DIGITAL RADIOGRAPHY- A NEW CONECPT IN RADIOLOGY

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 Concept of Digital radiography

A Project
on
CONCEPT OF DIGITAL RADIOGRAPHY

BY:

KARUNA PALIWAL
(B. Sc. MEDICAL TECHNOLOGY)
(IMAGING SCIENCES)
(2007-2010)

Department of Medical Technology

Technology
SYMBIOSIS INSTITUTE OF HEALTH SCIENCES
(SYMBIOSIS INTERNATIONAL DEEMED UNIVERSITY)

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 Concept of Digital radiography

SYMBIOSIS INSTITUTE OF HEALTH SCIENCES

CERTIFICATE

This is to certify that MISS. KARUNA PALIWAL has

successfully completed her project work titled DIGITAL
RADIOGRAPHY report in partial fulfillment of the
requirements of the graduate degree of B. SC. MEDICAL
TECHNOLOGY SPECIALISING IN IMAGING SCIENCES OF
SYMBIOSIS INSTITUTE OF HEALTH SCIENCES.
SCIENCES
For academic year 2009-2010.

DR. SANJAY SHERKAR DR. SAMMITA JADHAV [Link] YERAVDEKAR

RADIOLOGIST(DMRD,DNB) Head, Director, SIHS.
Medical Technology.

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 Concept of Digital radiography

Acknowledgement

It is my proud privilege to express my overwhelming gratitude towards my

esteemed teacher and revered guide DR. Sanjay Sherkar (DMRD, DNB). His
intention, supervision and blessing were the major driving force behind this
study.

I would like to thank my teachers and friends for helping me throughout

this project. I would also like to thank Dr. Rajiv Yeravdekar, Director, SIHS and
Dr. Sammita Jadhav HOD, BMT for providing me a platform for completion of
this project.

Last but not the least I would like to express my gratitude towards
Symbiosis Institute of Health Sciences (SIHS) and my teachers for their support
during the course of my project.

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 Concept of Digital radiography

ABSTRACT
Medical imaging is undergoing revolutionary change at this time. Since Roentgen’s discovery of X-
rays, anatomic image have been obtained in basically same fashion. Now that is changing and
changing very rapidly.

A conventional static radiographic image is made like a shadow graph, using a field of x-rays
that forms an image pattern after transmission through the patient. The image receptor, a screen-
film combination is the device that records this transmitted image directly.

Conventional fluoroscopy likewise produces a shadowgraph-type image on a receptor that

directly produces an image from transmitted x-ray beam. Until the 1960s a fluoroscope screen was
the image receptor used for this type of examination. Currently, image-intensifier tubes serves as
the image receptor. These are usually electronically coupled to a television monitor for remote
viewing.

These conventional systems have served us well for many years. Providing increasingly
better diagnostic images. They both, however, have several limitations. The static radiographic
images require processing time that can delay the completion of the examination. This can be
particularly bothersome in angiography and when film-subtraction techniques are employed. Once
one has obtained such images, there is very little that can be done to enhance their information
content. When the examination is complete, the images are in the form of hard-copy film that must
be cataloged and stored for future review. Another and perhaps more severe limitation is the noise
inherent in these images.

These limitations can be overcome somewhat by the incorporation of computer technology

into diagnostic X-ray imaging. This approach to imaging is based on transforming the conventional
analog images into digital form, processing the digital data in helpful ways, and displaying it in a
manner that makes it appear very much like a conventional image. Such data conversion and
manipulation would not be possible if it were not for advanced computer technology.

Digital imaging techniques are being applied to computed tomography (CT) ultrasound,
radioisotope studies, and magnetic resonance imaging (MRI), digital fluoroscopy (DF), and digital
radiography (DR) and computed radiography (CR). Digital fluoroscopy and radiography are currently
under rapid development and clinical deployment. Digital imaging system uses CCDs, Phosphors
(IP), and flat panel detectors as image receptors. These advances in the field of radiography boosted
the diagnostic field, patient care and mainly the cost effectiveness.

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CONTENTS

1. Acknowledgement 4
2. Abstract 5
3. Introduction to digital radiography 7
4. Types of digital radiography 16
5. Digitizer & Digitizing an image 41
6. Implementation 46
7. Patient dose consideration 46
8. Hard copy versus Soft copy 47
9. Digital image processing 48
10. Image quality in digital radiography and advantages 53
11. Quality assurance concerns and Artifacts 57
12. Conclusion 61
13. References 62

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3. INTRODUCTION TO DIGITAL RADIOGRAPHY

3.1 History
3.2 Image representation
3.2.1 Introduction
3.2.2 Spatial representation of digital image
3.3 Digital concept
3.3.1 Analog Vs Digital
3.3.2 Classification of digital radiography
[Link] Direct and Indirect digital radiography
3.4 Luminescence
3.4.1 Photoluminescence
a) Phosphoresces
b) Fluorescence

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3. Introduction
Digital radiographic image receptors are gradually replacing screen-film cassettes as radiology
departments converts to an all-digital environment. Computed tomography (CT) and magnetic
resonance imaging (MRI) are intrinsically digital, and ultrasound and nuclear medicine imaging
made the change to digital imaging from their analog ancestries in the [Link], reasons for this
are clear: screen-film is a tried and true detector system that produces excellent image quality
under most circumstances, and therefore the motivation for change is low. In addition, the large
field of view and high spatial resolution of radiography require digital radiographic image to contain
large amounts of digital data. For example, a typical CR and DR systems.

3.1 History
The development of digital radiologic imaging equipment was limited until sufficient computer
technology available to handle the large quantities of data generated. The microprocessors and
semiconductor memory made this development possible. Initial activity began in early 1970s,
developed along two independent lines, and became a clinical reality in 1980. At the 1981
International radiology meeting in Brussels, Fuji Photo Film Co., Ltd introduced the concept of
computed radiography employing photostimulable phosphor plate technology. In 1983 computed
radiography was first used clinically in Japan, and by 2003 more than 25,000 systems will be in
clinical use worldwide[2].

The medical physics groups at the University of Wisconsin and the University of Arizona
independently initiated studies of DF in the early 1970s. These studies were continued through the
decade by the research and development groups of most X-ray equipment manufacturers. The
approach in general was to use conventional fluoroscopy equipment and place a computer between
the television camera and the TV monitor. The video signal from the TV camera was shunted
through the computer, manipulated in various ways, and transmitted to the TV monitor in a form
ready for viewing.

Although there are several approaches to DR, the approach developed in the late 1970s to
complement computed tomography has enjoyed the widest application, invented by Godfrey
Hounsfield. Analog to digital converters and computers were also adapted to conventional
fluoroscopic image intensifier/TV systems in the 70's as well. Angiographic procedures for looking at
the blood vessels in the brain, kidneys, arms and legs, and the blood vessels of the heart all have
benefited tremendously from the adaptation of digital technology.

Over the next ten to fifteen years a large majority of conventional x-ray systems will also be
upgraded to all digital technology. Eventually, all of the film cassette/film screen systems will be
replaced by digital x-ray detectors. This technology is currently works-in-progress and is only
available at a handful of sites worldwide. An intermediate step called phosphor plate technology in
currently available at hundreds of sites around the world. These plates trap the x-ray energy and

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require an intermediate processing step to release the stored information so it can be converted
into a digital picture.

Image plates were pioneered for commercial use by Fuji in the 1980s. In modern hospitals a
photostimulable phosphor plate (PSP plate) is used in place of the photographic plate. After the
plate is X-rayed, excited electrons in the phosphor material remain "trapped" in "colour centers" in
the crystal lattice until stimulated by a laser beam passed over the plate surface. Since the 1970s,
new semiconductor detectors have been developed (silicon or germanium doped with lithium, Si (Li)
or Ge (Li)). X-ray photons are converted to electron-hole pairs in the semiconductor and are
collected to detect the X-rays. When the temperature is low enough (the detector is cooled by
Peltier effect or even cooler liquid nitrogen), it is possible to directly determine the X-ray energy
spectrum; this method is called energy dispersive X-ray spectroscopy. Practical application in
medical imaging started in the 1990s. Currently amorphous selenium is used in commercial large
area flat panel X-ray detectors for mammography and chest radiography.

3.2 IMAGE REPRESENTATION

3.2.1 Introduction
This chapter centers around the question of how to represent the information contained in images.
First, the information contained in images can be represented in entirely different ways. The most
important are the spatial representation (Section 2.2) and wave number representation (Section
2.3). These representations just look at spatial data from different points of view. Since the various
representations are complete and equivalent, they can be converted into each other. The
conversion between the spatial and wave number representation is the well-known Fourier
transform.

3.2.2 Spatial Representation of Digital Images

Pixel and Voxel

Images constitute a spatial distribution of the irradiance at a plane. Mathematically speaking, the
spatial irradiance distribution can be described as a continuous function of two spatial variables:
E(x1, x2) = E(x). (2.1)
Computers cannot handle continuous images but only arrays of digital numbers. Thus it is required
to represent images as two-dimensional arrays of points. A point on the 2-D grid is called a pixel or
pel. The 2D continuous image a (x, y) is divided into rows and columns. The intersection of a row
and a column is called a pixel. Both words are abbreviations of the word picture element. A pixel
represents the irradiance at the corresponding grid position. In the simplest case, the pixels are
located on a rectangular grid. The position of the pixel is given in the common notation for matrices.
The first index, m, denotes the position of the row, the second, n, the position of the column (Fig.
2.1a). If the digital image contains M × N pixels, i.e., is represented by an M × N matrix. Each pixel

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represents not just a point in the image but rather a rectangular region, the elementary cell of the
grid.

