aligned interests of dentists and their patients: in order to create a treatment plan they are confident about, dentists often have to expose patients to excessive amounts of radiation. Despite the harm it poses to their health, patients are occasionally resistant to accepting their dentists' treatment plans.

That's why the advantages of digital radiography—rapid acquisition time, image enhancement, and low radiation—are a boon for dentists and patients. I hesitate to say the benefits "trickle down" because the advantages of digital radiography are as clear and immediate for patients as they are for the dentists who adopt the technology.

Take, for instance, case acceptance rates between film and digital radiography. Seventy-three percent of respondents in a recent survey claimed digital radiography to be more diagnostic than film. This is because the ability to capture a diagnostic image in seconds and display the magnified image to a patient—compared to the 10 or 15 minutes it takes to capture and develop film X-rays—facilitates trust between patient and dentist.

Leaving a patient in the dental chair and returning minutes later with a one-inch diagnostic image lends a recondite air to the proposed treatment plan and engenders distrust. You do not want your patients to have to take a leap of faith in accepting treatment.

At my endodontic practice in Los Angeles, I show patients pre- and post- treatment radiographs. Patients experience a sort of "light bulb effect." By clearly demonstrating to them on a digital monitor their diagnosis and proposed treatment plan, I have seen significant improvements in case acceptance. Greater case acceptance means greater financial success for your practice and improved dental health for patients—a win-win for everyone.

Efficiency in capturing X-rays also translates to time saved. Less time spent developing film X-rays and taking patients through their treatment plans means more time actually treating patients. Over weeks and months, the minutes wasted developing film turn to hours. In my experience, I would estimate that by eliminating the time spent waiting for film radiographs to develop, I am able to see one more patient for every two or three that I treat.

The benefits of time saved also extend to patients. No matter how congenial an environment we create for patients, nobody wants to stay at the dentist's office a minute longer than necessary. If you are able to reduce the average treatment time from 1.5 hours to one hour, patients are more likely to believe their time at your practice was well-spent. If patients believe their time is valued when they visit the dentist, they will be more likely to return or refer.

Patients today are also far more likely to harbor health concerns about radiation exposure. At my practice, we believe in delivering critical care that we are confident about. This means taking multiple intraoral X-rays to develop a comprehensive treatment plan.

But digital radiography can reduce radiation exposure levels by up to as much as 85%. Fast acquisition times mean immediate feedback. This allows positioning adjustments to be made on the fly while minimizing patients' radiation exposure. Garnering information through digital radiography is less harmful to the patient's health and less costly for dentists.

Digital radiography minimizes the costly inefficiencies inherent to film and promotes a more symbiotic dentist-patient relationship. When dentists and patients are more in sync, both of their interests are better served—patients can reap the benefits of better health, doctors the rewards of a more financially successful practice.

Alex Parsi, DDS, is a Los Angeles root canal specialist. He started Los Angeles Endodontics in 2007. His office features 3-D imaging (CBCT), digital radiography, digital imaging, Zeiss microscopy, an advanced anesthesia delivery system, and diode lasers. He may be reached by email at doctorendo@gmail.com.