12th September, 2009

DIGITAL RADIOGRAPHY
Moderator:
Mr. Ram Singh (Lecturer) Deptt. of Radio-Diagnosis & Imaging PGIMER, Chandigarh-160012

Presented By:
Debendra Prasad Gupta
M. Sc. Med. Tech. (Radiodiagnosis) – 1st Year Student Deptt. of Radio-Diagnosis & Imaging PGIMER, Chandigarh-160012
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DIGITAL RADIOGRAPHY:
Definition: 

It is defined as the image data acquired from the numeric value i.e. in discrete binary digits by use of computers . Whereas in Conventional Radiography information is represented in the analog or continuous form rather than a discrete fashion.
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History: 

In 1980 researchers at “Fuji Laboratories” developed an erasable X-ray imaging device based on the x-ray excitation of a phosphor layer and subsequent reading of the stored image data with the help of infrared laser (i.e. Photostimulable Luminescence). Results showed that the imaging plate was more sensitive than conventional X-ray Film with intensifying screens.
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INTRODUCTION:

Since the clinical use of x-rays in 1895, majority of radiographic examinations have been carried out by the conventional method. The beam is projected through the patient and the transmitted beam, which has information about the body structures, is made to strike the cassette containing the film and the intensifying screens. This way the latent image is produced on the film. The latent image can be made visible and permanent by processing it with suitable chemicals. This conventional method of obtaining radiographs has dominated the field of radiography for many years. But now, it has been realized that the FS system has its own limitations.

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LIMITATIONS OF FS:
1. 2.

3.

4.

After the film has been exposed, the information contents cannot be enhanced. If the radiograph is too dark (Over-Exposed) or too light (Under-Exposed) either by Exposure Factor, Film Fault or Processing Faults, it has to be repeated i.e. No PostProcessing option which results in extra exposure to the patient. The completion of the examination is delayed as the film has to be processed to convert the latent image into a permanent one. A magnifying glass may be required to see very small structures in detail i.e. No Zooming & Panning Option.
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Cont…
5. 6. 7. 8. 9. 

Copied radiographs are of inferior quality than original ones. The film is a physical object and so it requires considerable more space for storage i.e. Storage & Retrieval Cost. Films can only be in one place at a time and they also get deteriorated with passage of time. Film can not be stored for longer time when required. Dynamic range of x-ray film is limited (i.e. 0.2 – 3). These limitations can be overcome by the incorporation of computer technology into the diagnostic x-ray imaging. With DR system conventional analog information is converted into digital form, processing the digital data and displaying the image on the monitor that surprisingly looks like a conventional image.
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MILESTONE IN DIGITAL RADIOGRAPHY:
Year 1980 1983 1990 1994 1995 1995 1997 2001 Development: Scan Projection Radiography (SPR). Computed Radiography (CR), Storage Phosphors. Charge-Coupled Device (CCD) Slot-Scan Direct Radiography (DR). Selenium Drum Direct Radiography (DR). Amorphous Silicon - Based–Cesium Iodide ( Scintillator ) Flat-Panel Detector in Indirect DR. Selenium-Based Flat-Panel Detector in Direct DR. Amorphous Silicon-Based - Gadolinium ( Scintillator ) FlatPanel Detector in Indirect DR. Dynamic Flat-Panel Detector for Digital Fluoroscopy in DSA.

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According to the nature, design and function of the detector the Digital radiography can be divided mainly in the following way: -

Digital Radiography (DR)

SPR

CR
Indirect Conversion
Storage Phosphor Plate (IP) BaFX:Eu+2

DR

NaI – Scintillator Photodiode

Indirect Conversion
Scintillator + CCD
CsI:Tl or CsI:Na & Gd2O2S:Tb3+

Direct Conversion
Selenium Drum Photoconductor + TFT (a:Se-DFPD)

Scintillator + Photodiode (a:Si) + TFT (IFPD)

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SCAN PROJECTION SYSTEM:

Earlier Scan projection radiography (SPR) was performed on a computer tomography CT system by translating the patient through the CT gantry aperture. It is based on CT–Technology, another projection radiography technique was developed using a narrow fan beam of X-Rays intercepted by linear array of detectors called “Scan Projection Radiography”. Basically, SPR involves the use of the existing CTGantry & Computer to generate an image that looks surprisingly like Conventional Radiography.
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SPR Cont…

The X-ray beam is shaped into a fan by collimators that confine the beam to a 2-10 mm thickness through on arch of 300 – 450. There are two collimators: 1)

The pre-patient collimators which shape the beam, reduced scatter radiation & control patient dose. The post-patient collimators which further reduce the scatter radiation rejection.
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2)

SPR Cont…

PRINCIPLE OF S.P.R.:

X-Ray beam after passing through patient is detected by detector array. The signal have been image information of the body parts are transferred to the computer where they get digitized & processed to reconstruct the image. To obtain a complete image of the body part, X-Ray tube & detector assembly remains stationary & the patient is translated through the X-ray beam or alternatively patient remains stationary, while the X-Ray tubedetector assembly translates .

