Attention to detail a must for good digital images

Nov 27, 2008

Editor's note: Edwin T. Parks' column, Talking Pictures, appears regularly on the DrBicuspid.com advice and opinion page, Second Opinion.

A patient brought in a printout of a digital full mouth series the other day. Nice paper, good contrast and density, but virtually no apices. We tried to minimize the number of images that needed to be repeated, but the patient wasn't too happy about it.

It is truly amazing that some clinicians will accept a "parapical" (my word for near the apex) when assessing the dentition. Can you hold the image to your temple and "imagine" the appearance of the periapical region? Does anyone really believe that a periapical image that is short of the apex is acceptable?

Several issues come to mind:

Getting a good periapical image with a rigid digital sensor is not as easy as getting the apex with traditional film. If we needed to take a film image again, at least we could say that the processor ate the film. No one believed that fairy tale. How many patients will believe that the CPU ate the image? You have to be a better technician to capture an acceptable image with a rigid sensor. You have to take advantage of the available space in the mouth -- toward the midline and the posterior.
Image quality is dictated by the clinician. If the apex isn't important to the doctor, it certainly isn't important to the staff.
How do you explain to a patient that you need to repeat a majority of images to develop a comprehensive treatment plan? I doubt that too many clinicians will repeat the imaging for free. But more important, what about the exposure to the patient? Just because digital imaging requires less radiation doesn't mean it requires no radiation.

No one comes out a winner in this scenario -- not the patient or the initial clinician or the current clinician. A little attention to detail would have prevented it from happening in the first place.

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