We appreciate Mr. Wadkins’ statement that modern, complex technology is easier to manipulate and alter. The study that we undertook in this instance has proven this very fact. Images were changed and used for fraudulent purposes. Any radiographic or other images that are submitted to any agency via electronic methods can be altered, and we also agree with Mr. Wadkins on this point. The fact that the public is not protected from this type of alteration should be a major concern, and we hope that we have conveyed this message adequately.
Mr. Wadkins points out the differences between direct and indirect digital imaging. We would ask this question: if we are trying to eliminate the potential fraudulent use of radiographic images, why do we even consider using direct digital images? Analog films are already common, inexpensive and easily transported and require low radiation doses to produce. As we have shown, they can be easily digitized and presented to patients or educational audiences, or transferred over the Internet for such things as disaster victim identification if this is needed. The advantage is that the original film can be maintained for subsequent verification of the image.
As Mr. Wadkins correctly points out, direct systems are very expensive. This, coupled with the fact that no hard copy of the product that allows transmission of the image is available, seems a good reason for practitioners to question the need for direct systems. The fact that it is currently so difficult, and expensive, to keep abreast of changing computer technology also compounds these problems. We disagree with Mr. Wadkins’ implication that original films may also be altered. The rigidity and "feel" of a film is very difficult to imitate. The presence of a double emulsion and the texture of the emulsion surface are found only on an original, analog film. Thus, to ensure that accurate information is received, it is our contention that insurers and others should continue to insist that only original radiographic films be submitted. Copy films are not suitable protection for the original information recorded on the image.
Perhaps when Mr. Wadkins qualifies as a dentist and enters practice, he will realize that his outlay of $10,000 per operatory for digital radiography equipment will necessarily be passed on directly or indirectly to his patients. We believe that he will soon learn that there are patients who may be unwilling or unable to pay for these associated costs. We wish him well in his future endeavors.
