COMPUTED

RADIOGRAPHY
• cassette-based DR, is the digital acquisition
modality that uses storage phosphor plates to
produce projection images. CR can be used in
standard radiographic rooms just like film/screen.
The use of CR requires the CR cassettes and
phosphor plates, the CR readers and technologist
quality control workstation, and a means to view
the images, either a printer or a viewing station.
• The storage phosphor plates are very similar to
our current intensifying screens. The biggest
difference is that the storage phosphors can
store a portion of the incident x-ray energy in
traps within the material for later readout
• CR was first introduced commercially in the
United States in 1983 by Fuji Medical Systems
of Japan
• The first system consisted of a phosphor
storage plate, a reader, and a laser printer to
print the image onto film. CR did not take off
very quickly because many radiologists were
reluctant to embrace the new technology.
• In the early 1990s, CR began to be
installed at a much greater rate because of
the technological improvements that had
occurred in the decade since its
introduction. Several major vendors have
CR systems installed in hospitals
throughout the United States
 DIGITAL RADIOGRAPHY

• Most digital radiography (cassette-less) systems

use an x-ray absorber material coupled to a flat
panel detector or a charged coupled device
(CCD) to form the image. Therefore an existing x-
ray room needs to be retrofitted with these
devices if a new DR room is not installed
• DR can be divided into two categories: indirect
capture and direct capture. Indirect capture
digital radiography devices absorb x-rays and
convert them into light. The light is then
detected by an area-CCD or thin-film transistor
(TFT) array and then converted into an electrical
signal that is sent to the computer for processing
• Direct capture devices convert the incident x-
ray energy directly into an electrical signal,
typically using a photoconductor as the x-ray
absorber, and send the electrical signal to the
computer for processing and viewing
• In the early 1970s, several early digital pioneers
developed the first clinical application for digital
images, digital subtraction angiography (DSA) at
the University of Arizona in Tucson. Drs. M. Paul
Capp and Sol Nudelman with Hans Roehrig, Dan
Fisher, and Meryll Frost developed the precursor
to the current full-field DR units.
• As the technology progressed, several
companies began developing large field
detectors, first using the CCD technology
developed by the military and shortly thereafter
using TFT arrays. CCD and TFT technology
developed and continues to develop in parallel.
Neither technology has proven to be better than
the other.
 COMPARISON OF CR AND DR WITH
CONVENTIONAL RADIOGRAPHY
• When comparing film/screen imaging with CR and
DR, several factors should be considered
• For conventional x-ray and CR, a traditional x-ray
room with a table and wall Bucky is required. For DR,
a detector replaces the Bucky apparatus in both the
table and wall stand. Because both conventional
radiography and CR use
• cassettes, technologists often rate them the same
in terms of ease and efficiency, but DR has an
advantage because the processing is done right
at the room’s console. The image will appear in 3
to 5 seconds, and the technologist knows right
away if the image needs to be repeated.
• Latent image formation is different with
conventional radiography, CR, and DR. In
conventional radiographic imaging, a film is
placed inside a cassette that contains an
intensifying screen. When the x-rays strike the
intensifying screen, light is produced.
• The light photons and x-ray photons interact with the silver halide
grains in the film emulsion, and an electron is ejected from the
halide. The ejected electron is attracted to the sensitivity speck.
The speck now has a negative charge, and silver ions are attracted
to equal out the charge. This process happens many times within
the emulsion to form the latent image. After chemical processing,
the sensitivity specks will be processed into black metallic silver,
and the manifest image is formed
• In CR, a photostimulable phosphor plate is placed
inside the CR cassette. Most storage phosphor
plates today are made of a barium fluorohalide
(where the halide is bromine and/or iodine) with
europium as an activator. When x-rays strike the
photostimulable phosphor, some light is given
off, as in a conventional intensifying screen, but
some of the photon energy is deposited within
the phosphor particles to create the latent image
• The phosphor plate is then fed through the CR reader. To
release the latent image, focused laser light (from one or
more lasers) is scanned over the plate, causing the electrons
to return to their original state and emitting light in the
process. This light is picked up by a photomultiplier tube and
converted into an electrical signal. The electrical signal is
then sent through an analog-to-digital converter to produce a
digital image that can be sent to the technologist review
station
• In DR there are no cassettes. The image acquisition
device is either built into the table and/or wall stand or
enclosed in a portable device. There are two distinct
image acquisition methods: indirect capture and direct
capture.
• Indirect capture is very similar to CR in that the x-ray
energy stimulates a scintillator, which gives off light
that is detected and turned into an electrical signal.
• With direct capture, the x-ray energy is detected by
a photoconductor that converts it directly to a digital
electrical signal.
• Image processing in conventional radiography is done with
chemicals and the shape of the film’s response curve. With CR
and DR, image processing takes place in a computer. For CR
the computer is located near the readers, whether there are
several readers distributed throughout the department or
there is one centrally located reader. For DR the computer is
either located next to the x-ray console or is integrated within
the console, and the image is processed before moving on to
the next exposure
• The exposure latitude or dynamic range used in
conventional radiography is based on the
characteristic response of the film, which is
nonlinear. Acquiring images with CR or DR, on
the other hand, involves using a detector that
can respond in a linear manner
• The exposure latitude is very wide because a single
detector can be sensitive to a wide range of exposures. In
conventional radiography, radiographic contrast is
primarily controlled by kilovoltage peak (kVp). With CR
and DR, kVp still influences subject contrast, but
radiographic contrast is primarily controlled by an image
processing look-up table. (A look-up table [LUT] is a table
that maps the image gray-scale values into some visible
output intensity on a monitor or printed film.
• With conventional radiography, optical density on
film is primarily controlled by milliamperage seconds
(mAs). For CR and DR, mAs has more influence on
image noise, whereas density is controlled by image
processing algorithms (with LUTs). It is important to
minimize scattered radiation with all three
acquisition systems, but CR and DR can be more
sensitive to scatter than screen/film.
• The materials used in the many CR and DR image
acquisition devices are more sensitive to low
energy photons. For example, the barium
fluorohalide phosphor screens have a k-edge at 37
keV, which produces increased absorption in this
energy range, a range that frequently contains x-
ray scatter.