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Washington State Dental Association


Note: Dr. Wentworth will be one member of an ethics panel conducting a lecture at the Pacific Northwest Dental Conference. Click here for lecture information.

Ethics of Digital Radiographs

A few years ago in this space, I briefly discussed what I called “digital etiquette” in sharing your digital records with other dentists. After spending over an hour just now trying to decipher radiographs sent to me from another office for a new patient, I figure it is time to readdress this topic in more detail. 

The ADA Principles of Ethics and Code of Professional Conduct speaks to this topic:

1.B. Patient Records
Dentists are obliged to safeguard the confidentiality of patient records. Dentists shall maintain patient records in a manner consistent with the protection of the welfare of the patient. Upon request of a patient or another dental practitioner, dentists shall provide any information in accordance with applicable law that will be beneficial for the future treatment of that patient.

Advisory Opinions

1.B.1. Furnishing Copies of Records
A dentist has the ethical obligation on request of either the patient or the patient’s new dentist to furnish in accordance with applicable law, either gratuitously or for nominal cost, such dental records or copies or summaries of them, including dental x-rays or copies of them, as will be beneficial for the future treatment of that patient. This obligation exists whether or not the patient’s account is paid in full. When we see a new patient, we need to determine if the patient has any previous records that will benefit our care of the patient.

This includes, at a minimum, current radiographs. 

The second principle in the Code is Nonmaleficence, stating “the dentist has a duty to refrain from harming the patient.” Although, in the world of medical imaging, dental x-rays are at the low end of radiation exposure, we have an ethical obligation to follow the ALARA principle (As Low As Reasonably Achievable) for x-ray exposure in ordering radiographs. When a patient has current films, the new dentist has an ethical obligation to obtain copies of them, unless the patient requests otherwise, and the previous dentist is obligated to provide them. 

Before digital technology, the x-rays were sent by regular mail or given to the patient, labeled with the patient’s name and the date taken. With digital films, we have additional challenges that are not as simple: Does the office receiving the films have the capacity to accept them digitally? If they want them printed out, we need to make sure they are diagnostic quality and printed on photo paper in the best resolution possible. If the receiving office would like them in digital format, do they want them sent electronically or uploaded to storage media, such as a CD? Also, what format do they require? Do they need each film as a separate file, or a series sent as a single file?


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