COMPUTED

AND DIGITAL
RADIOGRAPH
Y
D A N I E L C . M O N T E S , R RT
FA C U LT Y, C O L L E G E O F R A D I O L O G I C
TECHNOLOGY
LY C E U M - N O RT H W E S T E R N U N I V E R S I T Y
CONVENTIONAL FILM-SCREEN
RADIOGRAPHY
Before defining and discussing digital imaging, a basic understanding of
conventional film-screen imaging must be established.
Conventional radiography uses film and intensifying screens in the
image formation process. Film is placed on one or between two
intensifying screens that emit light when struck by x-rays. The light
exposes the film in proportion to the amount and energy of the x-ray
incident on the screen. The film is then processed with chemicals and
manifest image appears on the sheet of film.
The film is taken to a radiologist and placed on a lightbox for
interpretation.
DIGITAL IMAGING
Digital imaging is a broad term. This type of imaging is what allows
text, photos, drawings, animations and video to appear on the internet.
In medicine, one of the first uses of digital imaging was with the
introduction of the CT Scanner by Godfrey Hounsfield in the 1970’s.
The basic definition of digital imaging is any imaging acquisition process
that produces an electronic image that can be viewed and manipulated
on a computer.
The concept of moving images digitally was introduced by Albert Jutras
in Canada during his experimentation with teleradiology (moving
images via telephone lines to and from remote location) in the 1950’s.
INTRODUCTION TO CR AND DR
What is CR and DR? Both are digital.
Computed radiography (CR) was the first modernized system to replace
screen-film radiography which utilized multiple screens, cassettes and
developed the final image with chemical solutions or darkrooms.
Digital radiography (DR) is the successor to CR because it minimizes
the use of mechanical hardware such as image receptors and cassettes.
Updates to an existing DR system can be done electronically mostly
without installing additional hardware.
PRINCIPLES OF COMPUTED
RADIOGRAPHY
HISTORICAL PERSPECTIVE
Most people are familiar with the rapid development of CR during the
past 20 years or so. However, storage phosphor technology has a
much longer history than that.
The PSL effect – that is, the storage of incident higher-energy radiation
which later release as visible luminiscence through photostimulation –
was used as early as the mid-1800s to convert invisible (eg. ultraviolet)
aerial images into visible ones by means of full-field or area
illumination.
Not long after Roentgen’s discovery of x-rays in 1895, there were even
experiments with full-field x-ray imaging that used PSL intermediates.
HISTORICAL PERSPECTIVE
During WWII, infrared-stimulable storage phosphors were used
in night-vision cameras, in which an infrared scene (the
photostimulation source) imaged onto a previously energized
SP detector would cause it to release its energy as a visible
light replica of the invisible input.
The real forerunners to the CR systems of today, however, were
developed in the 1970’s, when researchers started to look ways
to improve on the inefficient light collection and the resultant
suboptimal image quality produced with the full-filled
illumination method.
HISTORICAL PERSPECTIVE
Presently, an acceleration in the conversion from screen-film radiography
(analog) to digital radiography (DR) is occurring. Digital imaging began with
computed tomography (CT) and magnetic resonance imaging (MRI).
DR was introduced in 1981 by Fuji with the first commercial computed
radiography (CR) imaging system. After many improvements that were made
over the next decade, CR became clinically acceptable and today enjoys
widespread use.
Load cassette Perform examination

