Special Report: Bringing vision into sharp focus

When hygienist Nikki Hayes called out “You guys have all gotta get down here and see this,” over the headset intercom system used by the staff at DPR Technology Editor Dr. John Flucke’s Lee’s Summit, Mo. practice, it sent everyone running. What they saw did not disappoint.

This was back in April, and Hayes had just captured the practice’s first image with the at the time still pre-release Gendex GXS-700 intraoral sensor. In fact because Dr. Flucke’s practice was the first in the world to get the new sensor for everyday use, this was actually the first digital radiograph the sensor captured in a truly clinical environment. The result made quite an impression on Dr. Flucke and his not-so-easily impressed staff.

“It was just an amazing image. Just phenomenal,” he said. “We get a chance to try out and play with a lot of stuff in my office. My staff sometimes is not so wowed about some things that maybe might wow another staff, but the images that come off these sensors are eye opening. From resolution to the sharpness of the image to the delineations, you could see it was definitely game changing.”

But this story begins long before this past spring, and it doesn’t start in Lee’s Summit. The GXS-700, which represents the 8th generation intraoral sensors from Gendex, was close to five years in the making, and its creation came about through the work of a number of teams located around the globe.

It starts with listening

There wasn’t a long break between the 2005 launch of Gendex’s 7th generation sensor, the eHD, and the start of work creating the GXS-700 sensor. Gendex Product Manager Filippo Impieri, who oversaw the project, said it all got underway after the company conducted a worldwide campaign of talking to Gendex customers, clinicians using digital sensors from other companies and clinicians using film x-rays to discuss what improvements they would find most useful.

This information, referred to by Impieri as the Voice of the Customer or VOC, was used to define the project goals from the very beginning. Topping this customer-based wishlist was better image quality from a sensor that would work in a variety of settings and with a variety of x-ray systems.

“For us, one of the key criteria with the new sensor development was being able to introduce in the market a level of image quality that was really top notch,” he said. “We have been working really hard from a technology standpoint to not only improve the resolution quality, but also the consistency of the image quality we can deliver.”

But image quality wasn’t the only improvement customers were looking for, and improving on both the ergonomics and patient comfort was placed as the second priority in the new sensor design. The third major goal of the project was to improve the sensor’s portability and streamline its workflow by creating a direct USB connection between the sensor and computer with no exterior box or interface needed.

Staying the course

Setting these goals is what Gendex Director of Operations Chris Koeppen called “Toll Gate One” the first major step of Gendex’s product development. The engineering team takes the lead, but once they’ve passed this stage Koeppen and his manufacturing and procurement teams get involved and stay closely tied to things to make sure the engineers’ concepts are feasible for large-scale production. Other parts of Gendex and its parent company’s other dental imaging organizations’ product development teams also are deeply involved throughout the process.

“In all of our new product development programs, we kind of have a multi-headed monster that governs the process all the way through,” he said. “When it comes to taking this sensor to market cross functionally, our procurement operations group was involved very early.”

Keeping various disciplinary teams involved helped the entire operation avoid problems because if one team hits a snag, another team often has an idea in waiting that provides a solution. Koeppen said the depths of the company’s resources are invaluable on a project with such a global vision and such lofty design goals, and it felt great to be a part of that process.

“At the end of the day, we delivered on what we all signed up for at TG2 when we resourced the project,” he said.

There were no real singular breakthroughs or eureka moments, but Impieri said experience designing the previous generation of Gendex sensors was important in guiding the GXS-700 project, and a clinical advisory team helped provide perspective along the way. He described the process as a steady march toward the established targets, and it’s been exciting to have achieved the three main objectives with a sensor he feels sets a new standard for the industry.

“The product that we specced out at the end of our VOC is actually remarkably similar to what we actually have been able to deliver to the market,” he said.

Hitting the bull’s-eyes

Working on all three goals simultaneously meant all the developments needed to be coordinated so they could all fit together in the same final sensor design. Adjustments to the case design could have great impact on the engineering work for the USB connection, but through it all, image quality was kept as the top priority.

“We would not compromise anything for image quality,” Impieri said.

The technological enhancements they worked toward focused on not only achieving the high image quality, but on making that quality reliable as well. The sensor had to not only capture great images under optimal conditions, but also work great for clinicians regardless of the x-ray system it’s paired with or the way that system is set up.

Those efforts seem to have paid off with the GXS-700 capable of up to 2.4-megapixel images with more than 20 visible line pairs per millimeter and a pixel size of 19.5 microns. The company focused on using the latest in CMOS sensors and refining the algorithms that process the captured x-ray data to create the sensor capable of producing radiographs crisp enough to wow Dr. Flucke and his staff.

“I think the combination of a complete, custom redesign for both the hardware and the software sensor components was extremely important for us to achieve a really high level of diagnostic results,” Impieri said.

While looking at improving the ergonomics and patient comfort of the sensor, Impieri said his team explored a range of physical designs. Working with a fast prototyping company to produce workable models, ongoing blind tests were conducted to optimize the housing design in terms of both patient comfort and ease of positioning for the clinician.

Plenty of plastic materials were studied to find the right choice to stand up to the mechanical stresses intraoral sensors must face, and it had to be able to be closed completely to protect the electronic components during sterilization. Still, the material had to feel right to both the patient and the clinician.

