1.

The Digital Radiography System

Digital radiography is performed by a system consisting of the following functional

Components:

 A digital image receptor

 A digital image processing unit
 An image management system
 Image and data storage devices
 Interface to a patient information system
 A communications network
 A display device with viewer operated controls

In this and other modules, each of these components will be considered and detail. At this
time we will briefly introduce the various components.

2. The Digital Receptor

The digital receptor is the device that intercepts the x-

ray beam after it has passed through the patients body
and produces an image in digital form, that is, a matrix
of pixels, each with a numerical value.

This replaces the cassette containing intensifying

screens and film that is used in non-digital, film-screen
radiography.

As we will soon see, there are several different types

of digital radiography receptors.

3. The Image Management System

Image management is a function performed by the

computer system associated with the digital
radiography process.

These functions consist of controlling the movement of

the images among the other components and
associating other data and information with the
images.

Some of these functions might be performed by the

computer component of a specific digital radiography
device or by a more extensive Digital Image
Management System (DIMS) that serves many
imaging devices within a facility. Note: it is not
unusual for the DIMS to be referred to by an older, and
 somewhat less appropriate name, PACS (Picture
Archiving and Communications System).

4. Patient Information System

The Patient Information System, perhaps known as the

Radiology Information System (RIS), is an adjunct to
the basic digital radiography system. Through the
interface, information such as patient ID, scheduling,
actual procedures performed, etc is transferred.

5. Imaging Processing

One of the major advantages of digital radiography is

the ability to process the images after they are
recorded.

Various forms of digital processing can be used to

change the characteristics of the digital images.

For digital radiographs the ability to change and

optimize the contrast is of great value.

It is also possible to use digital processing to enhance

visibility of detail in some radiographs.

The various processing methods are explored in much

more detail in another module.

6. Digital Image Storage

Digital radiographs, and other digital medical images,

are stored as digital data. Advantages (compared to
images recorded on film) include:

 Rapid storage and retrieval

 Less physical storage space required
 Ability to copy and duplicate without loss of image
quality.

The digital image storage methods and process is explored in more detail in another module.
 7. Communications Network

Another advantage of digital images is the ability to transfer them from one location to
another very rapidly.

This can be:

 Within the imaging facility to the storage and display

devices
 To other locations (Teleradiology)
 Anywhere in the world (by means of the internet)

The total network available for transferring digital

images is made up of a variety of integrated systems
as will be described in another module.

8. Digital Image Display and Display Control

Compared to radiographs recorded and displayed on

film, i.e. "softcopy", there are advantages of "softcopy"
displays.

One major advantage is the ability of the viewer to

adjust and optimize image characteristics such as
contrast.

Other advantages include the ability to zoom, compare

multiple images, and perform a variety of analytical
functions while viewing the images.

9. The Direct Digital Radiographic Receptor

We can think of the direct digital radiographic receptor

as "a digital x-ray camera".

The receptor is in the form of a matrix of many

individual pixel elements. They are based on a
combination of several different technologies, but all
have this common characteristic: when the pixel area
is exposed by the x-ray beam (after passing through
the patient's body), the x-ray photons are absorbed
and the energy produces an electrical signal. This
signal is a form of analog data that is then converted
into a digital number and stored as one pixel in the
image.
 10. Stimulable Phosphor Radiographic Receptor

We can think of the stimualible phosphor receptor as being like a conventional radiographic
intensifying screen in that it absorbs the x-ray photons and and then produces light.

The difference is that there is a delay between the x-ray exposure and the production of the
light. This is how it works:

 First, a receptor (cassette) containing only a

stimualible phosphor screen is exposed to record
an image. At this stage the image recorded by the
screen is an invisible latent image.

 The next step is to process the receptor through

the reader and processing unit. In this unit the
screen is scanned by a very small laser beam.
When the laser beam strikes a spot on the screen
it causes light to be produced (the stimulation
process). The light that is produced is proportional
to the x-ray exposure to that specific spot. The
result is that an image in the form of light is
produced on the surface of the stimualible
phosphor screen.
 A light detector measures the light and sends the
data on to produce a digitized image.

11. Image Formation

As the surface of the stimualible phosphor screen is

scanned by the laser beam, the analog data
representing the brightness of the light at each point is
converted into digital values for each pixel and stored
in the computer memory as a digital image.

12. Digital Receptor Dynamic Range

One of the significant characteristics of most digital

radiographic receptors is that they have a wide
dynamic range.