Position patient
Reload
cassette Process film
Escort patient to exam
room

Folder prepared Hang Image To radiologist

films QC
Films to folder
Study forms printed and file

Examination Repeat
Scheduled

Escort patient out

Before computed radiography (CR) is discussed, a review of workload steps

associated with screen-film radiography is in order.
COMPUTED RADIOGRAPHY
To conduct a screen-film
radiographic examination, one
COMPUTED RADIOGRAPHY (CR) TERMS
should first produce a paper
trail of the study, then process • PSL = photostimulable
the image in wet chemistry and luminiscence
finally physically file the image • PSP = photostimulable phosphor
after accepting that it is • SPS = storage phosphor screen
• IP = imaging plate
diagnostic. CR imaging • SP = storage phosphor
eliminates some of these steps • PMT = photomultiplier tube
and can produce better medical • PD = photodiode
images at lower patient dose.
COMPUTED RADIOGRAPHY
What is Computed Radiography?
◦ CR is a process by which radiographic images are produced without the use
of film.
◦ Image is captured on a flexible, phosphor coated, re-usable imaging plate
(IP).
◦ Image is exposed inside a traditional film cassette with lead screens.
◦ Imaging plate is then scanned by a laser scanner producing a digital image.
◦ Image can be enhanced, filtered, annotated, zoomed, measured, shared
and stored.
◦ IP can then be erased and reused thousand of times.
COMPUTED RADIOGRAPHY
THREE MAJOR COMPONENTS:
◦ Phosphor Imaging Plates (PIP)
◦ Replaces film/ captures the latent image
◦ PIP Reader (Scanner)
◦ Replaces chemical processing steps/ reads the latent image
◦ Workstation
◦ To review, document, grade and store the final adjusted image
COMPUTED RADIOGRAPHY
COMPUTED RADIOGRAPHY IMAGE RECEPTOR
◦ Many similarities have been observed between screen-film imaging and CR
imaging. Both modalities uses an image receptor that is x-ray sensitive
plate encased in a protective cassette. The two techniques can be used
interchangeably with any x-ray imaging system. Both can carry a latent
image, albeit in different form, that most be made visible via processing.
◦ Here, however, the similarities stop. In screen-film radiography, the
radiographic intensifying screen is a scintillator that emits light in response
to an x-ray interaction. In CR, the response to x-ray interaction is seen as
trapped electrons in a higher-energy metastable state.
COMPUTED RADIOGRAPHY
PHOTOSTIMULABLE LUMINISCENCE
◦ CR technology is based on certain halide-based phosphors, such as barium
fluorohalide with europium (BaFBr:Eu or BaFI:Eu), having energy storage
and excitation characteristics known as photostimulable luminiscence (PSL)
which:
◦ Enable phosphors to store x-ray energy temporarily.
◦ Release that energy upon excitation by a laser beam.
◦ The europium is present only in small amounts. It is an activator and is
responsible for the storage property of PSL. The activator is similar to the
sensitivity center of a film emulsion because without it, there would be no
latent image.
◦ Many Compton and photoelectric effect x-ray interactions occur with
outer-shell electrons, sending them into an excited, metastable state. When
these electrons return to the ground state, visible light is emitted.
COMPUTED RADIOGRAPHY
PHOTOSTIMULABLE LUMINISCENCE
◦ PSP screen is positioned within the cassette or imaging plate (IP).
◦ Commonly used phosphor material is barium fluorohalide.
◦ The phosphor particulates are bonded with a cohesive material forming a turbid
structure and deposited on a base for mechanical support.
◦ The PSP, barium fluorohalide is fashioned similarly to a radiographic
intensifying screen. Because the latent image occurs in the form of
metastable electrons, such screens are called storage phosphor screens
(SPSs).
◦ SPSs are mechanically stable, electrostatically protected and fashioned to
optimize the intensity of stimulated light. Some SPSs incorporate phosphors
grown as linear filament that enhance the absorption of x-rays and limit the
spread of stimulated emission.
COMPUTED RADIOGRAPHY
LIGHT STIMULATION-EMISSION
◦ Thermoluminiscent dosimetry (TLD) and optically stimulated
luminiscence (OSL) are the main radiation detectors used for
occupational radiation monitoring. Light is emitted when a TLD crystal is
heated. Light is emitted when an OSL crystal is illuminated. PSL is
similar to OSL.
◦ The sequence of events engaged in producing a PSL signal are as
follows:
◦ Exposure – the first of a sequence that results in an x-ray induced image-forming
signal.
◦ Stimulation – stimulation of the latent image results from the interaction of an
infrared laser beam with the PSP.
◦ Read – the light signal emitted after stimulation is detected and measured.
◦ Erase – prior to reuse, any residual metastable electrons are moved to the ground
state by an intense light.
COMPUTED RADIOGRAPHY
IMAGING PLATE
◦ The PSP screen is housed in a rugged
cassette and appears similar to a screen-
film cassette. In this form as an image
receptor, the PSP screen-film cassette is
called an imaging plate (IP).
◦ The IP is handled in the same manner as a
screen-film cassette; in fact, this is a
principal advantage of CR; CR can be
substituted for screen-film radiography
and used with any x-ray imaging system.
The PSP screen of the IP is not loaded and
unloaded in a darkroom. Rather, it is
handled in the manner of screen-film
daylight loader.
◦ The IP has lead backing that reduces
backscatter x-rays. This improves the
contrast resolution of the image receptor.
COMPUTED RADIOGRAPHY
IMAGING PLATE
◦ IP is coated with a material sensitive to ionizing radiation (x-
rays and gamma rays)
◦ Exposure to radiation excites the phosphor material and
creates a latent image
◦ IP is then scanned by a red laser and the image data is
extracted and displayed on the monitor
◦ IP is then erased by a bright light and ready for use again.
COMPUTED RADIOGRAPHY
CR READER
◦ A commercial CR reader could
be mistaken for a daylight film
processor. However, a daylight
film processor is based on wet
chemistry processing. The CR
reader represents the marriage
of mechanical, optical and
computer modules.
COMPUTED RADIOGRAPHY
CR READER – Mechanical Features
◦ When the CR cassette is inserted into the CR reader, the IP is
removed and is fitted to a precision drive mechanism. This drive
mechanism moves the IP constantly, yet slowly (slow scan) along the
long axis of the IP. Small fluctuations in velocity can result in banding
artifacts, so the motor drive must be absolutely constant.
◦ While the IP is being transported in the slow scan direction, a
deflection device such as rotating polygon or an oscillating mirror
deflects the laser beam back and forth across the IP. This is the fast
scan mode.
COMPUTED RADIOGRAPHY
CR READER – Mechanical Features
◦ Another method is for the cassette to be placed in the reader
vertically with the IP withdrawn downward. As this occurs, the
cassette is scanned by a horizontal laser.
◦ The IP barely leaves the cassette , so it is not subject to roller
damage. Furthermore, the scan is nearly always located at right
angles to the direction of any grid lines; in this way, aliasing artifacts
are reduced.
COMPUTED RADIOGRAPHY
CR READER – Optical Features
◦ The challenge to the CR reader is to precisely interrogate each
metastable electron of the latent image in a precise fashion.
Components of the optical subsystem include the laser, beam-
shaping optics, light-collecting optics, optical filters and a
photodetector.
◦ The laser is the source of stimulating light; however, it spreads as it
travels to the rotating/oscillating reflector. This light beam is focused
onto the reflector by a lens system that keeps the beam diameter
small – less than 100 µm.
* The laser beam size is critical for ensuring high spatial resolution.
COMPUTED RADIOGRAPHY
CR READER – Optical Features
◦ As the laser beam is deflected across the IP, it changes size and
shape. Special beam-shaping optics keeps the beam size, shape,
speed and intensity constant.
◦ Ralph Schaetzing describes a flashlight exercise to explain what is
needed for beam-shaping. Shine a flashlight perpendicularly on a
wall, and what do you see? A circle of light.
◦ Now, move the beam along the wall slowly but with constant
velocity, and what do you see? The beam becomes distorted, moves
faster and it is less intense. These types of changes in a CR reader are
corrected with the use of beam-shaping optics.
COMPUTED RADIOGRAPHY
CR READER – Computer Control
◦ The output of the photodetector is a time-varying analog signal that is
transmitted to a computer system that has multiple functions.
◦ The time-varying analog signal from the photodetector is processed for
amplitude, scale and compression. This shapes the signal before the
final image is formed. Then, the analog signal is digitized with attention
paid to proper sampling (time between samples) and quantization
(value of each sample).
◦ The image buffer is usually a hard disc. This is the place where a
completed image can be stored temporarily until it is transferred to a
workstation for interpretation or to an archival computer.
COMPUTED RADIOGRAPHY
CR READER
◦ Laser scanner
◦ Latent image (stored energy) is released as visible light.
◦ PMT reads emitted light as an analog signal and then converted to
digital (A-D).
◦ Several styles of scanners
◦ A/C Power
◦ Battery operated ones
◦ Resolution (down to 25 microns)
◦ Adjustable laser and PMTs settings
COMPUTED RADIOGRAPHY
COMPUTED RADIOGRAPHY
COMPUTED RADIOGRAPHY
WORKSTATION
◦ High speed computer
◦ High resolution monitor (3.5 megapixel +)
◦ Software for processing images
◦ Window leveling (brightness and contrast)
◦ IQI Senstivity – brightness (area of interest no brighter than)
◦ Various zoom/ filters and measurement tools
COMPUTED RADIOGRAPHY
Viewing the images can be done on either a:
◦ Cathode Ray Tube (CRT)
◦ Active Matrix Liquid Crystal Display (AMLCD), which is also referred to as a
flat panel detector:
◦ The AMLCD has better spatial resolution than the CRT since it has a higher
megapixel display.
◦ The AMLCD has better contrast resolution than the CRT since it has better
grayscale definition and noise is less.
The flat panel detector is the preferred detector, but it is not a
necessity.
Both displays are very inefficient and represent the weakest link in the
image-intensified chain for resolution.
COMPUTED RADIOGRAPHY
CR IMAGE PROCESSING
◦ When the PSP screen is exposed to x-rays, a fraction of that energy is
stored.
◦ After exposure, the IP is inserted into a CR reader.
◦ The IP is processed by a scanning system or reader which:
◦ Extracts the PSP screen from the cassette.
◦ Moves the screen across a high intensity scanning laser beam.
◦ Blue-violet light is emitted via PSL.
◦ Light energy is read by a photomultiplier tube, which converts the
light into an electric signal.
COMPUTED RADIOGRAPHY
COMPUTED RADIOGRAPHY
CR IMAGE PROCESSING
◦ The electronic signal is converted to a digital format for
manipulation, enhancement, viewing and printing if desired.
◦ The PSP screen is erased by a bright light inside the reader, reloaded
into the cassette and is ready for the next exposure.
◦ Entire process is 20 seconds.
COMPUTED RADIOGRAPHY
ADDITIONAL EQUIPMENT ◦ Archive Server
◦ CR Reader ◦ Web Server
◦ Imaging plates and ◦ Film Digitizer
cassettes
◦ QC Workstation
◦ Diagnostic Workstation/
Viewer

◦ Laser Printer
COMPUTED RADIOGRAPHY
COMPUTED RADIOGRAPHY
COMPUTED RADIOGRAPHY
CR READER DIAGNOSTIC VIEWER
(REPLACES DARKROOM AND PROCESSOR AND CHEMICALS) (REPLACES FILM, STORAGE AND VIEWBOXES)
CONVENTIONAL RADIOGRAPHY VS
COMPUTED RADIOGRAPHY
Factors Considered Conventional Radiography Computed Radiography

Image Receptor Imaging Plate

Exposure Medium (Cassette with film) (Cassette with PSP)

Image processed by
Processing Image processed by light
chemicals

Processing Time 45 secs – 3 mins 20 secs

Viewed thru a computer

Evaluation Viewed in a viewbox
monitor

Filed and stored in a filing Filed and stored in a

Archiving room archive server (computer)
PHOTOSTIMULABLE
PHOSPHOR (PSP) SCREEN
CONSTRUCTION
PHOTOSTIMULABLE PHOSPHOR
(PSP) SCREEN CONSTRUCTION

Photostimulable phosphor screen housed inside the imaging plate (cassette)

PHOTOSTIMULABLE PHOSPHOR
(PSP) SCREEN CONSTRUCTION

PROTECTIVE LAYER
◦ This is a very thin, tough, clear plastic that protects the phosphor layer.
PHOTOSTIMULABLE PHOSPHOR
(PSP) SCREEN CONSTRUCTION

PHOSPHOR OR ACTIVE LAYER

◦ A photostimulable phosphor that “traps” electrons.
◦ It is made of phosphors from bairum fluorohalide family. Contains light
absorbing dye to prevent light spread.
PHOTOSTIMULABLE PHOSPHOR
(PSP) SCREEN CONSTRUCTION

SUPPORT LAYER
◦ A semi-rigid material that gives the imaging sheet some strength.
◦ Supports the phosphor layer.
PHOTOSTIMULABLE PHOSPHOR
(PSP) SCREEN CONSTRUCTION

REFLECTIVE LAYER
◦ A layer that sends light in a forward direction when released in the cassette
reader.
◦ Some detail is lost in this process.
PHOTOSTIMULABLE PHOSPHOR
(PSP) SCREEN CONSTRUCTION

LEAD BACKSCATTER CONTROL

◦ To absorb backscatter

BACKING LAYER
◦ A soft polymer that protects the back of the cassette. The bar code reader is placed here
also.
Load cassette Perform examination

