05/02/2013    Kenneth Meisler, DPM

Purchasing a Digital X-Ray System (Michael Brody, DPM)

After 30 years in the same office, I moved to a
new much larger office in 2007. I decided to
switch to digital x-rays and go totally paperless
with EMR at that time. EMR was relatively easy,
digital x-rays was EXTREMELY easy.

I disagree with Dr. Brody recommending a CR
system for digital x-rays. In 2007, I tried to
save some money and bought one of the most
popular podiatry CR systems. After one year I
realized the quality of the images were not
acceptable. I upgraded to a 20/20 CR system and
it was a definite improvement (I sold my first CR
for almost what I paid for it). I used the 20/20
CR system very frequently in my office which has
3-4 podiatrists at a time. By that point, the
20/20 DR images were much better than the CR
images and I also noticed some degradation of
the quality of my CR image over time. When I
added in the increased speed of 20/20's DR system
I knew I had to upgrade again. DR image quality
is excellent and the images are almost
instantaneous There is no noticeable degradation
because there are no moving parts. 20/20 has not
had a single unit returned broken because someone
dropped it.

I think buying a CR system is like getting an 8
track tape, you can listen to music but it is
very outdated and will wear out.

Most importantly you need the best quality image
when looking for small fractures, osteochondral
lesions, stress fractures etc. You will be able
to practice better with quality images of a good
DR system., Especially in a few years when your
CR system images start to degrade.

In my opinion, Digital x-rays pay for themselves
by
1. Making you feel better about yourself and your
practice.
2. Impressing patients, they are still amazed by
it and many come in saying “I can’t believe my
other doctor didn’t have that”
3. Many hours a month saved pulling x-rays if
your are paperless and if you aren’t you should
be.
4.you never lose an x-ray
5. It is easy to e mail X rays to colleagues or
radiologists for second opinions.
6. X-rays are NEVER out of order. You can easily
follow the healing of an osteotomy or fracture.
As compared to finding the X rays in a folder out
of order and having to search through them to put
them in date order in front of the patient.
7. Savings in space for a developer and x ray
storage.
8.The staff loves it.

Do not skimp on your x-ray system. It is probably
the most important piece of equipment in your
office, buy the best you can! Too many podiatrist
drive BMW’s but skimp on their x-rays.
I drive a Prius but have the BEST podiatry
digital x-ray system. My digital x-ray system has
helped grow my practice!

Disclosure: Dr. Meisler is a paid consultant for
20/20 Imaging.

Kenneth Meisler, DPM, NY, NY, Kenmeisler@gmail.com

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05/04/2013    Raymond Posa, MBA

RE: Purchasing a Digital X-Ray System (Michael Brody, DPM)

Regarding Dr. Brody’s post on digital x-ray
systems CR vs. DR, there are some erroneous
statements. First CR is not a “true” digital
system. Think of CR as a copy machine, we all
know as you copy originals, you lose quality. The
CR system is more closely related to traditional
film than it is to digital x-ray.

In a CR system, a x-ray sensitive plate is put
inside a standard x-ray cassette and exposed just
like a traditional piece of film would be. Then
the cassette is placed into a reader (some CR
systems require you to remove the plate from the
cassette and place it into a reader. The image is
then scanned off the plate and converted to a
digital image. The process is somewhat labor
intensive and slow.

In a DR system the image is taken directly from
the imager to the PC, thus eliminating the need
to handle cassettes and the need to convert an
analog picture to a digital image.

I ran a time motion study using a mid-range CR
system ($75,000) vs. a 21 megapixel DR system
($25,000) and the speed difference in both the
image acquisition and the positioning of the
patient and the handling of the cassettes
resulted in a 3 to 1 time savings by using DR.
The time motion study showed it took just over 6
minutes to take 3 images in a study, process them
and get them on the computer screen with the CR
unit, the DR only took 1 minute and 56 seconds.

In a busy office this productivity gain is
significant. As for cost, most companies are
dropping their CR products because they are
yesterday’s technology. As for cost, there are
some digital x-ray companies that do not charge
ongoing maintenance support for the unit or their
software.

I have seen many more CR plates damaged than any
DR plate. The CR plates typically cost $800 each
and you need to keep about 6 on hand to operate
efficiently. With all of the handling and the
lifting and the dropping and the banging, these
CR plates get damaged frequently. The CR plates
also have a limited life span (about 800 images)
the image quality also drops significantly as you
approach the end of life of the plate. With the
DR system, you are never lifting the imager,
rather you rotate it from a horizontal to a
vertical position and the unit never leave
contact with the ground.

Finally, ask your x-ray dealer about the section
179 and ADA tax credits available on the DR
units, they generally off set have of the cost of
the unit.

Raymond F. Posa, MBA – Farmingdale, NJ
rposa@themantagroup.com