The 3-D spaces (and even higher-dimensional spaces) are also of interest in image processing. In
three-dimensional images a pixel turns into a voxel, an abbreviation of volume element. On a
rectangular grid, each voxel represents the mean gray value of cuboids. The position of a voxel is
given by three indices(x, y, z axis).

3.3 DIGITAL CONCEPT

3.3.1 Analog Vs Digital

Before knowing the difference between CR and DR, let’s look the difference between the analog
and digital image. Digital radiography is a form of x-ray imaging, where digital X-ray sensors are used
instead of traditional photographic film. Advantages include time efficiency through bypassing chemical
processing and the ability to digitally transfer and enhance images. Also less radiation can be used to produce
an image of similar contrast to conventional radiography.
The Digital image is the numerical representation of the object or image of the object, in the matrix
of array known as pixel which is used by the computers for further processing known as digital image
processing whereas; analog images are continuous images for e.g.: Chest X-ray which is used for human
viewing. The digital images have numbers for their representation at each definite point of the image while
on the other hand the analog images have brightness, film density, and color at each point.

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Fig. 3.2 – shows the differences between analog and digital image.

3.3.2 Classification of digital radiography

Digital radiography is the process of producing a digital image by the input of analog image with the
help of equipment known as analog to digital converter (ADC).

The digital radiography system can be classified in to two groups i.e;

Digital radiography

Direct digital radiography Indirect digital radiography

E.g.: USG, CT, MRI E.g. Computed radiography (CR)

& in X-ray imaging system DR includes image plate (IP)
Includes the detector elements as a detector element
i.e.; CCD & flat panel system.

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The classification is done on the basis of process of image formation. In, indirect radiography (e.g.
CR) the images are first formed on the image plate (i.e. latent image) which again digitized to get
the digital image. While in direct radiography there is no such material like image plate and no
latent image is formed. The images are formed digitally along with the exposure.

Digital Radiography (DR) is essentially filmless X-ray image capture. In place of X-ray film, a digital
image capture device is used to record the X-ray image and make it available as a digital file that can
be presented for interpretation and saved as part of the patient’s medical record. The advantages of
DR over film include immediate image preview and availability, a wider dynamic range which makes
it more forgiving for over- and under-exposure as well as the ability to apply special image
processing techniques that enhance overall display of the image. The largest motivator for
healthcare facilities to adopt DR is its potential to reduce costs associated with processing,
managing and storing films. Typically there are two variants of digital image capture devices. These
devices include Flat Panel detectors (FPDs), and High Density Line Scan Solid State detectors.

FPDs are classified in two main categories:

1. Amorphous Silicon (a-Si) is the most frequent type of FPD sold in the medical imaging industry
today. With a-Si detectors, a scintillator in the detector’s outer layer, which is made from Cesium
Iodide (CsI), or Gadolinium Oxysulfide (Gd2O2S), converts X-ray to light. Because the X-ray energy is
converted to light, the a-Si detector is considered an indirect image capture technology. The light is
then channeled through the a-Si photodiode layer where it is converted to a digital output signal.
The digital signal is then read out by Thin Film Transistors (TFT’s) or by fiber coupled Charged Couple
Devices (CCD’s). The image data file is sent to a computer for display where the X-ray technologist
can determine whether the image is appropriate for the intended anatomy. Once the Technologist
determines the image is appropriate it can be sent to the radiologist’s workstation or printed on
film for interpretation.

2. Amorphous Selenium (a-Se) FPD devices are known as “direct” detectors because no X-ray
energy conversion to light takes place within the detector. The outer layer of the flat panel in this
design is a high voltage bias electrode. The bias electrode accelerates the captured energy from an
X-ray exposure through the selenium layer. X-ray photons flowing through the selenium layer create
electron hole pairs. These electron holes transit through the selenium based on the potential of the
bias voltage charge. As the electron holes are replaced with electrons, the resultant charge pattern
in the selenium layer is read out by a TFT array or Electrometer Probes. The image data file is sent to
a computer for display where the X-ray technologist can review the image and check positioning
and if desired, transmit the image to the radiologist’s workstation for diagnosis.

3. The third type of DR detector is the High Density Line Scan Solid State device. It is comprised
of a Photostimulable Barium Fluoro Bromide doped with Europium (BaFBr:Eu) or Cesium Bromide
(CsBr) phosphor. The phosphor detector records the X-ray energy during exposure and is scanned
by a linear laser diode to excite the stored energy which is released and read out by a digital image
capture array of Charge Coupled Devices (CCD’s). The image data file is transmitted to the X-ray
technologist at a computer for review and then sent to the radiologist for further interpretation.

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Fig. 3.3 – Diagrammatic representation of image acquisition by direct digital radiography.

3.4 Luminescence
Luminescence is the phenomenon of emission of light on absorption of energy. When an X-rays falls
on a certain material these material will emits the light. And the invisible spectrum is changed into
the visible spectrum. The emission of light from substance bombarded by radiation is termed as
luminescence.

Fluorescent materials- The material which converts the invisible radiation into luminous (visible)
radiation are known as fluorescent materials and they are commonly known as phosphors. Few of
such materials used in radiology. The phosphors are used in crystalline and pure form. The smallest
part of impurities 1/100,000 will diminish the efficiency of many phosphors. These are many
expensive.

The fluorescent material must possess two characteristics-

1. It must absorb X-rays – absorption coefficient must be high.

2. It must efficiently convert the absorbed radiation to light.

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3.4.1 Photoluminescence
PHOTOLUMINESCENCE (abbreviated as PL) is a process in which a substance absorbs photons
(electromagnetic radiation) and then re-radiates photons (light photons). Quantum mechanically,
this can be described as an excitation to a higher energy state and then a return to a lower energy
state accompanied by the emission of a photon. This is one of many forms of luminescence (light
emission) and is distinguished by photo excitation (excitation by photons), hence the prefix photo-.
The period between absorption and emission is typically extremely short, in the order of 10
nanoseconds. Under special circumstances, however, this period can be extended into minutes or
hours.

Forms of photoluminescence

A) Fluorescence is the emission of visible light by a substance that has absorbed light of a
different wavelength. In most cases, absorption of light of a smaller wavelength induces
emission of light with a larger (less energetic) wavelength. A smaller wavelength emission is
sometimes observed from multiple photon absorption, but this occurs only under conditions
of intense radiation such as are available with laser light and stop upon the termination of
the exposure. The energy difference between the absorbed and emitted photons is
dissipated in the fluorescent material, via internal molecular vibrations and eventually heat.

B) Phosphorescence is a specific type of photoluminescence related to fluorescence. Unlike

fluorescence, a phosphorescent material does not immediately re-emit the radiation it
absorbs. The slower time scales of the re-emission are associated with "forbidden" energy
state transitions in quantum mechanics. As these transitions occur less often in certain
materials, absorbed radiation may be re-emitted at a lower intensity for up to several hours.

The figure shown below shows the different stages involved in photoluminescence. A) Different energy states
in an atom. B) Radiation exposure results in the excitation of the electron to the higher energy state. C)
Electrons comes down to lower energy state and trapped in the F-band. D) Again during exposure to laser
light energy is absorbed by the electrons. E) Heat energy is utilized by the electrons it gets excited to
conduction band and comes down to valance band losing their energy in the form of light which is used to
get an image.

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A B C

D E

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4. TYPES OF DIGITAL RADIOGRAPHY

4.1 Computed radiography

4.1.1 Components
4.1.2 Working
4.1.3 Applications of CR
4.1.4 Advantages and Disadvantages of CR

4.2 Direct radiography

4.2.1 CCDs
4.2.2 Flat panel detectors
[Link] Direct flat panel detectors
[Link] Indirect flat panel detectors
4.3 CR versus DR

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4. TYPES OF DIGITAL RADIOGRAPHY

4.1 Computed Radiography (CR)

CR is based on the principle of PHOTOSTIMULABLE LUMINESCENCE. It uses very similar equipment

to conventional radiography except that in place of a film to create the image, an imaging plate (IP)
made of photo stimulable phosphor is used. The imaging plate housed in a special cassette and
placed under the body part or object to be examined and the x-ray exposure is made. Hence,
instead of taking an exposed film into a darkroom for developing in chemical tanks or an automatic
film processor, the imaging plate is run through a special laser scanner, or CR reader, that reads and
digitizes the image. The digital image can then be viewed and enhanced using software that has
functions very similar to other conventional digital image-processing software, such as contrast,
brightness, filtration and zoom.

4.1.1 Components of CR

Computed radiography (CR) is a one of the recent advancements in the field of radiology which
helps in the field diagnostic imaging. It is composed of following components:

1. Cassettes with image plate

2. Identification station
3. Digitizer
4. Processing station

1. Cassettes with image plates

Cassettes

Cassette houses the image plate. Image plate is one which holds the latent image onto till it is
scanned in digitizer. The cassette performs dual functions- firstly; it holds/protect the image plate.
The inner lining of cassette is made up of felt which protects against mechanical damage,
electrostatic charging, dust and dirt.

