CR/DRCOMPUTERISED

/DIGITISEDRADIOGRAPHY

DR. SAGAR GARG

 LEARNING OBJECTIVES
How CR works.
Working of DR.
Advantages of CR over conventional
radiography.
Advantages of DR.
New advances.
 LUMINESCENT SCREENS
Luminescence refers to the process of
emission of light by a substance after
absorbing energy.
When luminescence takes more than 10^-8
seconds it is called phosphorescence.
Photophosphorescence is when light is
emitted after a substance is illuminated.
 PHOSPHORS
A phosphor is a substance used in x ray for
intensifying screens.
Calcium tungstate is spread over a film.
When this film is bombarded by x rays it absorbs x
ray energy and goes to higher energy state.
Then it immediately releases light in visible
spectrum.
The same is picked up by x ray film to form image
of body.
PHOTOSTIMULABLE PHOSPHORS
In photostimulable phosphorescence excited
substance emits light after it is stimulated by laser
Such substances are called photostimulable
phosphors.
We use one such phosphor - europium activated
barium fluorobromide in cr. Here europium is the
activator that forms a trap band for electrons.
 ARRANGEMENT
The photostimulable phosphor is coated on a
screen.
This screen is present in a cassette similar to
analogue x-ray cassette.
The cassette is stimulated by x-rays in
conventional x ray machine
 Cassette structure
Light weight aluminum
Plastic
Steel frame
Front panel made of low attenuation carbon fibre
Back panel contain lead foil to protect the plate
from backscatter
Back panel also contain chip to record the patient
demographic information
 Imaging plate structure
Approximately 1 mm Fluorinated polymer
thick material-protects the
phosphor layer

To reduce
scatter

PET-polyethylene
teraphthalate

Protects the base

from damage
MECHANISM OF ACTIONLATENT IMAGE
FORMATION
The phosphor picks up the energy of x rays
that strike it.
This energy causes some of its electrons to
escape from the valence band and reach a
higher energy state thus creating a hole.
In higher energy band electrons are trapped
and create a latent image.
 RETRIEVAL OF IMAGE
The cassette is taken to image processor in CR room.
Film is pulled out of cassette with rollers.
Here the phosphor is scanned by a laser beam 633nm
wavelength he-ne laser with the help of rotating
mirror.
The trapped electrons return to valence band with the
release of energy in the form of emission of light.
This light is in range of 300-500 nm. It is taken by
photomultiplier tube and the output of this
photomultiplier tube constitutes signal.
 RETRIVAL OF IMAGE
This signal is fed to a computer where it is
processed and stored and also displayed in normal
format.
We have to use a filter to filter out red light and
the photomultiplier tube will pick only green and
UV light.
After that the plate is flooded with high intensity
light to remove any residual latent image.
Due to thermal degradation the plate is readable
only for about 8 hours after exposure at room
temperature.
 DYNAMIC RANGE
Dynamic range refers to the exposure that causes the
film to be very black than that of faint grey not
detected by eye.
In cr system the dynamic range is high.
It varies from 5microroentgen to 50 milliroentgen.
Thus yielding exposure range of 10000 to 1.
Dynamic range of cr system is linear also called as
exposure latitude.
A wide latitude system allows more choice of kvp and
mas to radiographer.
A more linear variation with exposure helps avoid toe
and shouldering effect seen in analogue films.
It will also decrease the need for repeat exposure.
 SPATIAL RESOLUTION
Resolving power refers to the number of line pairs
per mm that can be resolved by the screen film
system.
Spatial resolution of cr is less than conventional
system.
In cr resolving power is typically limited by pixel
size.
For smaller plates pixel size is 90micrometer. For
larger ones it is 140 micrometer.
In case thinner phosphor layer is used as in
mammography , pixel size is 50micrometer.
 THIN FILM TRANSISTOR
Most common DR detectors are based on
amorphous silicon thin film transistor arrays.
Transistor amplifies the electrical signal.
In TFT array the amplifies signal is stored as an
electric charge.
This charge can be released by applying high
potential.
 TFT(CONT.)
In TFT array each row of detectors is
connected to the activating potential and
each column to the charge measuring device.
The potential is applied row by row , so that
the timing of the detected signal determines
the position of the pixel from where it
originated.
There are as many transistors as pixels so size
of each pixel is 100-200 micrometer.
 CCD DETECTORS
They are usually small. Single detector not larger than
5cm square in size.
Used in conjunction with a phosphor to detect the x
rays.
The light produced by the phosphor is focussed on
CCD detector with help of optical fibres.
Patient exposure time is 20ms and read out time is
1.2sec
CCD leads to deeper detection than flat plate.
So used in mammography for stereotactic films and
biopsy localisation.
 LENS COUPLED CCD

