Sensors

Digital radiography is following the same path as its photographic brethren by steadily overtaking film, with one estimate showing approximately 65% of U.S. dentists having already switched. While this transition may not be proceeding as rapidly as it is in photography, it is, nonetheless, inevitable. With digital technology, you take x-rays with your current equipment using a special sensor or plate. These sensors/plates are reusable, which eliminates the cost of film for periapicals and bitewings.

Digital images can be organized, stored, and recalled electronically for instant retrieval and presentation with special software. This software allows a wide array of patient-pleasing devices such as zoom, image reversal, image coloration, annotations, etc. These features are also very valuable when sending pre-determinations. You also have the capability of emailing images to colleagues or insurance companies. Even the quality of these email images is quite amazing.

Patients respond very favorably to digital images since they can more clearly see what you are talking about when you point to a shadowy area of an x-ray, because the image is much larger on the computer screen. Viewing an image on a computer monitor is also much more comfortable for patients since they are used to looking at one compared to trying to view a film-based image on a viewbox with its glare and unfamiliar feel. In addition, options such as coloration, image enhancement, and reverse images allow for better contrast and views of carious lesions, open margins, bone loss, and furcations.

However, there is no denying the fact that these systems are rather costly. Since their prices do not typically include the computer, software (in some cases), monitor, and the actual x-ray generating machine hanging on the wall, the only hard cost you are eliminating is the film. You will still need the equipment and room to process conventional films if you are taking panoramic x-rays, unless, of course, you have a digital version of that format or a phosphor plate for that type of image.

Types of Sensors

CCD/CMOS

Most common type of sensors that produce virtually instant images; you expose the x-ray and in a second or two you can see the image. Most are wired, which can be nuisance to both the operator and the patient. They also must be covered with a barrier bag, since they are not sterilizable. While some are relatively thin, all of them are substantially bulkier than film and they are rigid, which makes placing them correctly intraorally a challenge with some patients. Some have square edges and others have rounded and/or beveled corners for greater patient comfort. However, inserting them into some holders can be a nuisance.

Due to the virtually instant image after exposure, these sensors eliminate the wait while films are developed. The effort spent processing and mounting x-rays is also eliminated, which saves you and/or your staff valuable time. If the images need to be retaken, this can be done instantly.

CCD (charge-coupled device)

Miniature camera, similar to those found in intraoral cameras. It captures the image and then transforms it so it can be read by the software. They have been used for a longer period of time (the CCD chip was developed in the late 1960s to be used in TV cameras), so their quality is well-known and stable. They also have lower noise, which means that the software or hardware does not necessarily need to be used to refine the image. This makes it easier to capture good images immediately. Only a few manufacturers produce CCD sensors, therefore fewer are made and they cost more. Since their quality is well-known, companies no longer feel the need to spend time and money on improvements because they don't feel many can be made.

CMOS (complementary metal oxide semiconductor)

More like a memory chip. It captures the image and then stores it until it can be read by the software. They have a higher noise value, so the software or hardware must be utilized to refine the image. Another issue is that their quality may not be as uniform as with the CCD sensors because it is still a relatively new entry in the digital x-ray market. CMOS chips, however, cost less and are widely manufactured. It is easier to make these sensors in larger sizes and, because it is a newer sensor, research and development departments are spending a lot of time and money to introduce these sensors into more markets.

Phosphor Imaging Plates

Unlike CCD/CMOS sensors, phosphor imaging plates are more similar to film in that they are wireless and must be "developed" using a scanning device instead of developer and fixer. However, they still need to be protected from the oral cavity in barrier envelopes and some of them are stiffer, thinner, thicker, and/or larger than film. Some are also more difficult to secure in an x-ray holder. With this technology, you expose the plates, followed by loading them into a scanner, which then displays the images on a computer monitor. This means the images are not instant. Depending on the system, the image will be displayed on the monitor after 15-75 seconds and then you need to digitally "mount" it in a designated template.

After loading the images, you simply expose the plates to light for 3-5 minutes to erase them (at least one system includes a light box to erase the images and another erases them automatically after they are scanned), allowing them to be used for the next patient.

Ease of Use

Digital technology is not yet point and click. Auxiliaries must be computer-literate and be willing to shift their comfort zone away from low tech film. And, although some sensors are easier to place than others, none of them match the simplicity of film. Due to the importance of the size and comfort of the sensor, we have measured those available with each system. All the sizes have been rounded off to the nearest tenth. Therefore, the mm sizes are more precise than those in inches and may not always correspond to the inches dimension. The sizes can be compared to those of conventional film packets:

Film Size
Length
Height
Thickness
0 1.5in/38.6mm 1.0in/25.4mm 0.05in/1.3mm
1 1.6in/40.8mm 1.0in/25.4mm 0.05in/1.3mm
2 1.7in/44.1mm 1.3in/33.4mm 0.05in/1.3mm

 

 

 

 

 

And, as with anything digital, there may be times when the system just plain "goes down". While it is tempting to have a back-up, film-based system, it is unlikely you will ever go back to film after you convert to digital.

Software

Some systems require that you buy its software, while others allow you to buy just the hardware, especially when you already have a digital x-ray module in your practice management/clinical exam software. Nevertheless, most of these systems provide many of the same tools, such as rotating and flipping the image, enhancing the image in various ways, etc. The ratings are mainly based on the hardware, since you can't manipulate an image, no matter how good the software is, if you can't capture an adequate image in the first place.

DICOM

One of the most important parts of this kind of software is the ability to communicate with the hardware on different machines from different vendors. For this reason, most of the vendors are adopting DICOM (Digital Imaging and Communication in Medicine) standard for digital radiography. This results in a common language for formatting and exchanging images and information. Both systems in this section are DICOM compatible to fulfill the ADA standards.

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