COMPUTED

RADIOGRAPHY
Dawn Guzman Charman, M.Ed., R.T.
RAD TECH A

filmless radiology
departments
Diagnostic radiographers
have traded their film and chemistry
for a computer mouse
and monitor
advance for Rad Sci Prof, 8/9/99

What Is Digital Imaging?

Digital imaging is the acquisition of images
to a computer rather than directly to film.

New Technology

Has impacted
practicing radiologic technologist
educators
Administrators
students in the radiologic sciences.

 Many local area hospitals

and medical centers
have this equipment NOW

Computed
Radiography
Fundamentals
of
Computerized
Radiography

CR SYSTEM
COMPONENTS
CASSETTES (phosphor plates)
ID STATION
IMAGE PREVIEW (QC)
STATION
DIGITIZER
VIEWING STATION

COMPUTED RADIOGRAPHY
Medical Imaging is changing

FILMLESS Radiology is the

future
And the Future is here!
El Camino College
First educational institution in California or across the
country to offer this new technology on a college

Equipment Costs
Don Visintainer successfully
wrote grants, and received
funding from VTEA, P4E, and
private sources

Total
+

$410,916.00

History of CR
INDUSTRY
Theory of filmless radiography first introduced
in 1970
1981 Fugi introduced special cassettes with PSP
plates (replaces film)
Technology could not support system
First clinical use in Japan - 1983

Predictions
1980 Bell Labs believed that Unix would be
the worlds dominant operating system
1982 Bill Gates thought 640K of main
memory would suffice for workplace
operating systems ( This presentation is 80,000 kb)
1984 IBM predicted that personal
computers would not amount to anything

History of CR
By 1998 over 5000 CR systems in use
nationwide
1998 Local area hospitals begin to
incorporate CR systems in their
departments
(Riverside Co. Hosp builds new hospital in
Moreno Valley) completely CR system
1st generation equipment

TERMINOLOGY
F/S -

Film/Screen (currently used method)

CR -

Computed Radiography

DR -

Digital Radiography

DDR - Direct to Digital Radiography

IMAGE CREATION
SAME RADIOGRAPHY EQUIPMENT
USED
THE DIFFERENCE IS HOW IT IS
CAPTURED
STORED
VIEWED
And POST -PROCESSED

CONVENTIAL vs DIGITAL
IMAGING
Currently, most x-ray imaging
systems produce an analog image
(radiographs, & fluoroscopy).
Using x-ray tube films in cassettes

CONVENTIAL vs DIGITAL
IMAGING
Digital radiography systems require
that the electronic signal be
converted to a digital signal
Using x-ray tube cassettes with
phosphor plate OR
DR systems - transistors

COMPUTED RADIOGRAPHY
& DIRECT RADIOGRAPHY
& FILM SCREEN
IMAGE CAPTURE
FS - Film inside of cassette
CR - PHOTOSTIMULABLE PHOSPHOR PLATE
DR(DDR) - TFT (THIN FILM TRANSISTOR)

Cassette w/ film CR w psp plate

Directed Digital Radiography

(DDR)
Directed digital radiography, a
term used to describe total
electronic imaging capturing.
Eliminates the need for an
image plate altogether.

Amorphous Selenium detector technology for

DR Direct Radiography

IMAGE CAPTURE
CR
PSP photostimulable phosphor plate
REPLACES FILM IN THE CASSETTE

DR NO CASSETTE PHOTONS
CAPTURED DIRECTLY
ONTO A TRANSISTOR
SENT DIRECTLY TO A MONITOR

CR vs FS
FILM
Film in cassette
loaded in a darkroom
Processed in a
processor
FILM
Hard copy image
stores the image
Viewboxes view the
images

CR
PSP in cassette
Digital image
Scanned & read- CR
reader
COMPUTER
Image stored on
computer
Viewed on a Monitor
Hard copy (film) can be
made with laser printer

CASSETTES with Intensifying

Screens
The CASSETTE holds
the film in a light tight
container
It consist of front and
back intensifying
screens

CR BASICS
Eliminates the need for film as
a recording, storage & viewing
medium.
PSP Plate receiver
Archive Manager storage
Monitor - Viewing

General Overview
CR

PSP cassette exposed by

conventional X-ray equipment.
Latent image generated as a
matrix of trapped electrons
in the plate.

