Digital Imaging in Dentistry Applications and Challenges S. Brent Dove, DDS, MS University of Texas Health Science Center San Antonio, Texas

“A picture is worth a thousand words” “Knowledge is valuable” “Don’t waste it”

Digital Dental Radiology Intra-oral Panoramic Cephalometric Sinus and Skull Tomography CT MRI

Advantages of Digital Radiology No Darkroom No Chemical Processing Lower Cost Per Image Instant Viewing of Images Less Radiation to Patient Image Processing and Analysis Transmission of Images for Consultation

CCD/CMOS-based Sensor X-ray Beam Scintillator Fiber Optics CCD

Standard Standard High & High Resolution #2 #1 #0 High Resolution = 22.5 Standard = 45 Standard & High Resolution Standard High #2 #1 #0

CCD/CMOS - 45

CCD/CMOS - 22

Storage Phosphor X-ray Beam Imaging Plate

Storage Phosphor Helium-Neon Laser Photoreceptor Imaging Plate

Storage Phosphor

Storage Phosphor

Diagnostic Accuracy Primary Dental Caries Recurrent Dental Caries Periodontal Disease Periapical Lesions Endodontic File Length Determination

CCD Extra-oral Radiograpy

Tomography

Panoramic Radiography

Cephalometric Radiography

The Next Generation Three Dimensional Imaging TACT Small Volume CT

TACT™ Methodology Series of images taken from different angles

Slices of a maxillary molar

Small Volume CT

Small Volume CT

Small Volume CT

The Future is Full of Possibilities Optical Biopsy Laser Computed Tomography 3D Ultrasound Laser Fluorescence Computer-based FOTI

Computer Aided Diagnosis (CAD) Observational Errors Misinterpretation Errors Integration of Data Errors Most Beneficial in Observational Errors

“CAD systems do not necessarily have to be better than the clinician, just help him not miss obvious lesions.”

Computer Aided Diagnosis (CAD) PAP Cytology & Oral Brush Biopsy Mammography Chest X-ray Screening Periodontal Disease Dental Caries

Digital Subtraction Radiography -

Neural Network Detection

Digital Dental Imaging Intra-oral Radiography Panoramic Radiography Cephalometric Radiography Tomography Intra-oral Photography Extra-oral Photography Histology & Surgical Microscopy

Interoperability ????????

The DICOM Standard The Digital Imaging and Communications in Medicine (DICOM) Standard is a detailed specification that describes semantics and syntax for exchanging images and associated information. The standard applies to the operation of the interface which is used to transfer data in and out of an imaging device.

DICOM Workflow DICOM Display Workstation Storage, Query/Retrieve, Study Component LiteBox Query/Retrieve Results Management DICOM Acquisition Media Exchange Print Management Query/Retrieve, Patient & Study DICOM Archive

What is DICOM Digital Imaging and Communication in Medicine Standard for communication of images and image related information between devices International in scope All biomedical imaging Voluntary standard

DICOM is Biomedcial Informatics “the storage, retrieval, sharing, and optimal use of biomedical information, data, and knowledge for problem solving and decision making.” Edward Shortliffe “model formation, implementation of the model, application of implementaion to the real world, evaluation of the implementation” Titus Schleyer

DICOM, Informatics, Research Digital X-ray Visible Light Clinical Trials Structured Reporting

The Future is Full of Possibilities