Secondly, it receives and holds the image identification data. There is a memory chip which contains
all image relevant data, patient demographics image quality related data etc.

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Imaging Plate

The CR imaging plate (IP) contains photostimulable storage phosphors, which store the radiation
level received at each point in local electron energies. When the plate is put through the scanner,
the scanning laser beam causes the electrons to relax to lower energy levels, emitting light that is
detected by a photo-multiplier tube, which is then converted to an electronic signal. The electronic
signal is then converted to discrete (digital) values and placed into the image processor pixel map.

Imaging plates can theoretically be re-used thousands of times if they are handled carefully. IP
handling under industrial conditions, however, may result in damage after a few hundred uses. An
image can be erased by simply exposing the plate to a room-level fluorescent light. Most laser
scanners automatically erase the image plate after laser scanning is complete. The imaging plate can
then be re-used. Image plate is the sensitive part on which latent image is stored. The structure of
image plate is like films in the conventional radiography. Image plate has mainly four layers – EBC
top coat, phosphor layer, adhesive layer, black PET support layer, laminate layer.

a. EBC top coat( electron beam curled layer)

It is the protective layer of the image plate (IP). It ensures long life time of the IP and
provides efficient protection against mechanical wear during daily operation, static charging
and against cleaning solutions.

b. Phosphor layer

It is the sensitive layer of the IP which is similar to the emulsion layer of the conventional
film. IP is made of BaFBr and BaFI. Because of this mixture, the material is often just called
barium flurohalide activated with europium (BaFX:Eu3+). A CR plate is a flexible screen that is
enclosed in a cassette similar to a film-screen system. One imaging palate is used for each
exposure. The imaging is exposed in a procedure identical to screen-film radiography, and
the CR cassette is then brought to a CR reader unit. The cassette is placed in the reader unit,
and several processing steps then take place:

1. The cassette is moved into the reader and unit and the imaging plate is mechanically
removed from the cassette.
2. The imaging plate is translated across a moving stage and scanned by a laser beam.
3. The laser light stimulates the emission of trapped energy in the imaging plate, and visible
light is released from the plate.
4. The light released from the plate is collected by a fiber optic light guide and strikes a
photomultiplier tube (PMT), where it produces an electronic signal.
5. The electronic signal is digitized and stored.
6. The plate is then exposed to bright white light to erase any residual trapped energy.
7. The imaging plate is then returned to the cassette and is ready for reuse.

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c. Adhesive layer

It is the 3rd layer of the IP on which phosphor layer is mounted and the posterior connects to
the support layer (black PET layer)

d. Black PET layer

It is the support layer which provides the base for mounting other layers of IP and ensures
rigidity of the imaging plate.

e. Laminate layer

It is also known as backing layer. It is a soft polymer layer to protect the plate during stacking
of a number of imaging plates.

2. Identification station: It is the part of the console where the primary data of the patient is
fed in the computer. Examples, patient’s name, age, sex, patient ID, examination/part of the
body going to be x-rayed etc. These data are useful to differentiate the patient.

3. Digitizers: Digitizers (e.g.: Aka CR Reader), are responsible for converting the Analog to a
Digital Image by the process of digitization which is explained separately.

4. Processing station: It is also the part of the console. Processing station provides the user
interface and makes these images available for user for further processing, like Rotating
image, zooming, contrast width and level, grey scale inversion, image orientation,
magnification, measurement etc.

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Fig A: it shows the cassette with image plate

Fig B: identification station and processing station Fig C: Digitizer

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Advantages and Disadvantages of image plate-

Advantages of IP –

1. Image plates can be reused of thousands of times for exposure to get an image.
2. Imaging plate has high exposure latitude, means any exposure can give the image.
3. A valuable characteristic of the IP is its extreme dynamic range.

Disadvantage of IP-

1. IP is costly.
2. Improper handling can give rise to artifacts.
3. The latent image is lost if it is nor processed in time i.e. Approx. 48 hours after exposure.

Products:-

• Kodak classic CR system

• Kodak 975 CR system
• Fujifilm FCR capsule X/ XL II
• Konica Image Pilot CR
• Konica Xpress CR
• Agafa CR 30-X
• Agafa CR 35-X
• Agafa CR 85-X
• Agafa DX-S

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4.1.2 Working of CR -

Formation of Latent Image-

The digital image that is generated by the CR reader is stored temporarily on a local hard disk. Many
CR systems are joined directly to laser printers that make film hard copies of the digital images. CR
system often serve as entry points into a PACS and in such cases the digital radiographs is sent to
the PACS system for interpretation by the radiologists and long term archiving. The common
sequence is as follows:

Photo stimulated luminescence (PSL) is the release of stored energy within a phosphor by
stimulation with visible light, to produce a luminescent signal. Commonly this is used to allow the
storage of a weak radioactive signal in a phosphor plate that takes the place of X-ray film,
potentially over a prolonged period, which PSL transforms to obtain a highly sensitive image of the
original pattern of radiation. Also known as an image plate, a photostimulable phosphor (PSP)
plate can be used record a two-dimensional image of the intensity short-wavelength (typically, X-
ray) electromagnetic radiation. The device to read such a plate is known as a phosphor imager
(occasionally abbreviated to phosphor imager, perhaps reflecting its common application in
molecular biology of detecting radiolabled phosphorylated proteins and nucleic acids).

Creating an image requires illuminating the plate twice: the first exposure, to the radiation of
interest, "writes" the image, and a later, second illumination (typically by a visible-wavelength laser)
"reads" the image.

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Fig : it show the different stages involved in the acquisition of the computed radiograph.

The imaging plate is a completely analog device, but it is read out by analog and digital electronic
techniques as shown in Fig. The imaging plate is translated along the readout stage in the vertical
direction and a scanning laser beam interrogates the plate horizontally. The laser is scanned with
the use of rotating multifaceted mirror. As the red laser light from helium-neon laser strikes the
imaging phosphor at a location, the trapped energy from the x-ray exposure at the location is
released from the imaging plate. A fraction of the emitted light travels through the fiber optic light
guide and reaches the PMT. The electronic signal that is produced by the PMT is digitized and stored
in the memory. Therefore for every spatial location (x, y), a corresponding gray scale value is
determined, and this is how the digital image is produced in a CR reader.

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FIGURE: The hardware of a CR reader

is illustrated. The IP is mechanically
translated through the readout
system using rollers. A laser beam
strikes a rotating multifaceted
mirror, which causes the beam to
repeatedly scan across the IP. Light is
emitted from the plate by laser
stimulation. The emitted light travels
through a fiber optic light guide to
photomultiplier tube, where the light
is converted to an electronic signal.
The signal from the PMT
subsequently digitized.

The light that is released from the imaging plate is of a different color than the stimulating laser
light (fig). To eliminate detection by the PMT of the scattered laser light, an optical filter that
transmits the blue-green light that is emitted from the imaging plate, but attenuates the red laser
light, is mounted in the front of PMT.

FIG: The optical spectra used in a CR

reader system are illustrated. The red
laser light stimulates the release of
trapped x-ray energy in the imaging
plate. When the trapped electron
energy is released, a broad spectrum
of blue-green light is emitted. An
optical filter, placed in front of the
PMT, prevents the detection of the
red laser.

Fig describes how stimulated phosphor work. A small mass of screen material is shown being
exposed to the X-rays. Typically imaging plates are composed of about 85% BaFBr and 15% BaFI,
activated with small amount of europium. The activation procedure, also called doping, creates
defects in the BaFBr crystals that allow electrons to get trapped more efficiently.

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When the X-ray energy is absorbed by the BaFBr phosphor, the absorbed energy excites
electrons associated with the europium atom, causing divalent europium atoms (Eu2+) to be
oxidized and changed to the trivalent state (Eu3+). The excited electrons become mobile, and some
fraction of them interacts with a so called F-center. The F-center traps these electrons in a higher
energy, metastable state where they can remain for days to weeks, with some fading over time. The
latent image that exists on the imaging plate after X-ray exposure, but before reading out, exists as
billions of electrons trapped in F-centers. The number of trapped electrons per unit area of the
imaging plate is proportional to the intensity of X-rays incident at each location during exposure.

Fig- This figure illustrates the sequence of

events during the x-ray exposure and
readout of a photostimulable phosphor.
During exposure the electrons are excited
from the valance band to the conduction
band, and some of these are trapped in the
F-centers. During readout, laser light is
used to stimulate the trapped electrons
back up to the conduction band, where
they are free to transition to the valance
band, and in doing so the blue-green light is
emitted. The light energy emitted by the IP
is proportional to the absorbed x–ray
energy.

When the red laser light scans the exposed imaging plate, the red light is absorbed at F-center
where the energy of the red light is transferred to the electron. The photon energy of the red laser
light is less than that of the blue-green emission (ΔEred < ΔEblue green). However, the electron gains
enough energy to reach to the conduction band, enabling it to become mobile again. Many of these
electrons then become de-excited by releasing blue-green light as they become reabsorbed by the
trivalent europium atoms, converting them back to the divalent state. This is how the red laser light
stimulates emission of the blue and green light photons from the imaging plate.

The first readout of the imaging plate does not release all of the trapped electrons that form the
latent image; indeed a plate can be read a second time and a third time with only slight
degradation. To erase the latent image so that the imaging plate can be reused for another
exposure without ghosting, the plate is exposed to very bright light source, which flushes almost all
of the metastable electrons to their ground state, emptying most of the F-centers.

