Integrating digital systems: commitment and collaboration

One year ago, the radiology department at Ball Memorial Hospital, a 350-bed facility in Muncie, IN, was completely film-based. The need to support a new all-digital, 35-room emergency department (ED) hastened the facility's transition to a digital environment. Today, with the exception of mammography, the hospital's imaging services are now digital. To develop and implement the project, the hospital formed an internal implementation team. An independent consultant was also hired to evaluate the impact of these new technologies and to provide an estimated cost payback. After research, site visits, and vendor demonstrations, the hospital selected a single vendor for its picture archiving and communication system (PACS), digital radiography (DR), computed radiography (CR), and overall project management. The DR system was installed in the ED to provide digital image capture for a full range of trauma exams. The ED also initially began utilizing a Web-based PACS distribution originally implemented for after-hours teleradiology. The majority of the hospital's imaging studies are captured with 2 multi-cassette CR systems that serve 7 exam rooms in the radiology department. The hospital also installed remote operations panels to expedite entry of patient and exam information. Technologists readily embraced both CR and DR systems. The Web distribution system now transmits images to hospital-based computers and to 150 remote referring physicians. The PACS platform automatically e-mails key images and radiology reports to referring physicians. Authorized physicians can also request reports and images on an as-needed basis. The PACS vendor had previously performed multiple integrations with the radiology information system (RIS) vendor; the integration of PACS and RIS was extremely smooth. One of the critical components of a successful conversion is experienced, dedicated management. The hospital retained professional project management services to facilitate implementation and to ensure adequate training for all users.     

A new approach to RIS/DR interconnection.

The article focuses on a new, standards-based approach for linking modalities to a radiology information system (RIS) in the radiology department. Computers have been used in radiology for quite some time-for the complex processing of algorithms used by CT and MR, for example. The advent of computed radiography (CR) and direct radiography (DR) has helped bring x-ray film into the world of computers. DR uses a technology similar to that in digital cameras to convert the intensity and location of the diagnostic image into digital form. Many radiology departments now store images on disks and read from computer monitors in a reading room. With its high-volume radiology department, the Cleveland Clinic Foundation (CCF) has been a long-time user of one particular RIS system. As the department moved to DR implementation, it required a means to automatically include patient demographic information with the image at the time of study acquisition, so this information would be associated with the image throughout its history. Using an approach developed by several companies in connection with CCF, technologists now use only two interfaces on one computer screen. Further, a technologist can close the study from the DR unit, allowing more time for patient care. The collaborative effort between CCF and the companies involved has resulted in an exciting standards-based approach to linking its RIS and DR systems.     

数字X线摄影系统中低剂量应用的探讨

目的 通过数字X线摄影系统（DR）在胸部摄影检查中的应用评价DR的低剂量的优越性。方法 利用CDRAD 2.0低对比细节体模评价计算机X线摄影（CR）和DR的影像质量和表面空气吸收剂量（ESD）关系,分别利用两个系统（DR使用ESD约为CR的1/3）得到成人胸部30幅影像。由6位影像科医生来评价以上两者的影像系统对于肩胛骨内侧边缘等胸部结构的清晰程度。结果 CR影像和减少ESD的DR影像在影像诊断质量上差异没有统计学意义（P＞0.05）。结论 DR的较好的分辨率和低噪声特性,以及高DQE有助于减少患者接受的辐射剂量,而不影响诊断质量。     

Increased productivity of a digital imaging system: one hospital's experience.

During peak hours of operation, it was not uncommon for the radiology department at St. Luke's Episcopal Hospital in Houston, Texas, to have a backlog of six to ten patients. While some of this was due to competing schedules from the emergency department (ED) and inpatients, the major problem was an inefficient workflow, especially for emergency department patients. Our staff in the radiology department worked with the hospital management to include plans for a new radiology room in an ED renovation project. In designing the new radiology room the most important issues under consideration were the physical location of the room and the type of radiography system to be installed. With plans to implement PACS, we evaluated computed radiography and digital radiography options. At St. Luke's, we had had our first experience with digital radiography after the purchase of a dedicated digital chest system. As a beta test site for the manufacturer, we had an opportunity to test--what was at the time--a new digital radiography system. The powerful impact of digital radiography became most evident by the decreased patient backlog. Even without PACS, workflow became dramatically more efficient. Images now are available for review within seconds after exposure, since there are no films to process. This has reduced our average exam time from ten minutes to one and a half minutes, not including patient transport time. The efficiency demonstrated with the digital chest system provided evidence that digital systems could handle significantly more patients than computed radiography or screen-film systems, without a compromise in image quality. Therefore, we decided to put a digital radiography system in the new ED radiology room. We estimate that the new unit will pay for itself in less than three years.     

