Dental Radiology and Enterprise Imaging

What is Dental Radiology?

Imaging is an important tool in dentistry and part of the enterprise imaging ecosystem. Dental radiology is the most commonly used form of medical imaging in dentistry and enables dentists and oral surgeons to examine precise images of teeth, jaws, and surrounding structures using a small amount of radiation to detect used to detect cavities, bone loss, impacted teeth, periodontal diseases, tumors, and other issues in addition to monitoring the process of dental treatment orthodontics, or root canal therapy. In 2018, over 1.4 billion dental X-rays were performed in the United States with procedure types ranging from more classic intraoral and extraoral X-rays to newer cone beam computed tomographies (CBCTs) with over 90% in the intraoral X-ray category.

What are the types of imagery used in Dental Radiology?

The two types of imagery commonly used in dentistry are Cone-beam computed tomography (CBCT) and Digital Radiology. CBCT is particularly useful in implant dentistry, oral surgery, and orthodontics and produces 3D images of the teeth, jaw, and surrounding structures, providing more detailed images for the diagnosis, treatment planning, and monitoring of progress. Digital radiography is a newer technique that uses digital sensors and a low dose of radiation to capture images. This approach offers higher-resolution image quality and the ability to share images with other clinicians.

Intraoral cameras involve inserting small cameras into the mouth that can capture detailed images of the teeth and gums and are sometimes used in dental imaging. These cameras are used to detect cavities, periodontal disease, and other oral health issues and to show patients the condition of their teeth, which can help them make informed treatment decisions.

How large is the Dental Radiology segment?

Dental radiology is a substantial part of the medical imaging market and was valued at USD 1,487 million in 2021 according to Straits Research. It is expected to reach USD 12,511 million by 2030. North America accounts for the largest share of the market.

The expanding number of dental clinics increased awareness and proactive approach towards oral health, and surging incidences of dental diseases coupled with the escalating demand for advanced diagnostic techniques are driving the overall growth of the dental radiology market. Additionally, the increasing adoption of digital radiography, CBCT, and enterprise imaging systems is further bolstering the market.

Which dental specialties use imaging?

A dental specialty is a specific area of dentistry that necessitates additional post-doctoral education and is acknowledged by the National Commission on Recognition of Dental Specialties and Certifying Boards (NCRDSCB). The NCRDSCB currently recognizes 12 dental specialties.

  1. Dental Anesthesiology
  2. Dental Public Health
  3. Endodontics
  4. Oral and Maxillofacial Pathology
  5. Oral and Maxillofacial Radiology
  6. Oral and Maxillofacial Surgery
  7. Oral Medicine
  8. Orofacial Pain
  9. Orthodontics and Dentofacial Orthopedics
  10. Pediatric Dentistry
  11. Periodontics
  12. Prosthodontics
These imaging technologies can present challenges in managing the vast amounts of data in the form of high-resolution images. Dental studies can range in size from several megabytes to hundreds of megabytes in size. Panoramic images can be up to 50MB. This increase in file size may slow digital image transmission and the use of storage media. Queue prioritization and bandwidth optimization are crucial to improving turnaround times.
Oral and Maxillofacial Radiologists (OMRs) leverage advanced radiographic imaging technologies such as:
  • Digital Imaging
  • Magnetic Resonance Imaging (MRI)
  • Plain Films and Computed Tomography (CT)
  • Ultrasound (US)
These imaging technologies can present challenges in managing the vast amounts of data in the form of high-resolution images. Dental studies can range in size from several megabytes to hundreds of megabytes in size. Panoramic images can be up to 50MB. This increase in file size may slow digital image transmission and the use of storage media. Queue prioritization and bandwidth optimization are crucial to improving turnaround times.

What types of enterprise imaging workflows are related to Dental Radiology?

3D tomosynthesis has better lesion detection than 2D mammography as it prevents the masking effect of the overlying normal breast tissue and therefore allows the detection of your cancer. Source:

Digital Imaging and Communications in Medicine (DICOM) is the standard for the communication and management of medical imaging information and related data. DICOM is most commonly used for storing and transmitting medical images enabling the integration of medical imaging devices such as scanners, servers, workstations, printers, network hardware, and PACS (picture archiving and communication systems) from multiple manufacturers. DICOM is critical in streamlining workflows, improving the accuracy and efficiency of diagnoses, and enabling better patient care. DICOM systems support dental radiology workflows including

  1. Image acquisition involves initially capturing dental images through various modalities such as traditional X-rays, CBCT, digital radiography, and intraoral cameras.
  2. Image management includes storing, organizing, managing, and tagging the captured images with patient information, securing the images, and ensuring that they are accessible to authorized users.
  3. Image interpretation analyzes the images to properly diagnose, plan treatment, and monitor the progress of dental patients.
  4. Image distribution ensures images are secure and available to authorized users within the healthcare organization. This can include sharing the images with other dentists, oral surgeons, and specialists, as well as providing the images to patients and their families.
  5. Image archiving entails storing images of images for long-term retention, which can be used for future reference and follow-up.
These imaging workflows are an important part of the process for efficient management of dental imaging data, which can improve patient care, streamline diagnoses and treatment, and allow for better collaboration among healthcare professionals. Additionally, the use of an enterprise imaging system or a vendor-neutral archive (VNA) can help to integrate different modalities and make them accessible from one location.

How are dental images stored?