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 Concept of Digital radiography

Fig – one of the principal advantages

of CR over screen-film detector system
is the greater dynamic range that CR
provides. The usable exposure range
for CR system is much greater.

CR systems operate with a workflow pattern very similar to the screen-film radiography, CR
cassettes is exposed just like screen-film cassette, and they then brought to a reader unit, just as a
film-screen cassettes are brought to the film processors. The similarity in handling of the CR and
screen-film cassettes contributed to the initial success of CR. One of the disadvantages that CR over
screen-film radiography is its much larger dynamic range; in other words, the exposure latitude with
CR is much wider than with screen-film radiography system. Consequently, retakes due to
overexposure or underexposure are rare with CR. Although CR is capable of producing images with
proper grey scale at low and high exposure levels, quality assurance efforts should still be in place to
ensure proper exposure levels. CR images exposed to low exposure levels, while maintaining proper
grey scale in the image, have higher level of x-ray quantum noise. CR images produced at high
exposure have low quantum noise but result in higher x-ray dose to the patients

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 Concept of Digital radiography

4.1.3 Applications

CR and DR should not be confused with fluoroscopy, where there is a continuous beam of radiation,
and the images appear on the screen like on a TV. This is the system many people are familiar with,
where the image of the article being x-rayed is viewed in real time on a monitor or display. Many
people think airports use Fluoroscopes for baggage inspection, when in fact LDA's (Linear Diode
Arrays) are universally used to generate static images of luggage content. LDA's are also used in a
wide variety of other screening and imaging applications, and are also presented in a digital format.
Modern fluoroscopes use a device called an image intensifier to enhance the analog output of the
real time x-ray image, where it is picked up by either a video or CCD camera and digitally enhanced
to reduce the noise inherent in the system.

Industrial applications

Common applications for computed radiography include:

• Corrosion surveys on pipes, often through insulation;

• Examination of valves for erosion;
• Information shots on industrial components; e.g. checking to see if a valve is closed properly,
or checking for obstructions in valves and pipes;
• Examination of boiler water walls;
• Automotive casting inspection
• High pressure braze joint inspection (aerospace)
• Wax pattern core integrity verification in investment casting foundries
• Best when used with Se75 for small core piping due to internal scatter created by Ir192's
wavelength
• Code work for Nuclear Applications on all size piping.

Medical applications

Computed Radiography systems are the most common in medical applications because they have
proven reliability over more than two decades, flexibility to address a variety of clinical applications
and lower costs to take multiple exam rooms digital. DR systems are generally sold as full x-ray
room replacements and tied to a single x-ray generator. CR IPs can be retrofitted to existing exam
rooms and used in multiple x-ray sites since IPs are processed through a CR reader (scanner) that
can be shared between multiple exam rooms.

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 Concept of Digital radiography

4.1.4 Advantage and Disadvantage -

Advantages

• No silver based film or chemicals are required to process film.

• Reduced film storage costs because images can be stored digitally.
• Computed radiography often requires fewer retakes due to under- or over-exposure which
results in lower overall dose to the patient.
• Image acquisition is much faster - image previews can be available in less than 15 seconds.
• By adjusting image brightness and/or contrast, a wide range of thicknesses may be examined
in one exposure, unlike conventional film based radiography, which may require a different
exposure or multiple film speeds in one exposure to cover wide thickness range in a
component.
• Images can be enhanced digitally to aid in interpretation.
• Images can be stored on disk or transmitted for off-site review.
• Ever growing technology makes the CR more affordable than ever today. With chemicals,
dark room storage and staff to organize them, you could own a CR for the same monthly
cost while being environmentally conscious, depending upon the size of the Radiographic
Operation.

Disadvantages

• In medical applications, manual handling of the cassette housing the IP is considered a

disadvantage versus DR but it also offers more flexibility for patient positioning.
• CR is still not an approved method for higher quality radiologic applications (aerospace), due
to the possibility of digital manipulation to the captured image, the inherent geometric
unsharpness and resultant lower spatial resolution as compared to film (radiographic)
images, SNR (signal vs. noise)issues and sensitivity to scattered radiation, and the general
lack of procedural consensus among primes.
• There also are no quality (image resolution) standards for general radiography, only for
mammography, however, competition among manufacturers has raised the bar and newer
CR technologies with increased detective quantum efficiency (DQE) and higher spatial
resolution have emerged.
• Imaging plates (IPs) are expensive and can be damaged if the system being used requires
manual handling of the IPs. Theoretically, IPs may be reused thousands of times, but
constant use will always result in damage to the IP and image artifacts, eventually to the
point of necessary replacement.

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 Concept of Digital radiography

4.2 Direct radiography

4.2.1 CCD (Charged-coupled devices)

CCDs form images from visible light. CCD detectors are used in most modern vediocameras and in
digital cameras. The principal feature of the CCD detectors is that the CCD chip is itself is an
integrated circuit made of crystalline silicon, similar to the central processing unit of the computers.
A CCD chip has discrete pixel electronic etched into its surface; for example, a 2.5 x 2.5 cm CCD chip
may have 1024 x 1024 or 2048 x 2048 pixels on its surface. Large chip spanning 8 x 8 cm have been
produced. The silicon surface of the CCD is photosensitive – as visible light falls on each pixel,
electrons are liberated and build up in the pixel. More electrons are produced in a pixel that
receives greater light intensity. The electrons are kept in each pixel because there are electronic
barriers (voltage) on each side of pixel during exposure.

Once CCD chip has been exposed, the electronic charge that resides in each pixel is readout.
The readout process is akin to a bucket brigade (Fig.). Along one column of the CCD chip, the
electronic charge is shifted pixel by pixel by appropriate control of voltage levels at the boundaries
of each pixel. The charge from each pixel in the entire column is shifted simultaneously, in parallel.
For linear CCD detector, the entire line of pixels is thus read out one by one, in a shift and read, shift
and read process. For a two dimensional CCD detectors, the change on each column are shifted
onto the bottom row of pixels, that entire row is read out horizontally, and then the next charges
from all columns are shifted down one pixel, and so on.

CCD cameras produce high-quality images from visible light exposure and are commonly
used in medical imaging for fluoroscopy and digital cineradiography. In these devices, the amplified
light generated by the image intensifier is focused with the lenses or fiber optics on to the CCD chip
(Fig.). For a small field of view applications such as dental radiography (e.g., 25 x 50 detectors), an
intensifying screen is placed in front of the CCD chip and the system is exposed. The light emitted
from the screen is collected by the CCD chip, and because of the excellent coupling between the
screen and the CCD chip only a relatively small amount of the light generated in the screen is
wasted ( i.e., does not reaches to the CCD). For application in which the field of view is only slightly
larger than the area of CCD chip, such as digital biopsy system in mammography, a fiber optic taper
is placed in between the fiber optic and CCD (Fig.). The fiber optic taper serves as an efficient lens
that focuses the light produced in the screen onto the surface of CCD chip. Typically fiber optic taper
used in digital biopsy system have front surface that measures 50 x 50 mm (abutted to the screen)
and output surface that are 25 x 25 mm (abutted to the CCD). In these systems, the amount of light
lost in fiber optic taper is not trivial, but a substantial fraction of the light reaches the CCD chip.

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 Concept of Digital radiography

When there is a need to image a large field of view, such as in chest radiography, it is impossible to
focus the light emitted from the large screen (approximately 35 x 43 cm) onto the surface of CCD
chip without losing a large fraction of the light photons. The amount of light lost is proportional to
the demagnification factor required to couple the input area to the output area. As an example, the
area ratio (demagnification factor) for 35 x 43 cm chest radiography using a 30 x 30 mm CCD chip is
167:1. Even with perfect lenses in such system, the light loss is approximately 99.7%. Because an
insufficient number of quanta are used to conduct an image through an imaging chain after the
initial x-ray detection stage, a secondary quantum sink will occur. Although an image can be
produced if a sufficient number of x-ray photons are used, any x-ray system with a secondary
quantum sink will have image quality that is not commensurate with the x-ray dose used to make
the image.

Fig:- CCD are pixilated light detectors in which electronic charge builds up in each detectors
elements as a response to light exposure. After exposure, by toggling voltages between
adjacent detector elements, the charge packets are made to move in simultaneously down
each column of the array. After the charge packets have been shifted down one detector
element in each column, the bottom row of pixels is refreshed. This bottom row is readout
horizontally, in a bucket brigade fashion, so that the charged packet from each detector
element reaches the readout electronics of the CCD.

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 Concept of Digital radiography

Fig:- A: the top frame show the CCD chip coupled through tandem lenses to the output of an
image intensifier. Because of the huge light amplification of the image intensifier, many
thousands of light photons are produced by the absorption of an X-Ray photon. A small
fraction of these light photon pass through the lenses and are focused on to the CCD chip.
Although many light photons are lost in the lens and the aperture, the huge gain of the image
intensifiers ensures that a secondary quantum sink is avoided. B: digital mammography biopsy
system makes use of fiber optic coupling between a small field of view intensifying screen and
a CCD chip. Because the demagnification factor is low and the fiber optic lens is efficient, a
secondary quantum sink is avoided. C: for large field of view(FOV) applications, the use of
lenses coupled to an intensifying screen results an substantial loss of the light photons emitted
by X-ray interaction in the screen. This type of system suffers from a secondary quantum sink.

