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How to convert

to digital x-ray
version 2.0

steps to convert
analog x-ray
to digital x-ray
for crisp digital

How to convert to digital X-ray

Copyright 2016

Table of Contents
For Starters ........................................................................................... Page 4
DR Panel ................................................................................................ Page 6
DR Systems ........................................................................................ Page 10
CR .......................................................................................................... Page 13
Portable X-Ray Systems ................................................................. Page 16
The Next Step ..................................................................................... Page 19

For starters

for starters

Going digital- everything from the watch on your wrist to your copy of The Eagles greatest
hits has done it. Maybe its time for your X-ray room to do the same. While a case can be
made for the classic look of a clock face or the warm crackle and hiss of a needle on vinyl,
theres little doubt that the advantages of digital X-ray technology are better for patients and
practitioners alike.
Digital imaging eliminates processing chemicals, slashes processing time to a fraction, and
streamlines image review and storage. On top of all that, going digital can help X-ray users in
the U.S. avoid heavy 20% reimbursement cuts to film processing that come into effect January
2017. If these advantages pique your interest, this is the right eguide for you.
What New CMS Cuts Mean for X-ray Film Processing
This eguide is designed to take those of you on the cusp of your own digital revolution through
the process with three big ideas:

Methods of going digital

Pros and cons of those methods
The average costs of those methods

At the end of these pages, youll know what your options are, where each option shines (and
doesnt shine), and how much youre likely to spend on each of them. Theres also a bonus
chapter about going digital with your analog portable X-ray unit.
So, as The Eagles suggest, Take It Easy and let us guide you through the basics of going
digital with your X-ray equipment.

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DR panel

DR panel
Installing a digital radiography (DR) panel and computer workstation on your analog room will
allow it to acquire digital images at speed and quality levels commensurate with a factoryborn digital X-ray machine. This method places a digital detector panel in your bucky tray
where a cassette would otherwise go. Then, when an X-ray exposure is taken, the image is
sent directly from the detector to the workstation console for review. Because it offers the
best balance of cost and function, this is the digital conversion method we recommend
most often.

Pros of DR Panels
Within the DR panel conversion method there are a lot of options that can help accommodate
in terms practicality, ease of installation, and cost. These include:
Connection Type
Your choice of connection will have the greatest bearing on the cost of your panel(s)
and the ease of workflow in your scan room.

Tethered detector panels are

connected to the X-ray unit via cable.

Wireless detector panels (as Im sure you

can tell by the name) connect to your X-ray
workstation without cables or cords.

A fixed panel is a good solution for chiropractic rooms or U-arm X-ray

machines. Because there is no table in these settings, the detector
panel is secured in the single bucky tray and remains there.

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DR panel [continued]
Configuration Type
A single-panel configuration uses the same detector panel in both the table bucky
and the wall stand bucky. The panel is moved depending on the study that needs to
be done.
A dual-panel configuration adds a second detector panel to the system. One is placed
(and for the most part left) in the table bucky. The other panel is fitted and bolted into
the wall stand, eliminating the need to move detectors around for different studies.
Panel Compound
Although the differences are worth noting, your choice of panel compound will have
less practical impact than your connection type and configuration. There are two
main chemical compounds found in DR panels:
Cesium Iodide (CsI) detectors feature excellent image quality and lower X-ray
dosage than other detectors. The disadvantage with this option is a higher cost.
Gadolinium oxysulfate (GadOX) detectors are less expensive than CsI and offer
comparable image quality. In terms of radiation, however, these panels require
approximately 10% more dosage than CsI.
DR panel systems will work with any analog radiography system. They can also be shared
with your R/F room or your portable X-ray unit.
A DR panel system requires a low amount of labor to install. This is especially true of
wireless panels, the installation of which is primarily software setup.
DR panel upgrades cost less than replacing an analog system with a factory-born DR
In terms of image acquisition, the average DR panel will have an image captured and
rendered in about 5 seconds. This speed is about ten times faster than a CR (maybe more if
you count walking back and forth from your CR reader) and exponentially faster than film. Its
also about the same as the acquisition speed of a factory-born DR room.
The vast majority of DR panel service concerns can be addressed remotely.
Digital X-Ray Tech Support: Remote vs. On-Site

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DR panel [continued]
Costs of DR Panels
If the buyer opts for a single-panel configuration, there is an increased risk of damage to the
panel from tripping/falling/dropping during the frequent movements. This is especially true
when the panel is tethered.
Because they are frequently used in conjunction with older equipment styles, DR panels dont
have all of the same software integrations and workflow-optimized hardware that factory-born
DR rooms have.

