Digital Photographic Imaging for the Dental Lab or Private Practice
Introduction
With the recent emergence of inexpensive digital cameras and the low cost of personal computers (PCs) there has been a tremendous demand to replace the traditional 35mm print film photography that is part of most every lab or practice with a digital photographic system. Digital photography holds the promise of improved product quality, reduced preparation time and has marketing appeal to enhance a practice. What is not mentioned is that there are many pit falls along the way that may prevent reaching fruition of these goals. This has prompted MME Consulting to prepare this primer. Background Traditional 35mm print film photography has been a staple of Dental Labs and Private Dental Practices for many years. It has been used for documenting patients, as individual photographs (or slides) and in standard 'mounts', collections of standard referenced patient photos assembled in a collage called a mount. A mount typically consists of six or more intraoral and portrait photographs. Preparation of a mount would include photographing the patient, off-site development and printing of the film, manual sorting and cropping of the individual photographs for the specific mount locations, insertion of the photos into the mount (usually taping them to the back of a pre purchased black card stock mount), and insertion of the mount into a protective plastic sleeve to keep it from coming apart. For the purposes of this discussion, this method will be referred to as the existing practice standard. This procedure is labor intensive, involves outside suppliers, and usually takes more than one or two days to complete a case from start to finish. If the patient blinks or other factors ruin the photos, the patient must be called back and the process repeated. Digital photography promises to reduce or eliminate most of the headaches associated with the existing standard. The primary requisite of advancing a standard is that it the new procedure must improve upon or at least maintain all aspects of the standard that it replaces. It is not sufficient to assume that the new procedure's virtues outweigh the drawbacks it may introduce. As a profession, we are bound to meet or exceed what are generally known as 'peer standards'. Defining critical elements in the standard is sometimes difficult. For the practice of lab photography it is assumed that a digital system must meet the following established photographic standard criteria: |
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- Photographic quality appearance (gloss and resolution)
- Photographic stability (30+ year life, color-fast)
- Basic presentation format maintained (size and orientation of mount)
- The equipment costs were in excess of $27,000 (difficult to recoup in even the most prolific practices)
- The cameras were heavy and difficult to manipulate
- The camera and peripherals were easy to damage, leading to expensive repairs and down time of the system
- The computers were very slow in comparison to today's systems
- The software was complicated to use
- The consumable costs for the printer were quite high (greater than $3 per page)
- Advances in CCD technology have produced new high resolution digital cameras available for less that 1/10th the price of a Kodak DCS 420
- The new cameras weigh just ounces compared to the 3.75 pounds of the Kodak DCS 420
- New robust digital storage technology is used in place of the fragile storage media of the Kodak DCS 420
- Modern computers are hundreds of times faster than computers of even five years ago
- Increased volume sales has reduced the prices of printer media to below $1.70 per page
The ddi Model
In early 1998 Diagnostic Digital Imaging (ddi) in Sacramento, California decided that they were ready to replace their traditional photographic system with a new digital one. ddi worked with MME Consulting to develop a new digital standard that would meet or exceed its predecessors, while contributing to an improvement in the lab's bottom line.
Expectations
ddi is after all a business, and as such was concerned that any new system must pay for itself. ddi expected to see the following improvements:
- Elimination of film and printing expenses to the local photographic lab, as well as labor time picking up and dropping off film.
- Elimination of mounting consumable expenses such as paper mounts and tape, as well as labor time ordering and maintaining sufficient stock.
- Reduction of total labor time involved to complete the procedure which originally included photographing the patient, manually sorting and cropping the photos, taping the photos into the paper mounts, and finally labeling and sleeving the finished mount.
- Elimination of all callbacks for retakes due to out of focus, damaged or lost photos.
- Ability to offer 'While-U-Wait' service, previously impossible. This improves the turnaround time for the referring dentist.
- Improved image quality due to the immediate review and retake capabilities.
- Improved overall presentation quality of the mount.
- Perceived 'Cutting Edge' marketing appeal to our customers.
- Ability to maintain or distribute a digital archive of the mounted images for later reprints or use in other case planning applications.
- The new system should complete a case in less than seven minutes, from beginning the photography to when the operator hits 'print' at the computer. This would lead to x minute timesaving.
- The equipment must be purchased and configured for less than $20,000.