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 Concept of Digital radiography

4.2.2 FLAT PANEL DETECTORS

Flat panel detector systems make use of technology similar to that used in a laptop computer
display, and much of this has to do with wiring the huge number of individual display elements.
Instead of producing individual electrical connections to each one of the elements in a flat panel
display, a series of horizontal and vertical electrical lines are used which , when combined with
appropriate readout logic, can address each individual display element. With this approach only
2,000 connections between the imaging plate and the readout electronics are required for 1,000
into 1,000 displays instead of 1,000,000 individual connections. For a flat panel display, the wiring is
used to send signals from the computer graphics card to each display element, whereas in a
detector the wiring is used to measure the signal generated in each detector element.

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 Concept of Digital radiography

Fig; The figure shows the two types of Flat panel detectors image acquisition mechanism.
The first one show the Indirect flat panel and second, is the direct flat panel detector system.

[Link] Indirect Detection Flat Panel System

Indirect flat panel detectors are sensitive to visible light, and x-ray intensifying screen (typically
Gadolinium oxysulfide or cesium iodide) is used to convert incident x-rays to light, which is then
detected by the flat panel detector. The term indirect comes from the fact that x-rays are absorbed
in the screen, and the absorbed x-ray energy is then relayed to the photo detector by visible light
photons. This indirect detection strategy is analogous to a screen film system, except that the
electronic sensor replaces the light sensitive film emulsion. Dual- emulsion film is thin and x-rays
penetrate it easily; therefore, in a screen film cassette the film is sandwiched between screens to
reduce the average light propagation path length and improve spatial resolution. Flat panels are
thicker than film and do not transmit x-rays well; consequently, a sandwiched design is not possible.
Instead, the intensifying screen is layered on the front surface of the flat panel array. This means
that the light emanating from the back of the intensifying screen strikes the flat panel, and much of
the light that is released in the screen has to propagate relatively large distances through the
screen. This results in more blurring. To improve this situation, most flat panel detector systems for

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 Concept of Digital radiography

general radiography use CsI screens instead of Gd2O2S. CsI is grown in columnar crystals and the
columns act as light pipes to reduce the lateral spread of light.

A typical configuration for a flat panel detector system is shown in (Fig. 4-7). The flat panel
comprises a large number of individual detector elements, each one capable of storing charge in
response to x-ray exposure. Each detector element has a light sensitive region, and a small corner of
it contains the electronics. Just before exposure, the capacitor, which stores the accumulated x-ray
signal on each detector element, is shunted to ground, dissipating lingering charge and resetting the
device. The light sensitive region is a photoconductor, and electrons are released in the
photoconductor region on exposure to visible light. During exposure, charge is built up in each
detector element and is held thereby the capacitor. After exposure, the charge in each detector
element is readout using electronics as illustrated in (Fig. 4-8).

A transistor is a simple electronic switch that has three electrical connections- the gate, the source,
and the drain. Each detector element in a flat panel detector has a transistor associated with it; the
source is the capacitor that stores the charge accumulated during exposure, the drain is connected
to the readout line (vertical wires in fig. 4-8.), and the gate is connected to the horizontal wires
shown in (Fig. 4-8). Negative voltage applied to the gate causes the switch to be turned off (no
conduction from source to drain), whereas when a positive voltage is applied to the gate the switch
is turned on (source is connected to drain). Because each detector element has a transistor and the
device is manufactured using thin film deposition technology, these flat panel systems are called
thin-film transistor (TFT) image receptors.

Fig 4.7: A flat panel detector

array comprises a large
number of discrete detector
elements. Each detector
element contains both a
light sensitive area and a
region that holds electronic
components.

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Concept of Digital radiography

Fig 4.8: This figure illustrates the read

out process used for flat panel
detector arrays. Nine detector
elements are shown (A through I).
Three gate line (rows, R1, R2, R3) and
three readout lines (columns C1, C2,
C3) are illustrated.

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 Concept of Digital radiography

The readout procedure occurs as follows. During exposure, negative voltage is applied to all gate
lines, causing all of the transistor switches on the flat panel imager to be turned off. Therefore,
charge accumulated during exposure remains at the capacitor in each detector element. During
readout, positive voltage is sequentially applied to each gate line (e.g., R1, R2, R3, as shown in fig.
4-8), one gate line at a time. Thus, the switches for all detector elements along a row are turned on.
The multiplexer (top of fig. 4-8) is a device with a series of switches in which one switch is opened at
a time. The multiplexer sequentially connects each vertical wire (e.g. C1, C2, C3), via switches (S1,
S2, S3), to the digitizer, allowing each detector element along each row to be read out. For example,
referring to fig.4-8, when wire R2 is set to a positive gate voltage (all other horizontal wires being
negative), the switches on detector elements D, E, and F are opened. Therefore, current can in
principle flow between each of these detector elements (source) and the digitizer (drain). In the
multiplexer, if the switches S1 and S3 are turned off and S2 is on, then the electrons accumulated on
the detector element E are free to flow(under the influence of an applied voltage) from the storage
capacitor, through the charge amplifier, through the multiplexer (S2 is open) to the digitizer. Thus,
the array of detector elements is readout in a raster fashion, with the gate line selecting the row
and the multiplexer selecting the column. By this sequential readout approach, the charge from
each detector element is readout from the flat panel, digitized, and stored, forming a digital image.
Notice that in this procedure the signal from each detector element does not pass through any
other detector elements, as it does in a CCD camera. This means that the charge transfer efficiency
in a flat panel imager needs only to be good (approximately 98%), whereas for a CCD the charge
transfer efficiency needs to be excellent (greater than 99.9%). Therefore, flat panel systems are less
susceptible to imperfections that occur during fabrication.

The size of the detector element on a flat panel largely determines the spatial resolution of
the detector system. For example, for a flat panel with 125 x 125 µm pixels, the maximum spatial
frequency that can be conveyed in the image (the Nyquist frequency, FN) is (2 x 0.125 mm)-1 , or 4
cycles/mm. because it is desirable to have a high spatial resolution, small detector elements are
needed. However, the electronics (e.g.; the switch, capacitor, etc) of each detector element takes
up a certain amount of the area, so, for flat panel with smaller detector elements, a larger fraction
of the detector elements area is not sensitive to light. Therefore, the light collection efficiency
decreases as the detector elements get smaller. The ratio of the light sensitive area to the entire
area of each detector element is called the fill factor.

Fill factor = light sensitive area

area of detector element

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 Concept of Digital radiography

It is desirable to have a high fill factor, because light photons that are not detected do not
contribute to the image. If a sufficient number of the light photons generated in the intensifying
screen are lost owing to a low fill factor, then contrast resolution (which is related to the signal to
noise ratio) will be degraded. Therefore, the choice of the detector element dimensions required a
tradeoff between spatial resolution and contrast resolution.

[Link] Direct Detection Flat Panel System

Direct flat panel detectors are made from a layer of photoconductor material on top of a TFT array.
These photoconductor materials have many of the same properties as silicon, except they have
higher atomic numbers. Selenium is commonly used as the photoconductors. The TFT arrays of
these direct detection system make use of the same line-and-gate readout logic, as described for
the indirect detection systems. With direct detectors, the electrons released in the detector layer
from X- ray interactions are used to form the image directly. Light photons from the scintillation are
not used. A negative voltage is applied to a thin metallic layer (electrode) on the front surface of the
detector, and therefore the detector elements are held positive in relation to the top electrode.
During X-ray exposure, X-ray interaction in the selenium layer liberate electrons that migrates
through the selenium matrix under the influence of the applied electric field and are collected on
the detector elements. After exposure a detector elements are readout as described earlier for
indirect systems.

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 Concept of Digital radiography

Fig: A cross-section of an indirect

detection flat panel system
shows. X-ray interact with a
scintillator, where visible light is
emitted and diffuses towards the
photosensitive detector elements
of the panel.

With indirect systems, the light that is released in the intensifying screen diffuses as it
propagates to the TFT array, and this causes a certain amount of blurring. This blurring is identical to
that experienced in the screen film detectors. For indirect flat panel detectors, the columnar
structure of CsI is often exploited to reduce lateral spread but a significant amount of lateral
blurring does still occur. For direct detection system, in contrast, electrons are the secondary quanta
that carry the signal. Electrons are made to travel with a high degree of directionality by the
application of electric field. Therefore, virtually no blurring occurs in direct flat panel detectors.

Fig: Direct flat panel detectors are

often use a layer of amorphous
selenium photoconductor
coupled to a thin-film transistor
(TFT) array. In a direct detection
flat panel device, x-ray interaction
in the selenium layer releases
electrons , which are used to form
the signal directly. An electric
field applied across the selenium
layer minimizes the lateral spread
of the electrons, preserving
spatial resolution.

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 Concept of Digital radiography

Selenium (Z=34) has a higher atomic number than silicon (Z=14), but it is still quite low
compared with conventional X-ray intensifying screen phosphors that contain element such as
gadolinium (Z=64) or cesium (Z=55), and therefore the attenuation coefficient is relatively low at
diagnostic X-ray energies (40 to 130 keV). Intensifying screens need to be kept thin enough to
reduce light spreading thereby preserve spatial resolution. However, because electrons do not
spread laterally in the selenium direct detectors due to the electric field, selenium detectors made
much thicker than indirect detection system, to improve X-ray detection efficiency. Making the
selenium detectors thicker compensates for the relatively low X-ray absorption of selenium. In
addition to selenium, other materials such as mercuric oxide (HgI2), cadmium telluride (CdTe), and
lead iodide (PbI2) are being studied for the use in direct detection flat panel.