Position patient
Reload
cassette Process film
Escort patient to exam
room

Folder prepared Hang Image To radiologist

films QC
Films to folder
Study forms printed and file

Examination Repeat
Scheduled

Escort patient out

Because computed radiography (CR) is automatic and the IP reusable, there is

no need to reload the cassette.
EXPOSURE INDICATOR
is an indicator of light given off by the IP while being scanned by the
laser in the IP reader
can be known as “S” number or sensitivity number
Fuji systems uses the “S” number as the exposure indicator. The scale is
inversely related to exposure and density:
◦ a high “S” number indicates underexposure
◦ a low “S” number indicates overexposure
each change of 200 results in a change in exposure by a factor of 2:
◦ “S” number +200 = halving the exposure
◦ “S” number -200 = doubling the exposure
EXPOSURE INDICATOR
Kodak systems uses an exposure index as the exposure indicator. The
scale is directly related to exposure and density:
◦ a high exposure index number indicates overexposure
◦ a low exposure index number indicates underexposure
each change of 300 results in a change in exposure by a factor of 2:
◦ exposure index +300 = doubling the exposure
◦ exposure index -300 = halving the exposure
EXPOSURE INDICATOR
Checking the exposure index verifies that optimal quality digital
radiographic images were obtained with the least possible dose to the
patient
PRINCIPLES OF DIGITAL
RADIOGRAPHY
DIGITAL RADIOGRAPHY
cassette-less system
uses an x-ray absorber material coupled to a flat panel detector or a
charge-coupled device (CCD) to form the image
DIGITAL RADIOGRAPHY
DR is divided into two categories:
◦ Indirect capture devices absorb x-rays and converts them into light.
The light is detected by an area CCD or thin-film transistor (TFT)
array. This is then converted into an electrical signal that is sent to
the computer(digital) for processing and viewing.
◦ Direct capture devices convert the incident x-ray energy directly into
an electrical signal. It uses a photoconductor as the x-ray absorber
and sends the x-ray signal to the computer(digital) for processing
and viewing.
DIGITAL RADIOGRAPHY
DIGITAL RADIOGRAPHY
INDIRECT CAPTURE
◦ Exit beam radiation interacts first with a cesium iodide(CsI) phosphor
coated over an active matrix array(AMA). The light given off by the
CsI phosphor is then converted to an electrical signal via amorphous
silicon(a-Si) with which it interacts. The signal is stored on the TFT
until readout(one pixel at a time) and presented on the monitor for
viewing.
◦ Lower dose than direct capture.
DIGITAL RADIOGRAPHY
DIGITAL RADIOGRAPHY
DIRECT CAPTURE
◦ Exit beam radiation interacts directly with amorphous selenium(a-
Se) creating electron hole-pairs(EHP). The EHP is the signal that
charges the active matrix array and is stored on the thin-film
transistor. The TFT is read and presented on the monitor for viewing.
◦ Advantage: no spreading of light in the phosphor and spatial
resolution is improved (less blurring).
DIGITAL RADIOGRAPHY
DIRECT AND INDIRECT
CAPTURE
◦ In both systems, the latent
image is electronically stored
in the TFT which is read
sequentially one TFT to
another. Each TFT and its x-
ray detector represents a
pixel.
◦ Spatial resolution is limited
by pixel size.
IMAGE PROCESSING
Conventional radiography – done with chemicals
CR and DR – image processing takes place in a
computer
CR – the computer is located near the readers
DR – the computer is located near the x-ray console
and the image is processed before going to the next
exposure.
COMPARISON OF DETECTOR
MATERIALS
Screen-Film
◦ gadolinium
◦ lanthanum
◦ yttrium
CR
◦ europium activated-barium fluorohalide
DR
◦ amorphous silicon/amorphous selenium
COMPUTED RADIOGRAPHY(CR)
VS DIGITAL RADIOGRAPHY(DR)

