CR/DR

RADIOLOGY WORKFLOW
1. Patient arrives at hospital for radiologic exam
2. Patient registers in radiology area. (if the patient is new the patient is registered in the
Hospital Information System)
3. Exam ordered at Radiology Information System upon arrival at radiology registration
desk
 Exam accession number is automatically assigned, and a requisition is printed.
4. Technologist receives information from clerk and calls the patient in the waiting area for
exam
5. Patient escorted into the modality room
6. Exam is performed by a technologist
7. Exam is completed
8. Clerk pulls out old films
9. Clerk prepares all the necessary papers and films for radiologist
10. Films are hanged for radiologist’s review
11. Radiologist reviews films (images), check exam record and dictates reports
12. Transcriptionist types the draft report from the dictation
13. Radiologist reviews the report and signs it off
14. Final reports are input into Radiology Information System (RIS) for clinician viewing

Integrating the Healthcare Enterprise (IHE)

- An initiative by h.care professionals and industry to improve the way computer systems
in h.care share information
- Promotes the coordinated use of established standards such as DICOM and HL7 to
address specific clinical needs in support of optimal patient care.
- Systems developed in accordance with IHE communicate with one another better, are
easier to implements and enable care providers to use information more effectively
- Established in 1998
- Sponsored by the Healthcare Information and Management Systems Society (HIMSS),
the Radiological Society of North America (RSNA), and the American College of
Cardiology (ACC)
Integrating the Healthcare Enterprise (IHE) scheduled workflow
- In a setting where exams are normally ordered, Scheduled Workflow Integration Profile
determines the consistency and integrity of fundamental departmental imaging data
acquired.
- It defines a number of transactions that ensure patient and ordering data continuity as
well as specifying the steps of the scheduling and imaging acquisition process.
- It also makes it possible to decide if images and other proof items have been archived
based on a particular performed procedure phase and are available for following
workflow steps, such as reporting, to be enabled.
IHE POST PROCESSING WORKFLOW
1. Patient Information Reconciliation (PIR) – Coordinates patient record reconciliation
when images are acquired for patients who are unidentified or incorrectly identified.
2. Reporting Workflow (RWF) – for reporting tasks, such as dictation, transcription and
verification, provides worklists, status and result tracking
3. The Import Reconciliation Workflow (IRWF) – handles the import of images from CDs,
hardcopies and the reconciliation of local values with identifiers
4. Portable Imaging Data (PDI) – offers accurate image exchange and CD diagnostic reports
to be imported, writer, or optically viewed in a browser
5. Evidence Documents (ED) – explains how data items are produced, shared, and used,
such as digital measurements.
6. The Simple Image and Numeric Report (SINR) – specifies how to create, share and use
diagnostic radiology reports (including images and numeric data)
7. Consistent Image Presentation (CPI) – ensures consistent transformations of strength and
image between various hardcopy and softcopy devices
8. The Display of Clustered Procedures (PGP) – makes it simpler for the individual
requested procedures that the operator has grouped into a single scan to view and report
on photos.
9. Inside a single network, Access to Radiology Information (ARI) shares images. Medical
reports, and related information.

IMAGING PLATE
- In CR, image is captured in thin sheet of plastic known as Imaging Plate, which has
several layers:
 Protective layer
o thin, tough, clear plastic that protects the phosphor layer
 Phosphor (phosphate) / Active Layer
o layer of PSP that traps electrons during exposure
 o usually made of phosphors from the barium fluorohalide family (e.g.,
barium fluorohalide, chlorohalide, or bromohalide crystals)
o may also contain a dye that differentially absorbs the stimulating light to
prevent as much spread as possible and functions much the same as dye
added to conventional radiographic screens
 Reflective layer
 Conductive layer
 Color layer
 Support layer
 Backing layer
Doping Barium Fluorohalide with Europium

 When pure crystals of Barium fluorohalide are dopted with small amount of
Europium, crystals develop a tiny defect called metastable sites of F center (from
german fabzentren or color center)
 F center acts like electronic holes in the crystals that can trap electrons

Laser spot size directly influences the basic spatial resolution and contrast of an image

 Basic Spatial Resolution (SRB) is a definitive measure of the whole imaging systems
ability to resolve fine details.
 In order to achieve a higher SRB and thus allow imaging of smaller indications, a
smaller laser spot is required.

Laser with LARGER SPOT SIZE (50um) Laser with SMALLER SPOT SIZE (12.5um)
MORE signal LESS signal
Better SNR Lower SNR
Higher contrast Lower contrast
Lower resolution Higher resolution

Digital Detectors
 Cassette-Based: Image Storage Phosphor (CR)
o Image intensifier
o Scanned projection
 Direct Digitizing (Full Field)
o CCD camera
o Selenium Flat Panel (“Direct” Digital Radiography)
o Phosphor Flat Panel (“Indirect” DR)
  Future Technology

The Laser
 Laser is an acronym that stands for “Light Amplification by Stimulated Emission of
Radiation”
 Creates and amplifies a narrow, intense beam of coherent light
 Atoms or molecules of a crystal such as a gas, liquid, or substance such as ruby or garnet
are excited so that more of them are at high energy levels rather than low energy levels.