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SPR Cont…

COMPONENTS OF S.P.R. SYSTEM:
1. 2. 3. 4.

X-Ray Tube. Pre-Patient Collimator. Post-Patient Collimator. Detector Array.

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SPR Cont…

X-RAY TUBE ASSEMBLY:
X-Ray tube of high heat loading capacity usually above 1 MHu is required because of long imaging time. Usually 20 – 50 cm body part of patient is imaged at a translation speed of 1 – 20 cm/s. Two types of detector can be used: 1. A Gas Filled. 2. Scintillation Detectors couple with Solid State Photodiode, i.e. CCD.

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SPR Cont…

Advantage: In SPR X-ray beam is collimated in a fan x-ray beam by PrePatient & Post-Patient Collimators . i.e.: 1. 2. 3. 4.

High Amount of Associated Scatter Rejection. High Radiographic Image Contrast. High Dynamic Range (i.e. Low Contrast Detectibility). Image Manipulation. Scanning Time is More. Poor Spatial Resolution & More Radiation Dose to the patient.
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Disadvantages: 1. 2. 3.

ADVANCEMENT:

At the present time, SPR is re-emerging with some modification as a promising adjunct to Digital Mammography Tomosynthesis (DMT). The purpose of all forms of Tomography is to improve image contrast, and i.e. the goal of Digital Mammography Tomosynthesis (DMT).
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COMPUTED RADIOGRAPHY:
Definition:  Digital way of doing General Radiography with Conventional X-ray machines except Conventional Screen/Film and dark room is known as Computed Radiography. Principle:  It is based upon Photostimulated Luminescence in which the radiographic data is captured from a conventional X-ray machine and processed the data digitally to produce crisp and high quality radiographic images.
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Working:

The CR Cassette is exposed with transmitted x-rays beam in a similar fashion as the conventional cassette. The latent image is formed in the phosphor layer of the Imaging Plate in the form of Electrical Charge . Then the latent image is made visible on monitor by processing or scanned and read that exposed imaging plate by a laser scanning device called Image Reader. The output signal from the image reader is fed to an image array processor where the digital gray – scale image is formed. The digital image generated by the image reader is stored temporarily on a local hard disk which is processed a/c to need and the resulting image can be displayed either as soft (Video Display) copy on monitor or send it directly to laser printer that make hard (Film) copies of the digital image. The digital image can then be stored on an optical or magnetic disk for long term archiving or connected to the PACS through DICOM for Teleradiology.
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COMPONENTS OF THE C.R. SYSTEM:
1.) General X-ray Equipment: 3.) Image Reader: -

2.) Image Recorder: 4.) Image Processor: Cassette With Imaging Plate
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CASSETTE:
Material: • • • •

Body: - ABS ( Acrylonitryl butadiene styrene). Corners: - PUR (Polyurethane rubber). Hinges: - PP (Polypropylene). Inner lining: - Felt. Same as that of conventional cassette. Embedded memory chip. Contactless RF identification. 150 μm lead.

Sizes: •
• • •

Identification: -

Backscatter Protection: -

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THE IMAGING PLATE (IP):

The Imaging Plate (IP) is also known as Computed Radiography (CR) Plate or Storage Phosphor Screen (SPS) or Photostimulable Phosphor (PSP) detector to record the radiographic image in place of the conventional film/screen cassette. The imaging plate is housed in a rugged cassette & appears similar to a screen/film cassette. It is available in the same sizes as conventional cassettes. It is handled in the same manner as a screen/film cassette.
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Cont…

It is not loaded & unloaded in a dark room. Rather, it is handled in the manner of a screen/film daylight loader. A typical IP can store a latent image for a considerable period of time. However, it will lose about 25% of the stored signal b/w 10 min. to 8 hrs after an exposure resulting in the loss of energy through spontaneous phosphorescence. It retains the image for 24 hours, but some degradation may occur with passage of time. Imaging plate shows a linear response to the intensity of x-ray exposure over a broad range.
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CONSTRUCTION OF IMAGING PLATE (IP):
PROTECTIVE LAYER

Protective layer : -

PHOSPHOR LAYER ANTI-HALO & REFLECTIVE LAYER BASE BACKING LAYER

- Fluorinated Polymer Material
Phosphor Layer: - Ba FX: Eu +2 , 0.4mm thick.

Anti-halo Layer + Reflecting Layer
- Prevent laser light from passing through.