CR is a system where the image is first captured in analog format then sampled into a digital pixel
matrix.
DR is a system where the image is acquired immediately as a matrix of pixels.
DIGITAL IMAGE
CHARACTERISTICS
MATRIX
a digital radiographic image is formed as an electronic image that is
displayed on a grid called matrix.
The image is laid out in rows and columns called an image matrix.
Each cell in the image matrix is called a picture element or pixel.
Each cell in the image matrix is assigned a number based on the
brightness of the square.
Each cell has its own dynamic range of values according to the number
of bytes of processing.
This is called a gray scale range (or the number of gray shades).
MATRIX
the more pixels there are, the greater the image resolution.
the image is digitized both by position (spatial location) and by intensity
(gray level).
Each pixels consists of bits of information and the number of bits per
pixel that define the shade of gray of each pixel is known as bit depth. If
a pixel has a bit depth of 8, then the number of gray tones that pixel can
produce is 28 or 256 shades of gray.
Some CR and DR systems have bit depths of 10 or 12. Each pixel can
have a gray level between 0 to 4096.
The greater the bit(pixel)depth, the greater the contrast resolution.
[Link]
MATRIX
DYNAMIC RANGE
DYNAMIC RANGE
Wide (large) dynamic range:
◦ more shades of gray
◦ wide image latitude
◦ better contrast resolution (ability to distinguish between similar tissues)
◦ low contrast
Narrow (small) dynamic range:
◦ fewer shades of gray
◦ narrow image latitude
◦ less contrast resolution
◦ high contrast
DYNAMIC RANGE
DYNAMIC RANGE
DYNAMIC RANGE
DYNAMIC RANGE
SPATIAL RESOLUTION
The amount of detail present in any image.
Phosphor layer thickness and pixel size determine resolution in the digital
imaging.
The thinner the phosphor layer, the higher the resolution.
◦ A bit similar with screen-film phosphors.
◦ The thinner phosphor layer, the less overlapped light produced. And in turn,
this less overlapped light produced between adjacent phosphors, less
penumbra (geometric unsharpness) is produced.
In CR, resolution is 2.55 to 5 lp/mm (line pairs per mm = how we measure
spatial resolution) while in film-screen, it is 8 lp/mm. This results in less
detail. Because the dynamic range (gray scale) is much wider, the
difference in resolution is more difficult to discern. More tissue densities
on a digital image are seen, thus giving the appearance of more detail.
SPATIAL RESOLUTION
TECHNICAL FACTORS
Selection of kVp, mAs, distance, collimation and anatomic markers is
the same for cassette-less systems as it is for cassette-based systems.
Only one exposure is made at a time on the image receptor.
Collimation is more critical, because DR is more sensitive to scatter
radiation.
When grids are used with DR, there is the possibility that the grid will
interfere with the pixel rows – moiré pattern.
◦ Moiré pattern – looks like grid lines.
MOIRE PATTERN
A moiré pattern is a strange-
looking wavy pattern.
These are visible thin line
artifacts caused when the
digital image is resized for
display on a monitor.
TECHNICAL FACTORS
Noise – a random disturbance that reduces clarity:
◦ Insufficient mAs (too few photons used for a particular part) will
result in a lack of phosphor stimulation.
◦ Image will be grainy (also known as quantum mottle or noise).
◦ Electronic noise – during the process of converting x-rays to a digital
signal there is a potential of signal loss. The more time allowed for
signal conversion, the more precise the pixel values.
TECHNICAL FACTORS
Using the smallest imaging plate possible for each
exam results in using a smaller pixel size, thereby
increasing spatial resolution.
Collimation should still be used to reduce patient
dose.
Side or position markers should still be used for
medical legal reasons.
DIGITAL IMAGE
PROCESSING AND
MANIPULATION
DIGITAL IMAGE PROCESSING
AND MANIPULATION
Once x-ray photons have been converted into electrical signals,
these signals are available for processing and manipulation. This
is true for both PSP systems and FPD systems although a reader is
required for cassette-based PSP systems; all other systems have
processing mechanisms built within the acquisition equipment.
Images are processed to mimic the appearance of screen-film
images. Digital processing will also adjust for the technical errors,
allows a wider range of subject contrast, enhance the spatial
frequency of certain tissues and allows the radiologist to highlight
certain areas of interest.
DIGITAL IMAGE PROCESSING
AND MANIPULATION
There are two steps in image processing; preprocessing and
postprocessing.
Preprocessing – occurs prior to the image being displayed where
the algorithms determine the image histogram, detector defects
removed and noise corrections are performed.
Postprocessing – done by the technologist to prepare the image
for the radiologist through various user functions; may also be
done by the radiologist to produce specialized images to aid the
radiologist in the diagnosis.
IMAGE HISTOGRAM
The CR and DR imaging plates records a wide range of x-ray
exposures. If the entire range of exposure were digitized, values
at extremely high and low ends of range would also be digitized.
This would result in low-density resolution. To avoid this,
exposure data recognition processes only the optimal density
exposure range.
Data recognition program searches for anatomy recorded on the
imaging plate as follows:
• Finding collimation edges.
• Eliminating scatter outside the collimation.
IMAGE HISTOGRAM
Failure of the system to find the
collimation edges can result in
incorrect data collection.
Images may be too bright or too
dark.
Data within collimation result in
generation of a graphic
representation called a histogram.
Because information within the
collimated area is signal used for
image data, the information is the
source for a vendor-specific
exposure data indicator.
IMAGE HISTOGRAM
FORMATION
The imaging plate is scanned first.
Image location and orientation is determined.
Size of the signal is determined.
Value is placed on each pixel.
IMAGE HISTOGRAM
FORMATION
Histogram is generated from the image data that allows system to
find useful signal by locating the minimum (S1) and maximum
(S2) signal within the anatomic regions of interest in the image.
Histogram identifies all densities on the imaging plate in the form
of a graph:
• X-axis is related to amount of exposure.
• Y-axis displays the number of pixels for each exposure.
• Graphic representation appears as a series of peaks and valleys
and has a pattern that varies for each body part.
IMAGE HISTOGRAM
FORMATION
IMAGE HISTOGRAM
FORMATION
IMAGE HISTOGRAM
FORMATION
IMAGE HISTOGRAM
FORMATION
Low energy (kilovoltage peak) gives a wider histogram.
High energy (kilovoltage peak) gives a narrow histogram.
Histogram shows the distribution of pixel values for any given
exposure.
For example:
• Pixels have a value of 1, 2, 3, and 4 for a specific exposure.
• Histogram shows the frequency of each of those values and
actual number of values.
• Histogram sets the minimum (S1) and maximum (S2) “useful”
pixel values.
IMAGE HISTOGRAM ANALYSIS
Analysis is complex.
Shape of the histogram stays fairly constant for each part
exposed (anatomy specific).
For example:
• Shape of histogram for a chest radiograph on a large adult patient looks
different from a knee histogram generated from a pediatric knee exam.
IMAGE HISTOGRAM ANALYSIS
It is important to choose the correct anatomic region on the
menu before exposing the patient.
Raw data used to form the histogram are compared with a
“normal” histogram of the same body part by the computer.
DIGITAL RADIOGRAPHY SIGNAL
SAMPLING
The Nyquist Theorem
◦ Theorem states that when sampling a signal, the sampling frequency
must be greater than twice the bandwidth of the input signal so that
the reconstruction of the original image will be nearly perfect.
At least twice the number of pixels needed to form the image
must be sampled.
If too few pixels are sampled, the result is a lack of resolution.
THE NYQUIST THEOREM
The number of conversions in CR—electron to light, light to digital
information, analog to digital signal—results in loss of detail.
Some light is lost during the light-to-digital conversion because of
the spreading out of light photons.
Because there is a small distance between the phosphor plate
surface and the photosensitive diode of the photomultiplier,
some light spreads out there as well, resulting in loss of
information.
THE NYQUIST THEOREM
The longer the electrons are stored, the more energy they
lose.
When laser stimulates electrons, some lower-energy
electrons escape the active layer.
If enough energy was lost, some lower-energy electrons are
not stimulated enough to escape and information is lost.
All manufacturers suggest that imaging plates be read as
soon as possible to avoid this loss.
THE NYQUIST THEOREM
Indirect and direct radiography lose less signal to light
spread than conventional radiography.
The Nyquist theorem is still applied to ensure that sufficient
signal is sampled.
Because sample is preprocessed by the computer
immediately, signal loss is minimized but still occurs.
ALIASING
Spatial frequency is greater than the Nyquist
frequency.
Sampling occurs less than twice per cycle.
Information is lost.
Fluctuating signal is produced.
ALIASING
Wraparound image is produced.
Image appears as two
superimposed images slightly out
of alignment.
Aliasing results in a moiré effect.
Aliasing can be problematic
because of the same effect
occurring with grid errors.
It is important that the
technologist remembers to look at
both.
AUTOMATIC RESCALING
Exposure is greater than or less than what is
needed to produce an image.
Automatic rescaling occurs to display the pixels
for the area of interest.
Images are produced that have uniform density
and contrast regardless of the amount of
exposure.
AUTOMATIC RESCALING
Problems occur with rescaling:
◦ When too little exposure is used, resulting in quantum
mottle.
◦ When too much exposure is used, resulting in loss of
contrast and loss of distinct edges because of increased
scatter production.
Rescaling is no substitute for appropriate technical factors.
Danger exists of using higher than necessary milliampere-second values
to avoid quantum mottle.
LOOK-UP TABLE (LUT)
The look-up table (LUT) is a reference histogram.
LUT is used as a cross-reference to transform the raw information.
LUT is used to correct values.
LUT has a mapping function:
• All pixels are changed to a new gray value.
Image will have appropriate appearance in brightness and
contrast.
LUT is provided for every anatomic part.
LOOK-UP TABLE (LUT)
LOOK-UP TABLE (LUT)
LUT can be graphed as follows:
• Plotting the original values ranging from 0 to 255 on the
horizontal axis
• Plotting new values, also ranging from 0 to 255 on the vertical
axis
Contrast can be increased or decreased by changing the slope of
this graph.
Brightness (density) can be increased or decreased by moving the
line up or down the y-axis.
LOOK-UP TABLE (LUT)
LATITUDE
Latitude is the amount of error that still results in a quality image.

Histograms show a wide range of exposure because of automatic

rescaling of the pixels.
Actual exposure latitude is slightly greater than that of
screen/film exposures.
In CR, if exposure is more than 50% below ideal exposure,
quantum mottle results.
LATITUDE
If exposure is more than 200% above ideal exposure,
contrast loss results.
Biggest difference between digital and film/screen
radiography lies in the ability to manipulate the digitized
pixel values, which results in what seems like greater
exposure latitude.
Proper kilovolt and milliampere-second values prevent
mottle and contrast loss.
QUALITY CONTROL
WORKSTATION FUNCTIONS
Image processing parameters
Contrast manipulation
Spatial frequency resolution
Spatial frequency filtering
IMAGE PROCESSING
PARAMETERS
Digital systems have greater dynamic range than film/screen imaging.
Initial digital image appears linear when graphed because all shades of
gray are visible.
Digitalization gives the image a wide latitude.
If all shades were left in the image, contrast would be too low.
IMAGE PROCESSING
PARAMETERS
To avoid this, digital systems make use of various
contrast-enhancement parameters.
Names differ by vendor; Agfa uses MUSICA, Fuji
uses Gradation, and Kodak uses Tonescaling.
Purpose and effects are basically the same.
CONTRAST MANIPULATION
Contrast-enhancement parameters convert the digital input data
to an image with appropriate density and contrast.
Image contrast is controlled by using a parameter that changes
the steepness of the exposure gradient.
Density can be varied at the toe and shoulder of the curve,
removing the extremely low and extremely high density values
using a different parameter.
Another parameter allows density to remain unchanged while
contrast is varied. These parameters should be used to enhance
the image only; no amount of adjustment takes the place of
proper technical factor selection.
CONTRAST MANIPULATION
SPATIAL FREQUENCY
RESOLUTION
Sharpness or detail control is referred to as spatial frequency
resolution or simply spatial resolution.
Spatial resolution is measured in lines pair per millimeter
(lp/mm).
Sharpness is controlled in film/screen by various factors such as
focal spot size, screen and/or film speed, and object image
distance (OID). Focal spot and OID also affects image sharpness
on digital imaging.
Digitized images can be further controlled for sharpness by
adjusting processing parameters.
SPATIAL FREQUENCY
RESOLUTION
Controls are available for the following:
• Structure to be enhanced
• Degree of enhancement for each density to reduce image
graininess
• How much edge enhancement is applied.
If improper algorithms are applied, image formation is affected.
It is possible to degrade image information if algorithms are
improperly applied.
SPATIAL FREQUENCY FILTERING
Edge Enhancement
Smoothing
EDGE ENHANCEMENT
When the signal is obtained, averaging of the signal occurs to
shorten processing time and storage. The more pixels involved in
the averaging, the smoother the image appears.
Signal strength of one pixel is averaged with the strength of
adjacent pixels or neighborhood pixels.
Edge enhancement occurs when fewer pixels in the
neighborhood are included in the signal average.
The smaller the neighborhood, the greater the enhancement.
When frequencies of areas of interest are known, they can be
amplified (amplification) and other frequencies can be
suppressed.
EDGE ENHANCEMENT
Amplification, also known as high-pass filtering, results in an
increase of contrast and edge enhancement.
Suppression of frequencies, also known as masking, can result in
loss of small details.
High-pass filtering is useful for enhancing large structures such as
organs and soft tissues but can be noisy.
EDGE ENHANCEMENT
EDGE ENHANCEMENT
SMOOTHING
Smoothing is another type of spatial frequency filtering.
Smoothing is also known as low-pass filtering.
Smoothing results from averaging of the frequency of each pixel
with surrounding pixel values to remove high-frequency noise.
Result is a reduction of noise and contrast.
Low-pass filtering is useful for viewing small structures such as
fine bone tissues.
SMOOTHING
BASIC FUNCTIONS OF THE
PROCESSING SYSTEM
Postprocessing Image Manipulation
◦ Window Level and Width
◦ Background Removal or Shuttering
◦ Image Orientation
◦ Image Stitching
◦ Image Annotation
◦ Magnification
Image Management
◦ Patient Demographic Input
◦ Manual Send
◦ Archive Query
WINDOW LEVEL AND WIDTH
The most common image postprocessing parameters are those for
brightness and contrast.
Window level controls how bright or dark the image is.
◦ The higher the level is, the darker the image will be.

