George David
Associate Professor of Radiology
Medical College of Georgia
Computed
Computed Radiography
Radiography (CR)
(CR)
• Re-usable metal imaging plates replace film &
cassette
• Uses conventional bucky & x-ray equipment
CR
CR Exposure
Exposure &
& Readout
Readout
CR
CR Readout
Readout
Another
Another View:
View: CR
CR Operation
Operation
Computer
Computer Radiography
Radiography (CR)
(CR)
• plate is
photostimulable
phosphor
Higher Energy
• radiation traps - Electron
electrons in State
high energy
states Photon pumps
electron to
• higher states X-Ray higher energy state
form latent Photon
image Lower Energy - - - - - -
- -
- - -
- -
Electron - - - -
-
State - - - - - - -
- -
Reading
Reading Imaging
Imaging Plate
Plate
• reader scans plate with laser
• laser releases
electrons trapped in
high energy
states Laser Beam
• electrons fall to low
energy states
• electrons give up Higher Energy
energy as visible light Electron -
State
• light intensity is
measure of incident
radiation
Lower Energy
Electron State
Lower Energy - - - - - - -
- -
Electron - - - - -
- - - -
State - - - - - - -
- -
Reading
Reading Imaging
Imaging Plate
Plate
• Reader scans
plate with laser
light using
rotating mirror
• Film pulled
through scanner
by rollers
• Light given off by
plate measured
by
PM tube &
recorded by
computer
Laser
Laser &
& Emitted
Emitted Light
Light are
are Different
Different Colors
Colors
• Phosphor stimulated by laser light
• Intensity of emitted light indicates amount of radiation
incident on phosphor at each location
• Only color of light emitted by phosphor measured by PMT
CR
CR Operation
Operation
• after read-out, plate erased
using a bright light
• plate can be erased virtually
without limit
• Plate life defined not by erasure
cycles but by physical wear
CR
CR Phosphor
Phosphor Layer
Layer
• Phosphor balanced for
x-ray absorption characteristics
light output
laser light scatter
screen thickness
• Above variables affect
electronic noise
image resolution properties
speed of imaging system
• Overcoat protects plate from
physical damage
CR
CR Resolution
Resolution
• Small cassettes have better
spatial resolution
Smaller pixels
More pixels / mm
CR
CR Throughput
Throughput
• Generally slower than
film processing
• CR reader must finish
reading one plate
before starting to read
the next
• Film processors can
run films back to back
CR
CR Latitude
Latitude
• Much greater latitude
than screen/film
• Plate responds to many
decades of input
exposure
under / overexposures
unlikely
• Computer scale inputs
exposure to viewable
densities
Unlike film, receptor
separate from viewer
Film
Film Screen
Screen vs.
vs. CR
CR Latitude
Latitude
CR
Latitude: .01 –
100 mR
100
CR
CR Very
Very Sensitive
Sensitive to
to Scatter
Scatter
Digital
Digital Radiography
Radiography (DR)
(DR)
• Digital bucky
• Incorporated
into x-ray
equipment
Digital
Digital Radiography
Radiography
(DR)
(DR)
• Receptor provides direct digital output
• No processor / reader required
Images available in < 15 seconds
Much less work for technologist
Direct
Direct vs.
