Computed Radiography (CR)

Computed Radiography refers to the use of storage phosphor imaging plates instead of
the film screen combination used in traditional radiography. Imaging plates and
processing systems have been developed and marketed by the same manufacturers who
sell film, screens and chemical processing units. As a result the cassettes used in CR are
often similar to the cassettes used in film screen systems, which means you can generally
recognise which manufacturer has supplied the system by the cassettes used.

Imaging plates work on the principle of photostimulable luminescence. This means that
energy stored in the plate as a result of exposure to ionising radiation is released in the
form of light energy when the imaging plate is stimulated by a light source. The light
source used to read the imaging plates must have a longer wavelength than the
characteristic emissions of the phosphor in order to activate the process of luminescence.
Thus infra red or red lasers most commonly used to stimulate the phosphor plates. The
release of the characteristic radiation by the phosphor occurs within 7 milliseconds of the
laser light exposure. After the imaging plate has been scanned, it is erased by exposure to
a large amount of visible light for subsequent re-use. The luminescence is detected by the
image detector (Photo multiplier) & converts the signal into a time series. The signal is
then amplified and converted into a digital signal via an analogue to digital converter
(ADC)


The Structure of Imaging Plates

From [Link]/healthcare

As identified in the figure above, the imaging plate consists of a layer of a phosphor
usually Europium- doped barium fluorohalide phosphor, which is coated onto a
conductive layer. This contributes to increased image sharpness as it reduces problems
caused by electrostatic charges and absorbs light. The conductive layer is composed of
conductive crystals in a binder. In some cases, the imaging plate may have a light
reflection layer and a light shielding layer. The reflective layer, composed of light
reflecting particles, is sandwiched between the phosphor layer and the conductive layer.
The shielding layer is place between the support and the backing or laminate layer. The
light shielding layer is composed of carbon particles in a binder, and is used to prevent
light leakage into the plate from behind, especially useful when the imaging plate is being
read by the photo-multiplier as it ensures that the light in the system is generated by the
imaging plate and not from the external environment.

The protective layer is a thin transparent layer used, as the name suggests, to protect the
phosphor layer during handling. The backing layer is made from a soft polymer and
makes handling the imaging plate easier, and less likely to damage other imaging plates if
they are stacked. The support layer is a polyester base similar to that used in intensifying
screens.

Some means of identifying the imaging plate is important. Usually this is in the form of a
barcode printed on the back of the plate which is then read by a barcode reader to match
the imaging plate with a particular patient/examination.

Handling imaging plates
Imaging plates can be handled manually, and can also be taken out in daylight conditions
without substantial loss of image quality. It is usual however; that CR cassettes are
loaded into an automated unit which extracts the imaging plate for reading and then
reloads the cassette with the same imaging plate after it has been erased and is then ready
for use. The quality of the image retained on an imaging plate deteriorates over time.
Within in two hours after exposure, up to 20% of the image information can be lost, after
24 hours 50% of the information can have been lost due to spontaneous luminescence
within the imaging plate. It is therefore recommended that the imaging plates are read
within an hour after exposure. Additionally, if an imaging plate has not been used for a
number of days, then there is an increase in the amount of base fog in the image, and it is
advisable to erase plates that have been inactive for a while.

Principles of Imaging with CR

The atomic structure of the barium fluorohalide crystals is such that defects create gaps in
the higher energy levels. These gaps, or F centers act as traps to electrons. On exposure
to radiation, electrons are energized and move from the valency band, or the lower energy
level, within the atom to the higher energy conduction band.

Reading the Image
When the Imaging plate is fed into the Image reader, a laser scans the imaging plate. The
effect of the energy from the laser beam is that the electrons trapped in the conductive
band absorb the energy, and then release it by dropping back to the valency band and a
photon of light. This emission of light or luminescence is detected by a photomultiplier
which generates a digital signal from the intensity of the light emitted.

The photomultiplier consists of a photocathode, a multiplier chain, and an anode.
Electrons emitted by the photocathode as a result of light photons hitting the
photocathode, are accelerated and multiplied by the multiplier chain, with the anode
collecting the resulting currant. The multiplier chain consists of electron absorbers with
enhanced electron emission called dynodes. Various characteristics of a photomultiplier
effect the effectiveness of the system in converting the light signal into an analogue
electrical signal; Speed and linearity of response, in the time fluctuations of the signal, in
amplification factor (called gain), and in the wavelength spectrum accepted.

The light signal from the imaging plate is fed to the photomultiplier by a bundle of
fibreoptic cables arranged as a linear array which follows the progress of the laser as it
scans the imaging plate. The photomultiplier is connected to a analogue to digital
convertor (ADC) which digitises the signal and enables the image data to be transferred
to and processed by a computer.

CR Image processing
Once the image data is sent to the image processing workstation, then the real benefit of
CR can be demonstrated. Most CR Readers have a preview screen either built into the
reader or as part of the Identification Terminal. This enables the Radiographer to ensure
that all the necessary anatomy is present on the image, although the quality of the image
is usually poor and the size of the preview image is usually small.

CR systems have a complicated and often patented methods of processing images, these
methods, often refered to as algorithms, are sets of instructions, specific to the anatomical
area examined and often specific to the projection taken. This means that the image data
from a lateral chest xray is processed differently than a PA chest x-ray. The settings are
defined in collaboration with the department and the supplier of the equipment. Thus a
CR system from the same supplier may produce slightly different images in different
institutions.

Post processing of images allows the radiographer to improve the presentation of the
image before releasing them for printing or storage. The range of tools availiable for
image manipulation range from adjusting the contrast and brightness, to making edges or
lines in the image more distinctive. Other features include being able to collimate the
image, magnification or zoom functions, adding text or graphics to the image and
changing the orientation of the image by rotation.