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Chapter 1

Introduction to Digital Radiography
and PACS

Elsevier items and derived items © 2008 by Mosby, Inc.,

1

Objectives

Define the term digital imaging.
Explain latent image formation for conventional
radiography.
Describe the latent image formation process for
computed radiography.

Elsevier items and derived items © 2008 by Mosby, Inc.,

2

Objectives

Compare and contrast the latent image formation
process for indirect capture digital radiography and
direct capture digital radiography.
Explain what a PACS (picture archiving and
communication system) is and how it is used.
Define digital imaging and communications in
medicine.

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Key Terms         Computed radiography DICOM (digital imaging and communications in medicine) Digital imaging Digital radiography Direct capture DR Indirect capture DR PACS Teleradiology Elsevier items and derived items © 2008 by Mosby.. Inc. 4 .

Method uses intensifying screens.Conventional Radiography       Method is film-based. Film is processed chemically. 5 . Film is placed between two screens. Processed film is viewed on lightbox. Inc. Screens emit light when x-rays strike them. Elsevier items and derived items © 2008 by Mosby..

In radiology. 6 . Digital imaging is defined as any image acquisition process that produces an electronic image that can be viewed and manipulated on a computer. images can be sent via computer networks to a variety of locations.. Inc.Digital Imaging     Digital imaging is a broad term. Term was first used medically in 1970s in computed tomography (CT). Elsevier items and derived items © 2008 by Mosby.

First CT scanners imaged the head only. Inc. Elsevier items and derived items © 2008 by Mosby..Historical Development of Digital Imaging      CT coupled imaging devices and the computer. Early CT scanners required hours to produce a single slice. Reconstruction images took several days to produce. First scanner was developed by Siemens. 7 .

Lauterbur paper in 1973 sparked companies to research MRI. Many scientists and researchers were involved. Inc. Elsevier items and derived items © 2008 by Mosby. Analog-to-digital converters allowed real-time images to be viewed on TV monitors. 8 ..Historical Development of Digital Imaging      Magnetic resonance imaging (MRI) became available in the early 1980s. Advancements in fluoroscopy occurred in the 1970s as well.

Inc. Elsevier items and derived items © 2008 by Mosby. Ultrasound and nuclear medicine used screen capture to grab the image and convert it digitally. 9 .Historical Development of Digital Imaging    Fluoroscopic images could also be stored on a computer.. mammography converted to digital format. Eventually.

Development was encouraged and supported by the U. Inc. 10 . government..S. Early PACS systems were developed by the military to send images between Veterans Administration hospitals in the 1980s. Elsevier items and derived items © 2008 by Mosby.Digital Radiography Development    Concept began with Albert Jutras in Canada in the 1950s.

Digital Radiography Development    Early process involved scanning radiographs into the computer and sending them from computer to computer.. Computed and digital radiography followed. Elsevier items and derived items © 2008 by Mosby. Images were then stored in PACS. 11 . Inc.

Computed Radiography      Uses storage phosphor plates Uses existing equipment Requires special cassettes Requires a special cassette reader Uses a computer workstation and viewing station and a printer Elsevier items and derived items © 2008 by Mosby.. 12 . Inc.

a reader.. and a laser printer. Imaging plate stores x-ray energy for an extended time. First system used a phosphor storage plate. Elsevier items and derived items © 2008 by Mosby. Process was first introduced in the United States by Fuji Medical Systems of Japan in 1983. Inc. 13 .Computed Radiography     Storage phosphor plates are similar to intensifying screens.

Installation increased in the early 1990s. Elsevier items and derived items © 2008 by Mosby.. 14 .Computed Radiography    Method was slow to be accepted by radiologists. More and more hospitals are replacing film/screen technology with digital systems. Inc.

.Digital Radiography    Cassetteless system Uses a flat panel detector or charge-coupled device (CCD) hard-wired to computer Requires new installation of room or retrofit Elsevier items and derived items © 2008 by Mosby. Inc. 15 .

Digital Radiography   Two types of digital radiography Indirect capture DR • • • • Machine absorbs x-rays and converts them to light. Computer processes electric signals. Elsevier items and derived items © 2008 by Mosby.. 16 . Images are viewed on computer monitor. CCD or thin-film transistor (TFT) converts light to electric signals. Inc.

Image is viewed on computer screen.Digital Radiography  Direct capture DR • • • • Photoconductor absorbs x-rays. Inc. Electrical signal is sent to computer for processing. 17 . Elsevier items and derived items © 2008 by Mosby. TFT collects signal..

Elsevier items and derived items © 2008 by Mosby.Digital Radiography    First clinical application was in 1970s in digital subtraction.. 18 . Several companies began developing large field detectors. Inc. University of Arizona scientists applied the technique.

Elsevier items and derived items © 2008 by Mosby.Digital Radiography    DR used CCD technology developed by the military and then used TFT arrays shortly after.. No one technology has proved to be better than the other. 19 . CCD and TFT technology developed and continues to develop in parallel. Inc.

Elsevier items and derived items © 2008 by Mosby.Comparison of Film to CR and DR     For conventional x-ray film and computed radiography (CR). a traditional x-ray room with a table and wall Bucky is required.. Conventional and CR efficiency ratings are about the same. DR is much more efficient. and image is available immediately. a detector replaces the Bucky apparatus in the table and wall stand. For DR. Inc. 20 .

