The Real Truth About Digital Radiography

In a modern practice, digital radiography is essential

The day I dumped that blasted machine in the trash was one of the most triumphant days of my life. I said goodbye to developing time, processor maintenance, duplication time and pulling charts to obtain x-rays. Digital radiography is an information tool that allows you to share information with a patient in a way that has never before been possible. I never considered that x-rays were a case presentation tool until I got digital. Patients can absolutely see what you are talking about. I have 17.5 inch flat screen monitors in my operatories and patients turn their heads to see their images pop up on the screen. They can now easily see decay, bone loss, wisdom teeth, large fillings, tooth wear and periapical radiolucencies.

X-rays were never a very good patient education tool because of their small size. How many times have you pulled a view box off of your counter top, handed it to the patient and said, “Mrs. Jones, can you see that shadow right there? That’s tooth decay and we need to fix it.” Then Mrs. Jones says, “Where?” and you say, “Right there. Do you see it?“ and she says, “Not really” or “I think I do.” “Wait a minute Mrs. Jones, let me get something smaller to point with.” You search around for something. You find a perio probe or a cotton tipped applicator. “Now look Mrs. Jones, do you see it now?” Mrs. Jones squints her eyes. Her brow wrinkles up. She says, “Oh yeah, I see it now, right there?” “No Mrs. Jones, that’s the interproximal space, I mean it’s just space, you know space between your teeth. Space between your teeth is nothing to worry about, we all have space between our teeth. I’m talking about that shadow in your tooth right there. Right there.” You are pointing with your stick. Mrs. Jones smiles weakly and shrugs or nods. “O.K. I trust you, what should we do about it?“

Saving Time and Motion

Have you ever stopped to count the motions involved in loading film in and out of a holder such as a Rinn? There are multiple repetitive motions involved. With digital x-rays, the sensor never leaves the mouth. You just move it around. Digital radiography allows your hygienist or dental assistant to stay in the room with the patient. Patients do not like to be left sitting alone and bored in the dental chair. When a hygienist leaves the patient to go to the lab, there is a greater likelihood that she will run into another employee and start a conversation. In addition, if there is already another staff member feeding x-rays through, she’ll have to wait her turn leaving your patient alone and increasing your chair time.

The case of mistaken identity

How many times have you ever seen films go into the automatic processor and never come out, or the processor break down? How many times have you run out of fixer or developer and discovered the problem only after ruining x-rays?

Is less radiation really important?

Manufacturers are quick to explain that digital radiography greatly reduces radiation exposure, but really how important is this feature? There is significantly less radiation exposure to the patient because it takes less radiation to expose a digital sensor than it does to expose silver halide crystals. Whether decreasing radiation to the patient is significant or not in the amounts we use, patients perceive decreased radiation as a benefit and they will appreciate your progressiveness and concern for their well-being.

Supply costs are diminished

I wish I could count the times that a box of pano film has been inadvertently exposed in my office. Thankfully, I have a merciful staff that shields me from this knowledge in order to spare me unnecessary grief and consternation. Switching to digital radiography means you will not have to deal with ordering film, developer or mounts.

Reduced time, travel and training

Imagine that you could put a video camera above a dental office and monitor the traffic in and out of a dental laboratory every day. If you measured in miles, the trips to handle film, how many miles do you suppose it would be? Throw in the time it takes to phone in orders for supplies and unpacking, stocking into the lab cabinets and then again, stocking film into the operatories. A significant amount of time and distance each month is spent performing these tasks. Now imagine the sudden elimination of all that time and travel. What an impact!

With digital, no mounting is required so you do not have to expend time training an assistant to orient the dots, mount, troubleshoot bad x-rays, maintain film inventory or order chemicals. That’s what digital radiography has done for my practice.

Instantaneous feedback

With digital radiography, you shoot and receive immediate results. If there is a problem with the x-ray, everything is still in place and you re-shoot.

Consider shooting check films for endo. With film, you pull back the rubber dam, you insert your film holder trying to work around a wild tongue or a shallow palate, you align your x-ray head, push the trigger to shoot the x-ray head, take the film out of the mouth, put it through the x-ray processor, put the rubber dam back on, push the x-ray head back, let the dental chair back down into working position and then pray fervently that you got the shot. “Rats!” You missed the shot. Drag the film holder back out, put the lead shield back on, put the thyroid protector back on, put the film holder back in the mouth, realign the x-ray head, shoot, repeat all the other steps including praying and even then you may find yourself repeating the entire process. Even if you get the shot, a canal might overlap another one, a zygomatic arch might be in the way, the rubber dam clamp might overlap the apices and file tip, etc., etc. (I am beginning to sound like Yul Brynner in the King and I.)

