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Dr Amanda Hulands-Nave has generously shared some of the information she discussed at her session in the dental stream of the 2016 AVA Conference.
So if you embark on doing dental radiography you will need an Xray generator. You can use your existing xray generator for diagnostic radiography with intraoral films or plates but a longer working distance (80-100cm) will be required and this will also increase scatter. A specific dental xray unit can be purchased and this can take the form of a handheld unit or one which is wall mounted or on a mobile stand. Dental units are lower power, often with fixed kV and mA. Only time is varied. Generally these units work at a very short working distance and this decreases the scatter and WHS impacts.
The generator will need to project an image. The choices here are conventional intraoral chemical double coated emulsion film or digital DR (direct radiography via an intraoral sensor) or digital CR (computed radiography via a digital film that is then scanned through a digital imaging scanner).
Whilst conventional film systems may initially be cheaper to set up, there are ongoing costs involving film, chemistry and processor maintenance. Also these systems take a lot longer to capture and develop the images. There is also the environmental impact of the spent chemistry that requires disposal.
Digital systems are more expensive to buy and they do require a computer to be attached to them. The benefits though are in saving labour as the time it takes to capture an image is much less and there are much less re-takes of images as they can be digitally enhanced. There is less maintenance than chemical systems and once the systems are paid off there are very little, if any, ongoing costs.
Also the amount of xrays required to expose a digital image is around 80% less than that required for a conventional film5, thereby further reducing the WHS risk. DR systems, whilst having the advantage of obtaining an image within a few seconds have the disadvantage of only coming in a size 2 plate and most of the money is in the plate and if a pet is not properly anaesthetised, then damage to the sensor can occur, which can be expensive. CR systems come with multiple plate size choices. The money is in the scanner (which can be bulky) but the plates are cheaply replaced.
The only other cost to consider is the time it takes train the skill to capture and interpret the radiographs and the time to actually take the radiographs. This will be greater at the beginning and reduce with time and practice and will end up being offset by the time saved by better decision making.4
BUT
You can charge for the radiographs and the services to treat the pathology that you find and incorporate this into the professional fee to offset the costs and the clients will see value in it if you use the images as a powerful education tool.4
If people do not do a new procedure, it is either because they:
Hopefully you will not need to resort to nagging and providing ultimatums. Presenting staff with the facts, empowering them with the skills and allowing them to gain the job satisfaction that comes with fully utilising dental radiography should ensure that your machine does not collect dust.
Setting Standards of care related to dental radiography (eg all grade 2 dentals and above should have dental radiography performed) and then measuring the number of radiographs vs the number of dentals grade 2-4 provides an objective measure of policy implementation.
Providing a mentor who is approachable and can provide an expert opinion when staff are learning the interpretation can aid adoption of the new technique and having a dental “Champion” in the practice who helps to reinforce the cultural change can be a help.4
As for pricing your new dental radiography services, you will need to price to your market and consider your outlay, but consider a level that it doesn’t become a prohibitive for either the vet or the client and remember that you will increase the number of dentals that you do to help cover it.
Common excuses that can arise as why staff don’t adopt the new technique:
These excuses need to be addressed with training so that standards are followed.
The benefits of dental radiography are huge and listed below:
You will use your dental xray machine every day you book in dentals and you should be booking in dentals every day based on the average case load given the level of dental disease that exists. It will pay for itself very quickly.
You can use a calculator from dvm360 to see if your practice is ready for dental radiography. Click here to visit the calculator: CASELOAD CALCULATOR: Does your caseload warrant an investment in digital radiography?6
If you have any questions you would like to ask Amanda, just add them into the Comments section below.
References:
4. Personal experience
5. Bellows, J Intraoral Digital Radiology, 8700, AVMA Conference Proceedings 2010
6. DVM360 website
Amanda graduated from the University of Queensland with a Bachelor of Veterinary Science in 1999 and from Murdoch University with a Masters of Veterinary Studies in Small Animal Medicine and Surgery in 2005. Amanda also has been admitted (by examination) to both the Small Animal Internal Medicine and Dentistry Chapters of the Australian College of Veterinary Scientists.
Amanda has worked in mixed rural practice, exotic practice and small animal practice in capital cities and regional areas and she has been at Bellarine Veterinary Practice in Geelong since 2005. Her special interests are dentistry, endocrinology, intensive care, ultrasonography, reproduction services, dermatology and behaviour.
She is the proud owner of a cheeky chocolate labrador called Lochie and a black and white cat named Rupert who holds the obstructive FLUTD world record.
Connect with Dr Amanda Hulands-Nave BVSc(Hons) MVSt MACVSc (SA Med) MANZCVS (SA Dent):
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