Base:- PET- Polyethylene teraphtalate

Backing Layer: - Protects the base from damage & reduces back scatter X-rays. - 150 μm lead.
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THE IMAGING PLATE:
 

A Protective Layer composed of “Fluorinated Polymer” which make resistant to the abrasion, damaged & scratches caused on the IP during storage and transfer. The Phosphor Layer consist of a family of Photostimulable Phosphor crystals i.e. BrFX:Eu2+ where X can be any of halogens i.e. Chlorine (Cl), Bromine (Br) or Iodine (I) or an arbitary mixture of them. A typical Phosphor Layer composed of about 85% - BaFBr & 15% - BaFI, activated with a very small quantity of Europium (Eu) as activator in crystal. This Europium activation procedure, also called doping, creates defects in the BaFBr crystals that allow electrons to trapped more efficiently i.e. increases more DQE of crystal. Te Reflecting Layer lies b/w phosphor & base layer. which prevents the reflection of light is also applied. 25

Cont…

 

The Base Layer composed of “Polyethylene Teraphtalate Resign” over which a layer of photostimulable phosphor (Europium doped Barium Fluoro Bromide crystals- BaFBr:Eu+2) is coated. The next is Backing Layer composed of “Lead” which prevents the base from damage & reduces back scatter X-rays. The last is the Bar-Code Label which contains the number assigned to the imaging plate. This Bar-Code provides a mechanism for associating each imaging plate with Patient identification, Related examination & Positioning Information. The imaging plate is flexible and less than 1mm thick.

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LATENT IMAGE FORMATION IN IP:
 To prepare the imaging plat for an x-ray exposure, the plate is exposed to the intense light to erase any previous image.  For X-ray imaging, the IP is placed in a cassette and is used just like a film/screen cassette with standard radiographic equipment.  When exposed to X-ray, the Europium atoms in the phosphor crystalline lattice are ionized & converted from Eu2+ - Eu 3+ by librating a Valance Electron: Eu2+ - X-ray Irradiation - Eu3+ + e These electron are raised to Higher Energy state in the Conduction Band where they can moved through out the crystal lattice.

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Cont…
 The presence of impurities (e.g Bromine) introduce energy level in the Forbidden Zone called F – centre.  Once in the Conduction Band, the electron travel freely until they trapped in the F – centre in the Metastable State with an energy level slightly below that of Conduction Band but higher than that of Valance Band.  The no. of trapped electron is proportional to the amount of X-ray absorbed locally.  The trapped electron in the form of metastable state constitute the Latent Image.  Due to thermal motion electron will slowly be liberated from traps, and the Latent Image should there for be read without too much delay.  At room temp, the image should, however, be readable up 28 to 8 hrs. after exposure.

LIFETIME OF THE IP: One of the major advantages of CR is that the imaging plate is reusable and thousands of exposures can be made on it.However, 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, scuffs, cracks, and contamination with dust and dirt, which may interfere with the production of a good image.  The establishment of a well organised quality control program will play an important role in assessing the clinical quality of the imaging plate. This may easily be carried out by artefact assessment and uniformity evaluation across the plate.

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IMAGING PLATE CLEANER:
Dust and dirt build up on CR phosphor plates, leading to image artifacts. To avoid this, plates need cleaning at regular intervals. Solvent: Ethanol - 99.7%.  Additives: Catanac SN (Cyastat SN 50) - 0.3%.  Safety Precautions: - Highly flammable. - Keep container closed. - Keep away from sources of ignition.

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IMAGE READER:

The CR image reader is also known as Analog to Digital Converter (ADC). It is a device which converts the Continuous Analog Image of Imaging Plate into the Digital Image. It is consists of three parts: 1. Mechanical Feature. 2. Optical Feature & 3. Computer Control.

Definition: 

Construction: 

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What Happens to the Plate in the Reader?
1. Cassette is enter the reader. 2. Image plate is removed from cassette 3. Latent image is scanned by laser 4. Image plate is erased with high intensity light. 5. Image plate is returned to cassette and ejected.
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FUNCTION OR READING PROCESS:
  

After exposure the cassette is feeded into image reader system. Where the cassette is opened automatically and the imaging plate is removed from the cassette inside the reader. Then the IP is moved along its long axis and scanned sequentially (Horizontally) by a Monochromatic Infrared Laser Beam of Helium-Neon (He-Ne) Gas or Solid State Laser of intensity ≈ 633nm. The laser light stimulates the trapped electron moving them up to the conduction band where they make their exit returning to the lower energy Valance Band. This movement involves the transformation of Europium from the Eu3+ - Eu2+ i.e. Metastable State to Ground State by emission of energy in the form of light (Blue & Green) having a wavelength lower than that of the stimulated laser light. Eu3+ + e → (Influenced by IR Laser of 633 nm) → Eu2+ + hf (400 nm).
-