CR PSP plate
photostimulable phosphor (PSP) plate
Captures photons
Stored in traps on plate (latent image)
PLATE scanned in CR READER

CR Phosphor Plates
ABSORPTION

EMISSION
LASER STIMULATION

X-RAY

ELECTRON
TRAP

ELECTRON
TRAP

LIGHT

CR PSP plate
Stimulated by a RED LIGHT
Energy is RELEASED in a form of BLUE
light
LIGHT captured by PMT
changed to a digiial signal

How CR works
Released light is captured by a PMT
(photo multiplier tube)
This light is sent as a digital signal to the
computer
The intensity (brightness) of the light
correlates to the density on the image

Densities of the IMAGE

The light is proportional to
amount of light received
digital values are then equivalent
(not exactly the same) to a value
of optical density (OD) from a
film, at that location of the image

ERASING PLATE
After image is recorded
Plate is erased with high intensity white
light
and re-used

CR VS DR
CR -Indirect capture where the image
is first captured on plate and stored =
then converted to digital signal
DDR -Direct capture where the image is
acquired immediately as a matrix of
pixels sent to a monitor

DIRECT RADIOGRAPHY

uses a transistor receiver (like bucky)

that captures and converts x-ray energy
directly into digital signal
seen immediately on monitor
then sent to PACS/ printer/ other
workstations FOR VIEWING

CR vs DR
CR
imaging plate

DR
transistor receiver (like
bucky)

processed in a Digital
Reader

directly into digital

signal

Signal sent to computer

Viewed on a monitor

seen immediately on
monitor

Image Resolution
(how sharply is the image seen)
CR
4000 x 4000
image only as good a
monitor*
525 vs 1000 line
more pixels = more
memory needed to
store

CR 2 -5 lp/mm
RAD 3-6 lp/mm
DR ?
IMAGE APPEARS
SHARPER BECAUSE
CONTRAST CAN BE
ADJUSTED BY THE
COMPUTER
(DIFFERENCES IN
DENSITY)

ADVANTAGE OF CR/DR
Can optimize image quality
by manipulating digital data
to improve visualization of
anatomy and pathology
AFTER EXPOSURE TO PATIENT

ADVANTAGE OF CR/DR
CHANGES MADE TO IMAGE

AFTER THE EXPOSURE

CAN ELIMINATE THE NEED TO
REPEAT THE EXPOSURE

ADVANTAGE OF CR/DR vs FS

Rapid storage
retrieval of images NO LOST FILMS!
PAC (storage management)
Teleradiology - long distance transmission
of image information
Economic advantage - at least in the long
run?

CR/DR VS FILM/SCREEN
FILM these can not be modified
once processed
If copied lose quality
DR/CR print from file no loss
of quality

no fault TECHNIQUES
F/S: RT must choose technical factors
(mAs & kvp) to optimally visualize anatomic detail
CR: the selection of processing algorithms and
anatomical regions controls how the acquired
latent image is presented for display
HOW THE IMAGE LOOKS CAN BE ALTERED BY
THE COMPUTER EVEN WHEN BAD
TECHNIQUES ARE SET

DR
Initial expense high
very low dose to pt
image quality of 100s using a 400s
technique
Therfore the dose needed to make the
image

Storage /Archiving
FILM/SCREEN
films: bulky
deteriorates over time
requires large storage
& expense
environmental
concerns

CR & DR
8000 images stored
on CD-R
Jukebox CD storage
no deterioration of
images
easy access

Transmission of Images
PACS - Picture Archiving &
Communications
System
DICOM - Digital Images &
Communication
in Medicine
TELERADIOGRAPHY -Remote
Transmission of Images

Benefits of Computer (web)-based

Viewing Systems

Hardcopy studies are no longer misplaced

or lost- eliminates films
Multiple physicians may access same
patient films
Patients do not have to wait in Radiology
for films once study is completed

Film-less components

CR or DR
CD-ROM or similar output
Email capability
Digitizing capability or
service

Histogram Analysis
A histogram is a plot of gray scale value
vs. the frequency of occurrence
(# pixels) of the gray value in the image

 HISTOGRAM a bar graph depicting the

density distribution (in numerical values) of
the imaging plate
ALGORITHM a set of mathematical
values used to solve a problem or find an
average