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DR Systems

DR systems
The most direct way to go digital with your X-ray equipment is to completely replace your
analog system with a factory-born digital system. This option is one we dont discuss with
buyers very often due to its very high cost. Still, if your budget will bear it, a factory-born DR
system can produce crisp, clear images and save you substantial time over using film.

Pros of DR Systems
DR rooms are available in the same configuration types as analog rooms to accommodate
(and exceed) patient volume needs, study-specific positioning needs, and installation concerns.
Below are common examples. Note: some of the models mentioned below are available in
multiple configurations

Overhead (GE XR656, Siemens Ysio, Phillips Digital Diagnost)

Integrated (Philips Digital Diagnost)
Floor-mounted (GE Brivo)
U-Arm (Definium 5000 or Z-motion)

So long as an incoming DR room is in the same configuration as the outgoing analog room,
the system will have a similar footprint and there will be a low probability of needing to
remodel your X-ray space. In many cases, this will even be true of a rad room with a different
configuration. The only scenario that will always require remodeling is transitioning from any
of the other configurations to a ceiling-mounted DR room. This will necessitate the installation
of overhead support rails.
The average DR room will have an image captured and rendered in about 5 seconds. This
speed is far ahead of film and CR and about the same as a DR panel upgrade.

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DR systems [continued]
On the refurbished market, the novelty of DR rooms over most analog rad rooms increases the
likelihood that a given DR system will have lower scan times on the X-ray tube and less wear
and tear on other key components.
Newer systems also carry with them the software and applications advances that came along
in years after the manufacture of your analog rad room.

Cons of DR Systems
Of all the digital X-ray conversion methods, buying a factory-born DR room is the most
Installing a full DR room is the most labor-intensive way to go digital. Installation and
calibration of a DR room can take 2-4 days depending on the accessibility of your facility. Add
to that a day on the front end of the project to de-install and remove your analog system.

Costs of DR Systems



New DR Systems
Single Wireless Detector

Semi & Fully-Automated DR Systems

Dual Digital Detectors

A Final Word on DR Systems

If your facility has the budget to accommodate one, a factory-born DR room can yield substantial
dividends in both image quality and throughput. This type of system fits best in new hospital or
imaging center builds, large orthopedic practices with multiple doctors, or high-volume, standalone ER facilities.

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With a CR (computed radiography) reader, your X-ray system takes exposures in the usual
way but uses a CR-specific cassette in place of a traditional film cassette. After the exposure,
the cassette is run through the reader where the image is scanned into a digital format. The
cassette can then be cleared and used for future scans. Among your options for going digital,
CR in the one we least recommend and the one you are likely to replace the soonest.
That said, CR is still preferable to film and, in select circumstances, can be cost-effective. Lets
unpack the pros and cons below.

Pros of CR
Once the CR cassette is inserted in the CR reader, most
current units will have the image rendered digitally in
less than a minute. This method is exponentially faster
than dark room film processing.
Once an image is digitized, storage and transfer are far
simpler and more space-efficient than film.
CR equipment costs the least of any digital X-ray
Installation of a CR is on par with a wireless DR panel
in terms of labor. Once the reader is positioned and
connected to the facility network, the rest of the installation
is software-based.

