INTRODUCTION TO COMPUTED RADIOGRAPHY

Computed Radiography (CR) is a medical imaging technology that

uses digital technology to capture X-ray images.

In screen-film radiography, the radiographic intensifying screen is a

scintillator that emits light in response to an x-ray interaction. In CR, the
response to x-ray interaction is seen as trapped electrons in a higher energy
metastable state.

Computed Radiography involves the use of specially designed imaging

plates that capture X-ray energy and is placed in a cassette instead of a
piece of film. These plates, known as photostimulable phosphor plates,
store the X-ray energy temporarily. After exposure, these plates are
processed using a CR reader. The reader scans the plates with a laser
beam, stimulating the release of stored energy as light. This light is then
converted into a digital signal that forms the X-ray image. This process is
called the photostimulable luminescence (PSL).

PSL is the process by which trapped electrons, previously excited by

X-ray exposure, are released from their higher energy states and emit light
when stimulated by a laser. This emitted light is then collected and
converted into an electrical signal, which is used to create a digital image.

ELEMENTS OF CR
1. Imaging Plate or Storage Phosphor Screens (SPS) – The CR plate
has a thin layer of phosphor grains, known as a photostimulable
phosphor. The plates are usually 1 mm thick and are coated with
Europium activated fluorohalide compounds in crystalline formation
embedded in organic binding material.
- The SPS appears white because the small PSP particles (3–
10 µm) scatter light excessively. Such a scattering is
called turbid. PSP particles are randomly positioned
throughout a binder.
- With CR, a darkroom is unnecessary.

*Photostimulable phosphors (PSP) are capable of

emitting light even before being exposed to X-rays due to a
property called "thermoluminescence." Thermoluminescence is
the phenomenon where certain materials emit light when they are
heated after being exposed to a source of energy. The added
europium acts like an activator. It makes the material more
sensitive to X-rays, helping it absorb the X-ray energy and keep it
stored. When X-rays hit the material, the europium atoms inside
absorb the energy and get excited.
 Layers of Imaging Plate
a) Protective Layer - A thin layer of transparent film that
protects the phosphor.
b) Barium Fluorohalide Phosphor Layer - a closely
dispersed of fine-grained, europium-activated, barium
Fluoro-halide crystals, that store the latent image until
released when re- stimulated during processing (Thickness
is about 0.3 mm).
c) Light Reflective Layer - This layer increases the intensity
of light being emitted from the crystals by reflecting it back
toward the reader, instead of it being absorbed.
d) Conductive Layer - This is a light absorbing layer, made
up of conductive needle-like crystals that absorb any
unreflected light as well as any electrostatic charges.
e) Polyester Support Layer - Made from a polyester
material, this layer gives structural rigidity and a base for
the coating of all of the other layers. Polyester is used
because of its excellent stabilities well as its durability and
flexibility.
f) Light Shielding Layer - This is a carbon particle layer
that prevents the light from leaking from the rear of the
imaging plate.
g) Backing Layer - This is a protective layer made from a
soft polymer that prevents scratching when the plates are
stacked during the manufacturing process.

2. Digitizer or CR Reader- The plate is inserted into the digitizer where

it is scanned with a high power laser.
- The laser light causes the storage phosphors to release the
energy they have captured in the form of blue light
- The image buffer is usually a hard disc. This is the place
where a completed image can be stored temporarily until it
is transferred to a workstation for interpretation or to an
archival computer.

MECHANICAL FEATURES OF CR READER

The drive mechanisms are responsible for precisely controlling the
movement of the Imaging Plate (IP) during the reading process. These
mechanisms ensure that the IP moves in a coordinated manner to allow the
laser scanning system to capture the X-ray information stored within the IP.

 When the Computed Radiography (CR) cassette is placed into the CR

reader, the Imaging Plate (IP) is taken out from the cassette and
positioned on a precisely controlled drive mechanism. This mechanism
slowly moves the IP along its length in a constant and steady manner,
which is known as the "slow scan" direction.
  While the IP is moving in the slow scan direction, there's another
aspect happening concurrently. A device, often a rotating polygon or
an oscillating mirror, directs a laser beam across the IP in a back-and-
forth manner. This motion of the laser beam is what's referred to as
the "fast scan" mode. It essentially covers the width of the IP,
capturing information quickly.
 Both the slow scan and fast scan mechanisms are synchronized. As the
laser beam moves back and forth (fast scan), the slow scan motion of
the IP continues.

OPTICAL COMPONENTS OF CR READER

The optical components of a Computed Radiography (CR) reader play a
crucial role in capturing and processing the X-ray information stored within
the Imaging Plate (IP) and converting it into a digital X-ray image. These
components help to manipulate and direct the laser beam as it interacts with
the IP.