Window width controls the ratio of black to white, or contrast.

◦ The wider the window width is, the lower the contrast.

User is able to manipulate quickly through use of the mouse.

Remember, windowing and leveling are manipulations of the screen
image and is not adding or subtracting radiation exposure to the patient.
Minimal manipulation will be required for image with appropriate
exposure factors.
BACKGROUND REMOVAL OR
SHUTTER
Anytime a radiographic image is viewed, analog or digital,
unexposed borders around the collimation edges allow excess
light to enter the eye.
Known as veil glare, this excess light causes oversensitization of a
chemical within the eye called rhodopsin and results in
temporary white light blindness.
Although the eye recovers quickly enough so that viewer
recognizes only that the light is very bright, this glare is a great
distraction that interferes with image reception by the eye.
BACKGROUND REMOVAL OR
SHUTTER
In film/screen radiography, black cardboard glare masks or special
automatic collimation view boxes were used to lessen the effects
of veil glare, but no techniques were entirely successful or
convenient.
In digital imaging, automatic shuttering is used to blacken out the
white collimation borders, thus eliminating veil glare.
Shuttering is a viewing technique only and is should never be
used to mask poor collimation practices.
BACKGROUND REMOVAL OR
SHUTTER
Removal of the white unexposed borders results in an overall
smaller number of pixels.
This reduces the amount of information to be stored.
IMAGE ORIENTATION
Image orientation refers to the way anatomy is oriented on the
imaging plate.
In a PSP system, the image reader has to be informed of the
location of the patient’s head versus the location of the feet and
the right side versus the left side.
Image reader scans and reads the image from the leading edge of
the imaging plate to the opposite end. Image is displayed exactly
as it was read.
Different vendors mark the cassettes in different ways.
◦ Fuji uses a tape-type orientation marker.
◦ Kodak uses a sticker.
IMAGE ORIENTATION
Cassette must be oriented so that the image is processed to
display as expected.
Some exams require unusual orientation of the cassette.
Reader must be informed of the orientation of the anatomy with
respect to the reader.
In digital radiography, the position of the part should correspond
with the marked top and sides of the imaging plate.
IMAGE STITCHING
Image stitching is used for anatomy or areas of interest too large
to fit on one cassette.
Multiple images can be “stitched” together.
Sometimes, special cassette holders are used and positioned
vertically, corresponding to foot to hip or entire spine
radiography.
Images are processed in computer programs that nearly
seamlessly join the anatomy. Computer displays one single image.
Process eliminates the need for large (36-inch) cassettes
previously used in film/screen radiography.
IMAGE STITCHING
IMAGE ANNOTATION
Information other than standard identification must be added to
the image.
In screen/film radiography, additional information is marked by
the following:
• Time and date stickers
• Grease pencils
• Permanent markers
IMAGE ANNOTATION
Annotation function allows
selection of preset terms and/or
manual text input.
Annotation can be useful when
such additional information is
necessary.
Annotations overlay the image as
bitmap images.
Annotations may not transfer to
picture archival and
communication system (PACS).
Input of annotation for
identification of the patient’s left
or right side should never be used
as a substitute for technologist’s
anatomy markers.
MAGNIFICATION
Two basic types of magnification techniques are standard with
digital systems:
◦ One type functions as a magnifying glass:
◦ A box is placed over a small segment of anatomy on the main image.
◦ Box shows a magnified version of the underlying anatomy.
◦ The size of the magnified area and the amount of magnification can be
made larger or smaller.
◦ Other technique is “zoom.”
◦ Zoom allows magnification of the entire image.
◦ Image can be enlarged enough that only parts of it are visible on the
screen.
◦ Those parts can be seen through mouse navigation.
MAGNIFICATION
PATIENT DEMOGRAPHICS INPUT
Proper identification of the patient is even more critical with
digital images than with conventional hard copy film-screen
images.
Retrieval can be nearly impossible if image is not properly and
accurately identified.
PATIENT DEMOGRAPHICS INPUT
Demographic information about the patient includes the
following:
◦ Name
◦ Health care facility
◦ Patient identification number
◦ Date of birth
◦ Exam date
◦ Other pertinent information
These information should be input or linked via barcode label
scans before the start of the examination and before processing
phase.
PATIENT DEMOGRAPHICS INPUT
Occasionally, errors are made and demographic information must
be altered.
If technologist performing the exam is absolutely positive that
image is of the correct patient, then demographic information
can be altered at the processing stage.
This function should be tracked and changes should be linked to
the technologist altering the information to ensure accuracy and
accountability.
PATIENT DEMOGRAPHICS INPUT
Problems occur if the patient name is entered differently from
visit to visit or exam to exam.
For example:
• Patient’s name is Jane A. Doe and is entered that way.
• Name must be entered that way for every other exam.
• If name is entered as Jane Doe, then system will save it as a
different patient.
• Merging of files can be difficult.
PATIENT DEMOGRAPHICS INPUT
Problems occur if the patient name is entered differently from
visit to visit or exam to exam.
For example:
• Patient’s name is Jane A. Doe and is entered that way. Name must be
entered that way for every other exam. If name is entered as Jane
Doe, then system will save it as a different patient.
• Merging of files can be difficult if several versions of the name are
given.
• Suppose the patient gives a middle name on one visit but has
multiple exams under his or her first name.
• Retrieval of previous files will be difficult.
• The right images must be placed in the correct data files.
MANUAL SEND
Because the quality control (QC) workstation is networked to the
PACS, it also has the capability to send images to local network
workstations.
The manual send function allows the QC technologist to select
one or more local computers to receive images.
ARCHIVE QUERY
PACS archive can be queried for historical images.
Function allows retrieval of images from the PAC system based on
the following:
• Date of exam
• Patient name or number
• Exam number
• Pathologic condition
• Anatomic area
ARCHIVE QUERY
Example:
• Technologist could query PACS to retrieve all chest radiographs
for a particular date or range of dates.
• Technologist could query retrieval of all of a patient’s images.
• Multiple combinations of query fields are possible:
◦ Can generate general retrieval
◦ Specific recovery of images
DIGITAL IMAGE
ACQUISITION
(Photostimulable Phosphor
Image Capture)
ACQUIRING AND FORMING THE
IMAGE
With PSP systems, the patient is x-rayed the same way as in
conventional radiography.
The difference lies in how the exposure is recorded . In PSP, the
remnant beam interacts with electrons in the barium fluorohalide
crystals contained within the imaging plate. This interaction
stimulates (or gives energy to) electrons in the crystals, trapping
them in an area of the crystal known as the color or phosphor
center.
ACQUIRING AND FORMING THE
IMAGE
THE READER
There are two types of PSP readers:
◦ Point scan
◦ readers that have an optical stage, a scanning laser beam, translation
mechanics, a light pickup guide, a photomultiplier tube, a signal
transformer/amplifier and an analog-to-digital converter (ADC).
◦ at any point in time, only a single laser point radiates the IP.
◦ Line scan
◦ based on simultaneous stimulation of the imaging plate one line at a
time
◦ the acquisition of PSL occurs with CCD linear array photodetector
◦ instead of single laser beam, there is a scanning light collection lenses.
THE READER
With PSP systems, no chemicals are needed to process the image.
Instead after exposure, the cassette is fed into the reader that
removes the imaging plate and is scanned with a laser to release
the stored energy.
The technologist will often note two scan directions:
◦ Fast scan direction
◦ movement of laser across the imaging plate
◦ also known as the “scan”
◦ Slow scan direction
◦ movement of imaging plate through the reader
◦ also known as “translation” or “subscan direction”
THE LASER
A laser or light amplification of stimulated emission of radiation,
is a device that creates and amplifies a narrow, intense beam of
coherent light.
This requires a constant power source to prevent output
fluctuations. The laser beam passes through beam-shaping optics
to an optical mirror that directs the laser beam to the surface of
the imaging plate.
During the reading process, the IP is scanned with a helium-laser
beam or in more recent systems, solid-state laser diodes. The
laser with sufficient energy, allows the trapped electrons to
escape the active layer where now they emit blue violet light.
DIGITIZING THE SIGNAL
When digitizing the light signal from a photodetector, we are
talking about assigning a numerical value to each light photon.
The scanning process results in the conversion of the light
emitted from the storage sample and digitized to represent a
specific location within the image matrix and displays as a specific
brightness.
Matrix – group of squares that make up the image information
Pixel - or picture element; squares in the matrix
◦ the more pixels present, the greater the image resolution for a fixed
field of view
◦ each pixel contains bits of information (the number of bits per pixel
define the shade of each pixel or known as bit depth)
ERASING THE IMAGE
The process of reading the image returns most but not all the
