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Week of October 14, 2013

Digital imaging advancing care at the School of Dentistry

Digital imaging is making significant inroads at the University of Michigan School of Dentistry.

New digital imaging equipment was recently installed in 22 clinics throughout the school to enhance the quality of care patients receive as well as prepare students in dental, dental hygiene, and graduate programs for the digital environment they will experience after graduation.

Clinical instructor Dr. Erika Benavides and third-year dental student Brandon Shoukri use digital imaging to access patient radiographs and a dental model as they discuss a comprehensive treatment plan. Photo by Per Kjeldsen.

The latest efforts build upon the successful use of digital technology in the Dr. Roy Roberts Preclinical Laboratory as well as the digital impression system available in dental student clinics.

For 10 years, clinical instructors have been using digital technology to demonstrate dental procedures that first- and second-year dental students watch on a monitor at each of 110 workstations. Students apply that knowledge and develop their clinical skills on models of the oral cavity (typodonts), plastic teeth, and mannequin heads prior to treating patients in the school’s clinics. More recently, students have been taking digital impressions and replacing traditional stone models with highly accurate and durable stereolithography models.

Benefits cited

The new digital imaging equipment now being used includes intraoral X-ray units, sensors and phosphorous plates, as well as panoramic, panoramic-cephalogram, and cone beam computed tomography machines that provide excellent visualization of the teeth and bony structures of the head.

The radiographic images “will appear on a monitor in seven seconds or less,” said Roger Gillie, director of application services in Dental Informatics.

Students and clinical faculty can zoom in on a digital image, highlight details and share radiographs. Light boxes that have been used for many years to view film X-rays have been removed in the radiology clinic. However, in four clinics where predoctoral students treat patients under the supervision of clinical faculty, light boxes will remain since it will take about a year to scan tens of thousands of film radiographs to digital format.

Dr. Stephen Stefanac, associate dean for patient services, said, “the quality of the digital X-ray images is exceptional and should help us to detect problems in patients earlier. Also important,” he added, “is that students can now show detailed images to their patients to help them understand the treatment options that are available.”

Extensive rollout preparation

The digital imaging initiative involved extensive collaboration among clinicians, radiologists, and staff in patient services, radiology, dental informatics and others throughout the school, according to Dr. Erika Benavides, clinical assistant professor and oral and maxillofacial radiologist. She led the clinical digital imaging team.

“It was a giant research project,” Benavides said. “We reviewed a considerable amount of information from many different hardware vendors and, because the equipment had different capabilities, evaluated each system using objective criteria.”

Also critical was choosing the digital imaging software to use. “The software is the foundation that allows us to capture and store the images using the different radiology equipment, and allows clinicians and students to share the images throughout the School or even across campus,” she said. “Our clinician users were actively involved in evaluating the software, so their input was essential in making a final decision.”

After Jan. 1, 2014, the school will no longer create a paper record for new patients. “We will then digitize portions of 30,000 existing records,” Stefanac said. “When the paper records are in digital form and combined with new digital images, our students will have easier access to all their patient information.”

Eventually, digital images will be accessible on Apple and Android mobile devices. All information will be encrypted to comply with all protected health information standards.

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