粤港澳大湾区数字X射线骨关节摄影检查技术与防护规范专家共识

近年来,数字X射线摄影(DR)系统在我国广泛应用,数字X射线骨关节摄影检查是最为常见的检查之一。优化骨关节摄影检查技术、规范骨关节摄影标准影像、总结辐射防护要求,将进一步提升数字X射线摄影检查在骨关节的临床应用价值。粤港澳大湾区影像技术联盟组织相关专家,参考国内外文献,并结合粤港澳大湾区的临床实际情况,编写了骨关节摄影检查技术与防护规范专家共识,以指导与规范大湾区各级医疗机构的医学影像部门X射线骨关节摄影检查相关工作。     

Digital radiography detectors – A technical overview: Part 1

During the last two decades screen-film (SF) systems have been replaced by digital X-ray systems. The advent of digital technologies brought a number of digital solutions based on different detector and readout technologies. Improvements in technology allowed the development of new digital technologies for projection radiography such as computed radiography (CR) and digital radiography (DR). The large number of scientific papers concerning digital X-ray systems that have been published over the last 25 years indicates the relevance of these technologies in healthcare.There are important differences among different detector technologies that may affect system performance and image quality for diagnostic purposes. Radiographers are expected to have an effective understanding of digital X-ray technologies and a high level of knowledge and awareness concerning the capabilities of these systems. Patient safety and reliable diagnostic information are intrinsically linked to these factors.In this review article – which is the first of two parts – a global overview of the digital radiography systems (both CR and DR) currently available for clinical practice is provided.     

Effect of digital radiography on emergency department radiographic examinations

The purpose of this paper is to determine the time-savings realized as a result of conversion from film-based radiography to digital radiography (DR) in emergency department patients receiving multiple radiographic examinations. We retrospectively reviewed the computer records of 69 patients from the preconversion group (January 2004) and 62 patients from the postconversion group (January 2005), calculated the mean examination time per image from each group, and used a one-tailed t test to compare the two means. The preconversion (a mix of screen-film and computed radiography) group had a mean examination time of 3.27±1.50 min per image. The postconversion (DR) group had a mean examination time of 2.51±1.16 min. The p value between the two means is 0.000822 with a standard error of 0.330 min. DR reduces radiographic examination time by 23% when compared to conventional screen-film radiography.     

DR胸部X线摄影技术在临床的应用

目的评价直接数字X线摄影系统在胸部疾病诊断与筛查中的实用意义。方法自2005年9月以来,应用西门子FX直接数字X线摄影系统对我院门诊、急诊、住院患者及来院体检者进行了胸部检查。DR影像经激光打印机打印后,以数字化形式传入我院PACS供实时共享。DR影像显示病变的能力与常规X线平片进行了比较。结果自2005年9月应用西门子FX直接数字X线摄影系统以来,基本满足了我院门诊、急诊、住院患者胸部疾病诊断和来院体检者胸部疾病筛查的实际需要。与常规X线平片比较,DR影像能更清晰、准确地显示病灶。结论DR是诊断和筛查胸部疾病的重要影像技术,尤其与PACS联合应用是医院数字化管理的重要标志。     

上海市数字化乳腺X射线摄影装置质量控制检测分析

目的 对上海市数字化乳腺X射线摄影装置使用情况与设备性能质量状况进行对比分析,为合理选择数字化乳腺X射线摄影装置提供参考。 方法 依据国家相关标准和规范,采用X射线检测仪和乳腺成像性能检测模体,对上海市53台数字化乳腺X射线摄影装置的9项技术指标进行质量控制检测,并将两类数字化乳腺X射线机——计算机X射线摄影装置（CR）与数字X射线摄影装置（DR）的性能检测结果进行统计学分析。在分析两类乳腺机各项性能指标合格率差异的基础上,对两类乳腺机的乳腺平均剂量与图像质量进行进一步的比较分析。 结果 两类乳腺X射线机的合格率及乳腺平均剂量差异无统计学意义;对于模体影像,两类设备的差异具有统计学意义,DR乳腺机的图像质量优于CR乳腺机。 结论 应加强对数字化乳腺X射线摄影装置的日常检测,从辐射防护最优化角度推荐选择DR乳腺机代替CR乳腺机开展数字化乳腺摄影工作。     

Flat panel digital radiography compared with storage phosphor computed radiography: assessment of dose versus image quality in phantom studies