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Cont…

The intensity of the emitted light is proportional to the amount of x-ray energy absorbed in the PSP – layer. By using a Optical Filter, that absorbs red light but is transparent to Blue & Green light This emitted light is collected using a Light Guide & is fed to a Photomultiplier Tube where the light is converted to an Electrical Signal which is amplified to an Electric Output Signal. The Electric Output Signal is converted into Digitized Image Signal by ADC & stored in a computer as a Digital Matrix. 34

Cont…

The Digitized Image Signal is processed by computer & converted into again in Electric Output Signal by DAC which is displayed on the monitor. The whole read out process for a 14” X 17” imaging plate takes about 30 – 40 sec. thus, a maximum workload of 90 – 120 imaging plates per hrs. is theoretically possible. But, practically CR system can read only 65 – 70 IP/hrs accepting mixed cassette size & the time from cassette exposure to image presentation can be less than 90 sec. Therefore one reader can serve several radiographic rooms and the data input is stored on an easy image workstation. 35

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Cont…

Erasing Process:  

It is necessary to reuse the imaging plate again. Because residual Latent Image electrons are still trapped on higher energy level after readout. If residual latent image remained, ghosting could appear on subsequent use of the IP in the next exam. This energy is erased after the readout process using a high intensity white light from a bank of specially designed Fluorescent Lamps source that flushes the traps without reintroducing electron from the ground energy level.

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WORKSTATION:

Here Radiographic Technologist can be processed the digital image in a variety of ways depending upon the clinical application & the final image can be recorded as a hard copy through Multi Format Camera or Laser Imager. In the form of analog image. Here digital data is stored on the hard disk of a work station from where it can be processed, viewed, printed through or distributed via a local network to peripheral stations. The work station provides a DICOM compliant output which maybe directed to a laser Printer for hard copies, or networked to other viewing stations or archived in PACS for Teleradiology.

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ADVANTAGES OF C.R. SYSTEM:
  

 

No special equipment is required. No handling of Processing Chemicals. The Exposure Latitude is wider i.e. High Dynamic Range (1:10,000) which leads to reduced rates of failed x-ray exposure so in a single radiograph large densities variation can be obtained. Fewer Repeat examinations should be needed due to exposure factors because of the wide exposure Latitude. The CR system are cassette based, they can easily be integrated into existing radiographic devices are highly mobile so all types of Radiographic Examination i.e. Mobile, Portable (Bedside), Trauma, Dental Radiography are possible with the C.R. system.

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Cont…

  

If a single Imaging Plate shows defects, it can easily be replaced by the radiographer himself with no need for specialized equipment or service person. The image displayed on the monitor can be manipulated in a variety of ways: contrast enhancement, edge enhancement, black/white reversal, zooming & panning etc (i.e Post Processing). The process of storing the images does not require separate rooms and is relatively easier. Cost effective route to digital radiography. The acquired image can be transferred to many monitors, different places for viewing to large no. of person. Increased capability for consultation made possible by electronic transmission of digital images through PACS & Teleradiology (i.e. networking system).

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LIMITATIONS OF THE C.R. SYSTEM:
 

The technique is Time & Labor Intensive like FSR. Image reader takes time before the image can be displayed so the time taken is same as that required for FSR. Lesser spatial resolution as compared to conventional radiography. Speed Class of 100-200 is similar to that of Medium Speed FSR system so that radiation dose required is same or more than FSR. Radiological technologists receive no direct feedback on the accuracy of their selection of exposure factors as the resultant images are of consistent quality regardless of the exposure. This may lead to undesirable and undetected over exposure to the patient.

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INNOVATIONS & NEWER APPLICATIONS IN CR:
Some of the draw backs of CR system , namely: - Cassettes Handling. - Long Read Out Time of PSP Plates. - Low DQE & - Poor Resolution have been addressed by newer innovations & technological advances.
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AUTOMATED CR SYSTEM WITH FAST READOUT:
CR system efficiency has been recently improved by reducing the readout time & by removing the step of cassette handling.  Automated CR system achieve this by line – scan lasers & photodiode detectors that reduce the readout time of a PSP plate to less than 10s.  In these system there is no cassette handling, leading to totally automatic image data acquisition.

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NEWER PHOSPHORS FOR IP :
  

Commercially available IP have unstructured phosphor like Rubidium Chloride (RbCl) or BaFX:Eu These are scanned in a raster pattern. A needle – shaped phosphor RbI, CsBr, has been newly; introduced, e.g. Konica Minolta’s Regius 370 Upright DR & is considered more efficient due to its structural configuration of crystals. This crystal structure reduces lateral light diffusion because of the needle shaped configuration that acts as light guide. In addition the newer phosphors are more efficient with an increased DQE.

