Printers: General Office Use

Laser printers remain the standard for general office printing, whether you purchase a color or monochrome one. This printer will serve as the "workhorse printer." Monochrome laser printers offer unsurpassed reliability with archival printouts for both individual and networked usage. Please consider the following features when deciding which printer to purchase:

1. Printing clarity is determined by the printer's resolution - consider only a laser printer that produces 1200 x 1200 native dots per inch (dpi).

2. Purchase a printer that corresponds to the printer's intended workload. A printer that is rated at 10,000 pages per month and 20 or more pages per minute (ppm) is ideal for the average endodontic office.

3. Consider purchasing a network printer if two or more users will be sharing the printer.

4. When purchasing a printer, make sure it can accommodate both letter and legal size paper. A printer with several paper trays may also increase efficiency if both letterhead and plain paper are used.

5. A printer with a larger amount of installed memory will increase printing speed.

The hp Laser Jet 1300 is ideal for a single workstation where 20 ppm is adequate and monthly printing output does not exceed 10,000 pages. It prints at true 1200 x 1200 dpi and has up to two input trays.

 The hp Laser Jet 4200 is an expandable printer for small workgroups. It features 35 ppm, 30,000 pages per month and true 1200 x 1200 dpi resolution. It can hold up to three input trays with 850 sheets of paper.

In order to print from any computer to any "shared" printer, you must set up printer sharing over your network. Then prescirptions and other documents can be sent to the printer from your chairside computer workstations.

Printers: Patient Treatment Reports

Inkjet printers remain the standard for printing digital radiographs and visible light images in today's endodontic office. Even the laser printer cannot match the image quality of an inkjet printer for digital images. Since radiographic interpretation depends on a high resolution image, the best image quality takes precedence over speed and cost per image.

The Epson Stylus R2400  printer is my current choice for printing digital images in the endodontic office environment. It provides the highest quality output available from any pigment based inkjet. It has 2880 (horizontal) x 1440 (vertical) dpi resolution and uses The full ink set consists of 9 colors. Unfortunately this printer can only install 8 colors at the same time. This means you need to switch between Photo Black (PK) and Matte Black (MK) if you plan to switch between matte and glossy media. It uses the UltraChromeT K3 ink set with ultra-fine 4-picoliter ink droplets. The innovative ink system has individual ink cartridges for each of eight colors. This printer has many professional features, such as PRINT Image MatchingT technology (PIM) to enhance color matching. This unit will print in black and white mode.

This unit will print archival images that are estimated to last up to 80 years on media up to 13 x 44 inches. It also includes high-speed USB, FireWire IEEE 1394 connectivity and a convenient Parallel port. Print speed is the same when connected via the USB or Firewire ports, both of which are much faster than the Parallel port. You can connect two CPUs to the printer at the same time, one to the USB port and one to the Firewire port.

Ink: Epson brand inks can be purchased at most large office supply stores via catalog sales but are usually not stocked at store locations. Aftermarket inks can be bought at 4InkJets at your own risk.

Paper: While Epson recommends their heavy weight matte finish paper, most referring doctors don't like the thickness. We use Epson's photo quality ink jet paper "Epson Matte Paper #S041062" (27lb 4.9mil 8.5" x 11" 90 ISO brightness). This paper is thinner but is not archival, not recommended by Epson tech support for this printer, but seems to feed smoothly.

Color Laser Printers and Multifunction Printers

These printers can match the best laser printers for black and white, but the color images will prove inadequate. Color forms, however, will look very cool - but the inkswill sell at a premium for this advantage. Also, multifunction or all-in-one printers, combining scanner, copy machine, fax and  a printer, are potentially problematic because if the device malfunctions, all four functions will be lost.

Scanners

Scanning documents in the endodontic office affords excellent opportunities such as increasing security, reducing storage space and improving efficiency. Scanners can transmit their documents in a variety of formats, so careful attention should be given to the compatibility with dental management software. The idea is to scan documents into a patient's individual file so that all documents for that particular patient are easily accessible. Accounting and other miscellaneous office documents can also be scanned into a file on the server or client workstation for easy retrieval. Both scanners listed below include native support for Adobe Portable Document Format (PDF). PDF file format have become the document exchange standard due to its wide industry acceptance. PDF files can be viewed independently from other application software and they can be viewed as thumbnails in Microsoft Office application software, and each document can be password protected.

PDF: Unlike TIFF and JPEG image formats, PDF encapsulates other compression formats so that documents become application independent. These files have embedded metadata, or data within the image that can authenticate the document. As an open specification, PDF documents also maintain documents in a consistent format which makes PDF the best choice for long-term archiving, preserving the original appearance.

Security: PDF files improve security through digital signatures and document encryption features that improve HIPPA compliance and address general business security demands. All PDF files can be password protected to limit access only to those authorized to view the contents.

Versatility: PDF files can be viewed on every major computing platform including Microsoft Windows, Mac OS and UNIX.

Searchable Images: PDF creates image files that can be searched and indexed by Optical Character Recognition (OCR). Processing a document with OCR produces a searchable bitmap that is hidden behind the image, while preserving the look of the original image.

Fujitsu fi-4120C is a one-button "always-on" scanner which allows duplex color and monochrome scanning. Simplex (one sided): monochrome and grayscale @ 200dpi is 25ppm, and 25ppm for Color @ 150dpi; duplex is 25ipm for monochrome and grayscale @ 200dpi and 25ipm for color @ 150dpi.  It uses dual color CCD image sensors with 50-600 dpi (600 optical) resolution. This device includes automatic features such as color, page size and blank-page detection according to the manufacturer. It is a compact size (6.3"H x 11.9"W x6.7"D) and has a 50-page automatic document feeder. The scanner includes a complete version of Adobe® Acrobat® 5.0 software. The interface to your computer can be switched between SCSI-2 and USB 1.1 (box includes a PCI SCSI card and cable, and a 6" USB cable). This scanner supports TWAIN, which is probably the driver that your office management software automatically uses.

