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Moving from analog to digital 2.0


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Moving from analog to digital 2.0

  1. 1. Moving From Analog to Digital Not if, but when! The X-Ray Academy of Texas
  2. 2. Learning Objectives <ul><li>Define the key terms used in digital imaging </li></ul><ul><li>List the equipment needed to perform digital imaging </li></ul><ul><li>Explain the computed radiography (CR) digital system </li></ul><ul><li>Explain the digital radiography (DR) system </li></ul>
  3. 3. Learning Objectives <ul><li>Compare CR and DR digital systems </li></ul><ul><li>Recognize the importance of using exposure technique charts with digital imaging </li></ul><ul><li>Describe the processing and post-processing of a digital image </li></ul><ul><li>Explain what a picture archival and communications system (PACS) is and how it is used </li></ul>
  4. 4. Imaging Stages <ul><li>Image Acquisition </li></ul><ul><li>Image Processing </li></ul><ul><li>Image Display </li></ul><ul><li>Image Storage </li></ul>19-Dec-09 Stacy L. Palmer R.T. (R)
  5. 5. Analog <ul><li>An analog system uses an intensifying screen to create a latent image on x-ray film. The film is then processed, creating a manifest image that can be interpreted by a physician. It is later stored in the file room. </li></ul>19-Dec-09 Stacy L. Palmer R.T. (R)
  6. 6. 19-Dec-09 Stacy L. Palmer R.T. (R) Problems with Film: <ul><li>10% of films are not available when we want them! </li></ul><ul><li>15% of films are “hard” to locate or find! </li></ul><ul><ul><li>Search for films will approach 20 to 90 minutes per case </li></ul></ul><ul><li>25% of films are “misplaced” or not retrievable (misfiled). </li></ul><ul><li>10% of films are lost (referrals, residents, etc.) </li></ul><ul><li>Recent study – physicians spend two weeks/year (100 hours/year) trying to locate or find the films they need. </li></ul><ul><ul><li>Cost in physician time is estimated from $60 to $80 per study. </li></ul></ul>
  7. 7. 19-Dec-09 Stacy L. Palmer R.T. (R) Consider This About Typical Radiology & Diagnostic Imaging Departments: <ul><li>82% are profitable. </li></ul><ul><li>56% are the No. 1. source of revenue. </li></ul><ul><li>44% are also measured as #1 Cost Center. </li></ul><ul><li>69% could be more profitable. </li></ul><ul><li>75% can increase productivity/efficiency </li></ul><ul><li>68% now mandated to reduce costs by more than 12% within 15 months. </li></ul>Source: Radiology Management, Volume 23 No 1
  8. 8. 19-Dec-09 Stacy L. Palmer R.T. (R) Cost of Film Over 7 Years: {$15.82 Per Film Per Exam Per Year} 100,000 exams/year @ $1,600,000 Dollars ( Purchase, sort, utilization, storage, handling, staffing, disposing) It Is Estimated That A Single Sheet Cost $50 Over Its Life Source: Mayo Clinic Film Expense Study, 1997
  9. 9. Digital Imaging <ul><li>Digital Imaging is any modality that creates an image that can be viewed or stored on a computer. </li></ul>19-Dec-09 Stacy L. Palmer R.T. (R)
  10. 10. Digital Modalities <ul><li>CT (1970’s) </li></ul><ul><li>Fluoroscopy </li></ul><ul><li>MRI </li></ul><ul><li>Nuclear Medicine </li></ul><ul><li>Mammography </li></ul><ul><li>Ultrasound </li></ul><ul><li>X-Ray </li></ul>19-Dec-09 Stacy L. Palmer R.T. (R)
  11. 11. DR / Direct Radiography 19-Dec-09 Stacy L. Palmer R.T. (R) In a system of direct radiography, also called direct capture radiography, the image receptor is composed of an array of electronic sensors that respond to the radiation exiting the patient. These sensors send that information in digital format to a computer.