 Laser System - The laser system is responsible for generating a laser

beam with the appropriate characteristics for stimulating the release of
trapped X-ray energy from the IP. The laser system ensures that the
laser beam has the right intensity, wavelength, and focus for accurate
interaction with the IP.
 Rotating Polygon or Oscillating Mirror - It is used to direct the
laser beam across the width of the Imaging Plate. These components
allow the laser beam to rapidly scan back and forth in what is known as
the fast scan direction.
 Laser Beam Blanking Mechanism - To prevent unnecessary
exposure of the IP during the retrace process (when the laser beam
changes direction), a laser beam blanking mechanism is used. This
mechanism temporarily turns off the laser beam during the retrace
phase to avoid exposing the IP to the laser when it's not scanning.
 Optical Path Components - Various lenses, mirrors, and optical
elements are used to focus and guide the laser beam onto the surface
of the IP with precision. These components help ensure that the laser
beam accurately interacts with the stored X-ray energy within the IP.
 Photomultiplier Tube (PMT) - The PMT is an essential optical
detector that captures the emitted light from the IP as it releases the
stored X-ray energy. The PMT converts this light into electrical signals,
which are then used to generate the digital X-ray image.
 Beam Steering and Shaping Components - These components
help control the path and size of the laser beam as it interacts with the
IP. They ensure that the laser beam covers the entire width of the IP
and maintains consistent focus.
  Filters and Optical Filters - These components might be used to
modify the properties of the laser beam or emitted light, ensuring that
the captured signals are accurate and clear.

COMPUTER COMPLEMENT
The computer complement typically refers to the digital processing
and storage components that work alongside the reader to complete the
entire process of capturing, processing, and storing digital X-ray images.

 Image Processing Server - This server receives the digital X-ray

images captured by the CR reader. It performs various image
processing tasks, such as adjusting brightness and contrast, applying
filters, reducing noise, and enhancing image quality. The processed
images are then ready for interpretation by radiologists.
 Workstations - Radiologists and medical professionals use dedicated
workstations to view, interpret, and analyze the processed digital X-ray
images. These workstations provide specialized software tools for
diagnosing medical conditions accurately.
 Picture Archiving and Communication System (PACS) - PACS is a
digital storage and retrieval system used to store, manage, and access
medical images. It allows medical professionals to store and retrieve X-
ray images electronically, making them readily available for review,
comparison, and sharing.
 Digital Network - A digital network infrastructure connects the CR
reader, image processing server, workstations, and PACS, allowing
seamless transmission and sharing of images and patient data within
the healthcare facility.
 Image Management Software - This software manages the
organization, storage, and retrieval of digital X-ray images within the
PACS. It ensures that images are accessible and properly categorized
for efficient patient care.
 Security and Access Control - The computer complement includes
security measures to protect patient data and sensitive medical
information. Access control ensures that only authorized personnel can
view and manipulate the digital images.
 Backup and Redundancy - To ensure data integrity and availability,
backup and redundancy mechanisms are often implemented. This
safeguards against data loss and system failures.
 Integration with Electronic Health Records (EHR) - In many
healthcare settings, the computer complement integrates with
electronic health records, allowing seamless access to patient history
and medical information alongside the digital X-ray images.

COMPUTED RADIOGRAPHY PROCESS

1. Expose - The first of a sequence of events that results in an x-ray–
induced image forming signal.
 2. Stimulate - Stimulation of the latent image results from the
interaction of an infrared laser beam with the photostimulable
phosphor (PSP).
3. Read - The light signal emitted after stimulation is detected and
measured.
4. Erase - Before reuse, any residual metastable electrons are moved to
the ground state by an intense light. Ghosting happens if the residual
latent image remained so it should be removed by flooding with
intense white light.

BENEFITS OF COMPUTED RADIOGRAPHY

1. Enhanced Image Quality
2. Reduced of repeated exposure
3. Better image quality than Conventional Radiography
4. Phosphor plates are reusable for a thousand of times
5. Digital Storage and Accessibility
6. Faster Workflow
7. No film, processing chemicals, and dark room required

DISADVANTAGES OF COMPUTED RADIOGRAPHY

1. More expensive
2. High Maintenance
3. Plate is sensitive to fogging, needs to be erased daily, and is easily
damaged.
4. Lower spatial resolution
5. Dose-creep: since, exposure latitude is wide, high exposure technique
is used which increases the patient dose which is called dose-creep.

IMPACT ON HEALTHCARE
1. Accurate Diagnosis: The high image quality and manipulation
capabilities of CR aid healthcare professionals in making accurate
diagnoses, leading to better patient care.
2. Streamlined Workflow: Faster image acquisition and immediate
availability of digital images improve workflow efficiency in busy
medical environments.
3. Telemedicine and Consultations: Digital CR images can be easily
shared with specialists remotely, facilitating telemedicine and enabling
quick consultations.
4. Research and Education: CR images are valuable for medical
research and educational purposes. They can be used in presentations,
publications, and training programs.
5. Reduced Environmental Impact: The elimination of film and
chemicals reduces the environmental footprint of medical imaging
practices.