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Pan Imaging News V3 I4 Volume 3, Issue 4 US $6.00 Editor: Allan G. Farman, BDS, PhD (odont.), Digital Options for Panoramic Radiology DSc (odont.), Diplomate of the American Board of Oral and By Dr. Allan G. Farman in conjunction commercial dental intraoral sensor Maxillofacial Radiology, Professor of with William Jacobs became available in the U.S. market in Radiology and Imaging Sciences, 1991. Since that year, a number of Department of Surgical and Hospital Digital x-ray imaging is making different systems have become Dentistry, The University of substantial inroads into the dental available, and picking the right system Louisville School of Dentistry, practice. The purpose of this article is for the job is not an easy task. Louisville, KY. to provide a succinct overview of Systems are different in nature, and Contributor: current digital options for panoramic comparison is made difficult because William R. Jacobs, President, WRJ & dental radiography. physical specifications do not easily Associates, Dental Marketing translate into day-to-day dental Consultants, Homer Glen, Illinois Introduction operations. The move to panoramic digital An image is said to be digital Featured Article: radiography in dentistry has been when it is composed of separate Digital Options for Panoramic slower than the move toward intraoral (distinct) elements [1,2]. Each element Radiology digital radiography for a variety of is called a “picture element” or pixel. If reasons. Every dental practice is an image is displayed on the monitor, In The Recent Literature: different and has unique needs and and the pixel is smaller than the Radiation Dosage – Solid State wants. Before making a decision on smallest detail the viewer’s eye can Imaging digital panoramic radiography, you see, it is hard to determine that the Third Molar Assessment must weigh carefully your unique image is indeed a digital one. If this is operation, the type of practice and not the case, that is the individual Soft Versus Hard Copy patient mix, your staffing, your goals pixels can be spotted, the eye views and objectives, the systems available, the image as a mosaic of pixels. Learning Objectives: the overall economics and costs Each pixel can only take on a Gain understanding of digital involved, the timing, the state of the limited number of gray shades. The system options available for technology, and anticipated changes number of possible gray shades panoramic radiography. in technology. If you already have a depends on the number of bits (binary digital intraoral system the move may digits) that are used to store a pixel. A Learn the basic concept behind make sense. If you do not, then one-bit pixel can only take two values each approach along with the maybe going to digital intraoral first is (0 or 1 - that is black or white). An 8- advantages and disadvantages of best. Perhaps it is something you want bit pixel can take any one of 256 (28) each option. to delay to see how things develop values. A 16-bit pixel can take more and what new technologies are than sixty-five thousand grayscale Review points to consider in introduced in the next year or so. values (216). It is generally accepted analyzing options for your practice. Perhaps you wish to take small steps, that the human eye can only distin- first incorporating secondary capture guish about 20 magnitudes of light using a scanner to help you determine intensity, and is certainly unable to the best long-term approach for your discern all 256 gray levels that a practice. The decision is not an easy standard computer monitor can one and takes much thought and display. The total number of bits that investigation. This newsletter will are used to store an image is the address the basics of digital radiogra- number of pixels times the number of phy and show the alternative ap- bits per pixel. proaches available today. There are three methods avail- Digital radiography encompasses able to produce digital images. First, all the techniques that produce digital it is possible to digitize conventional (or computerized) images, as op- radiographs through secondary posed to conventional radiography, capture using transparency scanners which uses x-ray films. The first or specialized digital cameras. “ Film scanners and digital cameras can be used to produce a digital image from a film radiograph.” Alternatively, digital images can • No changes or additional be produced using storage phosphor training required plates or with solid-state systems, • Known entity — proven output usually involving use of a charge- • Relatively low cost of operation coupled device (CCD) comparable to • Excellent diagnostic clarity the computer chip found in a digital possible if exposed and pro- camera. cessed optimally Properties essential for digital • Widely accepted panoramic radiography include: • Images of diagnostic quality Digital X-ray Imaging • Radiation dose similar or Disadvantages reduced compared to film The following are some of the key radiography disadvantages of digital radiography: • Compatibility with existing • Added initial cost for equipment panoramic x-ray generators given you are presently using • Lossless archiving (storage of film the full original radiographicim- • Need for additional computers, age) monitors, networking and • Interoperability of image backup storage format so that the patient’s • Sensors (both solid-state and Fig. 1: Nikon CoolPixTM scanner with information can be conveniently phosphor systems) can add transparency adaptor in lid sufficient shared when professionally $15,000 to $25,000 to the cost for extraoral radiograph duplication. necessary. of the panoramic system • Changes in operations, sys- • Digital images allow perfect Film Disadvantages tems and procedures require an “clone” duplication and The following are some of the key investment in time and involve a backup disadvantages to using film radiogra- learning curve • Post-processing can help phy: • Not all digital image formats are optimize the diagnostic • Cost of consumables such as identical at this moment so yield film and processing solutions interoperability can be problem- • Digital radiology eliminates • Cost of processing equipment atic both in the same office and environmental silver and darkroom space when making outside referrals contamination from spent • Time consumption in film • Eventual hardware obsoles- fixer processing and processor cence maintenance If I decide to go digital, how do I • Processed film images are Digital X-ray Imaging get into it? What systems are rarely optimal Advantages available? • Used processing chemicals are The following are some of the key There are two ways to get toxic to the environment advantages of digital radiography: into digital panoramic radiography; • Film radiograph storage and • Digital x-ray imaging saves time (1) buy a totally new integrated retrieval can be problematic as there is no chemical pro- digital system; or (2) use your • Duplicates made from film cessing current panoramic system [3-5]. radiographs are invariably • Digital images are more If you use your current inferior to the original radio- consistent in quality for the panoramic system, undoubtedly graph same reason the most economical method, • Digital images ease communi- there are three alternatives to look Film Advantages cation with patients at: (1) Secondary Capture of The following are some of the key • Digital images are readily analog film images using scan- advantages to using film radiography: stored and retrieved ners, (2) photostimulable phos- • Low initial cost, especially for • Digital radiology opens the way phor plates and (3) retrofit (add- manual processing to electronic interchange on) solid- state systems with • Often already in place • Consultation can be expedited digital detectors[6]. TABLE 1. 2 DIGITAL METHODS Film scanners and cameras Table 1: Alternative digital approaches. Film scanners and digital cameras can be used to produce EXISTING PANORAMIC GENERATOR a digital image from a film radiograph. In general, secondary Film Based System capture is best achieved with a good quality scanner having a radiograph adaptor (i.e. scanning SECONDARY PHOSPHOR ADD ON/ light in the lid to pass light through CAPTURE PLATE RETROFIT CCD the radiograph, Fig. 1). Nikon and Epson produce excellent scan- • Scanner • Phosphor Plate • Sensor replaces film ners for this purpose with the costs varying from around $600 • Digital Camera • Plate reader/scanner • Sensor linked directly to $1,500 for a quality system. A linked to computer to computer sharp black and white photograph setting is preferred. Scanners are preferred to digital cameras as they practically eliminate optical BENEFITS BENEFITS BENEFITS distortion and the reflection from the surface of the radiograph that • No change to • Similar exposure • Directly digital would otherwise reduce image radiography procedures quality. Film scanners do not generator or •“Instant” image on exposure • No machine changes change the need to continue screen making radiographs with x-ray • Try digital out • Easy transition • Speed film. They introduce additional time-consuming activity to scan • Low cost • Can be used with • No consumables (film the images, but that is the price multiple machines and solutions) you pay to continue to use film • Digitize all file radiographs while digitally storing radiographs images. No matter how good your film scanner is, scanned images can only be as good as the original film radiographs. The COSTS COSTS COSTS advantage here is that you can scan and archive
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