  12. 12. Digital Radiography <ul><li>Referred to as “cassette-less” because the detector is incorporated into the x-ray table or upright wall unit </li></ul><ul><ul><li>Equipment may be indirect or direct conversion </li></ul></ul><ul><ul><li>Images are ready for viewing within seconds </li></ul></ul>
  13. 13. DR / Charge Coupled Device 19-Dec-09 Stacy L. Palmer R.T. (R)
  14. 14. DR / Charge Coupled Device Low Radiation / Low Noise Zone High Radiation / High Noise Zone CCD Lens Reflector Scintillator X-ray tube
  15. 15. CR / Computed Radiography 19-Dec-09 Stacy L. Palmer R.T. (R)
  16. 16. Computed Radiography <ul><li>Image obtained using cassettes containing photostimulable phosphor plates </li></ul><ul><li>CR systems equipment includes reader for image processing </li></ul>
  17. 17. CR / Computed Radiography <ul><li>Note: The phosphor plates used in computed radiography are not as sensitive to light as x-ray, but are extremely sensitive to scatter radiation. </li></ul>19-Dec-09 Stacy L. Palmer R.T. (R)
  18. 18. Digital Imaging System Technical Considerations <ul><li>Kilovoltage </li></ul><ul><ul><li>May be slightly higher than that used for conventional radiography </li></ul></ul><ul><li>Centering </li></ul><ul><ul><li>Body part of interest must be placed in or near the center of the detector </li></ul></ul><ul><li>Multiple exposures on one cassette </li></ul><ul><ul><li>Although not recommended, if IR is divided for two separate exposures, the portion not being exposed must be covered with a lead shield </li></ul></ul>
  19. 19. Digital Imaging System Technical Considerations <ul><li>Over- and underexposure </li></ul><ul><ul><li>Degree of image density is not an accurate indicator of over- or underexposure </li></ul></ul><ul><ul><li>Density may be indicated by a unique number that correlates to the amount of exposure </li></ul></ul><ul><li>Collimation </li></ul><ul><ul><li>Limit the field of radiation to the anatomy of interest </li></ul></ul><ul><ul><li>Inadequate collimation can result in inappropriate contrast </li></ul></ul>
  20. 20. Digital Imaging System Technical Considerations <ul><li>Open cassettes </li></ul><ul><ul><li>An exposed IR begins to lose the image within 15 seconds of opening the IR </li></ul></ul><ul><li>Grids </li></ul><ul><ul><li>Digital systems are more sensitive to scatter radiation </li></ul></ul><ul><ul><li>Use grids as appropriate </li></ul></ul>
  21. 21. Body Part Algorithms
  22. 22. Digitizing <ul><li>X-Ray Digitizer – A scanner used to convert existing analog images into a DICOM format. </li></ul>19-Dec-09 Stacy L. Palmer R.T. (R)
  23. 23. Image Matrix 19-Dec-09 Stacy L. Palmer R.T. (R)
  24. 24. 19-Dec-09 Stacy L. Palmer R.T. (R) <ul><li>Pixel </li></ul><ul><li>Voxel </li></ul><ul><li>Dynamic Range </li></ul>Image Matrix
  25. 25. Histogram/Brightness Level 19-Dec-09 Stacy L. Palmer R.T. (R)
  26. 26. 19-Dec-09 Stacy L. Palmer R.T. (R) Soft Tissue Lung
  27. 27. Window Level and Width 19-Dec-09 Stacy L. Palmer R.T. (R)
  28. 28. Window Level and Density 19-Dec-09 Stacy L. Palmer R.T. (R)
  29. 29. Window Width and Contrast 19-Dec-09 Stacy L. Palmer R.T. (R)
  30. 30. Window Width and Contrast 19-Dec-09 Stacy L. Palmer R.T. (R)
  31. 31. Exposure Technique Charts <ul><li>Ability to manipulate the computer image contrast and density does not eliminate the need for technique charts </li></ul><ul><li>Use technique charts to select mA, kVp, and time to avoid unnecessary patient exposure </li></ul>
  32. 32. “Dose Creep”
  33. 33. Dose Response Curve 19-Dec-09 Stacy L. Palmer R.T. (R)
  34. 34. Noise 19-Dec-09 Stacy L. Palmer R.T. (R)
  35. 35. Viewing the Image <ul><li>The computer-processed image can be viewed on a computer monitor or printed on film or paper. </li></ul><ul><li>For an image on a screen to have the quality approaching that of a film image, a special monitor must be used with a resolution of 1024 x 1024 pixels. </li></ul>19-Dec-09 Stacy L. Palmer R.T. (R)
  36. 36. Image Processing and Post-processing <ul><li>Both allow image manipulation of </li></ul><ul><ul><li>Density </li></ul></ul><ul><ul><li>Structures demonstrated </li></ul></ul><ul><ul><ul><li>Subtraction permits viewing of bone only or tissues only </li></ul></ul></ul><ul><ul><ul><li>Contrast enhancement adjusts contrast from very high to very low </li></ul></ul></ul>
  37. 37. Post Processing Techniques 19-Dec-09 Stacy L. Palmer R.T. (R) <ul><li>Subtraction </li></ul><ul><li>Contrast Enhancement </li></ul><ul><li>Edge Enhancement </li></ul><ul><li>Black and White Reversal </li></ul>
  38. 38. 19-Dec-09 Stacy L. Palmer R.T. (R) Digital Subtraction
  39. 39. Edge Enhancement 19-Dec-09 Stacy L. Palmer R.T. (R)
  40. 40. Contrast Enhancement 19-Dec-09 Stacy L. Palmer R.T. (R)
  41. 41. Black and White Reversal 19-Dec-09 Stacy L. Palmer R.T. (R)
  42. 42. QA Software <ul><li>Repeat Analysis </li></ul><ul><li>Dose Consistency Reporting </li></ul>19-Dec-09 Stacy L. Palmer R.T. (R)
  43. 43. Advanced Annotations <ul><li>Positioning Markers </li></ul><ul><li>Add predetermined text or free text </li></ul><ul><li>Zoom and roam image </li></ul><ul><li>Invert image </li></ul><ul><li>Apply shutters </li></ul><ul><li>Show/hide histogram </li></ul><ul><li>Advanced measurement options (Orthopedic Application) </li></ul><ul><li>Stitching for full leg/full spine </li></ul>19-Dec-09 Stacy L. Palmer R.T. (R)
  44. 44. DICOM <ul><li>D igital I maging and Co mmunications in M edicine </li></ul>19-Dec-09 Stacy L. Palmer R.T. (R) DICOM is the format that nearly all medical images are displayed in . It is similar to JPEG or GIF formats for images in computer languages.