Cons of CR
Among digital conversion methods, CR has the slowest image acquisition time. The time it
takes to remove the cassette from the bucky tray, take it to the reader, read it, clear it, and
replace it into the bucky, while far faster than film processing, is far slower than the nearly
instantaneous acquisition of other digital conversions.
CR Reader vs. DR Panel: Race Against the Clock [VIDEO]

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CR [continued]
There is no validation of image quality with a CR until after the time has already been spent
to process the cassette. Other conversion methods can show the image on the spot. Think
of the time difference between snapping a picture with your smartphone and clicking a few
buttons to email it to yourself versus standing around shaking a Polaroid until all your kids and
the guy in the foam-rubber Mickey Mouse costume show up. If one of the kids wasnt smiling,
youd waste a lot more time redoing the Polaroid than the smartphone shot.
Because of their mechanical components, CR readers require more maintenance than DR
For United States users, in 2018, CMS will introduce reimbursement cuts of 7% on all scans
processed via CR. These cuts are far less severe than the cuts to film reimbursements that begin
in 2017 but, in a high-volume facility, can still add up over time to a significant dollar loss.

Costs of CR
While the cost of a CR reader itself is relatively low, there are some additional costs involved
with keeping it supplied and maintained. Below are the current average prices for all of these
aspects of CR ownership:

Used CR Reader: $12,000 to $18,000

Cassettes: $800 to $1,200 each (depending on size)
Yearly Service: $7,000 to $9,000

A Final Word on CR
In a nutshell, we dont believe CR will be cost-effective in the long run for U.S. users of for
facilities with mid-high patient volume in other countries. Only low-volume clinics outside the
U.S. may be able to net monetary returns along with the benefits of leaving film behind.

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Portable X-Ray Systems

Portable X-Ray Systems

Portable X-ray systems are a staple in the radiology lineup of most hospitals. Now, as digital
imaging becomes more prevalent in fixed systems, many facilities want to see its benefits in
their portables as well. Theres good news for those facilities: all of the digital conversions
weve discussed so far are available for portable X-ray.

It was mentioned earlier that CR readers are compatible with all X-ray modalities. This includes
portables. The same CR that digitizes your rad room shots can digitize your portable
shots too.

DR Panels
The same panels that you use on your rad room can be used on your portable unit too.
An increasingly popular option for converting an analog portable to a digital portable is trading
in an analog system for money off the purchase of a refurbished portable with a DR panel
upgrade. Below is an example of what a package like this looks like from Block Imaging. The
portable in this scenario is a GE AMX IV.
Complete cosmetic refinishing
New batteries
New high-voltage cables
New casters
New drive wheels and motors
CPU upgrade
Increased vertical column rotation
Complete calibration and testing
Digital Upgrade
Tethered OR wireless flat panel detector
Laptop, tablet, or mounted touchscreen workstation
Acquisition software and applications

With a New Analog System

For situations where maximum portability is crucial, a DR panel works just as well with lightduty systems like the SourceRay SR-130 or the DynaRad Phantom.
Advantages of Wireless DR Panels for Portable X-Ray

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Portable X-Ray Systems [continued]

Portable DR System
Digital portable systems are being manufactured by companies like GE, Fuji, Shimadzu,
and Kodak, but are uncommon on the secondary market. In light of this relative rarity, its
debatable whether or not a factory-born digital portable is worth the extra up-front costs until
prices on digital portables come down and/or their availability on the used and refurbished
market comes up.

A Final Word on Portables

When it comes to choosing how youll
bring your portable capabilities into the
digital age, consider your volume level in
much the same way you would for your
fixed room.
For low to mid volume: Consider sharing
a DR panel between your fixed room and
your portable.
For mid to high volume: Buy a separate
panel for your portable.

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Next steps

next steps
Now that youve got the lowdown on how digital X-ray conversions work, the benefits they offer, and
some ballpark pricing, its time to start thinking about which option might be the best for your facility. If
youre ready to begin, the team here at Block Imaging is ready to help with that.
And if you need to know more along the way, remember that weve got a sales team, project managers,
and service engineers with years of experience to draw from. Feel free to call us: 517.668.8800


request DR panel prices


request a DR demo

For a complete listing of Blocks available systems and services please visit