Hardcopy Plays Important Role Even When Imaging Goes Digital By: Elizabeth B. Spannhake, DDS, MS, MPH

As dental practices become increasingly computerized, more offices are capturing images digitally. Yet my orthodontic practice is probably typical in one regard: we still rely heavily on hardcopy output for patient communications as well as other applications. In fact, we generate several hundred prints of digital images daily, including a hundred or so that we mail to referring general dentists or specialists.

My practice is a busy one; we have two offices that each see around 85 patients daily. We use imaging in a variety of ways. One is diagnostic. We use intraoral and extraoral x-rays for treatment planning and evaluation and to document referrals to specialists.

Photography also plays a role in treatment planning and evaluation. For example, it allows us to show patients how their treatment is affecting their smiles. But photography has many other uses as well. It is very helpful for patient communication. If we notice that a young patient has hygiene problems, for instance, we may photograph the patient and send a hardcopy home with a note that the youngster needs some help with oral hygiene. We often recommend the picture be put up on the refrigerator or even taped to a bathroom mirror as a graphic reminder to brush.

We have found photography to be useful for communicating with our patients’ other dentists or specialists. For example, a copy of that same photograph showing oral hygiene problems might be sent to the patient’s general dentist, along with a recommendation that a hygiene appointment be scheduled. As another example, we often see children with particular abnormalities in facial bone development. In these cases, we forward photographs of the abnormalities to oral maxillofacial surgeons during the referral process. Even in routine correspondence with other dentists involved in a case, I incorporate the patient’s headshot into my letters so the readers know, in a glance, what patient is being discussed.

Finally, we use photography for practice-building. If a mom brings in a new baby, or if a teenage patient shows up with orange and yellow hair, we snap a photograph to give as a keepsake or post on our office bulletin board.

For our photography, we use digital cameras exclusively. Our radiology systems, however, are film-based. But because our office record-keeping is computerized, today we scan all our x-rays and file them electronically.

At first glance, it would seem that, once our x-rays are digitized, we could work entirely from our digital records. Yet we’ve found that we still need to generate hardcopies of our radiographs. During chairside consultations, for example, we present prints of both x-rays and photographs to help explain procedures to our patients, or to show how treatments are progressing. Typically, these include two photo-graphic montages, one of the patient’s head (profile, relaxed frontal and broad smile) and one showing three or more standard intraoral views. But we also present printouts of the patient’s panoramic and lateral head films; these help us describe elements of the case that the photograph cannot show.

Together, the printed photographs and x-rays aid in our ability to discuss the case by giving a hands-on feel to our case presentations. This approach also means we don’t have to install computer screens in each operatory.

Often, Dr. Spannhake’s office digitizes x-rays, such as this panorex, and prints them on Kodak DMI Inkjet Paper. The prints are then used for case presentation, to help patients understand the basis for recommended treatment options.

Why Digitize X-Rays?
In the future, our office will consider direct digital x-ray systems. Today, we have achieved many of the benefits of direct digital radiography, with far less expense, by digitizing our films. We started scanning our films about three years ago. Since then, we have realized the efficiencies associated with computerized record-keeping. For example, our access to patient records is far less cumbersome. We can call patient files up from any of our office workstations with just a few keystrokes.

We have also found other advantages to digitized x-rays. For example, we can use imaging software to enhance dark areas of a radiograph. Sometimes we zoom in on areas of interest, and print only those areas. For example, if we find a patient has a cyst, we can isolate the cyst and surrounding tissues on the patient’s panoramic x-ray. We can then create a print showing just that area to send to a maxillofacial surgeon for pathological review.

The quality of our output is very good, owing to several factors. First, we originate on the highest quality film (Kodak Ektavision G Extraoral Film for our extraoral imaging and Kodak InSight Intraoral Film for our intraoral exams). Second, we pay attention to the performance of our x-ray systems and our processing, and make adjustments as needed to keep our image quality to standard.

We’ve also found a significant difference in the quality of available inkjet papers. Like most dentists probably do, we started with the brand of paper recommended by our hardware manufacturers. But after experimenting with many brands of paper, from the least expensive to the highest-priced, the best we’ve found is Kodak DMI Inkjet Paper for Dental Imaging. We’ve noticed that this paper gives excellent contrast and density, which is particularly important for printing x-rays. But in addition, the Kodak paper also seems to do a better job handling color than other papers. In our experience, other brands tend to add a red or blue cast to prints, but Kodak DMI paper gives consistent, truer color. This paper also has a glossy finish, which gives the images we print a photographic look and feel. It is priced comparably to other top-tier inkjet papers.

The image is an example of a photo montage that would be printed and show to a patient to help communicate case treatment planning.

The Digital Future
As dentists become more comfortable with digital technology, digital imaging will play a greater role in their practices. Today, for example, only a fraction of the offices we work with can receive patient documentation electronically. As more practices develop websites and incorporate email into their practice management, that will change.

Until that day, hardcopy prints of images will remain an important part of the referral process. And even when electronic file exchanges become more commonplace, hardcopy prints will continue to play a role. An analogy can be found in the world of commerce, where customers prefer to buy clothes from conventional shops, rather than over the Internet, because they want to touch that sweater or pair of jeans before they buy.

Hardcopy images have a similar appeal. They give dentists something they can physically hand to their patients to examine or take home. By adding a human element to case discussions, they play an irreplaceable role.

(Note: Kodak, Ektavision and InSight are trademarks.)

Dr. Elizabeth B. Spannhake, DDS, MS, MPH is a specialist in Orthodontics. She is in private practice with offices in Westminster and Mount Airy, Maryland. Dr. Spannhake is a member of the American Association of Orthodontists and the American Dental Association, as well as, a Diplomate of the American Board of Orthodontics. She is active in both state and regional dental societies and is currently the President of the Maryland State Society of Orthdontists. Dr. Spannhake has published and lectured on the topics of Infection Control in Dentistry, Clinical Nutrition and Orthodontics.

For more information contact: Dr. Spannhake, E 602 Center St., Suite 101, Mount Airy, MD 21771 or ebspannhake@home.com or Eastman Kodak, 343 State Street, Rochester, NY 14650 or www.kodak.com/go/dental.