electrons to a lower energy state, effectively removing the image
from the plate .
However, imaging plates are sensitive to scatter radiation and
should be erased to prevent a buildup of background signal. At
least once a week, the plates should be run through an erase
cycle to remove background radiation and scatter.
PREPROCESSING, PROCESSING
AND FORWARDING
Once the imaging plate has been read, the signal is sent to the
computer where it is preprocessed. The data then go to a monitor
where the technologist can review the image, manipulate if
necessary (postprocessing) and send it to the quality control (QC)
station and ultimately to the picture archiving and
communication system (PACS).
EXPOSURE
Part Selection
Technical Factors
Equipment Selection
Collimation
Side/Position Markers
PART SELECTION
Depending on the type of system being used, the technologist will
choose the body part imaged either prior to exposure of the
image receptor or after exposure.
If the examination room has a PSP housed in the detector in the
table or wall stand, the patient worklist will most likely be in the
room’s workstation, which means the technologist may choose
appropriate body part automatically.
Always check to make sure the appropriate part has been
selected.
PART SELECTION
PART SELECTION
When using cassette-based systems, the selection of the body
part is usually done after the exposure and it is imperative that
cassettes are kept apart so that the technologist knows which
cassette goes with which body part.
Image recognition is accomplished through complex
mathematical computer algorithms and if improper part and/or
position is designated, the image may be processed incorrectly
and fail to display properly.
If the proper examination/part selection results in an suboptimal
image, then service personnel should be notified of the problem.
PART SELECTION
TECHNICAL FACTORS
kilovoltage peak (kVp) selection
◦ kVp values range from 45 to 120 on most digital projection systems
◦ Attenuation will be the same for digital imaging systems as it is for film-
screen imaging.
◦ It is vital that the proper balance between patient dose and part penetration
be achieved.
◦ A major difference between analog imaging and digital imaging however is
that digital image contrast is no longer dependent on kVp. Sufficient kVp is
needed to penetrate the body part; however, higher kVp values can be used,
allowing for lower mAs values.
◦ The dynamic recording range of digital receptors is much higher than those
used in analog systems and inherently produces a wide variety of gray
values.
◦ Contrast is determined by computer processing.
TECHNICAL FACTORS
TECHNICAL FACTORS
milliamperage seconds (mAs) selection
◦ mAs selection is based on the number of photons needed for a
particular body part.
◦ If there are too few photons, no matter what level of kVp is chosen,
the result will be lack of sufficient phosphor stimulation.
◦ When insufficient light is produced, the image is grainy, a condition
known as quantum mottle or quantum noise.
TECHNICAL FACTORS
TECHNICAL FACTORS
EQUIPMENT SELECTION
Imaging Plate Selection
◦ Two important factors should be considered when selecting the PSP
imaging cassette: type and size.
◦ Manufacturers produce two types: standard and high resolution.
◦ Cassettes should be marked on the outside to indicate high-
resolution imaging plates because they contain a thinner phosphor
layer as compared to standard plates which results in greater image
sharpness because of the reduced amount of light spreading
(reduced blurring) in more lateral directions.
◦ High-resolution imaging plates are limited to smaller cassette sizes
and are most often used for extremities, mammography and other
examinations requiring more detail.
EQUIPMENT SELECTION
Imaging Plate Selection
◦ PSP digital images are displayed in
a matrix of pixels and the pixel size
is an important factor in
determining the resolution of the
image.
◦ If the matrix of an imaging system
remains constant, as the field of
view (FOV; synonymous with x-ray
field; amount of body part included
in the image) decreases, the pixel
size also decreases and spatial
resolution of the image increases.
EQUIPMENT SELECTION
Imaging Plate Selection
◦ A 2000 x 2000 matrix on a 8 x
10 cassette results in smaller
pixel size thus increasing
resolution.
◦ If for example, a hand were
imaged on a 14 x 17 cassette,
the entire cassette would be
read according to a 14 x 17
matrix size with much larger
pixels and the resultant image
would be very large.
EQUIPMENT SELECTION
Grid Selection
◦ Digital images are displayed in tiny rows of picture elements or pixels. Grid
lines that are projected onto the imaging plate when using a stationary grid
can interfere with the image and will result to a wavy artifact known as
moire pattern.
◦ PSP systems are more sensitive to low levels of radiation, the use of grid is
much more critical than in film-screen radiography.
EQUIPMENT SELECTION
COLLIMATION
When exposing the patient, the larger the volume of tissue being
irradiated, the more scatter will be produced.
Properly used collimation reduces the area of irradiation and the
volume of tissue in which scatter can be created.
Collimation is the reduction of the area of beam that reaches the
patient through the use of two pairs of lead shutters encased in a
housing attached to the x-ray tube.
Collimation results in increased contrast resolution because of
the reduction of scatter. Through postexposure image
manipulation known as shuttering, a black background can be
added around the original collimation edges, virtually eliminating
the distracting white or clear areas.
SIDE/POSITION MARKERS
Anyone who has used digital image processing equipment knows
that is very easy to mark images with left or right side markers or
other position or text markers after the exposure has been made.
However, it is strongly advised that conventional lead markers
should be used the same way as they are used in analog imaging.
Marking the patient examination at the same time of exposure
not only identifies the patient’s side but also identifies the
technologist performing the examination. This is also an issue of
legality.
When all of the appropriate technical factors and equipment have
been selected, the image receptor may be exposed and then
subjected to the reading process.
DIGITAL IMAGE
ACQUISITION
(Thin-Film Transistor Flat-
Panel Array Image Capture)
THIN-FILM TRANSISTOR FLAT-
PANEL ARRAY IMAGE CAPTURE
The first thin-film transistor (TFT) flat-panel amorphous silicon
and amorphous selenium detectors were introduced in 1995.
these were the first devices to move beyond the cassette into
detectors that would reside in the table and wall stand.
With flat-panel detectors (FPD), the materials used for detecting
x-ray signal and the sensors for recognizing that signal are
permanently enclosed inside a rigid protective housing.
ACTIVE-MATRIX FLAT-PANEL
IMAGER
Active-matrix flat-panel imagers (AMFPI) consist of a flat-
panel array with an x-ray absorption material.
The two main types of x-ray absorption material currently
being used are photoconductors and scintillators.
Photoconductors are materials that absorb x-rays, resulting
in an electrical charge.
Scintillators are phosphors that produce light when
absorbing x-rays.
ACTIVE-MATRIX FLAT-PANEL
IMAGER
An AMFPI detector measures the response of these
materials to x-ray absorption and is a large area two-
dimensional (2-D) array of pixels fastened to a thin glass
backing or substrate.
The absorption material is attached to the surface of this
array either electrically, as in the case of photoconductor, or
physically, as in the case of scintillator.
The choice of absorption material determines whether the
detector uses direct or indirect signal conversion.
DIRECT CONVERSION
In direct conversion, x-ray photons are absorbed by the coating
material and immediately converted into an electrical signal.
The flat-panel detector has a photoconductor made of
amorphous selenium (a-Se) which absorbs x-rays and converts
them into electrons and are stored in the TFT.
The TFT is a photosensitive array made up of small pixels, also
called as detector element (del). Each pixel contains a photodiode
that absorbs electrons and generates electrical charges.
A field effect transistor (FET) isolates each pixel element and
reacts like a switch to send the electrical charges to the image
processor.
INDIRECT CONVERSION
Indirect conversion detectors are similar direct detectors in
that they use TFT technology.
Unlike direct conversion, indirect conversion is a two-step
process:
◦ x-ray photons are converted into light
◦ light photons are converted into electrical signal

A phosphor such as gadolinium oxysulfide (Gd2O2S) or

thallium-doped cesium iodide (CSI[TI]) rapidly absorbs x-
rays and produces light.
INDIRECT CONVERSION
The phosphor layer is known as scintillation layer.
The scintillation layer can be structured or unstructured.
Unstructured scintillation layers produce more scattered
light than structured layer, thereby decreasing the efficiency
of the detector.
The light is then converted into an electrical signal by a
photodetector such as a hydrogenated amorphous silicon
(a-Si:H) photodiode array.
DIGITAL IMAGE
EVALUATION
EXPOSURE INDICATOR
The amount of light given off by the imaging plate is a result
of the radiation exposure that the plate has received.
The light is converted into a signal that is used to calculate
the exposure indicator number, which is a different number
from one vendor to another.
EXPOSURE INDICATOR
With film-screen radiography, this was particularly easy to evaluate by
just looking at the area of interest and determining if there was enough
or not enough radiographic density “darkness”.
With CR and DR imaging systems, the software utilized to process the
images is programmed to compensate for differences in exposure.
◦ In other words, if a radiograph is underexposed or overexposed, the software
adjusts the appearance to be presented on the monitor as “optimum”.