- It was desired to achieve pay back in less than 24 months. It was anticipated that initial imaging volume would be approximately 6 cases a day.
Digital Camera
The Olympus D600L was selected as the digital camera for several key reasons:
The Olympus D600L was selected as the digital camera for several key reasons:
- 1.4 million pixel resolution, 1280 x 1024. This is directly comparable to the resolution of the Kodak DCS-420 (a slightly higher 1524 x 1012).
- Through-the-lens (TTL) viewfinder. This is critical, and eliminates most of the lower price camera systems that tend to have secondary view ports. TTL is essential for performing accurate intraoral photography.
- The camera stores its images in JPEG image format by default (our desired format directly readable by Adobe Photoshop) eliminating the need to utilize an additional application to download and reformat the images.
- The camera stores the images on rugged, inexpensive Smart Media cards. These cards are flexible and come in 2, 4, 8, 16, and now 32 Mbyte capacities. We are able to store approximately 30 images on a single 8 meg card, and additional 8 meg cards cost only $30.
- The camera weighs only 16.6 oz, compared to the 3.75 lbs. Kodak DCS 420. It can be easily manipulated in one hand leaving your other hand free to work with the patient.
- The camera was initially price at $1,250 in early 1998 and has dropped to less than $600 since then.
Computer
MME Consulting's approach to computer systems is to buy from a reputable vendor, and buy a computer well suited to specific designated tasks. Rather than try and make do with upgrading an existing PC to do the job, ddi's anticipated imaging volume required the addition of new workstation. The system would be dedicated to the digital photography process.
A Dell 400 Workstation with dual 333 MHz Intel Pentium II processors and 128 Megs of RAM was initially selected. The system was equipped with Microsoft Windows NT in order to support the dual processors. It was known that the systems primary application would be Adobe Photoshop, a CPU and RAM intensive application. It was felt the additional dollars spent on the computer would directly equate to a reduction in time necessary to complete a case, and therefore pay for itself.
The system was also equipped with a 21" NEC P1250+ monitor. This is an essential component to productivity. Although the unit is large and several hundred dollars more than a typical 17" display, it allows the operator to effectively manipulate up to nine images at a time.
The system was equipped with a 3COM 3C905B network card, used to connect to ddi's existing network. This provided access to ample network storage, print services and Internet access.
Software
To consistently produce a high quality mounted photographic series requires imaging software capable of utilizing macros and allowing fine adjustments of numerable imaging characteristics. The leader in this market is Adobe Photoshop. We briefly evaluated JASC Inc.'s Paintshop Pro, but ultimately selected Adobe Photoshop for its wealth of features and flexibility.
MME Consulting's approach to computer systems is to buy from a reputable vendor, and buy a computer well suited to specific designated tasks. Rather than try and make do with upgrading an existing PC to do the job, ddi's anticipated imaging volume required the addition of new workstation. The system would be dedicated to the digital photography process.
A Dell 400 Workstation with dual 333 MHz Intel Pentium II processors and 128 Megs of RAM was initially selected. The system was equipped with Microsoft Windows NT in order to support the dual processors. It was known that the systems primary application would be Adobe Photoshop, a CPU and RAM intensive application. It was felt the additional dollars spent on the computer would directly equate to a reduction in time necessary to complete a case, and therefore pay for itself.
The system was also equipped with a 21" NEC P1250+ monitor. This is an essential component to productivity. Although the unit is large and several hundred dollars more than a typical 17" display, it allows the operator to effectively manipulate up to nine images at a time.
The system was equipped with a 3COM 3C905B network card, used to connect to ddi's existing network. This provided access to ample network storage, print services and Internet access.
Software
To consistently produce a high quality mounted photographic series requires imaging software capable of utilizing macros and allowing fine adjustments of numerable imaging characteristics. The leader in this market is Adobe Photoshop. We briefly evaluated JASC Inc.'s Paintshop Pro, but ultimately selected Adobe Photoshop for its wealth of features and flexibility.
Printer
It was hoped to find a less expensive alternative to the Kodak XLS-8600. We looked closely at Hewlett-Packard and Epson's high end inkjet printers, Fuji's competing dye-sublimation printer and Sienna's photographic printer. Each possibility was eventually eliminated for one or more significant reasons, and the Kodak Digital Science 8650 with optional network connection was selected.
