George David

Associate Professor of Radiology

1
Medical College of Georgia
Computed
Computed Radiography
Radiography (CR)
(CR)
• Re-usable metal imaging plates replace film &
cassette
• Uses conventional bucky & x-ray equipment

                                                                  

2
CR
CR Exposure
Exposure &
& Readout
Readout

3
CR
CR Readout
Readout

4
Another
Another View:
View: CR
CR Operation
Operation

5
 Computer
Computer Radiography
Radiography (CR)
(CR)
• plate is
photostimulable
phosphor
Higher Energy
• radiation traps - Electron

electrons in St at e

high energy
states Photon pumps
electron to
• higher states X-Ray higher energy state

form latent Photon

image Lower Energy - - - - - -

- -
- - -
- -
Electron - - - -
-
St ate - - - - - - -
- -
6
 Reading
Reading Imaging
Imaging Plate
Plate
• reader scans plate with laser
• laser releases
electrons trapped in
high energy
states La se r Be am

• electrons fall to low

energy states
• electrons give up Hig her Ene rg y
energy as visible light Ele c t ro n -
St a t e
• light intensity is
measure of incident
radiation
Lower Energy
Electron State

Lower Ene rg y - - - - - - -
- -
Ele c t ro n - - - - -
- - - -
St a t e - - - - - - - - 7
-
 Reading
Reading Imaging
Imaging Plate
Plate
• Reader scans
plate with laser
light using rotating
mirror
• Film pulled
through scanner
by rollers
• Light given off by
plate measured by
PM tube &
recorded by
computer

8
 Laser
Laser &
& Emitted
Emitted Light
Light are
are Different
Different Colors
Colors
• Phosphor stimulated by laser light
• Intensity of emitted light indicates amount of radiation incident
on phosphor at each location
• Only color of light emitted by phosphor measured by PMT

9
 CR
CR Operation
Operation

• after read-out, plate erased

using a bright light
• plate can be erased virtually
without limit
• Plate life defined not by erasure
cycles but by physical wear

10
 CR
CR Phosphor
Phosphor Layer
Layer
• Phosphor balanced for
 x-ray absorption characteristics
 light output
 laser light scatter
 screen thickness

• Above variables affect

 electronic noise
 image resolution properties
 speed of imaging system

• Overcoat protects plate from

physical damage
11
 CR
CR Resolution
Resolution
• Small cassettes have better
spatial resolution
Smaller pixels
More pixels / mm

12
 CR
CR Throughput
Throughput
• Generally slower than
film processing
• CR reader must finish
reading one plate

the next
 
before starting to read
  
• Film processors can
  
run films back to back
  
  
  
  
13
  
 CR
CR Latitude
Latitude
• Much greater latitude
than screen/film
• Plate responds to many
decades of input
exposure
 under / overexposures
unlikely
  
 
• Computer scale inputs   
exposure to viewable   
densities   
 Unlike film, receptor   
separate from viewer    14
  
Film
Film Screen
Screen vs.
vs. CR
CR Latitude
Latitude

CR Latitude: .
01 – 100 mR

100
15
CR
CR Very
Very Sensitive
Sensitive to
to Scatter
Scatter

16
 Digital
Digital Radiography
Radiography (DR)
(DR)
• Digital bucky
• Incorporated
into x-ray
equipment

17
 Digital
Digital Radiography
Radiography
(DR)
(DR)
• Receptor provides direct digital output
• No processor / reader required
 Images available in < 15 seconds
 Much less work for technologist

18
 Direct
Direct vs.
vs. Indirect
Indirect

TFT = THIN-FILM TRANSISTOR ARRAY19

 “Direct”
“Direct” DR
DR
• X-ray energy
converted directly
to electrical signal
• X-rays interact
with
semiconductor
material
 Amorphous selenium

• X-rays converted
directly into
electrical charge
 No intermediate steps

20
 “Indirect”
“Indirect” DR
DR
• X-ray strike scintillator producing
light
• Photodiode array converts light to
electrons

Light

21
 Indirect
Indirect DR
DR
• Light spreads can limit spatial resolution
• Can be controlled by “channeling”
• Winning in the marketplace