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Cont…

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MOBILE CR SYSTEM:

 

Bedside radiography of critically ill patients with conventional CR involves physical transport of the cassettes to the CR reader, often located far away. The situation gets worse as the no. of ‘portable ‘ films increase. To save Labor, Time & Improve Workflow, portable compact CR system have been introduced in late 2007, with FugiFilm (FCR Carbon XL CR Reader) & Carestream Health Inc (Pointof – CAreCR-ITX 560) machines. These system basically have a mobile X-ray unit with an integrated CR reader. So, they are easy to use & offer quick image availability in less than 25 sec.
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DUAL-ENERGY IMAGING:
It is done by two methods: 1.) Subtraction Technique & 2.) Double Expose Technique. 1.) Subtraction Technique: 

  

In this method, x-ray energies are separated by the insertion of a copper filter b/w two image plates which are then given a single exposure. the low energy image is recorded on the front image plate & a high energy image is recorded on the back. Owing to the difference in energy the absorption ratio of Xray through bone & soft tissue will differ for the two images. By subtracting these two images using weighted factors, bone or soft tissue detail can be selectively displayed.

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Cont… 2.). Double Expose Technique: In this method, by using a high & low KVp, two images are created in the two different image plates.  Soft tissue & bones can be separately depicted by this method.  Dual – energy technique are most effective when both images are acquired simultaneously.  Similar results are obtained with two exposure within a very short period of time. Uses:  In Chest Radiography, particularly for the evaluation of partially calcified nodules & pleural plaques.

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AUTOMATIC IMAGE STICHING:

 

  

This is useful in determining precise measurement in lengthy anatomical regions like- whole spine, lower limbs or upper limb in a skeletal survey. Now a days, the largest flat panel DR plates are available in 43 X 43 cm. Using these detectors, only a limited portion of the body part can be imaged at a time in a single exposure, thus making these detectors inadequate for studying the whole spine or the entire lower limb. To over come this problem, multiple sequential exposures at different patient positions are acquired in a still patient. Automatic stitching is then performed to reconstruct a larger composite image. This special software enables pixel shift and overlap.
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CR-BASED FFDM
 With the recent approval of the Clear View digital mammography products, FUJIFILM Medical Systems USA (Stamford, Conn) becomes the first vendor to offer a full-field digital mammography (FFDM) system based on CR technology in the United States.  CR for mammography uses imaging plates (IPs) made with photostimulable phosphor to convert x-rays into digital information. Existing glass, flat-panel FFDM systems rely on solid-state detectors.

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The CR Reader, the Clear View CSM, has a unique dual-side reading capability that permits the capture of x-ray information from both sides of the Imaging Plate (IP) simultaneously. The 50-µm laser excites the phosphor, which has a thicker coating compared to standard CR IPs. Light is emitted from both sides due to a clear base and is captured with dual 52 light guides.

SLOT SCAN SYSTEM:

This system uses narrow fan beam X-ray of about 5 mm & linear CCD array detector system. It has mechanically linked x-ray tube & collimator opposite the narrow CCD array with few rows of detector and scan along the long axis of the patient anatomy. It has two precisely aligned moving slit collimators, one on either side of the patient. Due to which this system provides the ultimate in scatter rejection & detector efficiency .
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Cont…  Thus use of a radiographic grid is not necessary, significantly using the radiation dose.  There are different possible movement of mechanical linked system & patient couch movement.  The exposure time to the patient is about 20 msec. & readout process time takes about 1 - 3sec.  Scan time depends on the area covered i.e. 2 – 30 seconds.  Because of the need for fixed installation, Slot Scan DR system is dedicated to Chest radiography, Mammography, or Dental Radiography.
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CCD Slot Scan Direct Radiography

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ADVANTAGES:
    

Scatter radiation almost totally absent. No grid is required. Radiation dose is reduced as grid no required. Detector efficiency is more with lower image noise. Longer & large anatomical regions are well covered.

DISADVANTAGES:
     

High initial cost. Longer acquisition time due to narrow fan beam. So, requirement of equipment with high rating of generator & X-ray tubes. i.e. high tube loading. Poor Spatial Resolution, due to Patient motion which degrade image quality during scanning. It is a fixed modality method with bulky design. Bedside Radiography is not possible. 56

SELENIUM DRUM DR SYSTEM:
Rotating selenium-dotted drum, which has a positive electrical surface charge, is exposed to x-rays. During exposure, a charge pattern proportional to that of the incident x-rays is generated on the drum surface and is recorded during rotation by an analog-to-digital converter .

Advantage:It provide good image quality that is superior to that provided by screen-film or CR systems.

Disadvantage:Because of their mechanical design, selenium drum detectors are dedicated for chest stand systems only with no mobility at all.

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DIRECT RADIOGRAPHY (DR):

DR technology converts x-rays into electrical charges by means of a direct readout process using CCD/TFT arrays.