Each of these items were purchased and the system was setup to test it. It was soon realized that we had a bunch of capable parts but lacked the fine details that create a complete system. Usability trials were conducted at the lab and the following additional changes and additions were made based on these experiences.
ddi spent little more than $17,000 for the equipment and software. No cost was assigned to internal resources used in the evaluation process due to the research nature of the project, but this cost would no doubt be significant.
In the first six months of full-time use, ddi completed 650 cases, or approximately 5.4 cases per day. In the second six months ddi completed nearly 1,100 cases, or approximately 9.2 cases per day, a 70% increase in volume. Some follow up investigation has shown that the increase in demand was directly attributable to the availability of the new, improved service.
The average finalized case size is an 8"x10" 300 dpi JPEG image, typically 350 kilobytes in size. Three or four completed mounts can be fit on a standard 3.5" floppy diskette for distribution or archival. Over 1,800 completed cases can be fit onto a single recordable CD for archival purposes.
Consumable costs are approximately $1.70 per case, including a secondary UV protective sleeve.
On average the procedure takes about 6 minutes to complete from start to finish, and in ideal circumstances can be done in less than 5 minutes. This allows for 'While-U-Wait' service, previously impossible.
As a result, the digital system has realized savings of $3.10 per case and has paid itself back in approximately 24 months assuming a standard break even analysis and neglecting tax impact. Conservatively assuming the current volume levels, ddi will realize an increase to the bottom line of an estimates $28,500 over the first five years. It is anticipated that some or all of the components will be replaced at that time with newer, more cost effective technology.
Customizing the ddi model
MME Consulting is currently helping others adapt the ddi model to their particular business.
The first step in the process is to develop metrics specific to your business. An honest and thorough attempt should be made to determine some key factors in your existing processes:
Before covering the specific details of the how-to, some words of caution to consider:
Camera System ($2,332)
The camera system is based on the newer version of the original Olympus D600L, and includes:
PC specifications are constantly evolving and the exact capacities (i.e. hard drive size and video memory) are not that critical in the process. Below is a list of what would be considered at least a minimum in today's marketplace.
If the expected volume is to be high and the budgets would allow, it is recommended to upgraded to a Dell Workstation 410 with dual 600 Mhz processor and 384 megs of RAM, adding another $1,612 to the base system price.
Software ($1,632)
The purchase of the computer supplied the operating system and only the following applications need to be added:
Portrait Lighting ($80)
It is difficult to make any recommendation for this as each site needs to be treated on a case by case basis. It is safe to assume that at least a digital slave trigger will be required ($80). The total equipment budget will range from $12,345 to $14,437 (excluding portrait lighting). Additional expenses will include consulting fees to evaluate your particular needs, develop a specific budget, procurement, installation and training. Other indirect costs may include additional furniture for the computer system and printer and lost productivity due to training and the transition.
Conclusion
The promise of digital photography is appealing to most labs. Your success in reaching your goals will rest heavily upon your ability to plan for and implement a complete solution. Enlisting the help of a firm like MME is an effective way to accomplish a custom solution and still realize the savings without having to become an expert on your own.
It was hoped to find a less expensive alternative to the Kodak XLS-8600. We looked closely at Hewlett-Packard and Epson's high end inkjet printers, Fuji's competing dye-sublimation printer and Sienna's photographic printer. Each possibility was eventually eliminated for one or more significant reasons, and the Kodak Digital Science 8650 with optional network connection was selected.
Each of these items were purchased and the system was setup to test it. It was soon realized that we had a bunch of capable parts but lacked the fine details that create a complete system. Usability trials were conducted at the lab and the following additional changes and additions were made based on these experiences.
- The Olympus's battery life was unacceptable. Although rechargeable NiMH batteries and a recharger were provided, their life was typically less than 12 exposures. It was decided to eliminate the batteries (lightening the camera significantly) and run exclusively on the available AC adapter.
- Once the AC adapter was in use, it was found that the standard six-foot cord did not allow for enough mobility. The cord on the adapter was modified to 15' in total length.
- Relying on the camera's integral flash for intraoral photography resulted in some pocket shadows and inconsistent lighting. Research uncovered an available lightweight ring flash made specifically for the Olympus by a third party. The ring flash was appropriately designed to act as a slave flash to the Olympus's integral flash, and was very simple to setup and use.
