Dale A. Miles DDS, MS, FRCD

Introduction
You're a dentist. You have computers. You're on the Internet - at home and/or the office. How can these tools help you in your practice? What can the Internet do for my patients and me? How are imaging and the Internet related? How can I profit from using these tools? Believe it or not, imaging and the Internet will play an ever-increasing role in your practice, and if managed properly, they will improve your profitability by increasing your productivity. Images, clinical and radiographic, are used daily in a dental practice for diagnosis, patient care, patient education and consultation. Increasingly, they're also used by dentists for documentation, claims submission and for presentation to colleagues. Digital images take up space, albeit a whole lot less than conventional paper and film images. Digital images must be stored on computers or archival media such as magnetic tape, CD ROM, DVD ROM and Flash media. Even though these storage devices are now very inexpensive, they require personal or personnel time to archive. They is another way to "back-up" your images and image database. It's called the Internet!

Pictures and Pixels
Whether captured directly by "megapixel" cameras or digital x-ray devices or scanned indirectly on desk top or slide scanners, dental images take up space. A single periapical x-ray image uses about 300-400KB if it is uncompressed. Three x-ray images fill an entire floppy disk. Clinical photographic images require even more space. But, hard drives are huge now and back up media is inexpensive. These hard drives can be used for temporary storage and can hold a large number of images. CD ROM disks hold 650-800 MB of binary data, enough to hold hundreds of images. You may want to use these storage devices to back up images weekly (for about 30 cents a disk). You may want to use DVD-R or DVD-RW disks to store even more image data. DVD disks hold about 4-5 GB per disk. That's a lot of images! They sell for about $30-40 per disk. A DVD-RW could then be used for archiving image data monthly until it is full. But, you might consider a different alternative - and ASP or application service provider.

Cameras that use Pixels
There are so many digital cameras on the market that the decision of which one to buy is quite difficult. Cameras come in 1.2, 2.0, 3.1, 4.0, 5.0 and even higher "megapixel" resolutions. The higher the pixel number the higher the spatial and even contrast or color resolution. With more pixels there comes a higher cost. Bit, just like the consumer experienced with computers, as more people bought and as the technology "matured", the costs came down. Three (3) and four (4) megapixel cameras can be now purchased for between $500 and $1000. For example the Olympus C-3020 Zoom with a 3.2 megapixel resolution and a macro lens can be bought online for between $384-443. This type of camera last year would have been closer to the $1000 mark (Source: www.megapixel.net). Even a popular camera like the Nikon CoolPix 5000 (5.24 megapixels) sells for under the $1000 price point ($847 online). Digital photography has been adopted much more readily than digital x-ray imaging, probably because the camera can also be used outside the office and because digital x-rays are performed (acquired) by the auxiliary, not the dentist, in most cases. Be that as it may, digital imaging - clinical or radiographic - will enable you to do so much more, so much more productively than conventional imaging. Please refer to Table 1 for the web addresses of these and other popular digital cameras.

The Internet, Application Service Providers and Images
This is a B2B (business to business) model that's now available to dentistry. Instead of (or in addition to) archiving your data on site, you could upload your images to a fast, secure (password protected), encrypted Internet site for storage and retrieval from any terminal in your office. You would, of course, need a fast Internet connection such as a DSL data line. This will cost you about $49-79 per month. The ASP would also charge you a small monthly fee for storage on their servers. But, you could upload automatically and save yourself time and money in lowered personnel costs. In addition, some ASPs, like Transcend www.transcendonline.com offer other services such as laboratory prescription generation, remote consultation services among other things for additional nominal fees. Another ASP business offering services to healthcare professionals is www.emed.com.

The Internet and Imaging
What other Internet services, tools can positively impact your practice? There are literally hundreds of web sites that you can search and save on your computer, chairside, to help you with your imaging needs. There are even free image processing programs - for dental x-ray images - that you can load onto your computer to "play with" and master BEFORE you purchase a digital system! One program that I have told dental audiences about for 5 years is NIH Image. First developed as a MacIntosh-based program, the developers soon realized that almost all dental practice management software was "Windows-based". So they liceensed the software to a company called Scion Corporation, an imaging hardware company from Maryland, for free downloads for dentists and other interested parties. Their homepage is www.scioncorp.com . You'll need to follow the links to "Download Scion Imaging Software Now" and register by choosing a login name and password. The download only takes about 5-10 minutes on a 56K modem. The program itself less than 1 MB.

In addition to software, the Internet offers an unbelievable, and sometimes overwhelming array of sites for dentistry, imaging, cameras, etc… Listed below in Table 1 are some of my favorite sites for digital imaging information - from basic principles to cameras and radiology.

Table 1 Imaging Websites

Your "Image" on the Internet
Patients by and large are more "web literate" than we are. Dentists are not really "early adopters" of Internet technology. Dentists who do use the Internet and have tried to use it to attract more patients have found that they do not see any increase in the number of new patients contacting their office. I do not think that this Internet approach is an effective "practice builder". However, there are other good reasons to use the Internet, especially with your existing practice population. Table 2 lists some of the reasons to develop and maintain your own practice web site.

Table 2

You should notice that almost every item listed in Table 2 requires an image archive or database to be effective. You will use icons, practice facility pictures, people pictures, pictures of your work, pictures of high-tech equipment you use and many other graphics to make your site informative, professional and interesting. Patients who you direct to your site and who use the services you provide will tell their friends, neighbors and colleagues about the contemporary practice you run and the interesting and professional people you employ. Now that's a practice builder! That's building your image as a cutting edge professional! You're going to need clinical cameras, digital x-rays and desk top scanners to achieve all this. And, you should probably employ a professional person or group to build and maintain your site.
Table 3 lists several web design resources/companies.

Dental Web Site Design

The table above is by no means a complete listing of web site developers. Some of my dentist colleagues have "built" their own web sites very effectively. But, the time and effort is probably not worth the energy you'll expend learning to create your own site. You have the "content", but you should probably leave this task to experts. It's not too expensive to create a web site, and the maintenance charges are nominal in most cases. There is a real pride of ownership to having your own site. It makes the office staff feel important, and as we have seen CAN help build a practice indirectly. There are just not too many patients "shopping" for a dentist "online". Just don't think that, "if you build it they will come"!

Web-based Consultations and Images
What would a consult be in our profession without the accompanying image(s)? Whether the consult is cosmetic, periodontal, pathologic or radiographic, the images we send with the referral letter are often the best representation of the problem under consideration. If you like writing letters, if you like printing pictures, if you like waiting 2 weeks for the answer, then "snail mail" is for you. If you're like me (or most of my profession), you want it now! Even yesterday!

Electronic consultation is in its infancy. But, the Internet will change the way we manage our patients drastically yet positively. The ASP mentioned above called Transcendonline.com already has a product called "Transnet" which allows any dentist with an Internet connection to "upload" a case - text, images and reports - to its site for review and second opinion by experts in every field of dentistry. The replies are rapid, sometimes the same day. The patient may be re-appointed promptly with the dentist prepared to proceed to the next stage of care almost immediately. Clinical photographs, digital x-ray images, and other pertinent information is easy to review "online" by the "expert". And, they can evaluate the case anywhere! I, myself, have reviewed radiographic cases and clinical oral medicine problems from a hotel room! This is the age of rapid information management. Why not immediate patient management too? The reader is advised to visit this site to see a demonstration of this capability, and the other ASP products offered.

From the information above, you can tell that imaging in the dental practice is becoming even more critical to contemporary patient care. The migration to digital imaging continues and the Internet will play an ever-increasing and FUN role in that migration. Don't hesitate to "Go Digital!". There's never been a better time.