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Dr. Dale Miles


Digital Training Ė Is It Important ?

Dale A. Miles BA, DDS, MS, FRCD

Director, www.edts.net


I 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.


This 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 later.

I 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.

Itís 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.

In 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 technology vicariously!

So, 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 position.

Reasons for obtaining "expert" training

There 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 "clinician-educator", especially 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.

Listed below are some of the advantages of "expert training":

  • Higher "level" of training; principles and practice Vs. practice only
  • Earned continuing education hours
  • Better "hands-on" experience
  • Quicker return on investment
  • Reduced introduction costs
  • "Safety net"

Letís examine each of these advantages in more detail.

Higher Level of Training

First, 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"!

Earned CE Hours

Because 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 trainer.I 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 so ill-prepared.

Please forgive my little digression, but I would like to see everyone "go digital", and I believe strongly that expert training is THE ONLY WAY TO GO.

Better "Hands-on" Experience

Like 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:

  1. Lecture(s) on digital imaging
  2. Image receptor placement practice
  3. Image processing techniques (electronic, that is)
  4. Application of processing techniques to clinical needs
  5. CDROM materials for review and "in-office" training

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 )

Quicker Return on Investment

Youíll 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.

Reduced Introduction Costs

This 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.

"Safety Net"

If 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 "expert" training.


If it 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!


© Dr Dale Miles DDS, MS, FRCD
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