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Medical Forum / General / Dentistry / September 2007Patient access to a digital tooth x-ray?
Is there any good reason why a dentist would not let the patient have a digital copy of a digital x-ray? I have been trying to get my dentist to send it to me, but he seems reluctant. When I first asked for a digital copy 4 months ago, he did some hand waving about the PC that held the x-rays not being connected to any others and so we could not get the digital copy out of the PC. My most recent x-ray of tooth #20 was very revealing of the strange state of the root tip, unlike the previous 6 or more I've had of that tooth over the past 9 months all of which failed to show the root tip at all by virtue of not going down that far. This tooth had a root canal therapy done on it 6 months ago, and I don't think any of the x- rays that the endodontist did of that tooth went down far enough either! The latest x-ray he did which he sent film copies of to my dentist and to my insurance company certainly did not show the root tip since I've seen that one in the dentist's office. This tooth #20 is still painful and frankly, I want to post the x-ray here to get some comments on it by the fine and intellectually curious dentists that frequent this newsgroup. Of course, I probably should not mention this to my reluctant dentist, or he will likely be even more reluctant... So, I ask again, isn't a patient entitled to a copy of x-rays done on his teeth, whether digital or not? But if it is a digital x-ray, it should be even easier to give the patient a copy, shouldn't it? And believe it or not, the dentist sent a _paper_ printout of this latest digital x-ray by regular mail to the endodontist who did the RCT for comment. The original digital image would have been much more revealing I am sure! What can I say to the dentist to persuade him to send me a digital copy - assuming he knows how. I would even offer to go to his office and show them how to do it, if indeed it is mainly technical knowledge that they are lacking to do this. I assume the PC that they are viewing the x-rays on at least has a USB port, and if so, it should be possible to save the image file to a USB flash drive... John. In the USA,,,,,,,,,,,,,,,, the dental office MUST furnish you with a legible & usable copy of your x-ray image upon written request from you. Expect to pay a reasonable copying fee.  Signature/ Amatus / > Is there any good reason why a dentist would not let the patient have > a digital copy of a digital x-ray? [quoted text clipped - 38 lines] > > John. > In the USA,,,,,,,,,,,,,,,, the dental office MUST furnish you with a legible > & usable copy of your x-ray image upon written request from you. Expect to > pay a reasonable copying fee. Is this an actual US law, or just common practice? I can see paying for a film copy of a standard x-ray, but what about a digital file? I would simply be requesting that a TIFF or JPEG file (or possibly some other type) be emailed to me. This is of course one big advantage of a digital x-ray, the other being image manipulation and zooming to enhance features. They might offer to send me a printout instead, which I think would be a pretty poor substitute. A secretary I talked to also said something about no problem sending a copy of the x-ray to another doctor, but they don't like to give them to patients. That seems like a bogus excuse to me: hey, it's my mouth they're sending x-rays through, after all! Ok, I guess even a digital file copy would still take someone some small amount of time to do, so I wouldn't object too much if they wanted to charge me $5 or $10 to do it, but that seems somewhat silly. John. >> In the USA,,,,,,,,,,,,,,,, the dental office MUST furnish you with a legible >> & usable copy of your x-ray image upon written request from you. Expect to >> pay a reasonable copying fee. > > Is this an actual US law, or just common practice? It's usually state law, but AFAIK pretty uniform around the country. > I can see paying for a film copy of a standard x-ray, but what about a > digital file? I would simply be requesting that a TIFF or JPEG file [quoted text clipped - 13 lines] > > John. Amatus would know better than I; I think some digital x-ray programs are stored as JPG files, but not all of them. Some may be in a proprietary format that you may need the program to read. But in any case, it should be possible to print a copy of the x-ray(s) on paper. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 Digital x-ray images are stored as a proprietary format to make the images secure. This prevents any manipulation of the image, so that the digital record becomes a better document in a court of law than a paper one. We convert the image to tiff, jpeg, giff or whatever desired when exporting the image to someone who does not have the same brand of software. No big deal. Signature/ Amatus / >>> In the USA,,,,,,,,,,,,,,,, the dental office MUST furnish you with a >>> legible [quoted text clipped - 30 lines] > > Steve It is federal law. HIPAA. It takes some time for a staff person to select the image, convert it to a tiff, jpg, whatever, and email it. Many offices will do it for free. HIPAA allows for a realistic copying fee to cover office overhead of creating the image and sending it to you. If you are in Canada or some other country, I don't know their rules. Signature/ Amatus / >> In the USA,,,,,,,,,,,,,,,, the dental office MUST furnish you with a >> legible [quoted text clipped - 21 lines] > > John. > It is federal law. HIPAA. I didn't know that--I suppose I should have. I thought the law covered privacy, didn't know it made provisions for access too. Thanks, Steve > It takes some time for a staff person to select the image, convert it to a > tiff, jpg, whatever, and email it. Many offices