Any time a new material or new piece of the sensor was considered, it sent Koeppen and his team back to work determining the logistical implications of this new part being included in the final version. It was important for him to make sure everything stayed on schedule and lived up to the company’s standards.

“When we anticipate changes, we’re side by side with engineers, checking lead times, working to leverage not only our internal resources but across our whole supply chain, as well as across our parent company to make sure we pull out all the stops to hit project timing and project quality,” he said.

Impieri recalls that after the design was close to ready and a working unit was put into a real clinical setting, the clinician was asked to swap the sensor he was using for a GXS-700 prototype in the middle of taking a full mouth series. He knew they had reached a goal when the patient immediately commented on the new sensor’s enhanced comfort.

“That was a great moment, because after all of our blind testing and everything we tried during the development, we could see the results right there in a clinical environment, and it was great,” he said.

When it came to developing the direct USB connection, it was all about minimizing the electronic components the sensor required so they would all fit on the back, and Impieri said a big R&D push in this area was among the first things they did when undertaking the project.

Ready for the public

Once the engineering and design was good to go, it was time for all of the resources Koeppen and his team had lined up to be put into action. He needed to be ready to meet whatever demand was generated by the engineering team’s developments. With this sensor he felt it would be big, and he felt everything was in place.

“Once we internally decide this product is ready for market, we need to be able to run 100 mph and meet or exceed customer demands and dealer demands out there,” he said. “I can say with a big grin on my face that when we cross-functionally signed off that this product was ready to go to market, I had the highest confidence in our manufacturing processes, our people building the product, our supply chain and our partners. I felt really good when we went past that last toll-gate that from this point on the momentum was going to be unstoppable.”

Of course getting that momentum all revved up was the task of another part of the Gendex team-sales. William Popek, one of Gendex’s Directors of Sales, began his involvement with the GXS-700 project about 12 months ahead of launch. He and the other directors were brought in to help define the sensor’s most attractive features and, through regional training sessions, to educate the entire sales team on every detail about the new technology.

Popek said the experience his sales team gained through previous launches made it easier to get them up to speed on the newest launch. With the high-quality images and the sensor’s physical properties as the headline features, being prepared to thoroughly discuss the sensor in front of clinicians at a tradeshow or in their practice was the real key.

“Each representative has their own unique style on how they deliver information, but we all need to be well-educated so that we know our facts, know our features, and know our benefits,” he said. “Ultimately when we’re one-on-one with a doctor, this is where it all comes into play. There’s a lot of dentists who are technically inclined and want to hear the details, and then there’s other doctors who only want to hear about how it will improve efficiency, and others who just want to know it provides a better image for diagnosis. We come to the table prepared to answer any question that is asked of us.”

One feature of the sensor that has proven attractive to dentists is that it is available in both Size 2 and Size 1, which makes it ideal for pediatric patients. Popek said being able to offer the GXS-700’s image quality to dentists with big pediatric patient populations is important, and Dr. Flucke said having the Size 1 sensor has been a huge advantage for his practice.

“They did a nice job of designing the form factor. It’s not real thick, the edges are rounded, it’s easy to place,” he said. “We used to spend a lot of time on children trying to get images and we’d frequently be relegated to phosphor plates, which is digital x-ray, but it’s certainly not a state-of-the-art digital x-ray. It’s nice to be able to have a No. 1 sensor that children don’t bite or gag on.”

Putting it into practice

Of course making sure the company had that real-world clinical feedback was key to bringing the GXS-700 sensor to market. While other clinicians advised Gendex during the design process, Dr. Flucke said he was thrilled and honored to have the chance to be the first to put the sensor through its paces at a busy practice.

After a month of testing the sensor, Dr. Flucke was on hand as Gendex officially launched the GXS-700 in May at this year’s California Dental Association meeting in Anaheim, Calif. Popek said tradeshows like that are an ideal way to show a large number of dentists just what the sensor can do, and having Dr. Flucke there to answer questions was important.

“When you hear it from an actual user, an actual owner, it can make all the difference in the world,” he said.

Dr. Flucke understood he would be called on to be that voice and he wanted to be sure he could provide honest answers to just about any question. He feels that honesty goes both ways between him and other clinicians as well as between him and Gendex, a company he said he is proud to work with because, “I really truly feel that they’re concerned not only about the doctor, but about the patient as well.”

During his prelaunch time with the GXS-700, he and his staff made sure to move the sensor around between operatories and computers while using it with a variety of positioners. They all came away impressed, with Dr. Flucke describing the sensor as “a workhorse” that he can count on to provide a great diagnostic image without the need for further digital enhancement.

“I’m still thrilled with it. The image is just that good,” he said. “Even after five months I’m still looking at the images and routinely blown away by what I see.”

He also still enjoys being there when a fellow dentist first gets to see the images captured by the GXS-700. In the months since the launch, Dr. Flucke has attended other meetings where Gendex was demonstrating the sensor’s capabilities, and he’s always excited to watch another clinician experience the same thrill he and his staff felt when they were summoned over the intercom to see their first GXS-700 image.

“It’s still pretty neat to see somebody go, ‘Wow that’s pretty sharp,’ ” he said. “And it is.”