Legal Implications

The new technologies and advancements in dental radiology also have brought forth new legal and ethical issues that should be considered. Although not new in medicine, dentistry and dental-related industries have done little to establish standards for the use of digital imaging in telemedicine and third party reimbursement (submission to insurance carriers). In our litigious society, radiographs have become increasingly important as evidence in a court of law. Therefore, dentistry must consider the ramifications of the use of digital radiography.

The enhancement features and manipulations that are available with the digital imaging software are positive attributes of this technology. The misuse of these devices may cause ethical and legal problems. Once the original digitized image is manipulated or enhanced, then the digitized image becomes a demonstration and not evidence in a legal case. If standards for encrypted
images were established, then the images would maintain their value as legal evidence. 24 Many companies are currently using encryption software to prevent the original image from being altered. With encryption software, if the original image is altered, the resulting image will be saved as a new image preserving
the integrity of the original. The importance of this was demonstrated in two studies that manipulated digital images and showed how they could be used fraudulently.25-26

Other problems that are inherent with the use of computers are inadvertently deleting image files, computer viruses, power outages, and illegal image manipulation. A preventive approach should be developed to help protect against these problems. One approach would be the required use of encryption codes. Other protective mechanisms might include backup disks, non-erasable permanent files for patient radiographic images, and establishing standards for keeping original radiographic images a certain length of time after the completion of a patient’s treatment. Specific issues surrounding teleradiology such as licensure, professional lia-bility, and patient privacy, confiden-tiality, and security are unresolved for dentistry and should be explored.27