You could compare a radiograph with optimum exposure beside a

radiograph that was exposed with four times the necessary exposure to
produce an optimum image, and on the monitor, they would look
almost identical.
EXPOSURE INDICATOR
In digital imaging, RTs lose the visual relationship between
the amount of exposure darkness “optical density” of the
radiograph.
It may help to think of digital imaging in the sense that
“optical density” is no longer a unit of measurement.
How dark or bright a digital image appears is now termed as
“image brightness”.
3 types:
◦ sensitivity number (“S” number)
◦ exposure index (EI)
◦ log meridian exposure (LgM)
SENSITIVITY NUMBER
The “S” number has an inversely relationship to
radiographic exposure.
◦ As exposure increases, “S” number decreases.
◦ Also has proportional relationship to exposure:
◦ If exposure doubles, the “S” number is halved.
Typical range is between 200 and 300(dependent upon the
body part imaged.)
SENSITIVITY NUMBER
Example:
◦ If a chest x-ray is performed using a 110 kVp and 6.4 mAs with a “S” number
of 100, approximately twice the exposure required was used.
◦ In order to compensate, the RT could lower the mAs to about 3.2 to produce
an image with a “S” number of 200.
EXPOSURE INDEX
The EI has a direct relationship to radiographic exposure.’
◦ As exposure increases, the EI increases.
◦ However, does not have a proportional relationship.
◦ For every double in the exposure (2x mAs), the EI should
increase by a factor of 300.
Optimal range for most exams, using EI, is between 1700
and 2100.
EXPOSURE INDEX
Example:
◦ If a PA chest is performed using a 110 kVp and 2 mAs with an EI of 1100, this
will produced an underexposed image.
◦ Therefore, doubling the mAs once to 4 mAs should produce an EI of 1400.
doubling the mAs again to 8 mAs should get it in the 1700 range.
LOG MERIDIAN EXPOSURE
The LgM exposure indicator has a direct relationship to
radiographic exposure.
◦ As exposure increases, the LgM increases.
◦ It does not have a proportional relationship.
◦ For every double in exposure, LgM increases by a factor of 0.3
◦ For every half in exposure, LgM decreases by 0.3.

Optimal range should be around 1.9 – 2.1.

Example:
◦ An overexposed PA chest used 10 mAs and produced a LgM of 2.4.
The mAs could be cut in half to 5 mAs to produce an appropriate 2.1
LgM.
EXPOSURE INDICATOR
“S” number
◦ inversely proportional
◦ 2x exposure = ½ “S” number

EI
◦ directly related
◦ 2x exposure = +300 EI

LgM
◦ directly related
◦ 2x exposure = +0.3 LgM
IMAGE BRIGHTNESS AND
CONTRAST
Though the processing algorithm is designed to create an
optimum brightness and scale of contrast for digital images, the
most important thing we need to remember is that the beam
physics remains the same.
The auto-corrections and post-processing alternatives are a great
feature and should be utilized to maximize image quality prior to
delivery to the radiologist.
So how do you supply a high-quality remnant beam to the IP with
the maximum potential to allow the software to do its job?
◦ By supplying the appropriate exposure to the IP and by doing
as much as possible to eliminate scatter radiation.
IMAGE BRIGHTNESS AND
CONTRAST
Scatter has even more of a negative effect on image quality with
digital equipment than with film-screen imaging.
The digital system will interpret any radiation exposure and will
not be able to distinguish scatter radiation as “unnecessary”.
Scatter radiation places photons all over the image which reduces
the difference in exposure reaching the IP.
With an increased amount of scatter radiation reaching the IP in
various locations, the entire image will be adjusted according to
the instructions in the processing algorithm and it will produce a
low-contrast image.
IMAGE BRIGHTNESS AND
CONTRAST
SCATTER RADIATION CONTROL
beam limitation (collimation)
◦ more tissue irradiated means more scatter radiation produced at the
image receptor/imaging plate.
◦ it is imperative to draw a distinction between beam restriction
(collimation) and image cropping (masking/shuttering).
use of grids
◦ definitely for parts over 10 cm of thickness.
◦ although, arguable on chest x-rays.

appropriate kVp range per body part/thickness.

minimize OID whenever possible.
utilize the appropriate processing algorithm.
SCATTER RADIATION CONTROL
SCATTER RADIATION CONTROL
SCATTER RADIATION CONTROL
SCATTER RADIATION CONTROL
SPATIAL RESOLUTION
The amount of detail present in any image; just as the crystal size
and thickness of the phosphor layer determine resolution in
analog imaging, phosphor layer thickness and pixel size help
determine spatial resolution in digital imaging.
The thinner the phosphor layer, the higher the resolution.
In film-screen radiography, the resolution at its best is limited to
approximately 10 lp/mm but in general PSP imaging, it is limited
to only 2.5-5 lp/mm.
Affected by the following:
◦ laser beam spot size – the smaller the laser, the higher the resolution
◦ translation speed – slower speed allows more exposure to be detected
◦ sampling frequency – the higher the frequency, more exposure is detected
SPATIAL RESOLUTION
However, because of the bit depth (number of gray shades that
can be displayed) is much higher, the difference in resolution is
more difficult to discern.
More tissues are seen on digital radiography giving the
appearance of more detail. This is because of the ability to display
more shades of gray but this does not mean that the digital
image contains more detail as compared to film-screen image.
ARTIFACTS
As with film-screen artifacts, artifacts can degrade images in
digital systems. Artifacts are any undesirable densities on
the processed image other than those caused by scatter
radiation or fog.
There are four common types of artifacts:
◦ imaging plate artifacts
◦ plate reader artifacts
◦ image processing artifacts
◦ printer artifacts
ARTIFACTS
IMAGING PLATE ARTIFACTS
As the imaging plate ages, it becomes prone to cracks from
the action of removing and replacing the imaging plate
within the reader.
The imaging plate must be replaced when cracks appear on
clinically useful areas.
IMAGING PLATE ARTIFACTS

Cracks on the imaging plate appear as areas of radiolucency

on the image.
IMAGING PLATE ARTIFACTS

Adhesive tape used to secure lead markers

When static exists because of low
to the cassette can leave residue on the
humidity, hair can cling to the imaging
imaging plate.
plate, creating another IP artifact.
IMAGING PLATE ARTIFACTS

Backscatter created by x-ray photons transmitted through

the back of cassette can cause dark line artifacts.
PLATE READER ARTIFACTS
The intermittent appearance of extraneous line patterns can
be caused by problems in the plate reader’s electronics.

Reader electronics may have to be replaced to remedy this

problem.
PLATE READER ARTIFACTS
Horizontal white lines may be
caused by dirt on the light guide in
the plate reader. Service personnel
will need to clean or replace the
light guide.
If the plate reader loads multiple
imaging plates in a single cassette,
only one of the plates will usually
be extracted, leaving the other to
be exposed multiple times.
The result is similar to a
conventional film-screen double-
exposed cassette.
PLATE READER ARTIFACTS
Incorrect erasure settings result in a residual image left in the imaging
plate before the next exposure. Results vary depending on how much
residual image is left and where it is located.
Orientation of the grid so that the grid lines are parallel to the laser scan
lines of the plate reader results in moire pattern error. Grids should be
high frequency and the grid lines should run perpendicular to the laser
scan lines.
IMAGE PROCESSING ARTIFACTS
Processing artifacts can occur for many different reasons,
such as choosing the incorrect processing parameter for a
particular body part or incorrect sampling of the image file.
It is very important to set appropriate technical factors and
choose the correct body part so that the software
algorithms will produce the desired image. Poor technique
(collimation, grid selection, mAs, kVp, etc.) and positioning
can cause these algorithm to misrepresent the image.
PRINTER ARTIFACTS
Fine white lines may appear on the image
because of debris on the mirror in the laser
printer. Service personnel need to clean the
printer.
PRINTER ARTIFACTS
Fine white lines may appear on the image
because of debris on the mirror in the laser
printer. Service personnel need to clean the
printer.
OPERATOR ERRORS
Insufficient collimation results in unattenuated radiation striking the
imaging plate.

