Photostimulable phosphor plates (PSP), commonly used in computed radiography (CR), helped many dental practices transition from film to digital imaging. Their thin, flexible design remains familiar to clinicians and comfortable for many patients.
However, unlike direct digital radiography (DR), CR requires each plate to be removed, transported to a scanner, processed, and prepared for reuse after every exposure. While these additional steps may seem minor individually, they can become a significant part of the daily workflow in busy practices (Sampaio-Oliveira et al., 2025).
1. More Steps, More Time
One of the biggest differences between CR and DR is what happens after the X-ray is taken.
With CR, the image cannot be viewed immediately. Each plate must be removed from its protective barrier, carried to a separate scanner, processed, and then returned for the next patient. A comprehensive 2025 review of 45 PSP systems reported minimum scanning times ranging from approximately 4 to 20 seconds, depending on the system, before accounting for plate handling or transport (Sampaio-Oliveira et al., 2025).
Clinical research has also shown that a full nine-image intraoral examination using PSP plates required approximately 67 seconds longer than CMOS sensors on average. While one minute may seem insignificant for a single patient, these repeated delays can accumulate throughout a busy clinical day, affecting scheduling, chair-side efficiency, and staff workload (Kamburoğlu et al., 2022).
2. The Hidden Cost Beyond Equipment
Although PSP plates are reusable, they undergo repeated handling throughout the day. Plates are inserted into protective sheaths, positioned in the patient's mouth, removed, transported, scanned, cleaned, and stored before being used again.
Recent studies found that cracks and scratches accounted for 77.1% of plate-related artifacts, with many plates exhibiting multiple types of damage (Yurttas, 2024). Additional research has identified bite marks, image fading, delayed scanning, scanner-related artifacts, and improper handling as common sources of image degradation (Elkhateeb et al., 2022).
The hidden cost is therefore not simply replacing worn plates. Practices also invest valuable staff time inspecting plates, troubleshooting image quality, maintaining scanning equipment, and performing quality-control procedures to ensure reliable diagnostic images.
3. Workflow Efficiency Matters
CR systems provide excellent diagnostic capability, but image quality depends not only on exposure—it also depends on what happens afterward.
Because PSP plates remain sensitive until they are scanned, factors such as delayed processing, ambient light exposure, and inconsistent handling may affect image quality (Sampaio-Oliveira et al., 2022). If an artifact obscures important anatomy, another image may be necessary, increasing appointment time and creating additional radiation exposure.
For high-volume practices, every additional handling step—from removing the barrier and carrying the plate to scanning and preparing it for reuse—adds another opportunity for workflow interruptions or human error.
Direct digital sensors simplify this process by displaying the image immediately after exposure, allowing clinicians to verify image quality without a separate scanning stage (Sampaio-Oliveira et al., 2025).
Conclusion
CR remains a valuable imaging option and continues to serve many practices well. However, the true cost of CR extends beyond the initial purchase price of the equipment.
When evaluating imaging systems, practices should also consider staff time, workflow efficiency, scanner processing, plate replacement, quality control, and the potential for repeat imaging. Looking beyond upfront costs provides a more complete picture of long-term operational efficiency—particularly in high-volume clinical environments.
References
Elkhateeb, S. M., et al. (2022). Analysis of artifacts in photostimulable phosphor plate digital radiography and their impact on image quality. World Journal of Clinical Cases, 10(2), 437–447.
Kamburoğlu, K., et al. (2022). Clinical comparison of intraoral CMOS and photostimulable phosphor imaging systems in terms of time efficiency, patient comfort, and subjective image quality. Imaging Science in Dentistry, 52(2), 93–101.
Sampaio-Oliveira, M., et al. (2022). How does ambient light affect the image quality of phosphor plate digital radiography? Sensors, 22(22), 8627.
Sampaio-Oliveira, M., et al. (2025). Intraoral digital radiography: A comprehensive report on the technical specifications of current and historical systems. Imaging Science in Dentistry.
Yurttas, M. (2024). Analysis of artifacts and errors on intraoral phosphor plate radiographs: A retrospective study. Galician Medical Journal, 31, e-GMJ2024-A06.