The storing of dental images has moved from traditional film X-rays to digital radiography. Film x-ray image management involved storing X-rays in a patient’s file folder along with hard copies of intraoral and extraoral photos. Now, digital imaging systems have separated acquisition and display, to help enable efficient storage, communication, and display of digital data. This has revolutionized image management in dentistry by providing almost unlimited storage capacity and improving the speed and accuracy of diagnosis and treatment planning.
The two methodologies used for the storing of dental imaging include
  1. Dedicated “standalone” systems, often based around a personal computer and used for single-modality applications such as a single intraoral camera or a single CCD x-ray detector. These systems have a method for short-term and long-term storage, and the ability to print good-quality images. However, connectivity and communication with other systems are limited.

3D tomosynthesis has better lesion detection than 2D mammography as it prevents the masking effect of the overlying normal breast tissue and therefore allows the detection of your cancer. Source: single-modality system, where the core functions of image handling are combined in one computer. Source: Pocket Dentistry

  1. Enterprise imaging systems allow for the integration of different modalities and provide a centralized location for accessing and managing images. Dedicated systems for each function allow multi-modality and multiple users to share the same system. This type of system, commonly known as PACS or MIMPS, is usually installed in larger institutions. A VNA is often deployed when there is a multi-department, multi-specialty, or enterprise scenario.

Distributed image handling, with dedicated systems for each function. Source: Pocket Dentistry

Vendor Neutral Archive (VNA) vs. Picture Archiving Communication Systems (PACS/MIMPS)

PACS/MIMPS is a medical imaging technology that provides economical storage and convenient access to images from multiple modalities. Medical images and reports are transmitted digitally via PACS/MIMPS. The universal format for PACS/MIMPS image storage and transfer is DICOM. Non-DICOM data, such as scanned documents, may be incorporated using formats like PDF, once encapsulated in DICOM. PACS/MIMPS systems are designed for workflow improvement functions including storage, archiving, backup, and retrieval. These are typically restricted to operating on a single-system-single-department basis, PACS/MIMPS is not ideal for interdepartmental collaboration.
Unlike a PACS/MIMPS system, a VNA allows medical images received from several devices, modalities, and locations to be viewed and stored collaboratively. Images can be stored using a standard interface, enabling access via any workstation, regardless of vendor. VNAs are built for long-term data storage and archiving facilitating cross-vendor migration without risk of imaging data loss. VNA is also capable of managing imaging data from different PACS/MIMPS repositories, helping increase control over medical data. VNA allows organizations to migrate from one vendor to another without imaging data loss.

Comparison of PACS/MIMPS vs. VNA. Source: SIIM

Dental Radiology and VNAs

A VNA consolidates all imaging data from multiple systems, departments, facilities, and vendors into a centralized access point serving as a single source of truth for patient imaging information. VNAs can store and display any file format, images, or multimedia content, DICOM or non-DICOM, as well as retrieve data in its native format. The VNA can also act as a workflow engine by creating a DICOM Modality Worklist to, route, prefetch, and send notifications. Today, VNA needs to support DICOMweb and FHIR connectivity and provide various APIs to deliver the data in and out of the VNA reliably and efficiently. Dental radiology can use a VNA as part of their enterprise imaging workflow to store and manage images from various modalities used in dental radiology, such as traditional X-rays, cone-beam computed tomography (CBCT), digital radiography, and intraoral cameras. This allows for the integration of different types of images and makes them accessible from one location.

Additionally, a VNA can be integrated with other clinical systems such as dental practice management software, electronic health records, and picture archiving and communication systems (PACS) which can improve the overall efficiency and quality of care for dental patients. And it can also support the distribution of images to authorized users within the healthcare organization, such as other dentists, oral surgeons, and other specialists. Helping to improve collaboration among healthcare professionals and enhance the diagnostic and treatment capabilities of the dental team.

Configuring dental devices for a VNA

Relevant priors, such as previous dental examinations, oral surgeries, or imaging studies, are crucial in interpreting current dental images, providing additional context, and differentiating between new changes and longstanding findings. It is essential to ensure that the VNA provides a query retrieve proxy to allow devices to access the images stored in it. This is especially important when numerous devices, ranging from hundreds to thousands, access these images frequently for reference and comparison. The query retrieves proxy and enables these devices to query multiple sources, including the VNA, thereby facilitating easier access to the relevant data. If these images are stored in the VNA, there might be hundreds, or even thousands, of devices pulling these images every minute. Ensuring the VNA can support and provide a query retrieve proxy to allow those devices to query multiple sources is critical to streamlining imaging workflows to provide timely patient care.

AE Title lists the title of the device’s DICOM application entity and is set by the device’s system administrator which associates the AE Title with the IP address. The IP access lists with DHCP support help ensure device querying is possible. Some panoramic studies have to be stored for a long period, so the ability to use multiple tiers of storage such as hot, warm, and cold is a crucial aspect of the process. Optimizing transmission and storage can be achieved by compressing on the fly.

To make sure that all patient information is up to date for proper retrieval, it is important to normalize the data. The dental viewer also requires certain parameters to be validated for the images to be correctly displayed and positioned.

Dicom Systems Dental Radiology imaging workflows

In addition to providing a comprehensive routing solution for images, Dicom Systems Unifier also offers data normalization, compression, and transmission optimization services. For proper archiving, it supports a variety of storage types, namely cold, hot, and warm. The Unifier can support dental bundles by sending and pulling reports via FHIR if there is a need to provide FHIR support for report delivery.

Contact an enterprise imaging workflow expert to learn more about how Unifier can help you achieve greater efficiency and productivity in your imaging operations.