Histogram
Low attenuation
(e.g., lungs)

High attenuation
(e.g., mediastinum)

12,000

Frequency

10,000
8,000
6,000
4,000
2,000
0

200

400

600

800

1,000

Digital number
Adapted
from AAPM
TG10

Statistical plots of the

frequency of occurrence of
each pixel's value

Basics of Digital Images

digital
images are a
(matrix) of
pixel (picture
element)
values

 The algorithm attempts to

distinguish among the parts of the
histogram which represent the
range of densities from bone to
soft tissue

 Histograms set for specific exams (body

parts)
should produce digital images that are
consistant (regardless of kVp or mAs used
Correct Algorithm (body part) must be
selected prior to processing imaging plate

Methods to Digitize an Image

1. Film Digitizer - Teleradiography system
(PACS, DICOM)
2. Video Camera (vidicon or plumbicon)
3. Computed Radiography
4. Direct Radiography

FILM DIGITIZER

Analog vs Digital
Analog - one value
blends into another
(like a thermometer)

100
80
60

Digital - distinct
separation
98.6
exact

East

40

West
North

20
0

1st

3rd

Qtr

Qtr

ANALOG TO DIGITAL IMAGE

Conversion of conventional analog
films
to digital format for PACs and
teleradiology applications
with scanning laser digitizers

CONTRAST & DENSITY

Most digital systems are capable of 1024
shades of gray - but the human eye can
see only about 30 shades of gray
The Optical Density and Contrast can be
adjusted after the exposure by the
Radiographer.
This is POST - PROCESSING

High displayed contrast narrow window width

Low displayed contrast (stretched) wide window width

Basics of Digital Images

Pixel values can be any bit depth (values
from 0 to 1023)
Image contrast can be manipulated to
stretched or contracted to alter the
displayed contrast.
Typically use window width and window
level to alter displayed contrast

80 KVP
5
5

100

30

15

200

500

 Then the COMPUTER corrects any

exposure errors
Therefore almost ANY technique can be
used on the patient
The computer will fix it

DOSE IMPLICATIONS
MORE EXPSOURE TO PATIENT
TECHNIQUES ESTABLISHED
HIGHER KVP = LESS MAS
LESS PATIENT DOSE

80 kvp 200mas
10 mas 80 kvp
Note
Quantum Mottle

Dose Implications
Images nearly always look better at
higher exposures.
Huge dynamic range means nearly
impossible to overexpose.

POST PROCESSING

TECHNIQUE CONISDERATIONS

KVP Dependant
Now COMPUTER controls
CONTRAST
Higher kVp to stimulate
electron traps

standard image

edge sharpening

DEVELOPER
FIXER
WASH
DRY

WATER - SOLVENT

PROCESSOR
PROBLEM FIXER

scratch

Crimping /cresent mark

REPEAT IMAGES

EMERGING PROBLEMS
BETTER NOT NECESSARILY
FASTER
LEARNING CURVE FOR
TECHNOLOGIST & PHYSICIANS
STUDENT APPLICATIONS &
ISSUES
PITFALLS OF CR

POSITIONING & PROPER

COLLIMATION ARE CRITICAL
TO GOOD IMAGING
OUTCOMES
Just like Phototiming, it can
magnify your mistakes

COLLIMATION CRITICAL
AS THE COMPUTER READS THE
DENSITY VALUE OF EACH PIXEL IT IS
AVERAGED INTO THE TOTAL
CLOSE COLLIMATION = BETTER
CONTRAST
BAD COLLIMATION = MORE GRAYS
AND LESS DETAIL

Digital imaging is not the end

all, cure all for imaging
problems.
It is still technologist dependent.

To Produce Quality Images

For Conventional Projection
or CR Radiography:
The same rules, theories, and laws still apply
and can not be overlooked FFD/OFD (SID/SOD)
Inverse Square Law Beam Alignment Tube-PartFilm Alignment
Collimation
Grids
Exposure Factors: KVP, MaS

Patient Positioning

 towel that was used

to help in
positioning a child

CR is MORE
sensitive to
ARTIFACTS

NEW IMAGE

CR image NEW IMAGE

Line caused
from dirt
collected in a
CR Reader

Double
exposure
Child

Hands over upper

abdomen

High resolution with digital

imaging