The benefits of digital imaging over conventional imaging have been covered in this publication and others for several years now. Increased storage space in your office due to not having to store film is just one benefit. Saving on film and developing costs is another benefit.

But the future of digital imaging will include further improvements in this technology. Chiropractic Products spoke to two representatives in the area of digital imaging to find out the current state of digital imaging and what to expect in the coming years. Fred Fischer is vice president of ALLPRO Imaging. Jay McElhannon is vice president of HCMI Inc.

What are the latest new technologies to make digital imaging more effective and easier to use?

Fischer: There are three types of digital imaging: DR (direct radiography), CR (computed radiography), and CCD cameras. While new manufacturers arise from time to time, the x-ray capture technology and associated software are stable platforms. If you mean, "Is the cost of digital imaging decreasing?" not in any substantive way. Manual CR systems are still the best buy for the chiropractic office.

McElhannon: In the past, CR (computerized radiography or "indirect" imaging) was the only real option available and was only offered as an upgrade to the existing x-ray system in the clinic (if compatible), and was used as a stepping stone to accommodate acquiring what would eventually be a digital image. CR systems still utilize a cassette and scanner or "reader" to yield an image. This process is a three-step process as with film-based systems and does not allow any real time-saving advantages comparable to the DR (direct digital radiology). DR systems allow image acquisition and viewing in 6 to 8 seconds without the use of any cassette or reader. The DR systems have fast become the standard in chiropractic digital imaging and have set the standards for the chiropractic profession.

What leasing/purchasing options are available for digital imaging equipment?

Dealers and direct sellers generally offer lease and finance programs for equipment such as the ScanX 14 In-Counter digital imaging system.

Fischer: Dealers and direct sellers generally offer lease and finance programs. Five-year leases with low-cost buyout at the end of the lease are the most popular.

McElhannon: Many financing companies have begun offering very good financing programs for digital systems. These companies have learned that digital imaging, while more expensive than traditional film-based systems, offer the chiropractor the most leading-edge technology available with a much faster return on investment (ROI). This in turn will lower the finance companies' risk or exposure to defaults on the loans.

How can you justify the cost of digital imaging compared to conventional, and when do chiropractors begin to see a return on investment?

Fischer: When all costs are considered, chiropractors are paying between $3.50 and $4.50 per x-ray film. Strictly on a dollar-and-cents basis, an office that exposes eight to 10 x-rays per day will save enough to amortize a $750 per month lease. That will pay for a manual CR system in 5 years. The benefits of better diagnosis, convenience, and patient satisfaction are immediate.

McElhannon: The ROI on the DR systems have been realized at a much faster time than with traditional film-based systems. At first glance, the transition to digital imaging can seem like a major capital expenditure. But with a careful analysis of the bigger picture, you'll discover that digital x-ray actually costs less than using film. With increased speed and performance, digital x-ray is simply much more efficient than systems based entirely on film. Add that to the elimination of film, cassettes, monthly service, development chemicals, space for dark room, and film storage, and it's easy to see that over time, cost clearly favors the digital format.

What steps must a chiropractor take to be able to display digital images on various computers throughout the office?

Digital systems such as the HCMI DCX direct digital x-ray system are easier to use than film systems, which results in faster exam completion.

Fischer: Office networking is not a job for amateurs. A Microsoft Certified Network Specialist should be consulted. Hard-wired systems are the fastest and most stable, but wireless networking can also work. Just be sure that if you go wireless, the network is secure or you may run afoul of HIPAA.

McElhannon: Installing the proper workstations software is always the beginning. This will allow the computer to receive, send, and manipulate the image. The images can be displayed in many formats throughout the clinic. However, for diagnostic purpose, the image must be displayed on a high-resolution monitor (2 megapixel or higher is recommended) and in a DICOM format. If the doctor wants to display the images in another room for a report of findings, he or she can display them in a JPEG format on any standard PC monitor.

What is the level of difficulty in using the equipment, and what support is available?

Fischer: Equipment is easy; software can be harder. Like any software, image acquisition, display, enhancement, and storage/retrieval programs need to be learned. Look for software that is icon-driven. It will be easier to learn and use. Be sure that in-office training is included with your purchase; also, follow-up in-office training is very valuable. You also want to purchase software support so that you get updates and at least telephone support. Don't assume that you will get support; be sure that it is in your purchase agreement.

McElhannon: The digital systems are arguably much easier to use than film systems and much faster to get the exams completed. The fact that you can see the image in 6 to 8 seconds (with DR) means you no longer have to wait until the films have been developed to see if you successfully captured the right view and quality that you set out to obtain. Once the install is completed and the in-service has been properly performed, the support is usually accomplished via the local dealer that has sold the system. In some cases, the manufacturer is available by phone or VPN to solve any larger issues that may come up. Most of the support issues can be addressed via a VPN connection and have proven a valuable tool in expediting any service issues.

Where is there still room for improvement in digital imaging, and what technologies do you foresee in the future?

Fischer: The "holy grail" of digital imaging is a DR system costing under $20,000. It is a 400-speed system with low x-ray dosage to the patient. It takes all images from extremities to 14- x 36-inch spine shots and has a tool kit that allows any measurement a chiropractor might want to make, right on the computer screen. Planning on waiting for such a system? Using film until an idealized system is invented does not make sense. You can benefit now from the convenience and cost savings of a manual CR system and upgrade to new technology in the future.

For more on imaging, check out our January 2007 article, "Refine Your Image."

McElhannon: Yes, there is room for improvement in digital imaging. The most recognizable improvements are related to the technology utilized in digital imaging. Materials utilized in capturing the images are always being improved. The scintillation material used this year may not be the same as next year, all in efforts to lower the patient's exposure rates and improve the overall quality of the image. This means new and better technology, not "cheaper." However, let's not fool ourselves; some consumers are relating the cost of digital systems to the electronics world—VCR/DVD players, for example—thinking the cost will go down, and therefore are forgoing purchasing a system until such a time. The reality is that technology is only going to improve and this will, in turn, raise the price for digital. Think about it: Twenty years ago you could buy a new x-ray system for $10,000; today, the cost to buy a quality new system is much higher and will only continue to increase as technology improves.

The future is here and now. For 10 to 15 years, we have all dreamed of having the ability to view images on our computer. Well, here it is, so let's start embracing this technology, as digital imaging is the standard in radiology today.