Choosing Digital Sensors
A practical guide for integrating this imaging technology
Aniket Jadhav, BDS, MDS, MSHA
Digital sensors can be a very helpful technology for most aspects of general dentistry, and especially for endodontics, dental implants, surgery, and immediate postoperative assessment. Digital sensors can be classified as direct or indirect digital (photostimulable phosphor plates, or PSPs).
Typically direct sensors are attached to the computer via a cable and either utilize CCD or CMOS technology. Regardless of hardware technology used, image resolution is similar. The latest generation of direct digital sensors can achieve resolution similar to the film-based imaging. Resolution varies by sensor and depends on the hardware specifications and technique used.
PSPs are not connected to computers directly by cable or wirelessly, but rather they need a dedicated scanner to process the image. PSP are similar to film and therefore represent a more comfortable transition to digital imaging for some clinicians. They are more flexible and cheaper, but offer slightly lower resolution than direct sensors.
Digital sensors replace film and processing chemicals with scanners and computers. This saves lot of space for the dark room and maintenance of the processing solution and equipment. There is also no need for physical file storage.
Digital sensors are also timesavers for clinicians. Images can be accessed easily and stored along with a patient’s health record, as well as securely shared with other providers when needed. Radiographic images can be stored in different formats (eg, jpeg, tiff), which varies among vendors. It is highly recommended to have a system that is DICOM conformant. DICOM images are not merely the radiographic images, but also contain patient information and offer seamless sharing among health care professionals. Although it is beyond the scope of this article, HIPAA compliance must always be ensured when sharing patients’ protected health information.
Regardless of type of imaging used, clinicians should utilize the lowest possible radiation dose to acquire diagnostically acceptable images as per the ALARA (As Low As Reasonably Achievable) principle. Digital sensors require a lesser radiation dose as compared to film, but patient exposure may actually increase especially with direct sensors due to the ease of making an exposure.
If you are considering adopting digital sensors in your office, here are some important factors to consider:
Software compatibility. The very first thing is to determine if digital sensors would be a good fit for the practice. Integrating a new technology means making changes to the current workflow. Before deciding on any imaging system, it is important to see if the system can be bridged to the current practice management/electronic health record system. This will make the job of the assisting and administrative staff easier, allowing them to seamlessly adjust to a new workflow and help them share patient health records and images with specialists or patients.
Patient comfort. A common concern about direct digital sensors is patient discomfort due to their thickness, as well as the difficulty in using them for patients with limited opening or a strong gag reflex. Training assisting staff and clinicians is key to minimizing discomfort. Paralleling technique (sensor and teeth are aligned parallel while x-ray beam is directed perpendicularly using XCP sensor holders) is widely used in dentistry. When patients experience a gag reflex or have a limited opening, however, bisecting angle technique (sensor is placed close to teeth and x-ray beam is directed at the imaginary line dividing the long axis of the tooth and the sensor) can be used instead. The majority of vendors have specific sensor holders designed for their system to acquire images using either of the techniques, which can be used with PSPs and film-based imaging as well.
Design is another important consideration for patient comfort. Some direct digital sensors are thicker or have sharper margins than others. Some manufacturers offer sensors with rounded edges that might be more comfortable for these patients. It is beneficial for clinicians to perform a test run before deciding on a system.