X-ray technology has changed dramatically over the years. Today, more and more chiropractic practices are using digital imaging to collect, store, and analyze images in order to diagnose a patient's condition in real time. Chiropractic Products interviewed personnel from four companies to give you a better understanding of how their imaging products can benefit your practice: Nicole Miller is the marketing specialist at ALLPRO Imaging, Melville, NY; Marcus Johnson, DC, is from DMX Works Inc, Palm Harbor, Fla; Jay McElhannon is vice president at HCMI Inc, Springfield, Mo; Steve Keller is vice president of sales at ScripHessco, Bolingbrook, Ill.

What type of computed radiography or direct digital radiography services and/or products does your company provide to chiropractic offices?

ALLPRO Imaging: ScanX 14 is a computed radiography system that uses a reusable imaging plate containing photosensitive storage phosphors that retain the image until it is sent to the computer. These plates can be reused thousands of times before being replaced. X-rays are taken in the usual manner. The phosphor storage plate is then removed from its cassette and inserted into ScanX, where the image is scanned and automatically transferred to your computer in less than 1 minute (for a 14-inch x 17-inch plate).

DMX Works: We manufacture two configurations of the Digital Motion X-Ray system. The portable system provides easy mobility within a clinic setting. Our mobile clinic system allows the user to travel to a wide array of locations to perform on-site digital motion x-ray studies.

HCMI: HCMI provides direct digital imaging.

ScripHessco: Computed radiography—AGFA Model CR30; digital radiography—Quantum ChiroDX direct digital imaging system; AMS picture archiving and communication system—AMS PACS; Quantum and Tingle High Frequency x-ray systems—traditional x-ray.

How has the development of digital imaging improved the way in which images can be taken, viewed, transferred, and stored?

ALLPRO Imaging: ScanX (computer radiography technology) has been engineered to make the transition from film to digital as straightforward and effortless as possible. Using an existing x-ray source, we replace the medium in which the x-ray is captured on with little to no variation of the x-ray exposure technique. If any, the x-ray exposure will be dropped. With digital, there are fewer retakes. You have greater latitude in getting good, readable images. Digital is much more forgiving of exposure errors because it has a wider dynamic range than film. If an image is under- or over-exposed, the computer adjusts the error and provides a useable image. With film, an error in exposure often means that the x-ray must be repeated, which means that the patient must be irradiated a second time.

You can enhance the image to bring out diagnostic detail. You can magnify, heighten contrast, and even colorize the affected area. Measurements can be made by using line segment, angle, and intermetatarsal angle tools. It's a great way for chiropractors to educate their patients about treatments and demonstrate a misalignment or disk problem.

Hard-copy film storage is obsolete. Digital images are saved for easy retrieval on the computer system and stored on secured backups. Images can be transmitted electronically in an instant. They can be e-mailed to a colleague for consultation or diagnostic confirmation, burned on a CD, or saved on a memory stick.

DMX Works: The digital motion x-ray can be captured in real time and instantly recorded to DVD and digital video. The images can then be instantly sent via e-mail.

HCMI: "Throughput," or speed in which the study can be acquired, has improved dramatically. What used to take 10 to 12 minutes, including processing of the film, now only requires approximately 2 to 5 minutes without the need to run a film through the processor. Viewing is done within 6 to 8 seconds on DCX direct digital systems. Transferring of images is done through the office network via computers. Storage is done immediately once the study has been completed via the hard-drive storage on the computer.

ScripHessco: Digital imaging has allowed chiropractors to instantly view pictures without running them through slow processors. The image can be manipulated to provide a good image about the precise area that the chiropractor needs to evaluate. The software allows the chiropractor to change the contrast and sharpness, which means less retakes and less dosage to the patient. Images can be stored on hard drives or PACS systems, allowing them to be retrieved or shared at any time without taking up a lot of storage room.

What are some of the important features of your system that allow a chiropractor to make an accurate diagnosis of a patient's condition?

