A. Miles BA, DDS, MS, FRCD
will try to make a strong case for
"expert" training if youíre
considering buying a digital x-ray
system. Please remember as you read
this article that I have a training
program at www.edts.net
which can provide this type of training.
Itís not self-serving, itís my strong
opinion and mission.
is a rhetorical question really. Of
course itís important! You and your
staff must be trained to use the technology
efficiently, to feel comfortable with
it, and to maximize the return on
this hi-tech investment. I wouldnít
have started this site if I didnít
truly believe that NO ONE is currently
meeting this demand! The vendors teach
you what they know. Who trained them?
Usually their training of your staff
consists of a good review of the tools,
and the use of some fancy image "tools"
that makes the image look good, but
that has little utility for diagnosis
or patient management. They do not
"re-tool" you or your staff
on optimal image placement. They cannot
appreciate the diagnostic tasks that
we face finding early and small, important
changes. They donít really know the
science behind the technology the
way a radiologist does. So who should
do this training? More about that
had a secretary tell me the other
day that she left her dentist (she
was asking about a new one) because
he showed her some digital x-rays
(she called them ultrasounds!) that
he had "colored". She, and
both of her children said that they
felt he had just "manipulated
the x-rays" to sell them something
they didnít need! I could understand
that perception. What I couldnít understand
was the lack of "patient education"
that must have been present for her
to arrive at her opinion.
one thing to have the opinion leader
gurus and sales people tell you that
you can "sell more dentistry".
Itís quite another for you to understand
the technology thoroughly, apply it
wisely, and educate your patient to
the benefits you and they will derive
from the careful interpretation of
the images including the "image
processing"! Remember, WE DONíT
USE THE WORD MANIPULATION!! As Iíve
explained in earlier articles, we
are processing the image electronically
to extract features about a suspected
disease process so we can make more
precise clinical decisions Ė just
like medical radiologists.
addition you, the dentist, must be
the most knowledgeable. Itís to you
that your auxiliary comes when thereís
a problem. They may become more proficient
that you at image acquisition. But,
they still nee you a their "safety
net" when thereís a problem.
Neither you nor they can learn this
is training important? Yes. Is it
necessary? Yes. Do you and your staff
have to be trained? Yes! Will it help
your practice? Yes. Will it help you
accelerate the return on your investment?
Yes. Will it help you manage your
patients better? Yes. Letís now explore
my reasons for taking this strong
for obtaining "expert" training
are significant reasons to obtain
expert training, not the least of
which is earning significant CE hours.
Most states have mandatory CE requirements
and the combination of lecture-based
and "hands-on" training
can amount to as many as 12 CE credits
on a single day. This is not to say
that vendorís do not offer excellent
training when they sell you a system.
However, most "trainers"
are neither educators nor clinicians.
They cannot approach this labor-intensive
task as it should be approached. The
one with formal training in oral and
maxillofacial radiology, is uniquely
suited to offer the best experience
to both dentist and auxiliary for
mastering digital imaging systems.
below are some of the advantages of
"level" of training;
principles and practice
Vs. practice only
continuing education hours
return on investment
examine each of these advantages in
Level of Training
there is a higher level of training
from an expert because their own training
background is in a recognized specialty,
oral radiology. This is dentistryís
newest specialty, and those trained
in formal programs have experience
with digital imaging, image processing
and the basic principles of film and
other imaging modalities such as CT,
MRI and tomography. This training
is complimented in many instances
by their unique roles as educators
in dental schools that allows them
to employ instructional expertise
theyíve developed as well. Think of
yourself and your staff member as
an "entry-level" student
with this technology. You must begin
to understand the digital imaging
process "from the ground up"
BEFORE you begin to apply the techniques
to diagnostic tasks. If you donít,
you will become frustrated when using
the system. This is what happened
in panoramic radiology. As Iíve said
before, "the technology was out
there long before the education".
Many of us made every error possible
in positioning because of the "Cliff
Notes" version of training offered
by the manufacturer or their trainer.
