T he technology used in conventional X-ray film is 100 years old. There are not many technologies that do not evolve and improve in 100 years, and the X-ray field is no different, although many doctors have not yet made the technology jump in this area. In the last 10 years alone, we have seen the development of affordable technology in the field.
The world of digital technology has ushered in incredible savings in cost and time across the board in our daily lives. We have seen vivid changes in the way that we take our family snap shots and the trickledown effect has been the acceptance of digital technology—in all aspects of life. The societal push for less waste and more efficiency should make most doctors at least explore the options afforded to their practices by going digital when it comes to X-rays.
What are the dollars and cents of going with digital X-ray opposed to conventional film? There is a front-loaded cost to digital radiography but, as an investment, digital radiography not only offers cost savings (no film, no chemicals, no processors), it can actually become a profit center. Going digital, X-ray moves from a cost per film, to a fixed cost—meaning that, dependent upon the number of X-rays that you take, it will make the practice a profit. As the doctor sees more patients, the cost of taking X-rays, per patient, actually decreases.
When upgrading from film to a digital system, the DC should consider that there may need to be additional equipment that they must upgrade as well, depending on which system they choose. In most instances this is the case but, with some systems, you can use the existing generators and bucky stand, so the doctor only has to purchase the digital plate, making the transition more affordable but easier to install. The doctor needs to determine which system requires new equipment and which ones can use existing modules, as this element does factor into over all cost and complexity—or lack thereof—of the switch to digital.
Radiation Level Comparison
I often get asked about the comparison of radiation levels between the conventional X-ray to digital. The newest text books in radiology now indicate that you can increase the kVp to higher levels with digital imaging because the software now controls contrast. So, you can limit the patient dosage by increasing the penetration of the beam—thereby reducing the absorbed dose. An increase in kVp does have to be within reason but, by increasing kVp, you can decrease mAs. Of course, with heavier patients you must increase the kVp in order to penetrate the excess mass and fluids.
There are also other safety benefits by going digital. There is no doubt that—as the office no longer uses processing chemicals—the air becomes much more clean and fresh; no one is exposed to toxic chemicals in film development or in having to dispose of the chemicals.
There is no doubt that—as the office no longer uses processing chemicals—the air becomes much more clean and fresh
What about maintenance?
Every company and system has different requirements for continuing maintenance. Most companies charge a monthly fee for technical support and also charge for all computer software upgrades. But not every company charges for technical support or computer software upgrades. It would be prudent to ask each vendor about their policies in these areas, as there could be hidden costs a doctor doesn’t realize unless he looks into maintenance and upgrade charges with each system.
Required Office Space and Training
Once a practice goes true digital X-ray, it eliminates the need for a processor, dark room and all of the required space to store film. CR still requires the use of a processor.
As far as training required to go digital, a doctor does need to traverse and understand the difference between digital images compared to film. The doctor needs to consistently evaluate diagnostic images and will require some training to do so. Some vendors have radiographers on staff who work with their clients to develop a technique chart that enables the doctor to obtain the desired images, leading to accurate diagnoses.
Image Quality Comparisons
Digital allows for further manipulation of the X-ray. In your general terms, it is the ability to window and level, or in layman’s terms, the ability to manipulate contrast and density, that enables the doctor to see different qualities in the image. Using digital X-ray allows the DC to get a consistent, quality image, because of the software manipulation ability, as compared to using film.
Using digital X-ray allows the DC to get a consistent, quality image, because of the software manipulation ability, as compared to using film.
HIPPA Compliant Issues
As with many things these days in a chiropractor’s office, you must consider HIPPA compliancy when making decisions on new technologies. With digital systems, the software allows password protection of the data via internal processes and procedures set for onsite security, thereby complying with HIPAA. (For doctors that want off-site HIPAA compliant storage, we have partnered with Central Data Storage, which stores and manages electronic patient imagining and documents.)
The standard for images must remain constant throughout the health care field. In order for chiropractors’ roles to become more vital today, they must take advantage of improved—and evolved—technology. That isn’t to say all facets of chiropractic care have to evolve, as many key elements of spinal adjustments may remain constant. But using conventional film X-ray is a technology that is 100 years old. As is the case with your family photos—now taking advantage of digital technology—it makes sense for the doctor of chiropractic to afford some of those same, related advantages by no longer using film in the process.