Chapter 8 Panoramic Digital Imaging
PANORAMIC DIGITAL IMAGING
1. Indirect Digital Imaging: In digital imaging there are several formats. The two most basic ones are referred to as indirect digital imaging and direct digital imaging. When an existing dental office converts to a paperless electronic chart, most likely the retention and storage of film will be considered undesirable. At that time the doctor will want to convert old charts and radiographs to an electronic medium. To do this, a scanner is used. This is called indirect digital imaging. Radiographs cannot be scanned with an ordinary scanner; a transparency adapter is needed. A home scanner with a transparency adapter is capable of scanning slides or film negatives. A full-size 8.5 × 11-inch transparency adapter will be needed for panoramic radiographs. In 2004, the price of this is $1200. An alternate method is to digitize the radiographs with a digital camera.
2. Direct Digital Imaging: In this instance the image is captured as a digital image right from the get-go. This is unquestionably the case when using the wired type of sensor. Remember, these are the CCD (charge-coupled device) sensor and the CMOS (complementary metal oxide sensor). Wireless CMOSs are available for intraoral radiography. Currently only CCD sensors are used in panoramic radiology. The other type of sensor is called the PSP (photostimulable phosphor plate). Because the plate must be scanned between exposing the plate and seeing the image in the computer, some purists have referred to the PSP system as a form of indirect digital imaging. Perhaps the PSP could be referred to as indirect direct digital imaging.
3. Converting Existing Machines to Digital: There are several considerations:
• Step 1: Software. Believe it or not, the first consideration is software. No matter what the brand, it absolutely must meet the international DICOM (Digital Imaging and Communication in Medicine) standard. As long as all the digital imaging software is DICOM-compliant, your intraoral, panoramic, and cephalometric images can be easily accessed. Otherwise, bridging software is needed and each type of image has to be kept in different electronic folders and the compatible software opened separately for each image type. This is a deplorable situation and non-DICOM-compliant products should be avoided without exception.
• Step 2: Choosing a Sensor. A decision is needed whether to select a CCD or PSP system. Both are available. If a PSP system such as DenOptix is already in use for the intraoral imaging, then going to the same brand panoramic PSP makes sense because the software and scanner will already be in place. If the office has selected a CCD or CMOS intraoral system, then converting the panoramic unit to CCD digital should be attempted. Some existing panoramic machines with soft, curved cassettes cannot be converted to CCD-type digital; instead, PSPs must be used. The best digital conversion kit is the one offered by the manufacturer; otherwise a universal converter such as the Trex Trophy system can be installed in some machines.
• Step 3: Image Transmission. Here we are referring to image transmission both in and out of the facility. The office must be networked. This can be with wires or wireless. The image capture computer is not where the images will be stored. They must be exported from this computer and imported into the patient’s electronic chart. They can also be sent via e-mail to third parties such as insurance companies, another practitioner, or a representative of the legal system. Anytime an image is exported out of the office, the recipient must be registered with you as a HIPAA business associate or be HIPAA-exempt. One way to ensure the patient’s privacy is to use bar codes, which are now readily available to dental offices.
• Step 4: Mainframe Computer and Server. Most likely, the computer in the front office will no longer serve as the main computer because memory for the digital images will be inadequate. Each panoramic or a 20-film, full-mouth intraoral survey requires 1 megabyte (MB) of hard disk memory. There are 1000 MB in a gigabyte (GB) so even a 100 GB hard drive will not suffice for long, especially if the doctor also has a digital video camera or even a still digital camera. So a mainframe computer is needed that is connected to a server that is in turn conne/>
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