  45. 45. PACS <ul><li>Picture Archival and Communications System </li></ul>19-Dec-09 Stacy L. Palmer R.T. (R)
  46. 46. Picture Archival and Communication Systems (PACS) <ul><li>PACS used to manage images </li></ul><ul><li>PACS network consists of </li></ul><ul><ul><li>Computers </li></ul></ul><ul><ul><li>Servers </li></ul></ul><ul><ul><li>Archives </li></ul></ul>
  47. 48. What are the advantages of PACS <ul><li>Faster delivery of medical images to the clinicians that evaluate and report on them. Resulting in faster availability of results. </li></ul><ul><li>No lost or misplaced images, which means fewer patients being postponed or cancelled for consultations or surgery while waiting for new images. </li></ul><ul><li>Flexible viewing with the ability to manipulate images on screen, which means patients can be diagnosed more effectively. </li></ul>19-Dec-09 Stacy L. Palmer R.T. (R)
  48. 49. What are the advantages of PACS <ul><li>Instant access to previous images and patient records. </li></ul><ul><li>Better collaboration, as PACS can be viewed from multiple terminals and locations by a range of clinicians, allowing discussion over diagnoses . </li></ul><ul><li>Fewer unnecessary re-investigations, which will in turn reduce the amount of radiation to which patients are exposed. </li></ul><ul><li>No space needed for film storage. </li></ul>19-Dec-09 Stacy L. Palmer R.T. (R)
  49. 50. HIS/RIS <ul><li>HIS – Hospital Information System </li></ul><ul><ul><li>Patient demographic information entered by the Facility at check in. (Electronic Medical Record) </li></ul></ul><ul><li>RIS – Radiology Information System </li></ul><ul><ul><li>Study information entered by the Radiology Department when the study is ordered. </li></ul></ul>19-Dec-09 Stacy L. Palmer R.T. (R)
  50. 51. Fully Integrated System <ul><li>With Agfa's IMPAX RIS solution you can electronically manage your radiology operations, end-to-end, from patient registration through worklist generation and medical reporting to transcription and business intelligence. Optional modules offer scheduling and management reporting capabilities, to provide a true end-to-end solution. </li></ul>19-Dec-09 Stacy L. Palmer R.T. (R)
  51. 52. Summary <ul><li>With CR and DR the image is produced, processed, viewed, and stored on a computer </li></ul><ul><li>CR uses an IR and requires a reader to process the image </li></ul><ul><li>DR is a cassette-less process that produces an image within seconds </li></ul><ul><li>Use technique charts to select exposure factors </li></ul>
  52. 53. Summary <ul><li>The appearance of digital images can be manipulated during and after processing </li></ul><ul><li>PACS is a network used to manage the images obtained through DR </li></ul><ul><li>DR technical considerations include kilovoltage, part centering, number of exposures per IR, over- and underexposure, cassette integrity, and collimation </li></ul>
  53. 54. Clicker Question <ul><li>Opening a cassette containing an exposed imaging plate may result in: </li></ul><ul><li>a) an image with excessive density </li></ul><ul><li>b) an image with insufficient density </li></ul><ul><li>c) erasure of the image </li></ul>
  54. 55. Clicker Question <ul><li>Data acquisition in which x-ray energy is converted to light and then to an electric signal describes the DR process of: </li></ul><ul><li>a) direct conversion </li></ul><ul><li>b) indirect conversion </li></ul>
  55. 56. Thank-You 19-Dec-09 Stacy L. Palmer R.T. (R) The End