Fig. : CsI phosphor detection system has better dose efficiency, whereas a-Se can provide better
spatial resolution.

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 Concept of Digital radiography

4.3 CR versus DR

Differences from Digital Radiography

Computed radiography (CR) is often distinguished from Digital Radiography (DR). CR and DR have
many similarities. Both CR and DR use a medium to capture x-ray energy and both produce a digital
image that can be enhanced for soft copy diagnosis or further review. CR generally involves the use
of a cassette that houses the imaging plate, similar to traditional film-screen systems, to record the
image whereas DR typically captures the image directly onto a flat panel detector without the use of
a cassette. Image processing or enhancement can be applied on DR images as well as CR images due
to the digital format of each. There are many different types of DR detectors.

Characteristics of computed radiography (CR) & digital radiography (DR)

Procedure Like film radiography, CR requires DR requires exposing the digital panel.
exposing the cassette. The cassette is then Image is then immediately available for
moved from the inspection site to the evaluation of the PC without moving the
reader location. The CR plate is digitally panel from the inspection site.
imaged, and the is evaluated on the PC.
Portability CR cassette is very portable. The CR The DR panel can be field portable,
reader/eraser is not portable and requires depending on the panel size.
an electrical power source.
Resolution The highest currently available resolution, The highest available resolution is the
with CR is 100 microns, with new 50 Envision 4x4 at 48 microns. The time to
micron versions available soon. At 100 acquire the image is typically 12 seconds.
microns, from 1 to 5 minutes is required
to digitize the image and ½ to 2 minutes to
erase depending on brand.
Speed Like film, CR requires multiple steps. DR is much faster than CR. It can provide
Typically CR takes 2-10 minutes or more image within a few seconds, mainly from 5
for taking the cassette to the reader, to 20 seconds.
reading, erasing, and returning to the
inspection site.
Production use Like film, the multi-step process for usingDR can provide continuous inspection of
CR is too slow for most production hundreds or even thousands of part per
applications. hour. Automatic detect recognition (ADR) is
also an option.
Cost CR systems require the purchase of a DR systems require the purchase of an
reader/eraser workstation with PC, display imaging panel, cable, PC, display and
and software also cassette. But it cost software.
effective than DR system.
Strengths CR excels for field operations where DR excels for production applications
access is limited or imaging plate must where speed and/or image quality are
conform to the object shape. paramount. Also, DR linear arrays can
provide X-ray views without parallax.

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 Concept of Digital radiography

5 . DIGITIZER & DIGITIZING AN IMAGE

5.1 Digitizer
5.2 Components
5.3 Process of digitization
5.4 Advantages of digitization

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 Concept of Digital radiography

4.1 Digitizer

Digitizer is responsible for converting the analog image into digital image. In simple words it is
responsible for converting the latent image into digital image which are used by the
computers for further used for image processing.

4.2 Components of digitizer

• Input/output slot
• Cassette unit
• IP transport units
• Scan unit
• Eraser unit
• CPU assembly
• Power unit

- It has an input/output slot where the cassette is inserted for scanning or ejected by the
Digitizer after the scanning and erasing is done.
- It has cassette units, which perform the operation of opening and closing the cassettes to
facilitate access to image plate for the rest of assembly.
- It has an image plate transport unit, which do the function of transporting the image plate
to and from the cassette unit to and from the scan unit. They rely upon a suction cup
assembly for pickup of the image plate.
- It has a scan unit, which is heart of the digitizer. It performs the operation of converting
latent X-ray image into 12 bit raw digital image.
- It has an erasure unit, which removes all the residual image data, which is not required after
the scanning of the image plate is done. It is nothing; but a high intensity halogen lamp does
the function of erasing.
- It has a CPU assembly, which controls and co-ordinates the overall function of the digitizer.
It is also responsible for the networking of the same in a LAN.
- It has a power unit, to provide each and every electrical/ electronic component of the entire
system, the required power at required voltage.

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 Concept of Digital radiography

Process in DIGITIZER-

Cassette moved into reader unit

Image plate is scanned by the laser unit

Laser light stimulates the emission of trapped energy in the form of visible light

Collected by fiber optic light guide and allows to strikes the PMT to produce electronic signal

Electronic signal digitized & stored

Plate exposed to white light

5.3 Process of Digitization

The primary objective when digitizing an image is to convert an analog image into numerical data
for processing by the computer, a conversion process known as digitization. The process of
digitization consists of three distinct steps:-

1. Scanning
2. Sampling
3. Quantization

1. Scanning: - The first step in digitization is division of the picture into small regions, a process
known as scanning. Each small region of the picture is called a picture element, or pixel. It
results in formation of grid consists of rows and columns. The size of the grid usually
depends on the number of pixels on each side of grid. The rows and columns play a role in
identifying a particular pixel by providing an address for that pixel. The rows and columns
make up what has been referred to as a matrix.
2. Sampling: - The second step in digitizing an image is sampling, a procedure done on the
entire image in which the brightness of each pixel is measured. A small spot of light is
projected on to the transparency and a photomultiplier tube positioned behind the picture
detects the transmitted light. The output of the photomultiplier tube is an electrical signal
(analog signal).
3. Quantization: - Quantization is the final step in digitizing a picture. In quantization, the
brightness value of each pixel sampled is assigned an integer (0, or a positive or negative
number) called a gray level. This is done for all the pixels that make up the picture and the
result is a range of numbers or gray levels, each of which has a precise location on the
rectangular grid of pixels. The total number gray level is called the gray scale. In

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 Concept of Digital radiography

quantization, the electrical signal is assigned an integer based on strength of the signal. In
general, the value of the integer is proportional to the signal strength. At the end of the
quantization process we have a digital image, an array of numbers representing the analog
image that we scanned, sampled and quantized. This array of numbers is sent to the
computer for further processing.

5.4 Advantages of digitization

The major goal of digitization is that a computer can process digital images. Some of the
major advantages of digitization are:-
1. Image Enhancement: - The image can be made to look more pleasing to the observer.
Certain characteristics of the image, such as contours and shapes, can be enhanced to
improve the overall quality of the image.
2. Image Restoration: - Poor images can be filtered to remove unwanted Noise a technique
referred to as filtering. Filtering can also help to remove unnecessary fine detail in the
image, a technique known as smoothing.
3. Image Analysis: - This is also referred to as scene analysis, which seeks to extract the
information contained in various objects in a scene without placing any interpretation on
them.
4. Image Detection: - The advantage of detection is to allow the observer to look for
specific shapes, contours, or textures while disregarding the other features in the image.
5. Pattern Recognition: - In digital image processing, the computer can see structures and
identify patterns.
6. Geometric Transformation: - In this process, images can be rotated or scaled by
changing the position of the pixels.
7. Data Compression: - The compression of digital images reduces the amount of data that
make up the image. This is important when the data has to be stored or transmitted.

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 Concept of Digital radiography

Fig : shows the Digital imaging system and its components.

Fig : show the display of radiograph on the CRT television.

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 Concept of Digital radiography

6. IMPLEMENTATION
The choice of the digital detector system requires a careful assessment of the needs of the facility.
CR is often the first digital radiographic system that is installed in a hospital, because it can be used
for providing portable examinations, where the cost of retakes in both time and money is high. A
significant benefit of CR over TFT based digital radiographic technology is that the reader is
stationary, but because the CR plates themselves are relatively inexpensive, several dozen plates
may be used in different radiographic rooms simultaneously. The number of rooms that one CR
reader can serve depends on the types of rooms, workload, and proximity. Typically, one CR reader
can handle the workload of three radiographic rooms. The cost of an individual flat panel detector is
high, and it can only be in one place at one time. The obvious utility for flat panel detectors is for
radiographic suites that have high patient throughput, such as a dedicated chest room. Because no
cassette handling is required and the images are rapidly available for checking positioning, the
through put in a single room using flat panel detectors can be much higher than for screen-film or
CR systems.

7. PATIENT DOSE CONSIDERATIONS

When film screen image receptors are used, an inadvertent overexposure of the patient will result
in a dark film, which provides immediate feedback to the technologist regarding the technique
factors (and relative dose) used. However, when digital image receptors are used, overexposure of
the patient can produce excellent images because the electronic systems compensates for (and
essentially mask) large fluctuations in exposure. Consequently, high exposure conditions may go
unnoticed unless appropriate measures for periodic monitoring are taken. For this reason, a quality
control program should be in place to ensure proper exposure levels. Most digital detector systems
provide an estimate of the incident exposure that can assist in the evaluation of exposure trends.
The exposures necessary to produce good images are directly related to the detective quantum
efficiency (DQE) of the detector: Detectors with high DQEs make more efficient use of the X-rays
and therefore require less exposure for adequate signal-to-noise ratios. X-ray exposure levels
should be tailored to the needs of the specific clinical examination, in consideration of the digital
detector and it’s DQE. For example, it is generally accepted that CR imaging systems require about
twice the exposure of a corresponding 400-speed screen-film detector for comparable image
quality. The CR system is therefore equivalent to a200-speed screen-film system for most general
radiographic examinations. Screen-film cassettes for extremity radiography are slower (i.e., require
more radiation) than those used for general radiography, and higher exposure levels are required
for exposure levels are required for extremity imaging with CR as well ( equivalent to 75-to 100-
speed screen-film systems).

