The key issues to resolve are:

1. How comfortable are you with computers?

    

2. What are your expectations?

    

3. What will digital radiography do that conventional radiography can't?

    

4. All things considered, is it worth it?

    

If you currently use a PC several hours or more a day, have installed basic hardware and software options successfully and were gratified and not infuriated by the experience, read on. Otherwise, don't learn basic PC operations on a digital radiography system. It can be done, but Rambling around while trying to manage a clinical case is very frustrating. I would classify these systems as moderately user friendly. If you already have computerized your office, computerizing your radiography will be considerably easier than that task.

The cost will vary, but expect to pay $8-12,000 per workstation. I feel that this technology is new enough that an extended service contract with your vendor is essential. Therefore, check out the cost and reliability of your vendor's support before you buy.

There are five major advantages of digital radiography.

1. Images are available in seconds. 2. Exposure is reduced 50-90%. (I use a 7Okvp machine and reduced exposure 80%) 3. For direct systems like Schick and Trophy angulation adjustments can be made before the sensor or x-ray head is moved. This allows for more accurate second shots 4. Image size, contrast and density can be manipulated to improve interpretation. 5. Record keeping is vastly improved. All films are labeled, filed and retrieved easily. Duplicate hard copies are the same as originals and simple to make

In addition to these unique qualities of digital radiography, there is a big bonus. Patients are amazed. While patients are impressed with microscopes, apex locators, "hot glue guns" and the like, they talk about the computer image like it was from Star Wars. Explaining dental problems are greatly enhanced and make consultations more effective.

One major issue regarding digital images is resolution. Ideally exposed, processed and displayed conventional film (how often does that happen in practice?) has a resolution of about 14 line pairs per millimeter. Digital images are in the 10-12 line pairs per millimeter range. While this can be significant in examining fine details, resolution is not the whole story in viewing images. Size, contrast and density are equally important and this is where digital images shine. I have found that both types of images provide different kinds of information. The situation is analogous to weather forecasting. Meteorologists get a better perspective with satellite images but still use observation data to fine-tune their forecast. If I were forced to choose one over the other, for an endodontic practice, I would choose digital.  

6. Printing options

Dye sublimation-Photographic quality "permanent" color prints on card stock can be produced in about 5 minutes. It is a bit expensive, about $.80/print. Thermographic-Black and white prints can be produced in about 1 minute for about $.30/print. These are unstable and are not readable after a couple of years.

CONCLUSION

Digital radiography is here and growing. This technology is similar to the home VCR. As the software and hardware improve in quality and price, digital systems will replace film. The early users will be those that have the greatest need for speed and image control. It is estimated that conventional films cost $2.50 to 3.50 to produce, mount and store. From purely a cost basis, it would take 5000 digital images to off set the cost of one workstation. That is about the number of images the average endodontist takes each year. If the clinician elected to charge a premium for a digital image, the payback would be much quicker. The cost of hardware and software upgrades adds to the payback time.

I have worked with digital radiography for three years. Even if these systems turned out to be more expensive than film, they are so nice to use clinically, that I would not switch back.