Integrating Dental Imaging Problems, Pitfalls, Successes

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Integrating Dental Imaging

• Problems, Pitfalls, Successes
• Eleonore Paunovich, DDS, MS
• South Texas Veterans Health Care System
• eleonore.paunovich_at_va.gov

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Program Objectives

• List the commercial dental imaging systems
  certified for use in the VA environment
• Describe the appropriate process for acquiring
  and implementing imaging technology in the VA
  environment
• Recognize alternative methods to accession,
  capture and record findings for dental images
• List the issues to be considered when acquiring
  and implementing CBCT technology in the Dental
  Service.

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Program Objectives

• List the commercial dental imaging systems
  certified for use in the VA environment
• Describe the appropriate process for acquiring
  and implementing imaging technology in the VA
  environment
• Recognize alternative methods to accession,
  capture and record findings for dental images
• List the issues to be considered when acquiring
  and implementing CBCT technology in the Dental
  Service.

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VistA Supported Dental Imaging Devices
http//www1.va.gov/imaging/docs/VistA_Imaging_DICO
M_Modality_Interfaces.pdf
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VistA Supported Dental Imaging Devices

most recently approved
http//www1.va.gov/imaging/docs/VistA_Imaging_DICO
M_Modality_Interfaces.pdf
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Multi-vendor Digital System Integrated with
Electronic Patient Record
http//www1.va.gov/IMAGING/docs/Joint_DICOM_Dental
_Req_Doc_V2_0.pdf
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Program Objectives

• List the commercial dental imaging systems
  certified for use in the VA environment
• Describe the appropriate process for acquiring
  and implementing imaging technology in the VA
  environment
• Recognize alternative methods to accession,
  capture and record findings for dental images
• List the issues to be considered when acquiring
  and implementing CBCT technology in the Dental
  Service.

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Where do I start?

• Determine whether components of dental imaging
  system are VistA supported (Dental Service Chief,
  VISTA Implementation Manager)
• 2. Imaging Hardware Medical Devices
• Intraoral Sensors
• Direct digital imaging or phosphorus screen
  technology
• Direct sensors need DC x-ray machines
• Variable mA and kVp settings on x-ray machines
• Sealed sensors?
• Panoramic/CBCT
• Floor space and wall support?
• Wheelchair access
• 3. Customer support, warranty, technical support

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Where do I start?

• 4. Network Configuration ---- IT
• workstations, servers
• network drops, connections, bandwidth
• network security, firewall issues
• 5. Space requirements Dental Service chief,
  IT, BioMed, IT, Network Security Officer

Dental, VistA, BIOMED IT
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Where do I start?

• Multiple Vendors Picture and Archiving System
  (PACS)
• Populate a modality worklist to generate an
  accession number and a study instance unique
  identification (UID) VISTA
• Dental hanging protocols
• 7. Training , Maintenance and Quality Assurance

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Main Clinic
Dental Digital Imaging Implementation Plan
Pro-Max Pan/Ceph/Tomo Unit
Scan X Units
Intraoral sensors
VISTA Imaging/DRM
ScanX Capture Stations
ProMax Capture Station
Storage Server
Intraoral sensor Capture Unit
ProMax Capture Station
ScanX Capture Station
ProMax Capture Station
ScanX Capture Station
Intraoral sensor Capture Unit
Intraoral sensor Capture Units
Intraoral sensor
Intraoral sensor
Intraoral sensor
Clinic 2
Clinic 3
Clinic 1
Pro-Max Pan Unit
Scan X
Pro-Max Pan/Ceph/Tomo Unit
Scan X
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Program Objectives

• List the commercial dental imaging systems
  certified for use in the VA environment
• Describe the appropriate process for acquiring
  and implementing imaging technology in the VA
  environment
• Recognize alternative methods to accession,
  capture and record findings for dental images
• List the issues to be considered when acquiring
  and implementing CBCT technology in the Dental
  Service.

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Integrating Different Hardware Systems?

• Picture Archiving and Communication System (PACS)
• MIPACS (Medicor Imaging)
• VISTA validated
• Apteryx
• Not VISTA validated
• Integrated image viewer and acquisition
  application at the enterprise level
• Compatible with majority of digital dental
  imaging hardware
• Both radiology and visible light (photos)
• Other dental software such as Dolphin orthodontic
  application
• DICOM compliant

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PACS Requirements

• PACS Software
• Image acquisition
• Image storage
• Image viewing
• Imaging archiving
• Integration into electronic record
• PACS Server
• Base storage size on 3-5 years of data
• Panoramic up to 10 MB
• Ceph up to16 MB
• Intra-oral - up to 5MB

http//www.medicorimaging.com
http//www.apteryx.com/
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Program Objectives

• List the commercial dental imaging systems
  certified for use in the VA environment
• Describe the appropriate process for acquiring
  and implementing imaging technology in the VA
  environment
• Recognize alternative methods to accession,
  capture and record findings for dental images
• List the issues to be considered when acquiring
  and implementing CBCT technology in the Dental
  Service.

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3-D Tomographic Imaging
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VISTA Approved Dental Imaging Devices

• 3-D Cone Beam Computed Tomography
• Planmeca
• Sirona
• Kodak

http//www1.va.gov/imaging/docs/VistA_Imaging_DICO
M_Modality_Interfaces.pdf
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Pre-Installation Checklist

• Consult with your VistA Imaging to determine
  whether dental devices under consideration are
  VistA supported
• Identify location of image acquisition devices
  and determine whether independent acquisition
  workstations and or servers are required
• Consult with BIOMED/IT for placement of network
  drops, network switches, ethernet connections,
  and structural modifications

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Pre-Installation Checklist

• Consult with Information Security if any software
  is being added to the network
• Consult with local Radiation Safety consultant if
  adding x-ray generators into operatories.
• Consult with local VistA Imaging contact re
  network integration configuration (IP addresses,
  port number, AE titles for Vista Modality work
  list and Storage server).

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Pre-Installation Checklist

• Dental digital imaging system is a medical system
  identify server locations which must be
  independent of communications servers
• Through Biomed identify a system administrator

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VISTA Validation

• http//www1.va.gov/imaging
• VistA Imaging DICOM Conformance Statement
• Joint VA/DOD DICOM Conformance Requirements for
  Digital Acquisition Modalities
• DICOM Modality Validation Information

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VA Dental Digital Imaging Requirements

• http//vaww4.va.gov/DENTAL/dentresource.asp