The resulting histogram is changed so that it is outside the normal

exposure indicator range for the body part selected.
Using the smallest imaging plate possible and proper collimation,
especially on small or thin patients, eliminates this error.
OPERATOR ERRORS
If the cassette is exposed with the back of the cassette
toward the source, the result is an image with a white grid-
type pattern and white areas that correspond to the hinges.
Care should be taken to expose only the tube side of the
cassette.
OPERATOR ERRORS
Underexposure produces quantum mottle and overexposure affects
contrast.
The proper selection of technical factors is critical to patient dose and
image quality and to ensure the appropriate production of light from
the imaging plate.
QUALITY ASSURANCE AND
MAINTENANCE ISSUES
QUALITY ASSURANCE
PROGRAM
What is a Quality Assurance Program ?
◦ An organized effort by the staff operating a facility to ensure that the
diagnostic images produced are of a sufficiently high quality so that they
consistently provide adequate diagnostic information at the lowest possible
cost and with the least possible exposure of the patient to radiation.
-World Health Organization
QUALITY ASSURANCE
PROGRAM
Objectives of QA Program
◦ to maintain optimal quality of diagnostic images
◦ to reduce unnecessary radiation exposure to patient and staff
◦ to be cost effective

The primary goal of a radiology QA program is to ensure the

consistent provision of prompt and accurate diagnosis of
patients
QUALITY ASSURANCE
PROGRAM
This program has many facets, including:
◦ Quality Control tests
◦ Administrative procedures
◦ Preventive maintenance procedures
◦ Training
QUALITY ASSURANCE
COMMITTEE
What is the Quality Assurance Committee ?
Personnel in the QA program who are responsible for
oversight of the QA program, setting the goals and
direction, determining policies, and assessing the
effectiveness of QA activities.
They have an overall documented strategy with clearly
defined work plans to achieve the goals and objectives of
the radiology department.
QUALITY ASSURANCE
COMMITTEE
QA committee members includes;
◦ Medical Physicist
◦ Radiologist
◦ Biomedical engineer
◦ Medical Imaging Technologist (MIT) and Radiographer
◦ Information Technology (IT) Technician
QUALITY ASSURANCE
COMMITTEE
Medical Physicist
◦ An individual who is competent to independently practice in
one or more of the subfields in medical physics.
◦ Advising the facility on radiation protection of the patient, staff
and members of the public.
◦ Conducting tests to ensure the safety and proper performance
of imaging equipment used.
◦ Assignment of Bio-medical engineering service staff for
corrective maintenance or preventive actions.
◦ Training of personnel utilized for quality control
◦ Develop and implement a radiation protection program
QUALITY ASSURANCE
COMMITTEE
Radiologist
◦ A medical doctor who specializes in the diagnosis and treatment of disease
and injury by using medical imaging technologies.
◦ Determine the overall quality of the output image
◦ Select the technologist to be the primary QC technologist, performing the
prescribed QC tests.
◦ Ensure that appropriate test equipment and materials are available to
perform the QC tests.
◦ Ensuring that medical physicists and radiographers have adequate training
and continuous education
QUALITY ASSURANCE
COMMITTEE
Biomedical Engineer
◦ Biomedical engineers use their knowledge of modern biological principles in
their engineering principle to design and develop devices and procedures
that solve medical and health-related problems.
◦ Biomedical engineer are involve in;
◦ Corrective and preventative maintenance
◦ Fault Reporting
QUALITY ASSURANCE
COMMITTEE
Medical Imaging Technologist (MIT) and Radiographer
◦ Ensuring that the appropriate protocol and technique factors
are used for the requested examination.
◦ Ensuring that the QC tests are performed, interpreted and
recorded appropriately.
◦ Perform all the checks for the daily, monthly and quarterly QC
testing of equipment
◦ Report faults immediately any deviation in trend of equipment
performance to QA manager
◦ Undertaking additional continuous education courses
QUALITY ASSURANCE
COMMITTEE
Information Technology (IT) Technician
◦ IT is a key element of any digital radiology facility that intends
to store, review and distribute images electronically or using
hard copy. There responsibility includes;
◦ Maintenance of the integrity of system databases to ensure
continuous and accurate operation of the information systems
◦ Planning
◦ Deployment
◦ Testing
DISPLAY AND DATA
MANAGEMENT
IMAGE DISPLAY
Following computer processing, the digital image is ready to be
displayed for viewing. 
Soft copy viewing refers to the display of the digital image at a
computer workstation, as opposed to viewing images on film or
another physical medium (hard copy).
The quality of the digital image is also affected by important
features of the display monitor, such as its luminance, resolution,
and viewing conditions such as ambient lighting and monitor
placement. Specialized postprocessing software is used at the
display workstation to aid the radiologist in image interpretation.
In addition to soft copy viewing, the digital image can be printed
on specialized film by a laser printer.
DISPLAY MONITOR
The quality of the digital image is affected by its acquisition
parameters and subsequent computer processing. In
addition, the quality of the digital image is affected by the
performance of the display monitor.
The quality of display monitors may not be equal among all
those used for viewing of digital images. Monitors used by
radiologists for diagnostic interpretation, referred to
as primary, must be of higher quality than the monitors
used only for routine image review.
DISPLAY MONITOR
However, the radiographer’s monitor
should be of sufficiently high quality in
order to discern all the image quality
characteristics accurately before sending
the image to the radiologist for diagnostic
interpretation.
Display monitors used for diagnostic
interpretation are typically monochrome
high-resolution monitors and can be
formatted as portrait or landscape and
configured with one, two, or four monitors.
A display monitor having diagonal
dimensions of 54 cm (21 inches) is
adequate to view images sized 35 × 43 cm
(14 × 17 inches).
CATHODE RAY TUBES (CRT)
A CRT monitor creates an image by accelerating and
focusing electrons to strike the faceplate composed of a
fluorescent screen. Because the image is scanned on the
screen in lines, the number of lines affects the quality of the
image displayed. It is recommended that CRT monitors scan
at least 525 lines per 1/30 of a second. The major
components of the CRT monitor are the electron gun
encasing a cathode, focusing coils and deflecting coils, and
the anode. This type of display monitor typically has a
curved faceplate, and its dimensions are deeper.
CATHODE RAY TUBES (CRT)

The CRT monitor creates an image by accelerating and focusing

electrons to strike the faceplate composed of a fluorescent
screen.
LIQUID CRYSTAL DISPLAY (LCD)
The LCD monitor passes light through liquid crystals to
display the image on the glass faceplate. Additional
components include a source for the electrical signal and
light waveforms and polarizing filters. The electrical signals
can vary the light waveforms that pass through the crystals
for viewing on the faceplate. The LCD monitor has a flat
faceplate, and its dimensions are thinner.
LIQUID CRYSTAL DISPLAY (LCD)

 The LCD monitor passes light through liquid crystals to display the
image on the glass faceplate.
LASER FILM
DATA MANAGEMENT
PICTURE ARCHIVAL AND
COMMUNICATION SYSTEMS
Networked group of computers, servers and archives to store digital
images.
Can accept any image that is in DICOM format.
Serves as the file room, reading room, duplicator and courier.
Provides image access to multiple users at the same time, on-demand
images, electronic annotations of images and specialty image
processing.
PICTURE ARCHIVAL AND
COMMUNICATION SYSTEMS
HOSPITAL INFORMATION
SYSTEM AND
RADIOLOGY INFORMATION
SYSTEM
The HIS holds the patient’s full medical information from
hospital billing to the in-patient ordering system.
The RIS holds all radiology-specific patient data from the
patient-scheduling information to the radiologist’s dictated
and transcribed report.
HIS-RIS INTERFACE
TELERADIOLOGY
Teleradiology is considered to be the transmission of a full
set of full integrity images to a Centre distant from where
the images were generated.

Purposes of teleradiology includes:

◦ Primary diagnostic interpretation
◦ Expert secondary consultation
◦ Preoperative surgical planning
TELERADIOLOGY
Benefits of Teleradiology
◦ Provide access to medical image reporting for underserviced
centers.
◦ Support patient consultations and inform patient treatment
decisions
◦ Provide access to image interpretation for remote regions
◦ Provide reporting in shifts to provide timely interpretation after
normal working hours