What that means is that the receptors respond to x-ray

exposure and produce digital data over a wide range of
x-ray exposure values as illustrated here.

There are distinct advantages of this characteristic as

we will see later.
We can appreciate this characteristic by comparing it to that of film in the next step.

13. Film Latitude (Dynamic Range)

Radiographic film has a somewhat limited dynamic range which is generally referred to as the
film latitude.

The latitude (or dynamic range) is the range of

receptor exposures over which an image and contrast
will be formed. The relationship between receptor
exposure and the resulting film density is usually
described by the film characteristic (or H & D) curve as
we see here.

The latitude (or dynamic range) is associated with that

part of the curve where there is some slope and
contrast will be formed.

In the region of the toe of the curve, there is no significant contrast formed, and this
corresponds to under-exposed areas within an image.

In the region of the shoulder of the curve there is no significant contrast formed and this
corresponds to areas of overexposure.

This somewhat limited latitude or dynamic range is a characteristic of film because of the way
images are formed with the silver halide crystals.

Digital receptors do not have this limitation.

14. The Exposure Histogram

Before we proceed with exploring the characteristics of digital receptors, let's develop the
concept of the exposure histogram as we see here.

X-ray images and image contrast are formed as the x-

ray beam passes through the body and experiences
different levels of attenuation through the various
anatomical regions.

In the example of the chest, the low-density lung

areas produce a relatively high exposure to the
receptor and dark areas in the image. The more dense
areas ,like the spine and below the diaphragm,
produce relatively low exposure to the receptor and
light areas in the image.

The histogram, as we see here, shows the amount of image area (in a digital image this is the
number of pixels) that receives the different levels of exposure that forms the image.

At this time our primary interest is in the range of exposures (width of the histogram) that
reaches the receptor.
 15. Imaging with Film

One of the challenges in doing film radiography is to get the range of exposures produce by
the body (as described by the exposure histogram) fitted into the latitude or dynamic range of
the film.

If the exposure falls outside of the latitude, there will

be little or no image contrast formed.

There are generally two conditions that contribute to

receptor exposure outside of a film's latitude:

 One is just an error in setting the correct exposure

 The other is that some body regions, such as the
chest, produce a relatively wide range of exposure
(histogram) that exceeds the latitude of the film.

Using a film with a wide latitude, as is usually done for chest imaging, can reduce this problem
but the tradeoff is that a film with a wide latitude generally produces less contrast than a so-
called contrast film.

16. The Advantage of a Wide Dynamic Range

Here we see one of the advantages of a digital

receptor that has a wide dynamic range.

Even when there is a wide exposure range coming

from the body (wide histogram) and exposures at
different levels (because of exposure errors), we see
that they still fit within the wide dynamic range of the
digital receptor.

This means that good image contrast can be formed

over a wide range of exposures.

17. Digital Image Contrast

In a digital image contrast is represented by the

different pixel values.

A typical digital radiographic receptor has a linear

relationship between exposure and the resulting pixel
value as shown here. We have also seen that this
relationship extends over a relatively wide range of
exposures to produce the wide dynamic range.
This can be contrasted with the non-linear (curved) relationship between exposure and
density, or image brightness, for film. As we have just seen, film also has a very limited
latitude or "working range" of exposures.

18. Optimum Exposure in Digital Radiography

The wide dynamic range and linear response of the typical digital receptor is like a "two-edged
sword".

The advantage is that a wide range of exposures, and exposure errors, will still produce good
image contrast. That is, the loss of contrast with exposure error is not a limiting factor as it is
with film.

So, what is the problem? It is that while images can

be produced throughout the range (as far as contrast
is concerned) there are two potential problems as we
see here.

Even though images with good contrast can be

produced with relatively low exposures, they will have
a high level of quantum noise. We recall from other
modules that the level of image (quantum) noise
depends on the exposure to the receptor. When a low
exposure is used, the result can be excessive image
noise.

The other problem is that excessively high and unnecessary exposures can be used to form
images. While these images will have good quality (low noise) there will be unnecessary
exposure to the patient. This problem does not exist with film radiography because the
increased exposure will result in a visibly overexposed film.

In general, for a radiographic procedure there is an optimum exposure that produces a good
balance between image noise and patient exposure. The challenge to the technologist is to
make sure that the technique factors are set to produce this optimum exposure.