22
 Digital
Digital Radiography
Radiography
(DR)
(DR)
• Potentially lower patient dose
than CR
• High latitude as for CR
• Digital bucky fragile
First DR portables coming
to market

23
 Summary
Summary

• DR becoming industry leader in

radiographic imaging
• DR images displayed & stored in
about 8 seconds
• DR has faster throughput
Up to 2-4 times faster than traditional
screen-film-darkroom technology

24
 Raw
Raw Data
Data Image
Image
• Unprocessed image as read from
receptor
 CR
» Intensity data from PMT’s as a result of scanning
plate with laser
 DR
» Raw Data read directly from TFT array

• Not a readable diagnostic image

• Requires computer post-
processing
 Specific software algorithms must be
applied to image prior to presenting it as
finished radiograph
25
* Enhancing
Enhancing Raw
Raw Image
Image
(Image
(Image Segmentation)
Segmentation)
1. Identify collimated image
border
2. Separate raw radiation
from anatomy
3. Apply appropriate tone-
scale to image
 Done with look-up table (LUT)
LUT

26
 Look
Look Up
Up Table
Table (LUT)
(LUT)
• Converts a raw
data pixel value to
a processed pixel
value
• “Original” raw
data pixel value
indicates amount
of radiation falling
on pixel
27
 Image
Image Segmentation
Segmentation
• Computer must establish location of
collimated border of image

• Computer then defines

anatomic region

• Finished image produced by

tone scaling
Requires histogram analysis of
anatomic region 28
 Histogram
Histogram

• Graph
showing how
much of
image is
exposed at
various levels

29
 Tone
Tone Scaling
Scaling
Post-Processing
Post-Processing
• Body part & projection-specific
algorithms determine average
exposure
Must correctly identify anatomical region
• LUT computed to display image with
proper
Density
Contrast

30
 LUT
LUT can
can Simulate
Simulate
Appearance
Appearance of
of Film
Film

31
 LUT
LUT Selection
Selection
• LUT
calculated
by algorithm
depends on
Body part
projection
• User can
also alter
LUT
manually
32
 LUT
LUT Selection
Selection
• Monitors on CR
reader or DR
console compared
to reading
workstations have
lower resolution
poorer quality
Recommended that
LUT not be manually
modified

33
 Film/Screen
Film/Screen Limited
Limited Latitude
Latitude

• Film use
has little
ambiguity
about
proper
radiation
exposure

34
Should
Should II Worry?
Worry?

In CR & DR,
image density is
no longer a
reliable indicator
of exposure factor
control.

35
36
 CR
CR // DR
DR Latitude
Latitude
DANGER
Will
Robinson!!!
• Almost impossible to
under or overexpose CR /
DR
• Underexposures look
noisy
• Overexposures look
GOOD!!!
37
 Exposure
Exposure Creep:
Creep
Creep:
Creep
Tendency
Tendency of
of radiographs
radiographs toward
toward
higher-then-necessary
higher-then-necessary exposures
exposures
• No detrimental effect on image quality
• Desire to see less noise on radiographs
• Increased exposure latitude
• No one complains

38
 So
So how
how do
do II know
know ifif exposure
exposure is
is
optimum
optimum by
by looking
looking atat my
my image?
image?

39
40
 Exposure
Exposure Index
Index

• Each manufacturer provides feedback to

technologist on exposure to digital
receptor
• Displayed on CR reader monitor
• Displayed on workstations

41
 Exposure
Exposure Index
Index
• Measure of radiation received by receptor
below anatomy
• Not a direct measure of patient exposure
• If exposure index higher than
recommended range, patient
overexposed

42
Exposure
Exposure Indication
Indication Varies
Varies
between
between Manufacturers
Manufacturers
Receptor Kodak Fuji S
Exposure EI Number
0.5 1700 400
1 2000 200
2 2300 100
4 2600 50
Kodak Fuji
 Logarithmic scale  “S” number goes down
 EI goes up 300 when as exposure goes up!
exposure doubled  S is half when
exposure doubled
43
 Exposure
Exposure Index
Index
• Technologist should strive to keep
exposure index consistent
• Kodak recommendation for exposure
index
1800 – 2200
• George’s recommendation
“Maximum tolerable noise”
As low as possible while providing
tolerable noise
This is not a beauty contest!