Now, consider endo shots using digital radiography. I can even take my own shots now. The first shot is lined up. I depress the button on the x-ray machine and hear a brief blip. Within three seconds an image appears. During this time, the x-ray head is still aimed at the same spot, the rubber dam is pulled aside and the patients head and the film holder remain exactly as they are. All references are intact. Using x-ray films, all references are lost - you only have your memory to rely on. If you miss the shot, it’s easy to see how to make the correction. It’s so fast to shoot another shot, and the radiation exposure is so low, I don’t mind taking several shots in order to elucidate as much information as possible as to exactly where those file tips are in relation to the apices of the roots you’re working on. Quality is increased while your stress is reduced and you will feel good about what you’re doing.

Let’s do the math

One of the major considerations about switching to digital is economics and the payback period. Applying the time savings already discussed, let’s apply some real numbers to the labor and materials costs.

Time savings resulting from immediately obtaining an image, with no developing or mounting time, can easily save you 10 minutes per patient. That’s up to 80 minutes per day or roughly an hour-and-a-half. If you calculate a hygienist’s hourly rate and multiply it by three, you get $90 per hour. Multiplied by the time savings means you save $135 per day in chairtime and labor by using digital x-rays. Now, you have created capacity and can now fit at least one more patient per day into your schedule. With an average hourly rate of $100 per hour, you have just increased your production by $235 per day and your hygienist still has a spare 30 minutes to increase your practice’s daily production revenue even more! Even if you calculate the savings based on a four-day workweek, the savings still amounts to roughly $3,500 per month (not to mention the savings from supplies, increased case acceptance, goodwill from value added service. Plus, the amount of money saved from film costs, duplicating, chemicals and maintenance.)

So, let’s assume you save $3,500 plus in production and another $3,500 in supplies. That’s $7,000 in extra revenue per month. If you’re doing endo 15 cases per month, that equates to 30 hours of doctor production time saved in a year. If your average production is $250 per hour, that’s another $7,500 per year in increased revenue. Now what do you think of digital radiography?

Digital radiography is essential if you’re going to go paperless. Once you go paperless, you will have eliminated one of the most arduous and time-consuming processes in the office - chart pulling and filing. Do you know how much time accessing and filing charts takes in your practice each day? Let’s assume your staff pulls about 20 charts a day. Once pulled, the charts are handed back and forth between the front desk and the operatory. Sometimes the charts are lost. How many miles of walking do you think occurs from just carrying charts back and forth, in addition to locating lost files? Let’s take the figure of two hours per day of chart handling in one form or another. A $20 per hour assistant times three in order to get overhead expense, that’s $60 per hour or $120 per day. That’s about $1,800 per month in chart pulling. That kicks the figure up to about $123,000 per year.

Digital pan:. . . . . . . . . $80,000

Digital sensors x 3: . . . $18,000

Total:. . . . . . . . . . . . . . $98,000

Tax write off:. . . . . . . . $30,000

Total:. . . . . . . . . . . . . . $70,000

Now, how can you justify the enormous cost of switching to digital radiography? Well, let’s look at the cost of owning digital: That’s right - digital can completely pay for itself in the very first year if you make use of all its benefits. Although I’ve only had digital in my office six months, I anticipate saving $100,000 my first year.

Minimize insurance nightmares

Have you ever experienced an insurance company stating they never received a patient’s x-rays? Personally, I’ve had insurance companies that have stated that many times for an individual patient. Not only is this situation extremely frustrating for you and your staff, it costs you additional money! Some dentists even compensate for these prevalent problems and shoot doubles to prevent a retake. But think about this...once your original is ’gone’ you now have to have the second copy duplicated to maintain a file copy for you records in the event this situation happens again. Have you ever stopped to calculate the cost of having an x-ray duplicated? And, the maddening thing about it is that the duplicated x-ray is not diagnostic anyway. First you have to pull the chart. Then you have to find the x-ray duplicating cassette. Next you have to find some film, remove the film from its container and put it into the cassette with the fresh film. Then you expose it and finally run it through the processor. The whole process takes about 10 minutes. Not only do you have to count the time and expense of an employee duplicating an x-ray, but you also have to count the time lost that the valuable employee could have used doing a task that had something to do with serving your patients. Who pays for duplication of x-rays? Does the insurance company? Does the patient? The answer is a resounding NO! The doctor pays for it. And why? So some selfish insurance company can clog up the everyday operations of your business to enhance their non-value added profits.

With digital x-rays, when the insurance company reports a missing x-ray, you simply poke a few buttons on your keyboard and a new one prints out of your 1200 dpi laser printer and you’re done. The whole thing takes less than one minute. It’s easy and it’s quick.

So, can you afford to adapt digital radiography into your practice? As a fellow colleague, I’m telling you, you simply can’t afford not to!