vs. Indirect
Indirect
TFT = THIN-FILM TRANSISTOR ARRAY
“Direct”
“Direct” DR
DR
• X-ray energy
converted directly
to electrical signal
• X-rays interact
with
semiconductor
material
Amorphous selenium
• X-rays converted
directly into
electrical charge
No intermediate
steps
“Indirect”
“Indirect” DR
DR
• X-ray strike scintillator producing
light
• Photodiode array converts light to
electrons
Light
Indirect
Indirect DR
DR
• Light spreads can limit spatial resolution
• Can be controlled by “channeling”
• Winning in the marketplace
Digital
Digital Radiography
Radiography
(DR)
(DR)
• Potentially lower patient dose
than CR
• High latitude as for CR
• Digital bucky fragile
First DR portables coming
to market
Summary
Summary
• DR becoming industry leader in
radiographic imaging
• DR images displayed & stored in
about 8 seconds
• DR has faster throughput
Up to 2-4 times faster than traditional
screen-film-darkroom technology
Raw
Raw Data
Data Image
Image
• Unprocessed image as read from
receptor
CR
» Intensity data from PMT’s as a result of scanning
plate with laser
DR
» Raw Data read directly from TFT array
• Not a readable diagnostic image
• Requires computer post-
processing
Specific software algorithms must be
applied to image prior to presenting it as
finished radiograph
* Enhancing
Enhancing Raw
Raw Image
Image
(Image
(Image Segmentation)
Segmentation)
1. Identify collimated image
border This process is
specific to a
2. Separate raw radiation particular body
from anatomy part and
projection
3. Apply appropriate tone-
scale to image
Done with look-up table (LUT)
LUT
Look
Look Up
Up Table
Table (LUT)
(LUT)
• Converts a raw
data pixel value to
a processed pixel
value
• “Original” raw
data pixel value
indicates amount
of radiation falling
on pixel
Image
Image Segmentation
Segmentation
• Computer must establish location of
collimated border of image
• Computer then defines
anatomic region
• Finished image produced by
tone scaling
Requires histogram analysis of
anatomic region
Histogram
Histogram
• Graph
showing how
much of
image is
exposed at
various levels
Tone
Tone Scaling
Scaling
Post-Processing
Post-Processing
• Body part & projection-specific
algorithms determine average
exposure
Must correctly identify anatomical region
• LUT computed to display image with
proper
Density
Contrast
LUT
LUT can
can Simulate
Simulate
Appearance
Appearance of
of Film
Film
LUT
LUT Selection
Selection
• LUT
calculated
by algorithm
depends on
Body part
projection
• User can
also alter
LUT
manually
LUT
LUT Selection
Selection
• Monitors on CR
reader or DR
console compared
to reading
workstations have
lower resolution
poorer quality
Recommended that
LUT not be manually
modified
Film/Screen
Film/Screen Limited
Limited Latitude
Latitude
• Film use
has little
ambiguity
about
proper
radiation
exposure
Should
Should II Worry?
Worry?
In CR & DR,
image density is
no longer a
reliable indicator
of exposure factor
control.
CR
CR // DR
DR Latitude
Latitude
DANGER
Will
Robinson!!!
• Almost impossible to
under or overexpose CR /
DR
• Underexposures look
noisy
• Overexposures look
GOOD!!!
Exposure
Exposure Creep:
Creep
Creep:
Creep
Tendency
Tendency of
of radiographs
radiographs toward
toward
higher-then-necessary
higher-then-necessary exposures
exposures
• No detrimental effect on image quality
• Desire to see less noise on radiographs
• Increased exposure latitude
• No one complains
So
So how
how do
do II know
know ifif exposure
exposure is
is
optimum
optimum by
by looking
looking atat my
my image?
image?
Exposure
Exposure Index
Index
• Each manufacturer provides feedback to
technologist on exposure to digital
receptor
• Displayed on CR reader monitor
• Displayed on workstations
Exposure
Exposure Index
Index
• Measure of radiation received by receptor
below anatomy
• Not a direct measure of patient exposure
• If exposure index higher than
recommended range, patient
overexposed
Exposure
Exposure Indication
Indication Varies
Varies
between
between Manufacturers
Manufacturers
Receptor Kodak Fuji S
Exposure EI Number
0.5 1700 400
1 2000 200
2 2300 100
4 2600 50
Kodak Fuji
Logarithmic scale “S” number goes down
EI goes up 300 when as exposure goes up!
exposure doubled S is half when
exposure doubled
Exposure
Exposure Index
Index
• Technologist should strive to keep
exposure index consistent
• Kodak recommendation for exposure
index
1800 – 2200
• George’s recommendation
“Maximum tolerable noise”
As low as possible while providing
tolerable noise
This is not a beauty contest!