19. Monitoring Exposure Levels

As we have just observed, one of the challenges with

digital radiography is knowing when the receptor is
correctly and optimally exposed. It is not like film
radiography where under and over exposures are
obvious.

Different digital radiography systems might not do it

the same way, but a typical approach is for the
equipment to calculate and display on the image the
exposure information.
 This is displayed as an "S" number. The displayed
value generally indicates the calculated SPEED of the
receptor that would match the actual exposure used.

A low exposure would result in a high calculated S number (like S=1000) and a high exposure
would produce low S numbers (like S=50).

The staff should determine what is the appropriate range of S values to be used and then
monitor the values to insure the exposures are optimum.

The optimum S numbers might be different for different digital radiographic systems and also
depend on the specific clinical procedure.

20. Digital Radiography Quality Characteristics

Like all medical images, digital radiographs have the

five specific quality characteristics as we see here .

We will now see how three of these, contrast, detail,

and noise are effected by the characteristics and
operation of the digital system.

21. Digital Radiograph Contrast Characteristics

The contrast sensitivity of a digital radiographic procedure and the image contrast depend on
several factors.

Two of these, the x-ray beam spectrum and the effects

of scattered radiation are similar to film radiography.

What is different, and generally an advantage, with

digital radiography is the ability to adjust and optimize
the contrast after the image has been recorded.

This usually occurs through the digital processing of

the image and then the adjustment of the window
when the image is being viewed.

The details of image processing and windowing are explored in another module.

22. Digital Radiographic Detail

As in all medical images, visibility of detail is reduced and limited by the blurring that occurs at
different stages of the imaging process as we see here.
What is common to both digital and film radiography are three sources of blurring:

 The focal spot (depends on size and object

location)

 Motion (if it is present)

 The receptor (generally because of light spreading
within the fluorescent or phosphor screen)

What is specific to digital radiography is that additional

blurring is introduced by dividing the image into pixels.
Each pixel is actually a blur. As we have already
observed in other modules, the size of a pixel (amount
of blurring) is the ratio of the field of view (image size
relative to the anatomy) and the matrix size.

Pixel size is a factor that must be considered because it limits detail in the images.

There is at least one form of digital image processing that can be used to increase visibility of
detail and it will be described in another module.

23. Noise in Digital Radiographs

The most predominant source of noise in digital

radiography is generally the quantum noise associated
with the random distribution of the x-ray photons
received by the image receptor.

As we have just observed, the level of noise depends

on the amount of receptor exposure used to produce
an image. With digital radiography it can be adjusted
over a rather wide range because of the wide dynamic
range of the typical digital receptor.

The noise is controlled by using the appropriate

exposure factors.

24. Summary and Conclusion

The digital radiography system consist of a variety of

functional components interacting to provide all of the
advantages of digital radiography.

There are specific features of the digital radiography

process that affect the characteristics and quality of
 the images. This must be considered and adjusted to
obtain optimum image quality.

Learning Objectives

1. Identify and briefly describe the functions of a total digital radiography system.
2. Describe the general advantages of digital radiography compared to film/screen
radiography.

3. Describe the general function of the receptor within a total digital radiography system.

4. Describe the general function of the image management component within a total
digital radiography system.

5. Describe the general function of the image processing component within a total digital
radiography system.

6. Describe the general function of the memory and storage component within a total
digital radiography system.

7. Describe the general function of the display and display control component within a
total digital radiography system.

8. Describe the general function of the communications network within a total digital
radiography system.

9. Describe the general function of the patient information system with respect to a
digital radiography system.

10. Describe and explain the general function of a direct digital radiography receptor.

11. Describe and explain the imaging process using a stimualible phosphor digital
radiography receptor.

12. Compare the advantages and disadvantages of direct and stimualible phosphor
receptor systems.

13. Illustrate and describe the concept of dynamic range for a radiography receptor.

14. Sketch and explain the factors that limit the dynamic range (latitude) of radiographic
film.

15. Sketch and compare the dynamic range (latitude) of film and digital radiography
receptors.

16. Describe some advantages and possible disadvantages of the wide dynamic range of
digital radiography receptors.

17. Identify and briefly describe the factors in a digital radiography system that have an
effect on contrast sensitivity and image contrast.
18. Identify and briefly describe the factors in a digital radiography system that have an
effect on blurring and visibility of detail.

19. Identify and describe the principle factor that affects image noise in digital
radiography.

20. Describe the process that a radiographer should follow to insure a proper balance
between patient exposure and image noise in digital radiography.