Direct Radiography (DR)
Indirect Conversion
Scintillator + CCD
CsI:Tl or CsI:Na & Gd2O2S:Tb3+

Direct Conversion
Selenium Drum Photoconductor (a:Se) + TFT (DFPD)
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Scintillator + Photodiode (a:Si) + TFT (IFPD)

INDIRECT DR:

In this case, X-ray energy is first converted into light photons by an phosphor scintillator (CsI:Tl, Gd2o2S:Tb). Then the light photons are converted in electric charge by Photodiode Phosphor (a:Si). The electric charge is converted in electrical signal by CCD/TFT which is digitized by ADC in digital signal & stored in computer. The stored digital signal in computer is processed and converted in analog signal by DAC to see on the monitor. The whole process will take only 1.3 – 3 sec.

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Cont…
Convert X-rays into light photon after then electronic signals for digital image formation.

Uses 3 step process : X –rays Visible Light Electronic Signals Image formation
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CsI:Tl, Gd2o2S:Tb

a:Si
TFT & ADC

DIRECT DR:
  

In this case we do not use the phosphor coating scintillator layer, thus eliminating the intermediate light producing step. Hence a:Se directly acts as the x-ray detector. The x-ray beam directly interacts with a thin layer of a:Se creating electron-hole pairs, which being charged, travel directly to the TFT. From TFT, the charge pattern is read out by charge amplifier & digitized by ADC in digital signal & stored in computer. The stored digital signal in computer is processed and converted in analog signal by DAC to see on the monitor. The whole process will take < 1.3 sec.
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Cont…
Convert X-rays into electronic signals for digital image formation

Uses 3 step process : X –rays Electronic Signals
TFT & ADC

a:Si

Image formation

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CONSTRUCTION & WORKING OF FPD SYSTEM:
 

The physical dimensions of the detector array are 40 x 50 x 4 cms with 2560 x 3072 pixel matrix. The matrix is covered with a scintillator layer of CsI:Tl or Gd2O2S:Tb in case of Indirect FPD only. The matrix array consists of a glass substrate onto which a layer of a:Si is evaporated in the case of Indirect FPD & a:Se in case of Direct FPD. The a:Si or a:Se is structured in a matrix of individual photo sensors and switching elements, either a TFT or a CCD which allows the connections of the sensor with the read out line in column direction.

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Cont…

TFT or CCD are controlled via address lines in the horizontal direction, in order to read out the single charge values of photodiodes. These signals are multiplexed and converted into digital signals by an A.D.C. inside the detector housing. The 2-D digital image data is directly transferred to the image processing computer via an optic fiber link. So the image is available in digital form shortly after the exposure has been made.
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ADVANTAGES of DR SYSTEM:
        

 

Increasing Workflow Efficiency, Saving Time & Labor. Integrating high power X-ray system of 30 – 1000 KW Rating, very Short Exposure Time , Eliminating Motion Blur. Variable Speed Acquisition possible (speed class 100 – 800) depending on acceptable SNR. Most DR system have presets available for various anatomical studies including optimized post processing e.g. chest, spine etc. Automatic tube detector positioning for selected study. Auto selection filter & Focal Spot Size a/c to the anatomical part. Automatic tracking for easy positioning. Immediate availability of image for Quality Check & Diagnosis. The examination becomes quick as no cassettes have to be fetched from the storage area, taken to the examination site, or to the processing unit after exposure. Radiography as well as fluoroscopy can be performed. Post processing can be done.

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DISADVANTAGES OF DR SYSTEMS:
 

High initial cost. Some radiographic view are difficult to obtain as the detectors are generally not free to be placed in any position. Careful handling is required due to fragile nature of most detectors. Due to its inflexibility, portable or ward radiography is not possible. Different equipment is required for different kinds of work.
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DIGITAL FLUOROSCOPY:
It provides Real Time Imaging of anatomic structures. As maximum image detail is required, so image brightness must be high.  Image intensifier was developed to replace the conventional fluoroscopic screen.  With the introduction of computer technology into fluoroscopy, digital images with better detail can be obtained.

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EQUIPMENT:
D.F. requires the same fluoroscopy equipment in addition to a computer, 2 video monitors, and a more complex operating console.  A high voltage generator.  A video system.  A charge couple device.

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ADVANTAGES:

Less radiation dose as compared to the I.I.T.V. system. Better image quality.

