Buyers Guide: Digital Panoramic X-rays

Dentalcompare
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Why Digital Panoramic X-ray

The panoramic x-ray has been around for decades. In recent years, digital versions of the classic format have allowed us to obtain images with improved clarity while exposing patients to less radiation. For most machines the clarity is so good, that the definition of a full mouth set of x-rays has begun to change. The FMX used to be 18 or 21 individual images, requiring 10-15 minutes for a clinician to acquire the necessary views. Even then, those shots often missed wisdom teeth and were not able to see key features in the mandible or maxilla.

With digital panoramic radiographs, we are able to completely visualize both upper and lower jaws in just a few seconds. There isn’t even a waiting period for the film to develop. Add to that a set of digital bitewing x-rays, and you have a set of records for a patient’s entire dentition that are more diagnostic than traditional film, were captured while exposing the patient to less radiation exposure, and could be completed by your staff in less than 90 seconds. With a digital panoramic x-ray system in your practice, if you do encounter a questionable area that requires a periapical radiograph, you can do so in that one area. 

What I Need to Know

Image

  • Compatibility – The main thing to be aware of is whether or not the unit integrates into your existing workflow. Many digital panoramic systems work with common drivers such as “TWAIN” that allow you to pull the radiograph into your software as a simple image file. This allows you to keep your existing imaging software without having to piggy-back another application at your workstations just for the panoramic system.
  • Alternative Views – Many new digital panoramic x-ray units allow you to collimate the exposure area to only show certain parts of the jaws. For example, you can capture an image of just the condyles, or acquire “super-bitewings” that only show the posterior teeth.
  • Menu Controls – Controls should be straightforward, and easy to navigate. Many machines now come with simple push button or touch pad navigation allowing you to switch between alternate views, or perhaps change settings for an adult vs. a child.
  • Footprint – While many of these machines are slimmer than ever, be aware of the footprint of the machine. It not only needs to physically fit into your practice, it also needs to fit in an area that integrates with your patient flow.
  • Upgrades – If you are considering getting 3D cone beam at some point, but are more comfortable starting with a 2D digital panoramic system, consider a machine that has an upgrade path to CBCT. The overall cost will be much less than buying two machines outright. Some machines even allow you to easily switch sensors to change from 2D to 3D imaging at a moment’s notice. Also, if you have the need for a lateral cephalometric image for orthodontics, many digital panoramic machines come with the ability to add this feature as well.
  • Tomograms – Some machines allow alternate views in which the focal trough is slightly shifted. Combining these views gives a “3D-like” effect that can show you image “slices” of a particular area of pathology or interest.
  • Warranty – While digital panoramic units are hardy machines, they still have moving parts. Be aware of warranty information, and how long it might take a service technician to come out to your office. Unlike a handpiece, you can’t just send these in for repair.
  • Scan Time – Expect to see scan times between 7 and 20 seconds.

Questions to Ask

  1. Is it compatible with my practice management software?
  2. What type of connection do I need, fiber-optic, Ethernet, or USB?
  3. Will I be able upgrade to cephalometric or cone beam radiographs with this system?
  4. What is the footprint and where will it go?
  5. What is the warranty on the system?
  6. What alternate views are available depending on the needs of my practice?

Definitions

Collimation: Adjusting the focus of a beam of light or radiation so it stays on a specific narrow path. In digital radiography collimation focuses the radiation in a specific and narrow field, allowing less radiation to be used and only capturing the desired image.

Focal Trough: The horseshoe shaped area where the images are in focus. Objects in front of or behind the Focal Trough can be distorted in the 2D panoramic radiograph.

Tomogram: A cross-sectional slice across a particular plane in object being studied via radiographic imaging captured by moving the x-ray source and the sensor in opposite directions.

TWAIN: A standardized software protocol allowing imaging devices and computer software from different manufacturers to communicate. A software driver specific to the imaging device allows it to send images to the computer software via the TWAIN standard.

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