COMPUTED RADIOGRAPHY.

THE C.R.

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 TERMINOLOGY.

Conventional - Uses film in cassettes (film holders).

Digital - Filmless; image is viewed on monitor.

C.R – Computed radiography – uses conventional

equipment with cassettes.

D.R – Direct digital radiography – uses special

equipment; cassetteless imaging.

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IMAGE RECEPTORS.
• Defined as the device that receives the energy of the x-
ray beam and forms the image of the body part.

Four types.
a) Cassette with film (conventional).

b) Image plate (IP – used in CR).

c) Detector panels (Direct radiography)

d) Fluoroscopic screen.

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 X-RAY PRODUCTION

• The energy conversion involves the conversion of;

• Electrical energy to Heat energy

• Kinetic energy to.. X-ray energy and heat energy.

• >99% of the energy conversion results in heat.

• <1% of the energy conversion results in x-rays.

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 IMAGE RECEPTORS.

Image receptors (IR)

can either be film
cassettes.

OR

CR (computerized
radiography) imaging
plates (IP).

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Imaging Receptor Orientation.

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 RADIOGRAPHIC/
FLUOROSCOPIC EQUIPMENT.

• Radiographic equipment produces static images

only.

While;

• Fluoroscopic equipment produces static AND

dynamic images.

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 Radiographic/Fluoroscopic Equipment.
In addition to the
components already
discussed,
fluoroscopic
equipment has a
movable fluoroscopic
carriage which
includes:
Image intensifier,
An additional x-
ray tube under the
table.

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 Radiographic/Fluoroscopic
Equipment.

Spot film device;– Permits the radiologist to obtain

static images during the fluoroscopic exam.
• Uses various cassettes.
• Allows one or more exposures/image receptor.

Digital fluoroscopy; Allows digital acquisition of spot

films (cassetteless)
• Stores static images on a computer.

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 COMPUTED FLUOROSCOPY.
 Continuous beam of radiation.

 Images appear on the screen like on a TV.

 Where the image of the body parts being x-rayed is

viewed in real time on a monitor or display.

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 COMPUTED RADIOGRAPHY.
 Uses similar equipment to conventional radiography.

 Except that in place of a film to create the image, an

imaging plate (IP) is used.

 Imaging plate(IP) is made of photostimulable

phosphors.

 Imaging plate(IP) housed in a special cassette is placed

under the patient body part or object to be examined and
the x-ray exposure is made.

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 COMPUTED RADIOGRAPHY.
• Instead of taking an exposed film into a darkroom for
developing in chemical tanks or an automatic film
processor.

• The Imaging plate (IP) is run through a special laser

scanner,
or

• CR-reader that reads and digitizes the image.

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 COMPUTED RADIOGRAPHY.
• The digital image can then be viewed and enhanced using
software that has functions very similar to other
conventional digital image processing software i.e.

a) Contrast.

b) Brightness.

c) Filtration.

d) Zoom.

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 COMPUTED RADIOGRAPHY.
IMAGING PLATE (IP).
Contains photo stimulable storage phosphors.

Stores the radiation level received at each point in local

electron energies.

When the plate is put through the scanner, the scanning

laser beam causes the electrons to relax to lower energy
levels (photo-stimulated luminescence).

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 COMPUTED RADIOGRAPHY.
IMAGING PLATE (IP).
Emitting light that is detected by a photo-multiplier
tube is then converted to an electronic signal.

The electronic signals is then converted to discrete

(digital) values and placed into the image processor
pixel map.

Imaging plate(IP) can be re-used thousands times if

they are handled carefully.

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 COMPUTED RADIOGRAPHY.
IMAGING PLATE (IP).
An image can be erased by simply exposing the plate to
a room-level fluorescent light.
 Most laser scanner automatically erases the Imaging
plate(IP) after laser scanning is complete.

The Imaging plate(IP) can then be re-used.

Re-usable phosphor plates are environmentally safe but

need to be disposed off according to local regulation,(?
Waste management).

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 COMPUTED RADIOGRAPHY (CR) AND
DIRECT RADIOGRAPHY (DR).
Similarities.
1. Both use a medium to capture x-ray energy.

2. Both produce digital image that can be enhanced for

soft copy diagnosis or further review.

3. Both can also present an image within seconds of

exposure.
a) CR; involves IP housed in a cassette.
b) DR; captures the image directly onto a flat panel
detectors without the use of a cassette.

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 COMPUTED RADIOGRAPHY (CR) AND
DIRECT RADIOGRAPHY (DR).

Similarities.
5. Image processing and enhancement can be applied on
DR images as well as CR images due to the digital format
of each.

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 COMPUTED RADIOGRAPHY (CR)
Advantages.
1) Instant radiographic image.