Calculated
Calculated Exposure
Exposure
Index
Index Affected
Affected by
by
• X-Ray technique selection
• Improper centering of image on
cassette
• Improper selection of study or
projection
• Placing two or more views on
same cassette
Can cause image to appear dark
Phototimed
Phototimed Phantom
Phantom Image
Image
• 75 kVp
• 88 mAs
• 2460 EI
Let’s
Let’s Approximately
Approximately Double
Double mAs
mAs
• 75 kVp • 75 kVp
• 88 mAs • 160 mAs
• 2460 EI • 2680 EI
Let’s
Let’s Go
Go Crazy
Crazy
• 75 kVp • 75 kVp
• 88 mAs • 640 mAs
• 2460 EI • 3300 EI
How
How Low
Low Can
Can You
You Go?
Go? Cut
Cut mAs
mAs in
in Half!
Half!
• 75 kVp • 75 kVp
• 88 mAs • 40 mAs
• 2460 EI • 2060 EI
Let’s
Let’s Go
Go Crazy
Crazy Low
Low
• 75 kVp • 75 kVp
• 8 mAs • 1 mAs
• 1380 EI • 550 EI
CR
CR Artifacts
Artifacts
• Physical damage to imaging
plates
Cracks, scuffs, scratches
Contamination
Dust / dirt
• Dirt in reader
• Highly sensitive to scatter
radiation
CR
CR Grid
Grid Interference
Interference
• 103 lines / inch grids have same frequency
as CR laser scanner. This can cause
“Moire” pattern artifact
• Align grid lines perpendicular to scan
orientation whenever possible
Reduces chances of artifacts caused by laser scanner.
DR
DR Artifacts
Artifacts
• Dead detector elements
• Spatial variations in
background signal & gain
• Grid interference
• Software can help correct for
above
Shifting
Shifting Gears:
Gears:
Fluoroscopy
Fluoroscopy Issues
Issues
Digital
Digital Video
Video Sources
Sources
• DR type image receptor
• Conventional Image Intensifier with Video
Signal Digitized (“Frame Grabber”)
Image
T I
um
Tube
a
b g
e e
TV
X-Ray Lens System
Input
Amplfier
Analog Digital
to Memory
Digital (Computer)
Convert
er
Digital
Digital Spot
Spot Film
Film
• Frame grabber digitizes image
• Digital image saved by computer
• Radiographic Technique used
required to control quantum noise
Last
Last Image
Image Hold
Hold
• Computer displays last fluoro image
before radiation shut off.
• Image noisier than for digital spot
Image made at fluoroscopic technique / intensity
• Allows operator to review static
processes without keeping beam on
ideal for teaching environments
ideal for orthopedic applications such as hip
pinning
• Less radiation than digital spot
Fluoro
Fluoro Frame
Frame
Averaging
Averaging
• Conventional fluoro only displays
current frame
• Frame averaging allows computer
to average current with user-
selectable number of previous
frames
Averages current frame & history
Fluoro
Fluoro Frame
Frame
Averaging
Averaging Tradeoff
Tradeoff
• Advantage:
Reduces quantum noise
• Disadvantage
Because history frames are averaged with
current frame, any motion can result in lag
Other
Other Fluoro
Fluoro
Features
Features
• Real-time Edge Enhancement /
Image Filtering
• Option of using lower frame rates
(15, 7.5, 3.75 fps rather than 30)
computer displays last frame until next
one
» reduces flicker
Lowers patient and scatter exposure
» Exposure proportional to frame rate
dynamic studies may be jumpy
The
The Future
Future of
of Digital
Digital
DR
DR Mobile
Mobile Units
Units
• See image
immediately
• Wireless
transmission of
images
Other
Other Possibilities
Possibilities
• Tomosynthesis
Multi-slice linear tomography from
one exposure series
• Histogram Equalization
Use computer to provide
approximately equal density to
various areas of image.
DR
DR &
& Energy
Energy Subtraction
Subtraction
• 2 images taken milliseconds
apart at 2 different kVp’s
• Combine / subtract images
Soft Tissue Image Bone Image
The
The End
End