PaperPort Deluxe 11 software is a good scanning program that will generate Adobe PDF documents when properly configured. These documents can be attached to your patient chart via the TWAIN interface in your management software.

Input Devices

Mouse and keyboard combinations have improved in recent years in both reliability and ergonomics. Choosing the cordless keyboard and optical mouse allows easy asepsis in the operatory setting. Application of clear plastic food wrap around the keyboard and a zip-lock type baggie for the mouse will provide a protective barrier during patient examination and treatment. 

The Logitech Cordless Desktop MX for Bluetooth is the ergonomic (split-key keyboard with mouse charger/antenna) choice for cordless keyboards with enhanced function keys, multimedia control, USB and PS/2 connectivity, and extended range of up to 30 feet.

Monitors

There are two basic screen types available today for computer operations in the endodontic office; the LCD (flat screen) and the CRT. Advantages of the LCD over the CRT are a smaller footprint, reduced electromagnetic radiation, no flicker, decreased energy use and less heat generation.

The gold standard for administrative and front desk workstations are LCD screens. But all flat screens are not created equal. Here is what to look for when selecting a screen:

1. Does the screen have the VESA standard hole pattern on the back so it can be mounted toan industry standard mounting arm. If it meets this standard, it has a mounting hole pattern in the back shaped like a square that measures 75 x 75mm (3" x 3") or 100 x 100 mm (4" x 4"). SPACEDEC manufactures many types of articulated support arms for  LCD monitors.

2.  LCD monitors are measured by the size of the viewable area. CRT screens, on the other hand, loose an inch or two from their stated measurement because of the size of the bezel. Therefore, a flat panel of 17-18" is equivalent to a CRT of approximately 21". Minimum recommended screen size is 19". Depending on available room, a 24" (1920 x 1200) flat panel is ideal. Most screens list horizontal and vertical viewing angles of at least 140 degrees. The ideal horizontal viewing angle is 160 degrees or more.

3. LCD is a transmissive technology. A fixed-intensity fluorescent white backlight is filtered by the liquid crystals arranged between two finely grooved surfaces. When the backlight finally fails, the screen will have to be repaired with a new backlight. Make sure the screen you purchase has a three year warrantee on the backlight. Most LCD screens will last about 60,000 hours (6.8 years) of continuous use. When the screen burns out, it will go black. In contrast, the average CRT will dim as it ages, and will produce an ISO compliant image for about 40,000 hours.

4. While a CRT can display a range of resolutions (number of pixels per unit of area) an LCD panel can display only one resolution at full-screen size using one cell per pixel. If an LCD panel has a native resolution of 1024x768, it can display at a resolution of 640x480 by using 66% of the screen. Most LCD screens can rescale a lower resolution image using rathiomatic expansion, which will work adequately for photographs but not very well for text or images with fine detail. Objects become jagged and artifacts fill the extra pixels. When re-sampling for scaling the image up, anti-aliasing will fill the extra pixels resulting in better results. The bottom line is choose a screen with a clear understanding of the native resolution and  plan to use it as specified.

5. Digital or analog? Buy only LCD monitors that support both digital (binary pulse) and analog (wave form) signal inputs. That's because LCD screens process information digitally, so having your computer send digital information to the video card and converting to analog, sending to the LCD screen and then converting back into a digital signal can result in fluttering and ghosting. Newer LCD screens and computes use special graphics boards with digital connectors to keep the images sharp.

6. Refresh rates are an important indicator of how well your screen will depict moving images. A refresh rate (or how fast the screen paints the image) of 30 milliseconds is a minimum standard.

7. Pay special attention to contrast ratios - to help depict a large range of light and dark tones. A contrast ratio of at least 350:1 should help paint an image with adequate appearance quality.

8. Integral stereo speakers are a nice feature on any monitor. Although most speakers are not "room-fillers", built-in speakers reduce desktop clutter and make the computer easier to move.

9. Several products are available for cleaning your LCD screens. Companies that sell these products are Clean Sweep Supply (www.cleansweepsupply.com) and Keysan (www.keysan.com)

Flat panel adjustable ceiling adapters are available from Premier Mounts 800-368-9700 or www.premiermounts.com.  A recommended unit is the AST-2446, which accommodates VESA-standard LCD flat panels and will allow adjustment of up to ± 90º from center, 360º swivel and cable access. For attachment to a concrete ceiling slab, a professional carpenter will be required. 

LCD flat panel monitors are available in almost every size and configuration. If you are using the industry standard S-Video output from the microscope or hand held camera, or from a DVD player, be sure to order a monitor that will accept a standard S-Video input. One suggested monitor, the 24" Dell^T UltraSharp™ 2407FPW Widescreen, Adjustable Stand, VGA/DVI is a winner. The Dell^T 2407GPW features analog as well as digital (DVI) capabilities, providing connection flexibility. Apart from one upstream and 4 downstream USB ports, this display also features S-Video and Composite Video connectors.

Adding an S-Video splitter will allow the video signal from the microscope to be sent to both the computer capture board and the LCD patient monitor, so capture of images into image management software can be accomplished while viewing the images on both the chairside computer workstation and the ceiling-hung LCD flat panel.

Patient wireless headsets can be added to the system to enhance the entertainment experience. Sony model MDR-RF920RK 900 MHz RF wireless headphones feature internal rechargeable  batteries and numerous frequencies, so that one operatory won't interfere with another.