Dental Product Insights: Digital X-ray Set-Up Best Practices

Video Transcript

Noah Levine: Hello, I'm Noah Levine, Editorial Director with Dental Products Report®. Today I'm joined by Micah Huish. Micah is with DentiMax, and he works, setting up x-rays for dental practices all across the country. Micah. Welcome. Thanks for joining us.

Micah Huish: Thank you for having me. I'm really excited to be here and kinda to talk about dental x-rays and what people like and dislike.

NL: Wonderful. Well, to give our audience a bit of a background, can you tell us a little bit more about what it is you do in dental practices.

MH: So what I do is I go in, we set up their software with our software and our sensor, or we go in with our sensor into their software, get them working with it, see how it functions, make sure they're familiar and comfortable with all of that. And then the fun part comes in where we actually do what we call our dial in process. So the dialing process is where we actually have you guys take a couple test x-rays on actual teeth, usually we recommend doing that, like on a co-worker, or employee, that way, we have time to talk and make changes. And then we actually kind of dig in and find out what you guys want, what's your guys's image, what you guys like, what's your kind of perfect looking image. And then we go in with our what are called precapture filters and adjust those filters to make it look more how you want it so that it's the best diagnostic image that we can get for you.

NL: Can you tell me about some of the different settings and kind of controls that you have at your disposal to adjust the x-rays?

MH: Of course. So in most cases, all softwares have the ability to adjust the image. After you take the x ray, they have some type of filter, some type of brightness, contrast tool, gamma tool, something like that. So we have the ability to adjust the capture filters with our sensor and our software so that we can have the image appear more how you want it right off the bat. So some of the things that we can adjust there. Obviously those same filters, the brightness, contrast, the gamma, how sharp the images, we can actually even adjust the types of contrast that you have. So maybe some person likes it a little bit more black and white, while somebody else maybe likes it, or maybe a more mono gray color. So all of those different things, we have normalized filters, we have unsharpened filters, there's a whole bunch of different filters that we can adjust to make the image come back into the software more how you want it.

NL: So is there sort of a typical look for x-rays that you know most practices are looking for?

MH: That's the thing that I think is so amazing, that's something I've found, that's pretty funny as you can go and work with six doctors all in one day. And I'll get I'll be like that's the image they're gonna love. Because that looks just like the one that I just got that the last doctor loved. And it looks nothing like and like, No, I don't want anything like that. I want it to be completely different. Most doctors do tend to like or kind of move towards the image does what they're used to, which is meaning what they've had in the past, what they've used for the last few years. So we go in there and adjust based on that. But no two doctors like the same image. There may be some similarities, but you can show the 10 doctors the same image. Five of them will say it's amazing. Five of them will say it's horrible.

NL: If they don't all agree on what is the type of image they like to diagnose with? Is there an image that you know, is kind of universally they don't want?

MH: Yeah, so the thing that we probably hear most often that they don't want is a grainy image when the image is too grainy. They feel like it adds in things that aren't really there. It makes it harder to see, you know, caries and decay all that stuff. The second probably most common thing that they want to be able to have is they want a good level of contrast, so that they can distinguish between the DEJ, the dentin, and the enamel, they can see the you know, the apex of the root very clearly, they can see caries very easily. So those are the two things that they want most is not to have a grainy image and to have enough contrast, because if they don't have enough, it's too hard to distinguish between the areas of the teeth.

NL: Are there controls that they can adjust in the practice themselves, or is it really something they should be setting up initially and then just continuing to shoot with the same settings every time?

MH: So the settings that we adjust usually, yes, once we have them set up, you just keep moving forward, you don't look back, you'll just continue getting the same good image. As long as they're being consistent. Obviously their exposure time plays a big factor, and the technique of the staff, plus how far away how close to the face if they're lining up their shots properly, all of that goes into what causes the image to look good or bad. And from our experience, what you'll notice is when they kind of slow down and take their time and take good x-rays, they should get a consistent image with the settings that we lock in, once we get them dialed in.

NL: In terms of that dialing in process, what does that look like?

MH: So again, that can depend on the doctor and their liking. So different specialties, like different features on an image. Say he's like an endodontist, they're gonna really like a super sharp image in most cases, because that allows them to see the apex and be able to see you know, all of the areas of the teeth that they specialize in. When you start taking x-rays, you get used to reading a specific style or look of x-rays. So when you switch to a new sensor, you either want it to be way better, or usually very similar to what you're used to, or kind of a mix between the two. And that's kind of what most doctors are looking for something they're familiar with, that's better than what they already have. And we can do that very, very often.