The vendorís make excellent attempts
to "educate", but they often
lack the personnel with the "tools"
to do the job "expertly"!
these expert trainers are often university
based or trained, they can offer the
training through accredited organizations,
those that have the ADAís CERP certification.
This ensures that the instructor has
the educational background and the
expertise to offer a valid CE program
and be able to "award" CE
credits for the experience. This is
a tremendous advantage over the manufacturerís
recognized this advantage many years
ago, which is why I embarked on my
mission to help prepare my colleagues
for the "digital age" which
is an inevitable outcome in their
dental practices. Dental and dental
auxiliary students I currently teach
are our "future" clinicians
Ė the manufacturerís potential customer.
But these manufacturers are selling
to the "real dental market",
us, now! How can we be expected to
buy and use technology for which weíre
forgive my little digression, but
I would like to see everyone "go
digital", and I believe strongly
that expert training is THE ONLY WAY
the vendors, I also believe that the
training is enhanced as a practical
experience. A lot of the errors made
by dentists who buy systems is due
to lack of fundamental training in
radiographic technique. To use these
digital systems effectively, you must
use a paralleling instrument and be
re-trained in receptor placement.
Those clinicians who use "bisecting-the-angle"
techniques find adoption of the new
sensors VERY DIFFICULT. And, when
they try to train their assistants
"on-site", they find that
the auxiliary gets frustrated, almost
as frustrated as they are when the
resultant image is less than ideal.
The best training experience, I feel,
would combine the following:
on digital imaging
receptor placement practice
processing techniques (electronic,
of processing techniques to clinical
materials for review and "in-office"
I donít believe thereís
a manufacturer around today that can
offer all of this to a client. ( Remember
when you hire a new assistent they
are usually trained by you )
Return on Investment
spend a lot of money. Youíll want
to recoup the costs of the investment.
I have written about this before in
earlier articles. Please return to
these on this site for review. Please
read "Digital Radiographic Imaging:
Technology for the Next Millennium"
and "What You Need to Know Before
You Buy" on this site. If you
and your staff understand the sensor
placement criteria, image acquisition
technique, image processing applications
and image storage needs, then there
will be fewer "surprises"
and everyone will adopt the technology
quicker and more capably. If you understand
something and are comfortable with
it, youíre more likely to USE
it! Hence, the profit from the system
and the time savings will "help
pay for the system" more rapidly.
You cannot learn this technology vicariously.
You must master it and master it quickly.
This only happens with good training.
concept is not unlike the previous
section. The faster you and the staff
are in mastering the techniques, the
shorter the time until "full
adoption". If you or your staff
are not adequately trained, there
will be costly errors made. Time spent
"re-imaging" the patient
or locating the digital files, is
lost productivity time for the office.
This costs money! You can save yourself
and your staff headaches and embarrassment
by expert training.
the manufacturer has to come back
to "re-train" you and/or
your staff, it costs you money. Some
charge $1000/day to re-train. In addition,
there is another loss to the practice
in productivity because of "shutting
down" for half a day to accommodate
the trainer. Some vendors also charge
you for the trainerís travel expenses.
If you receive excellent, "expert"
training in the first place, this
problem will be minimized. If you
have CDROM materials to refer back
to, you may also minimize the re-training
expense. You can solve many problems
by reviewing the CDROM training materials.
Finally, you can probably contact
the "expert" trainer a lot
easier to answer you questions than
you can the manufacturerís help desk.
Many "problems" could be
answered by the telephone because
of the better mutual understanding
of the technology that results from
seems like I believe VERY STRONGLY
in "expert training" for
adoption of "digital imaging"
systems, then Iíve made my point.
It isnít ego, it isnít cynicism, itís
REALITY! Your best chance of success
with the adoption of any new
technology is to obtain the very best
training you can for both you and
your staff. If you are seeking this
type of experience, please follow
the links on this site to www.edts.net.
There I think I may have a solution
to this training problem. Hope to
see you registered there soon!