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April, 2011

Digital Imaging: Is It Right For Your Practice?

By Andrew Cheesman

The questions and options that a chiropractor has in X-ray today are simple: He can take them the traditional way by using film, a dipping tank or processor and waiting for the picture to develop.

He can use computed radiology (CR), which utilizes a method of capturing an image on a plate and then by placing in a processor it becomes a digital image for computer presentation. He can use a complete referral-based program, he can use true digital sensor or not use X-ray at all.

Tradtional Technology

Most of the chiropractors in the U.S. are still using the traditional method of irradiating a film, putting it in a processer, then waiting for it to develop.

It was invented about 100 years ago and the patient had to endure 11 minutes of radiation to enable the doctor to get an X-ray.

With today's technology we now use only 2 percent of the original radiated dose. The office purchases film and chemicals and as the office takes more X-rays the cost increases proportionately. The benefits to this method are all about cost of entry. An office would only pay for an X-ray when it takes one. If the practice does not take many X-rays, or is more holistic based, it may only spend $30 per week on supplies and monthly processor cleaning. It would make little or no sense to invest in an enhanced X-ray system because the practice would not generate enough income to support it.

It is easy to criticize these systems; they smell, have harmful by-products, they are slow, there is a lot of identified and hidden waste.

In a practice that is growing, traditional X-rays may not only cause a bottle neck on readings, but in the event that an X-ray did not develop, the patient has to be retaken with all of the inherent risks that are associated with increased radiation exposure.

That being said, I have yet to meet a chiropractor who tells me that the traditional method for taking films make him any worse of a doctor.

Computed Radiography

CR, or computed radiography, is a process that utilizes phosphor plate technology. These plates trap the X-ray energy and require an intermediate processing step to release the stored information so it can be converted into a digital image.

The process was invented by Fujifilm in 1982 in Japan. It offered doctor's offices the ability to take digital images. The process became more cost-effective and much quicker than had been previously possible with traditional X-ray.

Once the image was converted to the computer it was then easily manipulated. There are many benefits to this technology. It is very flexible to use; and it produces excellent quality images that once converted to a digital signal can be stored and transferred like any other digital file across the office or e-mailed to anyone.

The negatives to this system are similar to those of film. Although there are no chemicals, there are still ongoing maintenance costs. The plates, after each use, are wiped by the processor for reuse (and if you are careful can last for many images); but, they are fragile and, more often than not, are damaged or simply wear out.

This forces the practice to continue to pay for new plates as capital expenditure, with no commensurate benefit. There is time involved and although there are some inexpensive CR units on the market, the lower the cost, the slower the processor. It was always seen as an intermediate technology and we are seeing less and less of them being advertised and marketed at trade shows.


It is really hard to have a firm grasp on what percentage of doctors send out X-rays; I do believe that we shall see more as we move towards true electronic health records (EHRs). A doctor's original concern that "if I let an X-ray leave my office that is the last that I will ever see of it", are gradually diminishing. By using digital images an office can burn a disk or e-mail any file to any other doctor for him to review without having to expose the patient to unnecessary radiation.

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