RATIONALE AND OBJECTIVE: To assess and quantify the dose reduction by use of a CsI-flat panel digital radiography (DR)-system compared with digital computed radiography (CR). MATERIALS AND METHODS: A TCDD-test using the CDRAD-phantom was performed at mAs-values of 5, 4, 2.5, 2, 1, and 0.5 mAs for both digital systems. Entrance surface doses were recorded for all images. Images were presented to four independent observers. For quantitative comparison the image quality figure (IQF) was calculated. Statistical analysis was performed using the Pearson correlation and the Wilcoxon test. A ROC analysis was performed using the TRG-phantom. Settings of 4, 2.5, 2 mAs for both systems were used. In addition, 1 and 0.5 mAs were used for the DR system only. Statistical significance was evaluated using Student test. RESULTS: The DR system provided equivalent results compared with CR with respect to high frequency information and superior results with respect to low contrast details. Compared with computed radiography, the flat panel detector demonstrated significantly lower IQFs, ensuring a better image quality with respect to contrast and detail detectability. IQFs for DR and CR were equal at a surface dose reduction of 87% for DR. ROC analysis revealed significantly higher values under the curve for DR up to a surface dose reduction of 70%. CONCLUSIONS: Image quality of DR proved to be far superior to CR in particular for low contrast details. The image quality of CR is similar to that of DR only at high dose levels.     

A comparison of low contrast performance for amorphous Silicon/caesium iodide direct radiography with a computed radiography: A contrast detail phantom study

A range of digital image acquisition devices exists in diagnostic radiology. This study compares contrast performance of two such systems: an amorphous Silicon/caesium iodide (a-Si:CsI) based flat panel (DR) digital chest radiography system and a computed radiography (CR) system. Images of a contrast detail resolution phantom were acquired at a range of radiation doses. Three observers assessed all hardcopy images using a four-alternative forced choice observer perception technique. Contrast detail performance was calculated and low contrast performance quantified.The DR system demonstrated significantly better low contrast performance and potential dose savings of up to 75% compared to the CR system. Threshold levels of contrast detail resolution were defined and levels of under- and over-exposure, compared to the threshold level, were highlighted. Both systems were noise limited at lower exposures and latitude limited at higher exposures. The results demonstrate that the DR system should perform better than the CR system under typical clinical conditions relevant to chest radiography particularly for the detection of low contrast details such as lung metastases or pneumothoraces.     

双能减影与数字X线成像诊断肺内孤立性结节ROC曲线评价

目的　比较双能减影 (DES)与数字X线成像 (DR)对肺内孤立性结节及结节内钙化的诊断价值。资料与方法　对 4 0例肺内有孤立性结节和 4 0例肺内无孤立性结节的病例行CT、DR及DES检查。 4位医师分别对两组影像学资料进行评价 ,结果采用受试者操作特征 (ROC)曲线进行统计分析。结果　在发现肺内孤立性结节方面 ,DES组的ROC曲线下面积 (Az =0 .94 0 )大于DR组 (Az =0 .891) ,两者统计学具有显著性差异 (P <0 .0 5 ) ;在发现肺内孤立性结节内钙化方面 ,DES组的ROC曲线下面积 (Az=0 .90 2 )大于DR组 (Az=0 .82 8) ,两者统计学具有显著性差异 (P <0 .0 5 )。结论　DES在发现肺内孤立性结节及钙化方面优于DR ,是对DR检查的有利补充     

DR全颈椎正位摄片方法的改进

目的分析改进数字化X射线摄影投照全颈椎正位片的方法。方法选择50例患者分别行数字化X射线摄影投照全颈椎张口正位和全颈椎常规正位进行比较。结果50例患者中，数字化X射线摄影全颈椎张口正位40例可清楚显示寰枢关节，50例均可清晰显示下颌骨和第3～7颈椎；数字化x射线摄影全颈椎常规正位21例可清楚显示寰枢关节，46例可清晰显示下颌骨，48例可清晰显示第3～7颈椎。结论全颈椎张口正位是数字化x射线摄影投照全颈椎正位相对满意的方法。     