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Flat panel detectors can reduce radiation dose by about twofold to threefold for adult imaging,
compared with CR for the same image quality, owing to the better quantum absorption and
conversion efficiency associated with that technology.

8. HARD COPY VERSUS SOFT COPY DISPLAY

Hard copy display refers to displaying images on film, and soft copy display refers using video
monitors. Digital radiographic images produced by flat panel TFT arrays or by CR systems are
significantly larger in matrix size than any other images produced in the radiology department. For
example, typical SPECT and positron emission tomography (PET) images are 128x128 pixels, MRI
images are typically 256x256 pixels, and CT images are 512x512 pixels. Digital subtraction
angiography images are often 1,024x, 1,024 pixels. Digital chest radiographs using 100µm pixels
result in an image matrix of 3,500x 4,300 pixels. A typical personal computer display screen is
slightly larger than 1x1k, and therefore could simultaneously display 64 full resolution SPECT
images, 16 full-resolution MRI images, or 4 full-resolution CT images. However, the 3.5x4.3k –pixel
digital chest image is much too large for a 1x1k monitor; only one fifteenth of the image data could
be displayed at any one time. Therefore, when digital radiographs are included in the image mix, the
display resolution of the monitors used for soft copy reading must be increased if entire images are
to be increased if entire images are to be displayed at full or nearly full spatial resolution. This
increases the cost of soft copy display workstations.

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9. DIGITAL IMAGE PROCESSING

DIGITAL VERSUS ANALOG PROCESSES

Although image receptors are referred to as “digital “, the initial stage of these devices produces an
analog signal. In CR, a photomultiplier tube detects the visible light emitted from the
photostimulable phosphor plate and produces a current that is sequently digitized, although CCD
and flat panel detector systems are divided into discrete detector element (and therefore are
referred as “pixilated” detectors), the signal produced in each pixel is an analog packet of electronic
charge which is digitized by an analog-to-digital converter (ADC) during image readout. Therefore
the initial stage of all digital detectors involves analog signals.

DIGITAL IMAGE PROCESSING

Subjecting numerical representation of objects to a series of operation to obtain a desired result.
One of the advantages of having an image in digital format is that its appearance can be modified
and sometimes improved using a computer to manipulate the image. Here, a brief introduction of
image processing is given.

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1. DIGITAL IMAGE CORRECTION

Most digital radiographic detector systems have an appreciable number of defects and
imperfections. There is even a grading system for CCD chips that relates to the number of defects in
the chip. Fortunately, under most situations the blemishes in the image can be corrected using
software. For both CCD and flat panel systems, invariably there are a certain number of detector
elements that do not work- they generate no response to light input and are called “dead pixels”.
After manufacture, each detector is tested for dead pixels, and a dead pixel map is made for each
individual detector array or CCD chip. Software uses the dead pixel map to correct the images
produced by that detector: The gray scale values in the pixels surrounding the dead pixel are
averaged, and this value replaces the gray scale of the dead pixel. When the fraction of dead pixels
is small, the correction procedure makes it almost impossible to see dead pixel defects in the image.
Because of the bucket brigade type of readout that a CCD uses, some dead pixels result in the loss
of a column of data (i.e., when charge cannot be transferred through the dead pixel). Column
defects can also be corrected with the use of interpolation procedures; however, different
interpolation techniques are used for column defects than for dead pixels.

In the absence of X-rays, each detector element has a certain amount of electronic noise
associated with it (“dark noise”). Finite gray scale values result from image acquisition in the
absence of X-rays, depending on the dark noise in each individual detector element. These noise
values are different from exposure to exposure, but a large number of dark images can be acquired
and averaged together, generating an average dark image D(x, y). This dark image is subtracted
from the images produced by the detector array.

Even for properly functioning detectors, there are subtle differences in the sensitivity of each
detector element. For large detector arrays, several amplifiers are used, and each one has a slightly
different gain. In some digital detector array systems, the amplifiers are associated with different
regions (i.e., adjacent groups of columns) of the detector: without correction, an obvious banding
pattern would be visible on the image. To correct the differences in gain between the detector
elements in the array, a gain image or flat field image is acquired. Figure 11-13 shows an image,
with and without flat field correction. To acquire a flat field image, the array is exposed to a
homogenous signal(a uniform X-ray beam with perhaps a copper filter placed near the X-ray tube to
approximate patient attenuation), and a series of images are acquired and averaged. This produces
the initial gain image G’(x, y). The dark image, D(x, y), is subtracted from the initial gain image to
obtain the gain image: G(x, y) = G’(x, y) - D(x, y). The average gray scale value on the gain image is
computed, and this may be designated Ĝ.

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Fig 9.1 : a) image before digital correction b) image after digital image correction.

When an initial (raw) medical X-ray image, Intw(x, y), is acquired, it is corrected to yield the final
image I(x, y) with the following equation:

I(x, y) = Ĝ (Intw(x, y) – D(x, y,))

G (x, y)

Virtually all digital X-ray detector systems with discrete detector elements make use of digital image
correction techniques. CR systems do not have discrete detectors, and so these techniques are not
applied in CR. However, corrections are applied to each row in a CR image to compensate for
differences in light conduction efficiency of the light guide. This correction process is conceptually
identical to the flat field correction described earlier for discrete detector array systems; however,
they are applied in only one dimension.

2. GLOBAL PROCESSING
One of the most common methods of image processing in radiology is performed by altering the
relation between digital numbers in the image and displayed brightness. Windowing and leveling of

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a digital image are common examples of this type of global image processing. Windowing and
leveling are simple procedures formed routinely; however, the consequences on the displayed
image are profound (fig11-14).14). Reversing the contrast of an image (changing an image with white
bones to one with black bones) is also a global processing technique. Global processing is often
performed by the display hardware instead of through manipulation of the image data directly.
Mathematically, global processing (including windowing and leveling) is performed by multiplying
and adding the gray scale value of each pixel in the image by (the same) constants and then
applying thresholding techniques. For example, image I(x I(x, y)) can be windowed and leveled to
produce image I ’(x, y),
), as following:

I ’(x, y) = b x [I(x, y) - a]

Then, limits are placed on image I’(x,y) to constrain the possible gray scale values to within the
dynamic range of the display system (usually 256 gray scale units
units- 8 bits). This is done
d by defining
upper (Thigh) and lower (Tlow) threshold limits:

If I’(x, y) > Thigh then I’(x

I’(x, y) = Thigh

If I’(x, y) < Tlow then I’(x,y) =Tlow

Notice that the image is inverted in contrast when the constant b is negative.

3. IMAGE PROCESSING BASED ON CONVOLUTION

The science of manipulating digital images often involves the mathematical operation called
convolution. Convolution is defined mathematically as follows:

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Where I(x) is the input, g(x) is the result, b(x) is called the convolution kernel. When applied to
digital images, this integral equation results in essentially just shifting and adding gray scale values.

The functional form of the convolution kernel b(x) (i.e., its shape when plotted) can have a profound
influence on the appearance of the processed image. Let us take the example of simple 3x3
convolution kernel, and examine how the nine values that result can be manipulated to achieve
different effects. The following kernel is called a delta function, and convolving with it does not
change an image in anyway:

0 0 0
0 1 0
0 0 0

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An entire image can be shifted one pixel to the left by the following kernel:

0 0 0
1 0 0
0 0 0

When all the values in the kernel are positive and non-zero, the kernel blur an image. For example,
the following kernel smoothes some of the noise in an image but also reduces its resolution
somewhat:

1 1 1
1 1 1
1 1 1

Smoothing with a 3 x 3 kernel produces a subtle blurring effect. However the convolution can be
performed using a larger kernel (for e.g., 11 x 11) to achieve substantial blurring effects that are
easy to see (fig.)

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10. Image quality in digital radiography and its advantage

Three factors are directly responsible for computed radiography image resolution: (1) dimension of
the crystals in the image plate, (2) size of the laser beam in the reader, and (3) image reading matrix.
Although computed radiography currently offers greater contrast resolution then conventional film.
The resolution with the computed radiography averages from 2 to 5 line pairs per millimeter (lp/mm),
whereas standard film can demonstrate 3 to 6lp/mm. With further advances in imaging plate
phosphor quality, a reduction in the micro beam laser size, and an increase in matrix dimension and
image, spatial resolution with computed radiography could become inherently superior to that of
conventional film-screen techniques. Present day diagnosis is not hampered by the current resolution
factors. However, chest imaging and mammography will further benefit from the increased spatial
resolution that these examination demand.

Cinical application
The process begins at the reception desk, where demographic information (patient name, birth date,
sex, identification [ID] number, examination ordered) is entered in the reception terminal transfer of
this information to the computed radiography processor may be accomplished directly via a radiology
information system (RIS) or health information system (HIS) interface, bar code, magnetic card, or
optical scanner. The
radiographer exposes the IP in the same manner as a convention film-screen system. The exposure
may be made using tabletop, mobile, or table/wall Bucky technique. The exposed imaging plate
cassette is taken to the control terminal of the CR reader unit. There, the patient demographic and
examination information is entered, and the cassette is scanned with the e bar code reader. In this
way, each specific exposed IP is linked to the correct patient and image data. This step replaces the
typical ID cameras stem in the film radiography.
The radiographer inserts the exposed cassette into the computed radiography reader. Once inside,
the cassette is automatically opened, the image plate is scanned, erased and returned to the cassette
or an internal stacker for use on another patient.