44
Calculated
Calculated Exposure
Exposure
Index
Index Affected
Affected by
by

• X-Ray technique selection

• Improper centering of image on
cassette
• Improper selection of study or
projection
• Placing two or more views on
same cassette
 Can cause image to appear dark
45
Phototimed
Phototimed Phantom
Phantom Image
Image

• 75 kVp
• 88 mAs
• 2460 EI

46
Let’s
Let’s Approximately
Approximately Double
Double mAs
mAs

• 75 kVp • 75 kVp
• 88 mAs • 160 mAs
• 2460 EI • 2680 EI 47
 Let’s
Let’s Go
Go Crazy
Crazy

• 75 kVp • 75 kVp
• 88 mAs • 640 mAs
• 2460 EI • 3300 EI 48
How
How Low
Low Can
Can You
You Go?
Go? Cut
Cut mAs
mAs in
in Half!
Half!

• 75 kVp • 75 kVp
• 88 mAs • 40 mAs
• 2460 EI • 2060 EI 49
 Let’s
Let’s Go
Go Crazy
Crazy Low
Low

• 75 kVp • 75 kVp
• 8 mAs • 1 mAs
• 1380 EI • 550 EI 50
 CR
CR Artifacts
Artifacts

• Physical damage to imaging

plates
Cracks, scuffs, scratches
Contamination
Dust / dirt
• Dirt in reader
• Highly sensitive to scatter
radiation
51
 CR
CR Grid
Grid Interference
Interference
• 103 lines / inch grids have same frequency
as CR laser scanner. This can cause
“Moire” pattern artifact
• Align grid lines perpendicular to scan
orientation whenever possible
 Reduces chances of artifacts caused by laser scanner.

52
 DR
DR Artifacts
Artifacts

• Dead detector elements

• Spatial variations in
background signal & gain
• Grid interference
• Software can help correct for
above

53
 Shifting
Shifting Gears:
Gears:
Fluoroscopy
Fluoroscopy Issues
Issues

54
 Digital
Digital Video
Video Sources
Sources
• DR type image receptor
• Conventional Image Intensifier with Video
Signal Digitized (“Frame Grabber”)

Image
T mI
u
b ga
Tube
e e
TV

X-Ray Lens System

Input

Amplfier

Analog Digital
to Memory
Digital (Computer)
Convert
55
er
 Digital
Digital Spot
Spot Film
Film
• Frame grabber digitizes image
• Digital image saved by computer
• Radiographic Technique used
 required to control quantum noise

56
 Last
Last Image
Image Hold
Hold
• Computer displays last fluoro image
before radiation shut off.
• Image noisier than for digital spot
 Image made at fluoroscopic technique / intensity

• Allows operator to review static

processes without keeping beam on
 ideal for teaching environments
 ideal for orthopedic applications such as hip
pinning
• Less radiation than digital spot
57
 Fluoro
Fluoro Frame
Frame
Averaging
Averaging
• Conventional fluoro only displays
current frame
• Frame averaging allows computer
to average current with user-
selectable number of previous
frames
Averages current frame & history

58
 Fluoro
Fluoro Frame
Frame
Averaging
Averaging Tradeoff
Tradeoff

• Advantage:
Reduces quantum noise

• Disadvantage
Because history frames are averaged with
current frame, any motion can result in lag

59
 Other
Other Fluoro
Fluoro
Features
Features
• Real-time Edge Enhancement /
Image Filtering
• Option of using lower frame rates
(15, 7.5, 3.75 fps rather than 30)
computer displays last frame until next
one
» reduces flicker
Lowers patient and scatter exposure
» Exposure proportional to frame rate
dynamic studies may be jumpy
60
The
The Future
Future of
of Digital
Digital

61
 DR
DR Mobile
Mobile Units
Units
• See image
immediately
• Wireless
transmission of
images

62
 Other
Other Possibilities
Possibilities
• Tomosynthesis
Multi-slice linear tomography from
one exposure series
• Histogram Equalization
Use computer to provide
approximately equal density to
various areas of image.

63
DR
DR &
& Energy
Energy Subtraction
Subtraction
• 2 images taken milliseconds
apart at 2 different kVp’s
• Combine / subtract images

Soft Tissue Image Bone Image

64
The
The End
End

?
65