NL: If someone, you know, adds a DentiMax sensor to their practice, they've been using some other brand sensor for a while, and this isn't going to be a replacement, but an extra sensor, are you able to dial in that sensor to essentially mimic whatever other sensor that the practice is using?

MH: All sensors do take different images, they have different components, products, filters, things like that. But we have made integrations that allow it to be very, very close. Lots of doctors can't tell the difference between the two images. But just based on things that we know, we can usually tell the difference between them. Most software out there now, automatically apply a filter after you capture. So you take the x-ray, if you were to look at that x-ray, what it looked like just with the actual sensor and what it captured before their filter was added, you probably be pretty surprised at what really is returning before they added their filters. Most offices use filters, there's a lot of filters out there that make the image, to my eye, much more pleasant, much more readable. But again, that is a complete preference based on usually again what you're used to. But yes, I recommend that doctors play with filters, try filters, see what helps them diagnose better, because the more they're diagnosing, obviously, the better off they're going to do. And those filters are created to help diagnose images.

NL: Are there specific filters that you find doctors using more than others?

MH: Yeah, so the one that we see most often is the brightness contrast/filter. Hygenists use it to try and adjust the image to help diagnose. Doctors use it to adjust the image to diagnose. What that technically does, is it usually changes how light or how dark the image is. And an also adds in more or less contrast, which helps kind of make some of those areas of the tooth pop a little bit more. Such as you know, interproximal caries, it also helps it so that if you're not sure on something, when you adjust it, a lot of times caries will stay a darker color no matter where you adjust that brightness contrast tool. So it just kind of helps reiterate the fact that yes, that is a caries right there.

NL: Can you see different things in a darker or lighter x-ray image?

MH: From my experience, hygenists usually like the image a little bit lighter, doctors usually like them a little bit darker, and that there's some variation in that. But in a darker image, the problem with having an image that's too dark is it can sometimes introduce like burnout if the image is a little too overexposed, where it actually is starting to almost eat away part of the image because the burnout kind of starts to evaporate the teeth kind of look. You may not be able to see caries because the image is so dark that it's hidden behind some of that shadowing, you know, things like that. So those are kind of the downfalls of going too dark. But what it also does is when you're darker, your pulp chambers usually pop more allowing you to see the apex a little bit easier, things like that, you can see the apex of the root all of that very visibly, because the image is darker. When they're too light. It kind of is actually somewhat similar where it's so light you might not see it caries because it's so washed out that there's no distinguishing features of the tooth where you can't see the DEJ very clearly. You can't determine what the different colors of each part of the tooth are.

NL: How does the communication with a practice go? I imagine most doctors don't know the specifics of how to ask for what they want and an image so how do you work with them to get it to that image?

MH: Yeah, I wish you could hear some of the phone calls. It's sometimes, it's a guessing game because we'll hear the word sharpen, and my definition of what a sharper image is, would mean like more crisp, the lines are crisp, they're sharp, they're hard edge, you know, but somebody else may be using the word sharp to me, they want a more of a contrast, they want a sharper image, meaning more colors more bright, like brighter colors, more defined colors, things like that. So it is a little bit of a guessing game. But we usually ask, you know, questions. So we usually start out the call, by having them show us kind of what they like kind of talking about what they want to see. And that allows us to kind of try and understand some of their verbiage or their terminology a little bit better, so that when we are in the process of asking the questions of how they want their image, it makes it easier for us to understand them. But usually we ask questions. And then if we don't understand, we'll adjust. And we have the ability to show them what we think they mean. And then if that's not that we can undo and redo and change to whatever it is that they really do mean, we like to have them show us what they like or dislike. In some cases, it didn't have anything they may like, and tell us why they like it. Show us kind of point things out to us. And then we'll do our best to either, like I said, mimic that image as close as possible or getting something that plus much better. That's what I love doing. I love trying to have that competition to see how much better I can make their image than what they already have.

NL: Well, Micah Huish thank you so much for joining us sharing your expertise and telling us all about what you do for DentiMax.

MH: Awesome. It was a pleasure having this conversation with you. If you guys have any questions, feel free to reach out to DentiMax and anytime we'd love to talk with you and kind of get to know you guys a little bit better and teach you what we know.