Techniques to improve Diagnostic Efficacy

In addition to the manipulation of images on a work station, several other techniques can be used to
improve the diagnostic efficacy of computed radiography. These techniques include dynamic range
control and energy substraction.
Dynamic range control (DRC) is a processing protocol to set optical density of certain anatomic
regions that normally appear as overexposed or underexposed. These regions might exist in high
density or lower density areas. The computer generates a filter (mask) image from the original, and
the filter is then superimposed on the original. The result of DRC is better visualization of the
mediastinum in chest imaging and better soft tissue display in shoulder and knee images.

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Energy substraction is a recently developed type of processing. It requires the use of two image
plate with a 1mm copper filter sandwiched between them. The first plate records the full energy
spectrum of the radiation beam. Radiation that passes through the first plate undergoes low energy
filtration (bean hardening) by the copper filter before it enters the second plate. The image recorded
by the second plate consists primarily of the high energy component of the beam: therefore the
bone/calcium contrast is markedly reduced over that in the image recorded on the first plate. The
substraction process, aided by the computer, takes place twice. This provides one image of the soft
tissue and a second image of the bone and calcium.

Pitfalls
Correctly produced computed radiography images have few undesirable characteristics, and these
will not cause diagnostic problems, even with a relatively inexperienced operator. Edge-
enhancements artifacts are the primary problems in this type of imaging. In certain circumstances,
edge enhancement creates an appearance that may be confused with the pathologic disorder. On the
edge enhanced image a dark band may appear at the interface between the structures that differ
widely in density. This effect is primarily seen in CR images involving metal prosthesis and barium
contrast study. The dark line of the edge enhancement artifact is always perfectly symmetric around
the dense object, which makes it relatively easy to distinguish from a lesion causing lucency.

Benefits
When CR/DR system is used, several benefits are readily apparent. These benefits are discussed in the
following sections:

Improved diagnostic accuracy and expanded diagnostic scope

with the storage of laser scanned x-ray image on high sensitivity IP minute differences in x-ray
absorption are detected, providing highly detailed and easily readable diagnostic information. The
wide exposure latitude permits diagnosis of entire area of interest, allowing imaging from bones to
soft tissue with a single exposure.

X-Ray dosage reduction

x-ray dosage reduction is dependent upon the type and speed of the conventional
film/screen system in place at institution converting to CR. If the institution is utilizing a 400-speed
film/screen system, the then CR imaging plates will requires 15% to 25% more exposure. The best
way is to increase the kV to minimize the increase dose to the patient and to increase the number of
photons reaching to the IP.

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Repeat rate reduction

Because of the wide technique latitude of the CR system, technical errors are easily corrected to
provide prime diagnostic information. When a film/screen combination is used, technical errors in
either direction can markedly degrade the image quality. Technical errors have much less effect on
the final quality of a CR image.

Teleradiographic transmission
Image plate reader devices can be linked via dedicated phone lines, microwave transmission, or
other teleradiographic means to centralize the review of the image. This sharing is an obvious benefit
to affiliated hospitals or clinics that are separated by large geographic distance but shares
professional staffs.

PACS (Picture Archive & Communication System)

Many radiology departments are contemplating the installation of a PACS for the immediate or near
future. With CR, all imaging modalities can now be integrated and can share processing, display, and
archiving ventures.
PACS will allow radiology department to finally move to film less environment and reduce the cost
of purchasing radiographic films. However the initial cost of purchasing all computer hardware
necessary to eliminate the need of films is still quite high. Despite the fact that the first experiments
with PACS took place in the early 1980s, it has not been until the late 1990s that clinically useful,
routinely operating PACS systems have been installed.

Advantages and Disadvantages of PACS:-

Advantages of PACS:-
1 Near complete elimination of last films.
2 Quicker access to prior examinations.
3 Ability to compare multi modality images on same patient.
4 4 Availability of full digital data when interpreting exams.
5 Ability for a single exam to be viewed in multiple locations at the same time.
6 Potential improvements in workflow.

Disadvantages of PACS:-
1 High initial cost.
2Lower reliability than film based systems.
3 Learning a new paradigm for radiologist interpretations of examinations.
4 Potential decreases in diagnostic ability.

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11. Quality Assurance Concerns And artifacts

A positive design feature of a computed radiography system is its ability to minimize image artifacts,
whether induced from system irregularities or operator errors. However, periodic failures in these
safeguards are inevitable and affect image quality.
System noise, artifacts, and unevenness in an image are determined by the noise inherent in the
imaging plate (structure noise) and reader system (quantum noise). Digital processing errors can
create artifacts and density irregularities.
The operator can control several artifacts. Dust on the imaging plate can be seen on the resulting
image. It is therefore important to maintain a periodic schedule of cleaning the imaging plate surfaces
for quality assurance, just as a similar program of quality control maintenance is used for radiographic
intensifying screens. In addition, grids of a particular ratio and line factor are recommended for
various examinations. If these recommendations are not followed, a moiré pattern of laser light
scanning lines or data loss can occur. Scatter radiation is detrimental to the quality of both computed
radiographic and conventional film-screen image. Grids may be used when warranted by the
examination or the patient’s body habitus.
Although computed radiography systems are able to correct gross technical error, there is a limit to
the minimum dosage required for appropriate penetration and a diagnostic image. The imaging plates
require a minimum amount of photon energy and this is supplied by amount of kilo voltage used for
the examination. The various vendors have minimum kVp requirements to help with the necessary
photon energy and to help reduce the dosage to the patient. Inadequate radiation doses result in
image that demonstrates quantum mottle or area of devoid data.

Artifacts
Computed radiography system based on photostimulable phosphor technology is now being more
widely used in radiology departments in our country. This warrants radiologists to be familiar with
its technical principles and image quality and therefore artifacts that degrade image quality.
Although most artifacts that occur in conventional radiography have become familiar, computed
radiography (CR) systems produce artifacts that differ from those found in conventional
radiography.

CASSETTE BASED FILMLESS ARTIFACTS

1. IMAGING PLATE ARTIFACTS

- CRACKS –AREAS OF LUCENCY is seen (fig 11.1a), Thin White Jagged Wavy lines usually on the
perimeter. The solution is to replace the IP.
- Adhesive tape residue- cleans the IP at regular intervals.
- Static causing hair to adhere to plate- It destroys the image quality. The solution is to clean
the IP at regular intervals.

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- Backscatter – shows the general foggy appearance on the image (fig11.1b). The solution is to
apply lead foils to the back of the cassette.

Fig 11.1 : A) image artifact due to crack IP; B) image artifact due to backscatter

2. PLATE READER ARTIFACTS

- Extraneous line patterns caused by electronics
- White lines (horizontal) dirt on light guide of reader
- loading of more than one IP into a cassette=double exposure artifact
- Grid orientation so that grid lines are parallel to the plate reader’s laser scan = moiré pattern
(fig 11.2). (Grids should be high frequency and grid lines need to run perpendicular to the
laser scan line. To avoid this set up grid so the lines on the IP are perpendicular to the
readers scan lines.

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Fig 11.2 Moire pattern seen in

Absence of malfunctioning
bucky, loading IP into with grid
lines parallel to the reader scan
lines.
-

3. Printer Artifacts
- Fine white lines from debris on mirror in printer (fig 11.3). This is due to inadequate erasure,
increase exposure cycle times.

Fig 11.3 shows fogging with hint of

previous image

4. Operator ARTIFACTS
- Insufficient collimation = incorrect exposure range (S) reading
- Backward cassette- when the cassette is loaded upside down (fig11.4). To avoid this load the
cassette properly
- Underexposure = quantum mottle

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Fig 11.4 it shows the image of the

back of the cassette.
-
CR Handling and Storage Artifacts
- Debris on image receptor
- Discoloration of fluorescent screens
- Fogging
- “ghost images”
- “dead” detector images

Cassette less Artifacts

- Conversion from x-ray to digital is very fast

- Potential for signal loss
- Electronic noise – most typical of artifact
- Rapid exposures can cause lose of signal=reduction of image quality

DR Processing Artifacts

- Electronic rather than chemical

- Artifacts caused by interference with electronic components

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12. Conclusion

The CR/DR systems completely eliminated all dark room process and ultimately increase
department efficiency. Computed radiography will improve both the operational and diagnostic
efficiency of radiography departments. With the placement of conventional projection
radiography in digital format, computed radiography forms the keystone for PACS. CR improves
the efficiency of conventional projection radiography by providing consistent image quality,
decreasing repeat exposure, and minimizing patient radiation exposure, and decreasing lost
images. By realizing such benefits, many departments have already found that CR/DR is
justifiable long term investment.

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Reference –

1. Radiologic sciences for technologists- Stewart C Bushong

2. Merrill’s atlas of radiographic position & procedure volume III- Philip W
Ballinger & Eugene D frank
3. Christensen’s Physics of Diagnostic Radiology- Thomas S Curry
4. Physics of Medical Imaging
5. [Link]
6. [Link]
7. [Link]

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