ALLPRO Imaging: Opposed to using film and environmentally unsafe chemicals for developing an image, a durable reusable phosphor storage plate (PSP) is employed to capture the x-ray, which is then digitized by the ScanX. Never again will the office have to deal with film, chemistry, processor maintenance, or even a darkroom.

The ScanX digital system from ALLPRO Imaging provides ease of use with one step scanning.

We can rapidly acquire a 14-inch x 17-inch PSP at 3.8 lp/mm within 55 seconds in normal office lighting conditions. The user can easily increase the scanning resolution to a full 7 lp/mm within the approved medical digital imaging software. During the scanning process, we ergonomically introduce In-Line Erase technology, which erases the PSP as it scans to allow the plate to be ready for the next exposure, increasing office workflow and efficiency.

Once the digital image is on the screen, the software allows the user to view the skeletal and soft tissue. The digital image comes alive, allowing the user to have full manipulation ability upon the image with an array of software tools and functions to make accurate diagnoses time and time again. Tools such as on-screen measurements, magnification, and window leveling make diagnosing problematic regions of interest trouble-free.

There is now a digital copy saved and stored safely on the computer for future reference. That image can then be DICOM communicated to any number of PACS throughout the world for referrals and second opinions. The digitally enhanced image can also educate patients by helping them visualize the diagnosis and treatment plans.

In addition, the office will gain real estate since there will no longer be a need for a dedicated darkroom and film filing archive system. The ScanX will pay for itself and help save money over a short period of time, since there will no longer be a need for purchase of film, chemistry developer, or a need for retakes. Once the initial cost of the system is overcome, each x-ray taken thereafter will be profit in the chiropractor's bottom line.

DMX Works: The Digital Motion X-Ray system gives you the ability to evaluate structure as well as function. This is done by instructing the patient to move through specific arcs of motion to demonstrate fixations, ligamentous instability, and fractures.

HCMI: The DCX system produces a very high-level image resolution—3.2 to 3.4 Lpi—coupled with the ability to manipulate the image quality via window and leveling (adjusting the contrast and density), allowing for a more accurate diagnosis.

ScripHessco: The AGFA CR system is the fastest computed radiography system on the market. While other system speeds are as slow as 200, the AGFA system runs at just about the same speed (400) as an existing high-frequency system. Within 30 seconds, a picture is taken and is ready for viewing. AGFA's multiscale image-processing software, Musica, is easy to use. Upgrades, within the same release, are included at no charge.

Can diagnostics and imaging help a chiropractor with insurance reimbursement? What type of documentation is needed for insurance reimbursement?

DMX Works: Yes. We can demonstrate the full extent of the patient's injuries that are often undetected by static x-rays and MRI. The patient's digital motion x-ray study, which is stored on DVD, can easily be sent to the insurance company. This objective documentation will justify the need for treatment, therapy, and rehabilitation for the patient's care. For example, most patients suffering from cervical injuries have symptoms of headaches, posterior neck pain, and increased pain with movement.

HCMI: It is the same as with traditional film-based applications.

ScripHessco: The diagnostic quality of digital x-rays will definitely help the chiropractor with insurance reimbursement. With higher-quality imaging comes accurate diagnosis. The AGFA system also offers a bone densitometry package. Bone densitometry may be billed separately and also expands the chiropractor's office capabilities.

What type of training and support do you offer to chiropractors?

ALLPRO Imaging: Our authorized dealers provide installation, service, and training.

DMX Works: Initial training occurs on-site at your clinic following installation. Advanced training seminars are held monthly at DMX-Works' corporate office in Palm Harbor, Fla.

HCMI: Once a DCX system is purchased, the customers are given application training and support is handled through the local dealership. This is backed up with HCMI digital tech support.

ScripHessco: We install, service, and train throughout the United States. We use factory-trained technicians and actual factory representatives who install, service, and train.