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DEVELOPMENTS IN D.F. :
 

Flat panel detector system has replaced the I.I.T.V. system. X-rays passing through the patient are converted into electrical signals by the F.P.D. These are then passed through the amplifier and ADC where they are converted into digital signals. The digital image data is directly transferred to an image storage PC via an optic fiber link at the rate of 30 f/s This system permits high speed digital image acquisition, processing and display. Images are of excellent resolution.
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DYNAMIC FPD FLUOROSCOPY:

Dynamic Detector

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INNOVATIONS & NEWER APPLICATIONS IN DR:
Digital Radiography is witnessing rapid innovations in hardware as well as software applications.  Clinical utility & the true potential of these applications will be understood better in the years ahead. Few of the exciting applications are:

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PHOTON COUNTING TYPE DR SYSTEM:

It is similar to Slot Scanning Type system but uses a different types of multi slit detector made up of Crystalline Silicon (Si) which is some what similar to the one used in direct type of Flat Panel Detectors System. A voltage of about 100 volts is applied across the array of thin (50µm) Si crystals. Absorbed X-ray produce electrons & holes. Each of these event is counted in a timer meter with time corresponding to the spatial location along the direction of X-ray fan beam sweep.
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Cont…

 1) 2)

Each absorbed X-ray photon results in a unit count regardless of the photon energy. As the electrical pulse generated is much higher than the electronic noise, this type of DR system produce images with high SNR. Uses: Mammography (Sectramicrodose). In gaseous micros trip detectors for Biplane Whole Body Imaging in erect weight bearing position with excellent result ( EOS of Biospace med).
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Advantages:     

Radiation dose is reduced as grid is not required. High system DQE. High SNR due to minimal electronic noise. No ghost image (Previous exposure is residue). High contrast & detail resolution.

Disadvantages:   

Exposure time is long. Patients motion may degrade image quality. Requirement of equipment with high rating of generators & X-ray tubes.
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DIGITAL TOMOSYNTHESIS:

  

In this technique multiple low dose exposure are given from various angles while the x-ray tube moves in an arc & the detector remains stationary. Multiple images with different focal zones are possible to be created by addition of these low dose images after pixel shift. It emphasize contrast in a particular layer of a region of body. Generated images can be viewed singly or as a cine loop. It is also considered to useful in Mammography, Chest, IVU studies.
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DIGITAL MAMMOGRAPHY TOMOSYNTHESIS (DMT):
 

 

It is a recent advanced application of DM. In this technique, an area X-ray beam interacts with the digital mammographic image receptor, producing a digital mammogram. This digital mammogram is repeated several times at different angles. Each images is available in digital form & can be reconstructed as a 3D Matrix of values, each representing a Voxel. With these digital data available, a tomographic section can be reconstructed with enhanced image contrast at acceptable patient radiation dose.

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MOBILE /PORTABLE DR:
     

Now a days flat panel detector portable radiography is also possible. This method was first invented by Canon. The FPD are available in 17” X 17” with a cable for portable/mobile radiography. As a general a FPD connected by a cable to a mobile or portable unit having a monitor. The use of portable DR system hampered by the fragility of the FPDs & the high costs. A portable DR system, when compared with an FSR system, avoids all problems related to the availability, storage, transportation, disposed of films & chemicals.

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WIRELESS FPDs:
     

With the introduction of the model Pixium 3543 from Thales, wireless portable DR system is now a reality. After exposure, it wirelessly transfer image data to the DR system. Alternatively the image data can be transferred to DR console via an Ethernet cable. It has no cables & does not interfere with surrounding machines. So, it is easy to handle as a CR cassettes. Typically a 17” X 14” image size is made available within 3s. It is particularly well suited for use with immobilized patients, in operating rooms, intensive care units, emergency situations, and rooms for exams requiring difficult or unusual X-ray projections.
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WIRELESS FPD SYSTEM:
Pixium RAD 4600 Pixium Portable 3543 Power supply WiFi (or back-up cable) Optical Fiber RS 232 Pixium Portable Docking Station Power supply Ethernet Cable
Acquisition board Ethernet Board

X-Ray Generator

PC PixRad software
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FLUOROSCOPY:

Real – time digital imaging in DR is possible with the invention Pixium RF 4343, from Thales. It facilitates high-quality radiography & fluoroscopy (up to 30 images/sec.) This fluoroscopy feature is use in Gastroenterology, Urology & Vascular applications. Newer FPDs like Pixium 4700 & Pixium 4800 from Thales are used for Vascular & Cardiovascular DSA applications by permitting low – dose fluoroscopy.
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Integris Allura Flat Dynamic Detector for Cardio

Scintillator

Photodiode array

Refresh light 85

IMAGE QUALITY PARAMETERS:
      

Pixel Size, Matrix & Detector Size. Dynamic Range & Contrast. Spatial Resolution. Limiting Spatial Resolution (LSR). Signal to Noise Ratio (SNR). Modulation Transfer Function (MTF). Detective Quantum Efficiency (DQE).
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DYNAMIC RANGE & CONTRAST:
Contrast levels or film densities generated over a range of x-ray exposure levels. Narrow Dynamic Range Dynamic range is a measure of the signal response of a detector that is exposed to xrays. Wide Dynamic Range

Image Brightness

Straight

Image Brightness

Toe Part

Straight Shoulder

Shoulder Toe Part

X-ray Detected

X-ray Detected

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Cont…

Low Contrast

High Contrast

Film-Screen

Detector

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LIMITING SPATIAL RESOLUTION (LSR):

solution Re

 Spatial Resolution refers to the minimum resolvable separation between high-contrast objects.  In Digital Detectors, Spatial Resolution is defined and limited by the minimum Pixel Size.

