Is it as good as film? Wrong question.
Is it diagnostic?
What makes a digital radiograph diagnostic? It is a combination of image and software. Dentists tend to focus on the sensor and the final image but it is the software that matters more – or at least as much – as the sensor when it comes to delivering a diagnostic image.
In this regard I have long been a fan of XDR Radiography.
Doug Yoon, the founder of XDR is a dentist, a scientist and one of the smartest people I know in dentistry. Doug recently reminded me of the XDR motto “Imaging Through Science”. What that means in practice is that the team at XDR is constantly looking to refine the digital x-ray process through scientific investigation based on diagnostic efficacy. Sadly some vendors concentrate on what looks good and what will sell rather than on what is the best diagnostic result. Instead of a lot of cool looking but useless enhancements XDR actually uses advanced image enhancement to improve diagnostics…what a concept.
Don’t get me wrong, XDR has one of the best sensors on the market as well as great software.
Are you up for some in the weeds, future focused, nerdy stuff? If so keep reading.
The opening question about film refers to our early attempts to diagnose dental disease from a digital image by looking at it, just we used to do with film. But do we really need to look at an image to diagnose? Do we even need an image? No, we do not.
When we diagnose an x-ray image, we are using our eyes combined with knowledge, training and experience to detect changes in tissue density. These density changes are indicated by how opaque the image is. We have learned that lack of opacity indicates loss of density which indicates pathology. We can see changes in the image because the pixels are displaying different shades of gray. Here is the part we tend to ignore. The computer knows the difference in each pixel even if it does not display it as an image.
Imaging software can be trained to distinguish patterns and changes in grayscale that are too subtle for the human eye to detect. Once the software has been trained to know what pathology looks like whether it is interproximal caries, periapical pathology or crestal bone loss the software can render a diagnosis without rendering an image. That is what machine learning and artificial intelligence is all about.
We are a ways away from total digital diagnosis and will certainly pass through a significant hybrid step where the software does a preliminary diagnosis and also renders an image for the human to look at. However, once you get past the film-based paradigm from the early days of Roentgen you can see that we do not need a picture we just need a data steam that can be used to detect tissue changes that indicate pathology.
Until we get there we will still need to use our eyes, knowledge, training and experience looking at the best image we can get to diagnose dental disease. XDR will help you do that.