. and light is produced. 21 . Inc. X-rays strike the intensifying screen. Elsevier items and derived items © 2008 by Mosby.Comparison of Film to CR and DR  Latent image formation is different in CR and DR. The light and x-ray photons interact with the silver halide grains in the film emulsion.  Conventional film/screen • • • Film is placed inside of a cassette that contains an intensifying screen.

and silver ions will be attracted to equal out the charge. Speck now has a negative charge. Ejected electron is attracted to the sensitivity speck. After chemical processing. Elsevier items and derived items © 2008 by Mosby. 22 . Inc.. the sensitivity specks will be processed into black metallic silver and the manifest image is formed. Process happens many times within the emulsion to form the latent image.Comparison of Film to CR and DR • • • • • An electron is ejected from the halide.

some light is given off. Some of the photon energy is deposited within the phosphor particles to create the latent image.Comparison of Film to CR and DR  CR • • • • • A storage phosphor plate is placed inside of CR cassette. Inc. Elsevier items and derived items © 2008 by Mosby. The phosphor plate is then fed through the CR reader.. Most storage phosphor plates are made of a barium fluorohalide. When x-rays strike the photosensitive phosphor. 23 .

24 . The electrical signal is then sent through an analog-to-digital converter to produce a digital image that can then be sent to the technologist review station. emitting light in the process.Comparison of Film to CR and DR  CR. Elsevier items and derived items © 2008 by Mosby. causing the electrons to return to their original state. This light is picked up by a photomultiplier tube and converted into an electrical signal. Inc.. continued • • • Focused laser light is scanned over the plate.

25 .Comparison of Film to CR and DR  DR • • • No cassettes are required. Elsevier items and derived items © 2008 by Mosby.. Two distinct image acquisition methods are indirect capture and direct capture. The image acquisition device is built into the table and/or wall stand or is enclosed in a portable device. Inc.

With direct capture.Comparison of Film to CR and DR  DR. the x-ray energy is detected by a photoconductor that converts it directly to a digital electrical signal. continued • • Indirect capture is similar to CR in that the x-ray energy stimulates a scintillator. 26 . which gives off light that is detected and turned into an electrical signal. Inc.. Elsevier items and derived items © 2008 by Mosby.

Elsevier items and derived items © 2008 by Mosby.. CR and DR • • • Image processing takes place in a computer. the computer is located near the readers. For DR. Inc. and the image is processed before moving on to the next exposure. or it may be integrated within the console.Image Processing  Conventional radiography •  Image is determined by the film itself and the chemicals. For CR. 27 . the computer is located next to x-ray console.

Exposure Latitude or Dynamic Range  Conventional radiography • • • Based on the characteristic response of the film. Inc. Elsevier items and derived items © 2008 by Mosby. Optical density on film is primarily controlled by milliamperesecond setting. which is nonlinear. Radiographic contrast is primarily controlled by kilovoltage peak. 28 ..

Milliampere-second setting has more control over image noise.. whereas density is controlled by image-processing algorithms. allowing the single detector to be sensitive to a wide range of exposures. Kilovoltage peak still influences subject contrast.Exposure Latitude or Dynamic Range  CR and DR • • • • Contain a detector that can respond in a linear manner. Elsevier items and derived items © 2008 by Mosby. Inc. 29 . but radiographic contrast is primarily controlled by an image processing look-up table. Exposure latitude is wide.

Inc..Scatter Sensitivity    It is important to minimize scattered radiation with all three acquisition systems. CR and DR can be more sensitive to scatter than screen/film. Elsevier items and derived items © 2008 by Mosby. Materials used in the many CR and DR image acquisition devices are more sensitive to low-energy photons. 30 .

ondemand images. and specialty image processing Elsevier items and derived items © 2008 by Mosby.. 31 . and archives to store digital images Can accept any image that is in DICOM format Serves as the file room. electronic annotations of images. Inc. and courier Provides image access to multiple users at the same time. servers. duplicator. reading room.Picture Archival and Communication Systems     Networked group of computers.

Inc.Picture Archival and Communication Systems   Custom designed for each facility Components/features can vary based on the following: • • • • Volume of patients Number of interpretation areas Viewing locations Funding Elsevier items and derived items © 2008 by Mosby. 32 ..

DICOM standards helped change this by allowing communication between vendors’ products. Vendors kept systems proprietary and did not share information.Picture Archival and Communication Systems     Early systems did not have standardized image formats. Matching up systems was difficult. Inc.. 33 . Elsevier items and derived items © 2008 by Mosby.

hospital information systems. PACS was interfaced with radiology information systems.Picture Archival and Communication Systems  First full-scale PACS • • • Veterans Administration Medical Center in Baltimore used PACS in 1993.. Inc. Elsevier items and derived items © 2008 by Mosby. PACS covered all modalities except mammography. and electronic medical records. Shortly after. 34 .

35 .. Inc.PACS Uses  Made up of different components • • • • • • • Reading stations Physician review stations Web access Technologist quality control stations Administrative stations Archive systems Multiple interfaces to other hospital and radiology systems Elsevier items and derived items © 2008 by Mosby.

36 . PACS reading stations may also have image processing capabilities. PACS now can be used in multiple departments. PACS allows radiologists to reconstruct and stitch images in their offices. Archive space can be shared among departments. Inc.PACS Uses      Early PACS seen only in radiology and some cardiology departments. Elsevier items and derived items © 2008 by Mosby..

Elsevier items and derived items © 2008 by Mosby. 37 . System saves time and provides better fit.PACS Uses  Orthopedic workstations are available for the following: • • • Surgeons can plan joint replacement surgery.. Specialized software allows matching of best replacement for patient with patient anatomy. Inc.