- The existing standard portrait lighting flash was not working properly with the Olympus. It was a slave flash system designed to eliminate the background shadow created in portrait photography. It was flashing, but the shadows persisted. It was discovered that nearly all digital cameras (the Olympus included) produce a double flash. The first flash is used while sensing how much light is available for the CCD sensor ( calibration of sorts), and the second is for the actual exposure. The first flash would trigger our slave flash and then when the second flash came when the slave was recharging. The solution was the purchase of a third party slave flash trigger specifically for use in this situation.
- The photographic backdrop we had been using, simply a white piece of hard board, was replaced with a professional photographic white pull down screen.
- The Olympus has poor auto focus consistency in low light office situations. Additional general spot incandescent lighting was added to the portrait photography area to eliminate this tendency.
- It was discovered that the maximum image that could be printed on 8.5" x 11" paper in the Kodak printer was 8" x 8.93". A full 8" x 10" image was necessary. Switching to Kodak's 8.5" x 12" paper produces a maximum image area of 8" x 10".
- It was decided to outsource the creation of truly professional and appealing 'Template' for use in Adobe Photoshop. The template would market the lab to the community and display the exceptionally good quality photographs. We enlisted BioMex consulting to create the template and macros used in the procedures. The results were tremendous. The template was beautiful and the macros reduced case preparation time to only a few minutes.
- An additional 256 megs of RAM was purchased and installed in the imaging workstation PC. This alone reduced case preparation time in Adobe Photoshop more than 20 seconds, easily paying for itself.
- The standard serial cable used to transfer images from the camera to the PC was replaced with a PC-Card adapter and internal PC-Card reader for the workstation PC. Transferring eight images by serial cable took nearly three minutes, and the same eight images take less than three seconds through the PC-Card reader.
- Considerable effort was devoted to an area often overlooked, color quality. In order to ensure that a 'red' that was photographed appeared exactly as 'red' in the print, color calibration of the camera, computer and the printer was performed. Although the procedures are extensive, the basic concept is to photograph a known color standard, and then to 'tune' the display on the computer and the output of the printer to match. This procedure is best performed by a technician trained in this area.
ddi spent little more than $17,000 for the equipment and software. No cost was assigned to internal resources used in the evaluation process due to the research nature of the project, but this cost would no doubt be significant.
In the first six months of full-time use, ddi completed 650 cases, or approximately 5.4 cases per day. In the second six months ddi completed nearly 1,100 cases, or approximately 9.2 cases per day, a 70% increase in volume. Some follow up investigation has shown that the increase in demand was directly attributable to the availability of the new, improved service.
The average finalized case size is an 8"x10" 300 dpi JPEG image, typically 350 kilobytes in size. Three or four completed mounts can be fit on a standard 3.5" floppy diskette for distribution or archival. Over 1,800 completed cases can be fit onto a single recordable CD for archival purposes.
Consumable costs are approximately $1.70 per case, including a secondary UV protective sleeve.
On average the procedure takes about 6 minutes to complete from start to finish, and in ideal circumstances can be done in less than 5 minutes. This allows for 'While-U-Wait' service, previously impossible.
As a result, the digital system has realized savings of $3.10 per case and has paid itself back in approximately 24 months assuming a standard break even analysis and neglecting tax impact. Conservatively assuming the current volume levels, ddi will realize an increase to the bottom line of an estimates $28,500 over the first five years. It is anticipated that some or all of the components will be replaced at that time with newer, more cost effective technology.
Customizing the ddi model
MME Consulting is currently helping others adapt the ddi model to their particular business.
The first step in the process is to develop metrics specific to your business. An honest and thorough attempt should be made to determine some key factors in your existing processes:
- What is your total cost to perform your existing procedure including labor, materials and outside services?
- How much staff time is involved including photography, development outsourcing, and mount preparation and assembly?
- What is your current volume of cases per month?
Before covering the specific details of the how-to, some words of caution to consider:
- Do you have staff members that are proficient at computer application? Do they have the will to learn and adapt? The user is the ultimate system integrator, and they need to master the camera and the computer. It is pointless to install the most capable system in the world if you do not have staff capable and willing to use it. Training only goes so far, and a user's aptitude carries the skill to the next level of proficiency. This is key for any new system. Don't expect to achieve 7-minute procedure times until they have done 100 cases or more.
