Digital Radiography versus Computed Radiography

Digital Radiography versus Computed

Radiography
By Dr. Liji Thomas, MD
Reviewed by Dr. Jennifer Logan, MD, MPH

Both computed radiography (CR) and digital radiography (DR) require the use
of digital technologies which rely on computer networks and high-bandwidth
web facilities.

DR uses flat panel detectors based on direct or indirect conversion of X-rays to

charge, which is then processed to produce a digital image.

Flat panel detector. Image Credit: Alexander Zhukovsky Design

CR uses cassette-based phosphor storage plates (PSP), which are then scanned
by the computerized system into a digital format for image processing,
archiving, and presentation. However, with DR, the whole procedure is digitized
from X-ray detection onward.

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Radiologist and patient in a x-ray room. Classic ceiling-mounted x-ray system.

Image Credit: Romaset / Shutterstock

Advantages of CR
CR is the first step towards adopting digital imaging technology in many
imaging centers because of the low cost required for initial installation.
The system is compatible with most existing conventional systems,
whereas DR systems come in an expensive package, and are not
compatible with existing X-ray devices.
CR can use cassettes of multiple sizes, which means the detector size can
be selected to match the procedure and to increase the flexibility of
positioning, whatever the area of examination.
Portable X-ray systems can have imaging plate readers incorporated into
them to provide rapid bedside radiographic examinations as well as image
presentation, for speedy diagnosis.
Single plate readers are powerful and compact and allow high patient
throughput. While one plate is being processed, the next image can be
acquired in rapid sequence.

Disadvantages of CR
CR requires the cassette be removed from the X-ray machine and then
placed into a reader. This is a labor-intensive step that requires the

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technician to leave the patient and work station with each imaging
procedure, even if for a short time.
The PSPs used in CR require longer readout and processing time.
When single-plate readers are used, overexposures entail additional delay
as the old signals are not completely erased very quickly. This means that
a new plate cannot be inserted before the old plate is cleared of residual
signals.
PSP detectors are in detection position all the time. This allows them to
pick up background radiation and other scattered radiation such as image
noise. This is particularly important if the case if they are kept in is in or
near an X-ray room.
Another source of noise is the failure to erase signals from stored plates
after more than a day or so. Taking care of multiple PSPs can entail
significant labor and therefore cost, to keep inventory, clean cassettes, and
assure quality.
There is a short delay of approximately 1 minute for scanning CR plates.
Cassette transfer plus plate scanning may take more time and labor than is
convenient in facilities with a high patient workload, even if the machines
are near each other. However, modern CR systems use plate readers that
are integrated into the X-ray equipment itself, leaving little difference
between CR and DR. In comparison, the DR systems house all components
together and do not require any transfer of film or cassette. The time
needed to produce a final DR image is 10 seconds or less.
Image quality - PSP plates used in CR have a lower efficiency of detection
compared to DR detectors. Thus, a higher radiation dose is needed to
obtain adequate image resolution. However, the development of dual-side
readout phosphors, as well as storage phosphors based on cesium bromide
structure, has resulted in a better detection efficiency, which can match DR
detectors in some cases.

Advantages of DR
The efficiency of X-ray detection is measured by detective quantum
efficiency, DQE, which is about 60%–65% with DR but only 30% with CR.
Thus, the use of DR is associated with lower patient exposures because of
very low imaging failure rates.
The high speed of image acquisition is another advantage of DR
technology.
Image quality is excellent with DR whereas CR images are somewhat

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inferior to film X-ray systems. However, diagnostic accuracy is comparable

between CR and film-based systems.
Whereas the initial cost of CR is lower, DR systems provide high-speed
workflow for technologists and speeded-up patient management, which is
especially important in outpatient settings where patients need to return to
home or work. Less than 1 minute is needed between exposure and image
acquisition.
Portability of DR systems is now being envisaged with the development of
wireless (or previously, wired) DR detectors. This removes one of the big
obstacles to the use of DR, namely, lack of portability. However, there is a
long way to go before DR becomes comparable to CR in this respect. The
ability to retrofit existing technology with DR detectors will mark the
beginning of serious competition between CR and DR in small-scale
imaging setups.

Disadvantages for DR
The conventional DR systems are not very flexible for taking difficult views.
However, newer systems are being designed to offer greater positioning
flexibility.
The initial investment costs are very high, on average up to 5 times that of
a good-quality CR setup, including the reader and PSPs. This limits them to
settings where return on investment is assured because of high patient
throughput.

The following table summarizes the pros and cons of CR and DR:

CR DR
Lower initial investment Higher initial investment
Can be retrofitted to existing All-new setup necessary
installations
Lower image quality Better image quality
More time to final image viewing (5-7 Rapid image viewing (within 1 minute)
minutes)
Labor-intensive due to the need for Completely digitized setup
cassette transfer to the plate reader
Lower patient throughput High patient throughput
More bulky Compact profile

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More portable Less portable unless newer wireless

systems used
More flexible positioning and sizes Difficult to acquire awkward views
Higher risk of overexposure Lower risk of overexposure
Suitable for low or moderate workflow Ideal for high workflow
Less efficient More efficient
Less costly to replace More costly parts, requires to be
protected from dropping or rough
handling
More easy to damage and need more Online or remote servicing possible to
maintenance cut down cost of ownership

Sources
appliedradiology.com/.../digital-radiography-the-bottom-line-comparison-
of-cr-and-dr-technology
https://www.slideshare.net/mohitgoel9212/cr-dr-50287860
https://pubs.rsna.org/doi/full/10.1148/rg.273065075
www.iaea.org/.../digital-radiography#18

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Last Updated: Nov 27, 2018

Written by

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Digital Radiography versus Computed Radiography

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College,
University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in
obstetrics/gynecology in a private hospital for a few years following her graduation.
She has counseled hundreds of patients facing issues from pregnancy-related
problems and infertility, and has been in charge of over 2,000 deliveries, striving
always to achieve a normal delivery rather than operative.

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