Dental Digital Xrays

Factual Questions
1

Any Dentists in the house?

I have requested a copy all of my dental records from my usual dentist, including all xrays. I’ve been thinking about changing my dental provider and I would also like a copy of those files for my own records.

What type of file would be sent to another dental provider?

I was sent a number of files that were all low resolution JPGs. I was expecting something like DCM or DCM30 (DICOM) format.

I’m finding it hard to believe that another dental pro would use low resolution JPGs.

Any help here?

2

In my job (not a dentist, but I think my experience is similar enough) I often request x-ray images from other providers. Until recent years, they’d come on CDs that included a viewer as a .exe file that you’d have to run first, and that would have the interactive functionality that would enable you to view the images and adjust all the parameters. More recently, many have moved to passcode-protected web-based links that allow you to do the same things. Things like this are what go between providers.

Sounds like in your case, as a patient requesting copies of your own images, they just sent you static jpegs, basically screenshots.

It’d be an interesting question if it’d be within your rights as a patient to be given access to the viewer. I think you should, but that’s just me.

3

I had never heard of DICOM before, but it sounds profoundly unsuitable for sending to random individual patients.

4

I have gotten the CD with the DICOM files and the viewer. It was a lot more useful when I showed it to a private specialist than a crappy JPEG would have been. Are you suggesting that when you request a copy of your images they hand you anything except an unaltered copy of the raw original data?

5

Just to add a data point, years ago when a specialist sent my dog for an MRI scan, I asked for the images and the MRI facility gave me a CD exactly like that. It makes even more sense for an MRI than for X-ray images because an MRI consists of hundreds or even thousands of images representing “slices” through the affected region, and the viewer on the CD basically assembles them into what are effectively 3D views. After getting a pessimistic prognosis from the specialist, I took the CD to a veterinary college and research center for a second opinion. They were unfortunately equally pessimistic, but at least it allowed me to get the best possible expertise to evaluate the situation.

6

This is what I think has happened. Low resolution JPGs would be considered “non-diagnostic” and wouldn’t be sent to another dental professional.

Seems like this practice is trying to deceive me, but I wanted to make sure that my understanding of these images are correct.

7

I’m suggesting that a technical profession isn’t necessary likely going to send information in the same way to a patient that they are to share information with another professional in that specialty. I’m suggesting when an individual says “I want a copy of those x-rays for my records”, they want a printed image or jpeg much more often than they want a CD containing a special program for viewing a file in a custom interface filled with specialized technical jargon. If the patient said “I want a copy of my x-rays sent to my new doctor”, then I would expect them to send the technical version.

8

This is the last message that I sent to the practice:

"JPG is the file format of Xrays that would be sent to other dental professionals? Is this the file you would send to an Endodontist or Oral surgeon?

Ar you sure it isn’t DCM or DCM30 (DICOM) format?"

This is the reply that I got:

“Yes, this is the only way to send to other offices or patients.”

9

I just need confirmation that this is true or not true.

If it’s not true, then I need to escalate, and I will be more unhappy with this practice.

10

This is a practice you’re leaving, yes?

I suspect they figured that out from the request, and you confirmed it by asking for professional-grade electronic medical record artifacts.

They’ll do nothing for you not literally required by law.

11

I can’t tell you what’s true for every dental practice, but somewhere in the attic I have a CD with a DICOM viewer and the associated files that made up my X-ray record from my dentist. Got those when I moved from seattle to socal.

12

Yeah, I have some of those from a medical practice. That’s what got me to thinking about low-res JPGs.

13

I was sort of thinking about leaving, but wasn’t at all commited to that.

I am thinking about it a LOT harder now.

14

BTW, going from the wiki, DICOM seems to be a container, not a format. In much the same way that an MKV is a container for multiple possible formats of video, audio, and text files. So a DICOM of digital x-rays could contain the same jpegs they sent you, along with something similar to EXIF data.

A DICOM data object consists of a number of attributes, including items such as name, ID, etc., and also one special attribute containing the image pixel data (i.e. logically, the main object has no “header” as such, being merely a list of attributes, including the pixel data). A single DICOM object can have only one attribute containing pixel data. For many modalities, this corresponds to a single image. However, the attribute may contain multiple “frames”, allowing storage of cine loops or other multi-frame data. Another example is NM data, where an NM image, by definition, is a multi-dimensional multi-frame image. In these cases, three- or four-dimensional data can be encapsulated in a single DICOM object. Pixel data can be compressed using a variety of standards, including JPEG, lossless JPEG, JPEG 2000, and run-length encoding (RLE). LZW (zip) compression can be used for the whole data set (not just the pixel data), but this has rarely been implemented.

15

At such low resolution? One file chosen at random is showing 96 dpi (846x662 pixels).

16

As for that, I can’t say. Maybe they have a crappy scanner.

17

Unless they’re firmly planted in the last century, they shouldn’t be scanning anything. X-rays are all digital now (at least in my experience).

18

Yes. It’s possible. As described above, DICOM defines the format for a bundle of information that can include image data in many formats. Individual applications that accept DICOM messages can’t necessarily display all the content in the messages through it’s PRINT function. Sometimes the DICOM message image data is extracted and stored in databases that also may or may not be able to display them.

19

If I’m penetrating the jargon correctly, this is about digital dental x-rays. On this equipment, there are 3 options:

High speed, with a scan time of 7 seconds and a resolution of 530x689

High resolution, with a scan time of 16 seconds and a resolution of 941x1223

Super high resolution, with a scan time of 30 seconds and a resolution of 1652x2147

So it seems that you are overestimating the resolution that the x-ray machines work at.

20

If you haven’t already, you could try going to the office with a flash drive and ask them to copy your images with the viewer on it. Make it easy for them.