2) Lower radiation dose to patient.

3) Better control over image quality, despite the exposure

level.

4) No problems associated with chemicals and developing.

5) Reduced film storage space and labour.

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 COMPUTED RADIOGRAPHY (CR)
Advantages.
6. No lost radiographs.

7. Secure and instant image storage and retrieval.

8. Large detailed image display for diagnosis and

treatment plan presentation.

9. Image enhancement for improved viewing.

10). Capability for electronic communication including

claims filing and off-site viewing.
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 COMPUTED RADIOGRAPHY (CR).
Disadvantages.
1. Manual handling of the IP cassette is considered a
disadvantage vs. DR but it also offers more flexibility
for patient positioning.

2. In CR there is possibility of digital manipulation

during post processing (distort).

3. The inherent geometric unsharpness and resultant

lower spatial resolution as compared to film
(radiographic) images.

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 COMPUTED RADIOGRAPHY (CR).

4. Sensitivity to scattered radiation.

5. There are no quality (image resolution)

standards compared to general radiography.

6. Imaging plates(IP) are expensive and can be

damaged if the system being used requires
manual handling of the IPs.

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 COMPUTED RADIOGRAPHY (CR).

Note.
Theoretically, Imaging plates(IP) may be re-used
thousands of times.

But

Constant use will always result in damage to the IP and

image artifacts increase eventually to the point of
necessary replacement.

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 DIGITAL PICTURE ARCHIVING AND
COMMUNICATION SYSTEM. (PACS).
What is PACS?
P: picture, images and reports.
A: archive, online, near line and offline.
C: communication, networking, transfer protocols.
S: system, components and architecture.

Introduction.
A PACS is a blend of both hardware and software
dedicated to the storage, retrieval, management,
distribution and presentation of electronic images.

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 DIGITAL PICTURE ARCHIVING AND
COMMUNICATION SYSTEM. (PACS).
Using PACS, whole images and their reports can be
available at any nearby terminal.

PACS has been widely introduced as a credible

alternative to the traditional film-based radiological
services.

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 Digital picture archiving and
communication system. (PACS)
A PACS consist of 4 major components.
1) The imaging modalities such as CT, MRI, US,
CR/DR.

2) A secured network for the transmission of patient

information.

3) Workstations for interpreting and reviewing images.

4) Archives for the storage and retrieval of images and

reports.
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 PACS administrator’s roles.
1. Implementing a PACS.

2. System maintenance.

3. Image and information management.

Implementing a PACS.
 Financial and workflow study.
 Request for proposal and tender drafting.

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1.Implementing a PACS.
 Workflow modification including job reallocation and
resource relocation.
 Training and operation manuals.
 Acceptance of systems.

2. System maintenance.
 Contingency plan.
 Incompatibility handling.
 First line support and problems escalating.
 System security and performance monitoring.

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3. Image and information management.
 Maintain high image quality.

 Data integrity.

 Quality assurance program.

 Tele-radiography.

 Anytime available storage management.

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 Uses of PACS

PACS has 4 main uses.

1. Hard-copy replacement.
2. Remote access.
3. Electronic image interpretation platform.
4. Radiology workflow management.

Hard copy replacement;

PACS replaces hard-copy based means of managing
medical images, such as film archive.

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 Uses of PACS contds
Hard copy replacement;
With the decreasing price of digital storage, PACS
provide a growing cost and space advantage over film
archives in addition to the instant access to prior
images at the same institution.

Digital copies are also referred to as soft-copy.

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 Remote access.

 It expands on the possibilities of conventional systems

by providing capabilities of off-site viewing and
reporting (distance education, tele-diagnosis).

 It enables practitioners in different physical locations to

access the same information simultaneously for tele-
radiology.

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Electronic image interpretation platform.

 PACS provides the electronic platform for radiology

images interfacing with other medical automation
systems such as Hospital Information System(HIS),
Electronic Medical Record(EMR), and Radiology
Information System(RIS).

Radiology workflow management.

PACS is used by radiology personnel to manage the
workflow of patient exams.

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DICOM-CD based PACS (Digital imaging
and communication in medicine).

Is standard for handling, storing, printing and

transmitting information in medical imaging.

 It includes a file format formation and network

communication protocols.

 A simple PACs can be organized around DICOM-

CDs.

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DICOM-CD based PACS (Digital imaging
and communication in medicine).

The system writes a CD containing demographics

and images at the conclusion of the study.

Long studies are written on multiple disks.

Human-readable identifiers e.g. patient name, and

laboratory numbers are manually placed on the
disk .

The disk is then stored on a file shelf.

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DICOM-CD based PACS.
(Digital imaging and communication in medicine).