An array consisting of several CCD

chips forms a detector area similar
to that of a flat-panel detector.
Optical lenses are needed to
reduce the area of the projected
light to fit the CCD array, which
subsequently converts the light
energy into electrical charges
 Drawback
Decrease in the number of photons reaching
the CCD,resulting in a lower signal-to-noise
ratio(SNR) and relatively low quantum
efficiency.
 CCD
limitations
advantages
Relatively cheaper Bulky design
Individual defective Small CCD arrays than
component can be replaced typical projected Xray areas
Upgradable to future Optical system-more signal
innovation noise
Thermal noise in CCD can
degrade image quality
Repeated exposure to xrays
may damage optical system
 Selenium drum
A rotating selenium drum, which has a
positive electrical surface charge, is exposed
to x-rays.
During exposure, a charge pattern
proportional to that of the incident x-rays is
generated on the drum surface and is
recorded during rotation by an analog to-
digital converter.
 SELENIUM DRUM DETECTOR
Several clinical studies have confirmed that
selenium drum detectors provide good image
quality that is superior to that provided by
screen-film or CR systems(ADVANTAGE)

However because of their mechanical design,

selenium drum detectors are dedicated thorax
stand systems with no mobility at all.
(DISADVANTAGE)
 Comparative analysis and overview
ANALOG DIGITAL

STORAGE Lots of physical space required No physical space required,storage

along with time and energy takes less time
required to store hard copies
DISTRIBUTION Hard copy is available only at one Soft copy is available at PACS
location

VIEWING Hard copy is limited by its size,can Soft copy can easily be viewed by large
only be viewed by small audience audience

LIFESPAN Screen film image quality degrades Image quality does not degrade over
over time time

COST Screens and chemicals are less Expensive to purchase equipment at

costly in isolation however first however cost effective in long run
repetitive purchases is more
expensive in long run
 Image post-processing
After exposure and readout, the raw imaging data must be
processed for display on the computer

AIM- to improve the image quality-

reducing noise
removing technical artifacts
optimizing contrast for viewing

Spatial resolution cannot be influenced by processing software

because it is dependent on the technical variables of the
detector(eg;pixel size)
 Contrast adjustment

Contrast enhancement-makes anatomical structure more visible and distinguishable

Contrast reduction-result in smoothing of structure
Edge enhancement

Provide sharper delineation

Of fine structures of bone
Black and white reversal
 Image postprocessing
Positioning markers
Add predetermined text or free text
Zoom and roam image
Invert image
Show/hide histogram
Advanced measurement options
Stitching for full leg/full spine
 Aspects of image quality
Pixel size,matrix and detector size
Spatial resolution
Modulation transfer function
Dynamic range
Radiation exposure
 RESOLUTION AND SHARPNESS
Detector dose indicator tells us about the average
dose of radiation given to the plate.
Thus an image of average density is made for
nearby detectors.
But to increase the sharpness of image at edges
and to improve contrast edge enhancement or
high pass filtering is done while image pocessing.
It will have an opposite efffect and increase
sharpness of image created by neaby detectors.
DETECTOR QUANTUM EFFICIENCY
DQE refers to x ray photons detected vs.
Noise detected by detectors.
If zero noise is detected and only x rays
forming image is detected then DQE is said to
be 100%.
But in actual world DQE for DR is 65% and for
CR it is 35%.
So in a DR there is less image to noise ratio.
We can reduce the radiation to be given.
 Modulation transfer function
Definition - capacity of the detector to transfer the
modulation of the input signal at a given spatial
frequency to its output .
MTF has to do with the display of contrast and object
size.
More specifically, MTF is responsible for converting
contrast values of different-sized objects (object
contrast) into contrast intensity levels in the image
(image contrast).
 ARTIFACTS IN DIGITAL
RAGIOLOGY(CR+DR)
IMAGE COMPOSITING-superimposition of two structures from
different locations due to double exposure of same film
 IMAGE LAG