- Resist the urge to install all sorts of software on the imaging workstation. This is an inevitable temptation since it is usually the fastest and best-equipped system in an office. Adding more and more Windows applications to a system generally deteriorates its stability (how often it 'crashes'). Set it up, and then don't tinker with it. Just install what software you need to get the job done.
- Buying cheap (low quality) computer equipment for its initial capital savings is usually a poor decision. A single incident that takes the computer out of service for even a day will usually mean lost revenue and additional expense greater than the original money saved. MME strongly recommends the use of established vendors such as Dell, Gateway or Micron, and to avoid no name brands. These no-names may be perfectly adequate for use at home but not in a business where the bottom line is directly affected by system reliability.
- Heed the established peer standards. MME believes it is 'below standard' for any lab to produce a mounted case on the current level of inkjet printers. Current inkjet printers do not produce long life, colorfast images. A drop of water or perspiration will wash away the inks, and sunlight will yellow and degrade the image quickly. Although this may change soon, currently only dye-sublimation and photographic printers produce acceptable results. It is an acceptable compromise for a private practice to use an inkjet printer for their own internal use, as it is their own decision. A lab cannot assume that each of their clients is willing to receive non-long-life and non-colorfast output, as the client is likely unaware of the issues.
- Buy the largest possible monitor that space and the budget can afford (at least 21"). Digital imaging is a graphical process, and a larger monitor makes the process much easier for the technician.
- A great deal of the success in ddi's experience was a result of already having a sound and established office network. The network allowed for much faster background printing, and provided ample storage space for images on the file server. Since the file server was already equipped with a high-speed backup system, no other precautions were necessary to backup the finalized mounted images. A small office network can provide significant benefits for small offices with even just two or three computers. A network would also make it possible to have several computers capable of mounting a case (a necessity in high volume practices), sharing input from a shared digital camera and outputting to a shared printer.
Camera System ($2,332)
The camera system is based on the newer version of the original Olympus D600L, and includes:
- Olympus D620L digital camera
- Olympus Accessory Pack (if you would like a nice storage case and spare charger)
- Two Additional 8 meg Smart Media Cards
- Modified Olympus AC Power Adapter
- Digislave RF-150 Ring Flash with 6" PC Cord
PC specifications are constantly evolving and the exact capacities (i.e. hard drive size and video memory) are not that critical in the process. Below is a list of what would be considered at least a minimum in today's marketplace.
- Dell Dimension XPS-T 600
- 600 Mhz Intel Pentium III Processor
- 256 Meg of RAM
- 13 Gigabyte EIDE Hard Drive
- 8 Meg AGP Video
- 40x CDROM Drive
- 1.44 Mbyte 3.5" diskette drive
- Integrated sound and modest speakers
- 3COM 3C905B 10/100 Network Card
- NEC P1250+ 21" Monitor
- Antec Datachute internal PC Card reader
- APC Backups Pro 420 PnP Uninteruptable Power Supply
If the expected volume is to be high and the budgets would allow, it is recommended to upgraded to a Dell Workstation 410 with dual 600 Mhz processor and 384 megs of RAM, adding another $1,612 to the base system price.
Software ($1,632)
The purchase of the computer supplied the operating system and only the following applications need to be added:
- Adobe Photoshop 5.5 for Windows
- BioMex Template System
- Kodak Digital Science 8650 with optional 10/100 network connection
- 8.5" x 12" 3-Color Print Paper (100 sheets)
- 8.5" x 12" CMY Color Ribbon (for 100 sheets)
Portrait Lighting ($80)
It is difficult to make any recommendation for this as each site needs to be treated on a case by case basis. It is safe to assume that at least a digital slave trigger will be required ($80). The total equipment budget will range from $12,345 to $14,437 (excluding portrait lighting). Additional expenses will include consulting fees to evaluate your particular needs, develop a specific budget, procurement, installation and training. Other indirect costs may include additional furniture for the computer system and printer and lost productivity due to training and the transition.
Conclusion
The promise of digital photography is appealing to most labs. Your success in reaching your goals will rest heavily upon your ability to plan for and implement a complete solution. Enlisting the help of a firm like MME is an effective way to accomplish a custom solution and still realize the savings without having to become an expert on your own.