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SIGNAL TO NOISE RATIO (SNR):
Quantum Mottle (QM): - It is an appearance of noise in the radiographic image due to low SNR of the information reaching the image recording system.
Contrast Ratio

Increasing Contrast

Signal Noise High SNR Low SNR

Decreasing Noise

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IMPACT OF NOISE:

Quantum and Electronic noise are unavoidable in a digital imaging chain. The effect, often expressed as Signal-to-Noise Ratio (SNR), can vary widely from system to system. Signal ------------- = Noise Useful Image Formation -----------------------------------Erratic (Unwanted) Information

1:1 SNR

2:1 SNR

5:1 SNR

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MODULATION TRANSFER FUNCTION (MTF).

Modulation transfer function (MTF) is the capacity of the detector to transfer the modulation of the input signal at a given spatial frequency to its output. X-Ray Photons:

Light Photons

Light Photons

Electron

Gd2O2S:Tb + a:Si
High Scattering Low MTF

CsI:Tl + a:Si Low Scattering Good MTF

a:Se
No Scattering “Perfect” MTF 92

DEECTIVE QUANTUM EFFICIENCY (DQE):
Detective Quantum Efficiency (DQE) is one of the fundamental physical variables related to image quality in radiography & refers to the efficiency of a detector in converging incident X-ray energy into an image signal.

It depends on: - Radiation Exposure. - Spatial Frequency. - MTF. - Detector Material. - Quality of the radiation applied (Voltage & Current).
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1 Digital Radiographic Room = 2.6 Conventional Screen/Film Room !

Imaging Technique
Conventional Screen Film Radiography Computed Radiography Direct Capture Radiography

Average Exam time
6:05 Minutes 7:02 Minutes 2:18 Minutes

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Technical Features Of Various DR Feature  X-ray Readout Detector Pixel Size System: Converter size
Converter size Screen Film Gd2O2S Storage Phosphor Slot scan CCD Direct FPD BaFBr:Eu CsI:Tl a:Se
Gd2O2S:Tb

Matrix Size

Film LASER CCD Active Se Matrix

14x17 14x17 17x17 14x17

Grain Size ……….. 2 100 - 200 µm 162 µm 139 µm 160 µm 143 µm 1760x2140 2736x2736 2560x3072 2688x2688 3121x3121
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Indirect FPD CsI:Tl

Active a:Si 17x17 Matrix Active a:Si 17x17 Matrix

IMAGE RECEPTOR COMPARISION:
FEATURE
GENERATION OF VISIBLE IMAGE IMAGE VIEWING RESOLUTION CONSTRUCTION LIFE SPAN IMAGE ENHANCEMENT

FILM/SCREEN CR (PSP)
Lower Laser Scanner, Computer Chemical, Wet Processing Delayed, View box Transillumination 16-20 lp/mm Thin, Flexible Single Use Fixed Unchangeable Image

DR
Lower Computer

RADIATION DOSE Higher

Delayed, Computer Monitor In few seconds, Computer Monitor 6-8 lp/mm Thin, Flexible Reusable after Erasure Multiple Operations: Contrast, Density, Magnification, Positive/Negative, Measurement 8-10 lp/mm Thick, Rigid & Robust Reusable (Unlimited) Multiple Operations: Contrast, Density, Magnification, Positive/Negative, Measurement

STORAGE

Patient Record, Huge Variety of Archiving Variety of Archiving Method: Space required Method: - Server, Zip, OMD, Server, Zip, OMD, MOD, CD, MOD, CD, DVD, PACS DVD, PACS
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IDEAL DR SYSTEM:
 Physical

Design: - Compatible in size with Film Cassette. - Immediate Readout. - Robust. - Cost Effective.

 Image

Capture: - High Quantum efficiency. - Low Dose.

 Image

Quality: - Spatial & Contrast Resolution as good as Film/Screen System. - Wide Dynamic Range. - DICOM Compatible.

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CONCLUSION:
 

With the advent of computed radiography diagnostic radiology is advancing towards a film less system. The replacement of film by detectors and storage devices eliminated several inherent drawbacks of conventional radiography and decreases the radiation exposure to the patient and radiographer. Very soon digital imaging will become more common and affordable for all aspect of radiography. With the development of Digital Radiography , the Radiographic Examination becomes more easy, handy and less time consuming method with good quality of image. 98

References:1. 2. 3. 4. 5. 6. 7.

http://www.google.com http://www.wikipedia.com’ http://www.xray2000.co.uk http://www.radiologyinfo.com http://www.amersham,health.com Indian Radiology Journal American College of Radiology Journal
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