If your personality and practice demands radiographic images with the highest possible resolution, hairline detail and total familiarity with what you wish to see then stick with film. If you appreciate versatility in image presentation, speed of image analysis, convenient cataloging and all the trappings that digital imaging has to offer or claims to offer, then ‘going digital’ is for you. If, however, you are on the verge of taking the plunge into the world of digital but cannot quite do it, here are a few things for you to consider.

You will be purchasing a considerable amount of computer hardware, depending on the size of your practice and wht services you wish to offer. The simplest system consists of a laptop, sensor and some imaging software. A few thousand dollars will do the job and the result will be a simple and effective system for a sole practitioner. A multi operatory practice will require a central computer system, extra storage, multiple monitors, wiring, multiple sensors, a significant investment of staff time both in training and Quality Assurance, maintenance agreements for software, hardware and possibly firmware, PLUS a lot of money. Six figure installations are not that uncommon, and that’s just for starters.

Consider that about half the practices in British Columbia now use digital imaging in its’ various configurations. Consider also that most recent graduates have never examined a film-based radiographic image and it’s easy to see where this technology is going.

Here are some things to think about:

• You will be storing a lot of patient data. It must be secure and backed up off-site.
• You should purchase software from a vendor that is going to be around for a while to support it and provide free updates. All software is in a continual state of evolution.
• Choose software that allows for you to assess image quality.
• Your system will require maintenance and there are a limited number of competent people available who can do the work and understand your requirements. Choose these carefully.
• Make sure that the software you purchase is compatible with your hardware. There are many subtle pitfalls here.
• Consider carefully what you will do when the system fails. It will fail on occasion.
• Look carefully at the two popular systems, known as CR and DR. While one is less expensive than the other, maintenance is an issue that can eat up the difference.
• Consider the fact that you will be called upon to share images with others. This subject is ‘hot’ and present and is a sleeper. Many of the ad hoc methods that are currently in use are going to be subject to scrutiny by the political and legal community as soon as the inevitable event occurs.
• Patient dose: D speed film requires about 300 mR at 70 kv to provide an acceptable BW image. F speed (Insite by Kodak) requires about 120. DR imaging appears to need around 80-90 and CR patient dose is almost identical to that of F speed film. These results are based on about 7000 tests and 35,000 exposures undertaken in dental practices.

Dental imaging is here to stay and will become the modality of choice by dentists.

Dan Hanson, P.Eng

Chief Inspector, Innovative Biomedical Engineering