IMAGE LAG/GHOSTING-
The rapid acquisition of images can
result in latent signal from one
exposure lingering into the readout of
subsequent exposures,producing
what appears to be an incomplete
erasure of the previous image’known
as image lag/ghosting
Mainly a DR artifact because of rapid
image acquisition ability
 IMAGE ARTIFACTS

Incorrect detector orientation-upside down

cassette(spoke like radiopaque lines)
Backscatter-(in portable DR due to thin
backside shielding- to make it lighter)
Stitching artifacts-occur when two separate
CR OR DR images are merged into a single
image
 Innovations and recent advances
Some of the drawbacks of CR systems, namely
cassette handling
long read out time of PSP plates
low DQE and
poor resolution
Have been addressed by newer innovations and
technological advances.
 Advances in CR
A) Automated CR systems with fast readout
Automated CR systems reduce the readout
time less than 10sec.
In these systems there is no cassette handling,
leading to totally automatic image data
acquisition
(B) Newer phosphors for PSP plates:
Commercially available PSP plates have unstructured phosphor like
rubidium chloride or barium fluorohalides doped with Europium.

A needle-shaped phosphor cesium bromide, has been newly

introduced,, and is considered more efficient due its structured
configuration of crystals.

It reduces light diffusion because of the needle shaped configuration

that acts as light guide. In addition the newer phosphors are more
efficient with an increased DQE
C)Mobile CR systems:
Mobile X-ray unit with an integrated CR
reader.
They are easy to use and offer quick image
availability in less than 25 sec.
 ADVANCES IN DR Tomosynthesis

Multiple low dose exposures are given from various angles while the
X-ray tube moves in an arc and the detector remains stationary.

Multiple images with different focal zones are possible to be created

by addition of these low dose images after pixel shift. It emphasizes
contrast in a particular layer of a region of body.

Generated images can be viewed singly or as a cine loop.

It is considered useful in Chest, IVU studies and mammography

 Dual-energy imaging
By using a high and low kilo-voltage technique, two
datasets are created. Soft tissues and bones can be
separately depicted by this method.
Dual-energy techniques are most effective when both
images are acquired simultaneously. Similar results are
obtained with two exposures within a very short
period of time.
This is useful in chest radiography, particularly for the
evaluation of partially calcified nodules and pleural
plaques
 Computer aided diagnosis (CAD)
software programs

These are important in early detection of cancer of the lung

and breast. The suspicious areas are marked by the
software for review by the radiologist.
The efficiency of CAD software program is related to its
sensitivity and specificity profile.
The main advantage of CAD is that it permits a radiologist
to avoid overlooking diagnostically significant findings.
 AUTOMATIC IMAGE STICHING
.
Useful in determining precise measurements in lengthy anatomical regions
like the spine or lower limbs
.
The largest flat-panel DR plates available today are 43 × 43 cm. Using these
detectors, only a limited portion of the body part can be imaged at one
given time, thus making these detectors inadequate for studying the whole
spine or the entire lower limb.
To overcome this problem, multiple sequential exposures at different
patient positions are acquired in a still patient. Automatic stitching is then
performed to reconstruct a larger composite image. This special software
enables pixel shift and overlap.
 MOBILE DR

This is in general a 17 × 14-inches

flat panel detector (FPD)
connected by a cable to a mobile
x-ray system having a monitor.

The use of mobile DR systems is

hampered by the fragility of the
FPDs and the high costs.

A mobile DR system, when

compared with an FSR system,
avoids problems related to the
availability, storage,
transportation and disposal of
films and chemicals.
 WIRELESS FPD’S

Wirelessly transfers image data to the DR system e.g. with wifi.

It has no cables and does not interfere with surrounding machines.

Typically a 17 x 14-inch image is made available within 3 sec.

This allows radiography of difficult regions of the body like the axilla
or the TM joint and enables radiography in unusual positions as in a
flexed knee, or in a limb with limited mobility due to contractures.
THANKS