American National Standard Institute (ANSI)

- Coordinates standard development. It accredits Standard Development Organizations
(SDOs) and designates United States Technical Advisory Groups (TAGs) to the
International Organization for Standardization (ISO).
- All accredited organizations must accept the internally accepted principles of
standardization: transparency, openness, impartiality, effectiveness and relevance,
consensus, performance0based, coherence, due process, and technical assistance.
- ANSI-designated SDOs; Health Level Seven (HL7) and National Electrical
Manufacturer’s Association.

International Organization for Standardization (ISO)

- Is an independent, non-governmental, international organization that develops standards
to ensure the quality, safety, and efficiency of products and it does in order to certify
business or organizations.
- It ensures quality and safety in both products and services in international trade. The ISO
standards can help cut costs by improved systems.

Health Level Seven (HL7)

- Was founded on March 1987
- Organized by a user-vendor committee to create a standard for electronic data exchange
in healthcare settings, particularly for hospital applications.
- Standard development organization
- Develops specifications to structure, encode and exchange patient healthcare information.
The primary objective is to ease exchange between healthcare systems.
- Standard for the exchange of files between healthcare information systems
 - Main purpose is to require the formatting and structure of information exchange: it does
not define the definite technical details of how the information is to be delivered from
one system to another.
- The goal of HL7 is to enhance interoperability between healthcare information systems
(HISs) that have implement it. It focuses on the interfaces between dissimilar HISs by
creating a common data exchange language using prebuilt messages. However, HL7 does
not dictate system architecture or how data is stored in an application.
- HL7 is a transaction-based protocol that is driven by events such as the admittance of a
patient to a hospital.

SEVEN (7) LAYERS OF OSI MODEL

Physical  Physical structure

 Coax, Fiber, Wireless, Hubs , Repeaters
Data Link  Frames
 Ethernet, PPP, switch, Bridge
Network  Packets
 IP, ICMP, IPSec, IGMP
Transport  End-to-end connections
 TCP, UDP
Session  Synch & send to port
 API’s, sockets, WinSock
Presentation  Syntax layer
 SSL, SSH, IMAP, FTP, MPEG, JPEG
Application  End user layer
 HTTP, FTP, IRC, SSH, DNS

Open Systems Interconnection (OSI) reference model is a conceptual framework that

describes functions of the networking or telecommunication system independently from the
underlying technology infrastructure. It divides data communication into seven abstraction layers
and standardizes protocols into appropriate groups of networking functionality to ensure
interoperability within the communication system regardless of the technology type, vendor, and
model.

National Electrical Manufacturers Association (NEMA)

- Largest trade association of electrical equipment manufacturers in the US.
- Founded in 1926, it advocates for the industry, and publishes standards for electrical
products.
HyperText Markup Language (HTML)
- a set of markup symbols or codes inserted into a file intended for display on the internet.
The markup tells web browsers how to display a web page’s words and images.
- computer language that facilitates website creation.
Command Description
< P > .< /P> Beginning and end of paragraph
< B> .< /B> Beginning and end of bold text
< Hn> .< /Hn> Beginning and end of header text
( 1 – n – 6)
< UL> .< /UL> Beginning and end of unnumbered list
< LI> Item in list
< HTML> .< /HTML> Beginning and end of HTML

WHAT IS COMPUTED RADIOGRAPHY?

 Generic term applied to an imaging system comprised of:
1) Photostimulable Storage Phosphor to acquire the x-ray projection image
2) CR Reader to extract the electronic latent image
3) Digital electronics to convert the signals to digital form

CR
The digital replacement of conventional x-ray film radiography and offers enormous
advantages for inspection tasks – the use of consumables is virtually eliminated and the
time to produce an image is drastically shortened

CR system also known as:

SP

 Storage Phosphors (PSP)

DLR

 Digital Luminescence Radiography

PSL

 PhotoStimulable Luminescence Radiography

CR vs DR
CR DR
Imaging Plate CCD, TFT, or photodiode receiver (like
Bucky)
Processed in a digital reader Directly into digital signal
Signal sent to computer Seen immediately on monitor
Viewed on a monitor

Multipurpose Internet Massage Extensions (MIME)

- Prior to MIME, e-mail messages could only include ASCII text. With the advent of
MIME, e-mail messages could be extended to include many different non-textual content
elements including DICOM images.

Q&A
international organization with a formalized process to develop technical framework that specify
precisely how standards shall be used to solve specific problems.
× IHE
What standard exist in Integration Challenges and General IT Standards?
× Operating System and Programming Languages
Primary role is to collect, manage, store, and transmit the electronic medical record, or EMR, of
a particular patient
× HIS
Measure of the signal response of a detector that is exposed to x-rays
× Dynamic range
Display of the digital image at a computer workstation
× Softcopy
The pixel ____ determines the system’s ability to display a range of shades of gray represent
anatomic structure
× Bit depth
Photoconductor absorbs x-rays. TFT collects signal. Electrical signal is sent to computer for
processing. Image is viewed on computer screen.
× Direct capture

Protocol that allows extension of email messages to include non-textual content including medical
images

× MIME

The greater the MATRIZ SIZE, and the smaller the PIZEL SIZE, the greater the SPATIAL RESOLUTION