will do it for free. HIPAA > allows for a realistic copying fee to cover office overhead of creating the > image and sending it to you. > > If you are in Canada or some other country, I don't know their rules. SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 Check out section 4.3.2 of HIPAA regulations. The $0.25 per page refers to photocopies of paper records. You are, also, allowed to charge the patient for a staff person's time to drive to a copying center and back (ie Kinko's). The $0.25 is the fee for my office since we have a copying machine on site. Image copies are based on the cost of actually duplicating the image. the media it is copied to and the time to create and send it. I would have to look for that exact wording. Below is section 4.3.2 from the HIPAA guidelines for *my office*. It will be different for every office. ................................. All staff of our office shall: a.. Accommodate a patient's written request to see or copy his or her medical record. b.. The request must be in writing and signed and dated by the patient or their legal guardian. c.. If the request is to see the record, patient may have immediate access within the office, business operations permitting. Patients will be provided a place to review the records away from other patients, but a staff member shall be present while the patient is reviewing the record to ensure that the record remains intact and unaltered. d.. If the request is for a copy of the record or a portion thereof, a copy shall be made available within five business days of receiving payment from the patient. e.. The copy may be picked up in person or mailed (return receipt requested) if the patient so requests in writing. f.. The cost of the photocopy is 25 cents per page plus return receipt requested postage charges. g.. Follow all procedures of this office regarding processing patient records access requests. Violation of these policies can carry serious consequences for the practice. Disciplinary actions for anyone violating this policy may include suspension without pay or termination. ........................................ Signature/ Amatus / >> It is federal law. HIPAA. > [quoted text clipped - 10 lines] >> >> If you are in Canada or some other country, I don't know their rules. > If you are in Canada or some other country, I don't know their rules. Same rules amongst us Hosers. By the way, I can't imaging anyone charging to email an x-ray or photo as a JPEG. It takes 10 seconds to do that in my office. Maybe the OP's dentist doesn't have internet access at his office, at which point he could export the file as a jpeg, copy it to a USB key, and take it home to email. John > It is federal law. HIPAA. > [quoted text clipped - 4 lines] > > If you are in Canada or some other country, I don't know their rules. I'm in the US. Thanks for the good info everyone, particularly Amatus! John. I charge $0.25 per image copied, with a minimum of $5 (and a maximum of $25) to copy to CD-ROM. Email for free. Signature/ Amatus / >> It is federal law. HIPAA. >> [quoted text clipped - 13 lines] > > John. > I charge $0.25 per image copied, with a minimum of $5 (and a maximum of $25) > to copy to CD-ROM. Email for free. Ok, so after further prompting, my dentist sent me a printout of the digital x-ray at no cost to me. When I had pressed him to get a digital image file, he protested that his machine was not on the network, and would send me a printout instead. Sigh... Well, the printout is better than I thought it would be, though not as good as I remember the on-screen image to be. There is "Schick Technologies" on the printout, and googling that led me to the site of the company that makes the device and software he uses (http:// www.schicktech.com/items.php?catid=3). I downloaded the user guide, and in about 10 seconds found that it is easy enough to use the File / Export menu to create a TIFF or JPEG file, which I'm sure can be written to a USB flash drive. Oh well... In any event, I ended up scanning the printout to get a JPEG. I cropped it to remove the dentist's name and address. I'd like to upload the 95 KB file for you guys to look at. I'd be very interested to know what you think about the tooth and its prospects (#20, lower left second bicuspid). It had RCT done six months ago, and a temp crown put on 4 months ago. The problem is, I don't have access to file sharing sites at work. Could I impose on one of you to upload the image somewhere where we can all see it (except perhaps myself!) after I email it to you? Thanks, John. Or put it on a binary newsgroup and let us know which NG to look at. Signature/ Amatus / >> I charge $0.25 per image copied, with a minimum of $5 (and a maximum of >> $25) [quoted text clipped - 28 lines] > > John. > Or put it on a binary newsgroup and let us know which NG to look at. Ok, let's try this: http://www.bestsharing.com/files/N8VAJ8k343764/tooth20-150dpi-cropped-q95.jpg.html which is a link to download the image. I got a friend to upload the x-ray image for me. Is it accessible to everyone? Again, this is tooth #20 (lower left second bicuspid), the one with the two filled canals, and the crude looking temp crown on top. The root tip looks suspiciously fractured or something, although the dentist and endodontist say is is nothing to be concerned about. What do you guys think? Might an apicoectomy help in this case? John. >> Or put it on a binary newsgroup and let us know which NG to look at. > [quoted text clipped - 15 lines] > > John. Good x-ray. There is a slight overfill of one of the canals, but this generally isn't a problem. One concern I have isn't with the root canal, but the remaining coronal tooth structure. This is cropped somewhat from the x-ray, but it looks to me like there could be a fracture on the distal aspect of the tooth (the surface facing the tooth directly behind). There also seems to be a cup-shaped area of periodontal bone loss in this area, which supports the possibility that there is a small crack. However, the crack isn't far down at all. What I would do is remove all that temporary gunk and try to remove this loose piece, then temporize the tooth. I have a feeling the pain may resolve quickly. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > Good x-ray. There is a slight overfill of one of the canals, but this > generally isn't a problem. Is the overfill the white globs at the end of the longer canal? > One concern I have isn't with the root canal, but the remaining coronal > tooth structure. This is cropped somewhat from the x-ray, but it looks [quoted text clipped - 5 lines] > try to remove this loose piece, then temporize the tooth. I have a > feeling the pain may resolve quickly. That fracture you're talking about isn't the highly visible dark gap far above the gum line is it? I believe that's just the gap between the tooth and the temp crown. What does "temporize the tooth" mean? John. >> Good x-ray. There is a slight overfill of one of the canals, but this >> generally isn't a problem. > > Is the overfill the white globs at the end of the longer canal? Yes. >> One concern I have isn't with the root canal, but the remaining coronal >> tooth structure. This is cropped somewhat from the x-ray, but it looks [quoted text clipped - 9 lines] > far above the gum line is it? I believe that's just the gap between > the tooth and the temp crown. Possible, but I'd bet it's below the gumline. The gumline shows poorly if at all on the x-ray. The whitish material between the teeth is the bone. That may be the temporary crown, but it's very dense for a temporary crown material. I use acrylics, which are difficult to see on x-ray. This may be the temporary crown. An x-ray of the entire tooth would clear this up. > What does "temporize the tooth" mean? Usually another temporary crown (assuming this one doesn't fit after removal of any fractured structure. Steve > John. SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 On Sep 27, 4:32 pm, Mark & Steven Bornfeld <bornfeldm...@dentaltwins.com> wrote: > >> Good x-ray. There is a slight overfill of one of the canals, but this > >> generally isn't a problem. [quoted text clipped - 23 lines] > x-ray. This may be the temporary crown. An x-ray of the entire tooth > would clear this up. I just want to make sure I'm seeing the same thing you are. There is a pure white thumb of some material (filling, crown?) projecting at an angle downward distally. At the tip of this thumb, there is a very visible dark gap. Is this the crack you see? If so, I am pretty sure that is just above the gum line and is just a space between the crown and the tooth. My gums are fairly receded in this area... And the cup shaped area of bone loss you mentioned would be in the bone between tooth 20 and 19? Why would that support the presence of a crack in the tooth? John. > I just want to make sure I'm seeing the same thing you are. There is > a pure white thumb of some material (filling, crown?) projecting at an > angle downward distally. At the tip of this thumb, there is a very > visible dark gap. Is this the crack you see? I'm commenting from memory, because for some reason your server won't allow me to download the jpeg. Yes, I believe that is the gap I'm seeing. If so, I am pretty sure > that is just above the gum line and is just a space between the crown > and the tooth. My gums are fairly receded in this area... Could be. It does look close enough to the bone that I thought it was under the gum. But the appearance can be deceiving, depending upon how the x-ray was taken. > And the cup shaped area of bone loss you mentioned would be in the > bone between tooth 20 and 19? Why would that support the presence of > a crack in the tooth? A crack that extends down the root surface to the bone will lead to an infection in that area. Usually though it is centered around the fracture. It may not extend circumferentially around the root, but I have seen these defects that do--though they may be due to general periodontal problems and excessive biting stress rather than a fracture. Steve > John. >>> Or put it on a binary newsgroup and let us know which NG to look at. >> [quoted text clipped - 29 lines] > >Steve Yep, the endo looks good. Good catch on the distal crack and bone loss. As usual I concur with your opinion. I don't know............. Tooth looks good to me. RCT fill is dense enough. Slight overfill, but that happens often. Dark line at distal is just margin of crown. You can see shadow of gingiva on this image and the crown margin is about 1 mm under the tissues. I would want to see careful probing along the periphery to rule out a fracture and I see a radiolucency on the mesial root of #19. Perhaps hyper-occlusion? Signature/ Amatus / > >>>> Or put it on a binary newsgroup and let us know which NG to look at. [quoted text clipped - 36 lines] > > As usual I concur with your opinion. > Is there any good reason why a dentist would not let the patient have > a digital copy of a digital x-ray? > >snipped< If you feel there is still a problem that the dentist won't follow up then contact a lawyer now. Jamffer Assuming USA, just remind the office that HIPAA entitles you to a copy, you would like a copy and are ready to sign the required form so they can release a copy to you. If they ask for $5 to create a copy of the image, that would sound fair. I charge a minimum of $5 for one image; and a maximum of $25 to copy an entire record (all notes and images). Signature/ Amatus / > >> Is there any good reason why a dentist would not let the patient have [quoted text clipped - 5 lines] > contact a lawyer now. > Jamffer |
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