Note;

The main aim of DICOM is to support the

distribution and viewing of medical images from
CT, MRI and other medical modalities.

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As a reminder, the advantages of CR are;

• Its large dynamic range.

• Digital format.

• Portability.

• Post-processing capability.

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 OPTIMIZATION OF CR IMAGES.
• There are several factors affecting the quality of CR
images, and radiographers or technologists are the key
persons who are responsible in delivering;
a) Good quality radiographs.
b) With reasonable radiation dose given to the patients.
• Quality control of the technical parameters and
radiographic positioning are therefore critical to a CR
image.

• Optimization of a CR image quality may be achieved

by optimizing the following factors:

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 FACTORS AFFECTING QUALITY OF CR
IMAGE

 Positioning and collimation.

 Exposure techniques.

 Image processing selection.

 Lifetime of the PSP.

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 COLLIMATION.
• Proper collimation reduces scatter radiation in the
region of interest .

• Reduces the noise that degrades the radiographic

contrast.

• This good practice is still valid with CR, and most

image processing software employed in CR relies on
the fact that the image collimator edge is detected, so
that the contrast may be optimized.

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 EXPOSURE TECHNIQUES.
• In order to introduce CR as a replacement for film-
screen technique, the common thinking is that it would
be reasonable to adhere to the same exposure techniques
to help the radiographers to adapt to the newer
technology.
• But this is not necessarily the case.
• CR may be operated at a different film speed, and then
optimizing the exposure technique accordingly.
• Existing CR has a speed similar to medium speed film-
screen system (200) while spatial resolution is still
generally inferior.
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 IMAGE PROCESSING SELECTION
Proper selection of an image processing algorithm

specific to each type of x-ray examination is thus

important.
The technical skills of radiographers definitely play a

crucial role in determining the quality of the

radiographic image.

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Even though a CR image may be adjusted to

improve the image visibility in the cases of over-

or under-exposures.
It would still be impossible for an image

processing to improve the visibility of clinical

features that were not available in the raw image.

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• Some examples of
artifacts in CR (a) an
image with loss of
contrast as a result of
improper selection of
image processing;

• The same image (b)

now shows acceptable
image quality as a
result of proper
selection of image
processing.
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 LIFETIME OF THE PSP

• One of the major advantages of CR is that the phosphor

plate is reusable.

• There are a number of factors that may affect the

lifetime of an imaging plate.

• The plates are subjected to normal wear and tear from

scratches, cracks, and contamination with dust and dirt,
which may interfere with the production of a good
image.

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• The establishment of a well-organized quality
control program will play an important role in
assessing the clinical quality of the imaging
plate.
• This may easily be carried out by artifact
assessment and uniformity evaluation across the
plate.
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DIGITAL ARTIFACTS

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 DIGITAL ARTIFACTS.
CR artifacts require special attention.

This is due to the fact that CR artifacts may be produced

from various components of the CR system itself.

 Artifacts may also be generated by the users who are

not aware of the proper imaging techniques or selection
of appropriate image processing protocols.

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 DIGITAL ARTIFACTS.
Since CR is also very sensitive to scatter radiation, it is
vital that anti-scattered grids be used as in conventional
radiography.

Radiographers should be concerned since these may

generate unwanted artifacts that could not be corrected
by any image processing algorithm.

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50
Standard image. Edge sharpening.

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Halo effect with Edge enhancement.

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56
DIRT ON SCREENS.

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 ACQUIRING GOOD QUALITY IMAGES.
• Regardless of the acquisition technology, good
radiographic images can be produced only when
certain fundamental requirements are met.

• Appropriate radiographic technique must be used;

1. Proper tube potential (kVp).
2. Beam current (mAs).
3. Appropriate Source-to-image distance (SID)FFD.
4. Collimation.
5. Alignment of the X-ray central ray.
6. Positioning of detector and subject for the specific
anatomic projection.

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Whether from underexposure or misalignment of a scatter
reduction grid, too few X-rays produce noisy images.

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Double exposure is a classic operator error, that
constitutes approximately 2% of all rejected images.
• The consequence of double exposure can be either
a single repeated examination, when an inanimate
object is involved or two repeated examinations
when two patients are involved .

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 Double exposures contd
In DR, double exposures can also be caused by power

interruptions and communications errors, as well as by

inadequate erasure secondary to overexposure or erasure
mechanism failure.

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DOUBLE EXPOSURE .

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DOUBLE EXPOSURE.

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Errors in the selection of the anatomic projection
can cause inappropriate processing.

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Different exam parameters
in different rooms.

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• Screens can be checked with a UV light for
errors (QC programs)

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 ITS HIGH TIME WE GO
DIGITAL/ FILMLESS.
 END……………………

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