两种数字化X射线摄影技术影像质量与成像剂量的比较

目的对比研究非晶硒平板探测器直接数字化X射线摄影(DR)及计算机x射线摄影(CR)两种数字化X射线摄影技术影像质量与吸收剂量的关系。方法应用DR和CR系统分别对对比度．细节体模(CDRAD2．0)进行不同吸收剂量的曝光成像。记录每次曝光的体模表面吸收剂量，并将所获取的影像在图像诊断工作站显示器上由4位观片者进行观察，计算影像质量表征因子(IQF)。应用ANOVA检验法统计、比较两种数字化摄影技术的图像质量与吸收剂量的差别。结果与CR相比，DR具有更低的IQF值，对人体组织对比度和结构细节有更好的信息检出特性。两种成像技术产生相同IQF值时，DR系统在体模表面产生的表面剂量比CR系统降低了77％。结论DR技术对于低对比度组织细节的检测好于CR技术。在获得相同影像信息的前提下，与CR相比应用DR大大降低了被检者吸收剂量。     

CR/DR systems: what each technology offers today; what is expected for the future

Computed radiography (CR) is considered by some to be the work-horse for digital image capture of general radiography exams because it is affordable, offers excellent image quality and exposure latitude and utilizes existing x-ray systems. CR systems deliver digital imaging to general radiology departments and lower-volume areas that can include hospital floors and outpatient imaging centers. Digital radiography (DR) technology is more expensive, but some believe it earns its keep with significant productivity gains and the capacity for higher image quality or lower dose. DR systems are especially appropriate for emergency room settings and high-volume areas in general radiology departments, orthopedic clinics, imaging centers and other facilities. Facilities with growing patient volumes and limited space often choose to install DR systems in one or 2 exam rooms to double the productivity of those rooms, while one or more CR systems serve the remaining rooms or remote areas. Patients benefit from both faster image capture (it takes less time for each imaging exam) and hospitals achieve a digital distribution process that speeds delivery of radiology reports to referring physicians and a more efficient imaging workflow that can lead to increased revenues.     

Solid-state, flat-panel, digital radiography detectors and their physical imaging characteristics

Solid-state, digital radiography (DR) detectors, designed specifically for standard projection radiography, emerged just before the turn of the millennium. This new generation of digital image detector comprises a thin layer of x-ray absorptive material combined with an electronic active matrix array fabricated in a thin film of hydrogenated amorphous silicon (a-Si:H). DR detectors can offer both efficient (low-dose) x-ray image acquisition plus on-line readout of the latent image as electronic data. To date, solid-state, flat-panel, DR detectors have come in two principal designs, the indirect-conversion (x-ray scintillator-based) and the direct-conversion (x-ray photoconductor-based) types. This review describes the underlying principles and enabling technologies exploited by these designs of detector, and evaluates their physical imaging characteristics, comparing performance both against each other and computed radiography (CR). In standard projection radiography indirect conversion DR detectors currently offer superior physical image quality and dose efficiency compared with direct conversion DR and modern point-scan CR. These conclusions have been confirmed in the findings of clinical evaluations of DR detectors. Future trends in solid-state DR detector technologies are also briefly considered. Salient innovations include WiFi-enabled, portable DR detectors, improvements in x-ray absorber layers and developments in alternative electronic media to a-Si:H.     

数字X线摄影对早期食管癌的诊断价值

目的探讨数字化成像对早期食管癌的诊断价值。方法83例经手术病理证实早期食管癌根据X线检查机型分为数字化X线摄影组(DR组,48例)和普通X线摄影组(对照组,35例),所有患者均作多相钡剂造影,以大口服钡法为主,并摄电子点片及选择性激光输出,X线片摄常规正侧位及左、右前斜位片,电子点片多体位摄取。结果DR组48例中术前发现早期食管癌45例,漏诊3例,诊断准确率为93.3%;对照组35例中术前发现早期食管癌29例,漏诊6例。两组检出率行统计学分析,P<0.01,差异有显著性统计学意义。结论数字化X线机的应用能显著提高早期食管癌的检出率,但胃镜及细胞学检查仍是其必要的补充。     

移动DR乳腺摄影研究

目的:研究普通DR进行数字乳腺摄影可行性。方法:用佳能可移动DR板和国产乳腺钼靶X线机进行试验拍片对比。结果:制作的数字乳腺片质量较高。结论:普通DR板可用于高质量的数字乳腺片制作。     

碘化铯/非晶硅数字摄影系统拍摄胸片的适宜管电压:高千伏摄影是否适用于间接DR

目的探索碘化铯/非晶硅数字摄影系统(间接DR)拍摄胸片的适宜管电压。方法(1)分别对60名正常成人拍摄80、100、150 kV正位胸片,由5位放射科医师对比每人的3张图像质量,对多个解剖部位的显示情况和图像总体印象进行评分;(2)分别固定表面入射剂量和出射剂量,对人胸部体模拍摄80、100、120、150 kV正位胸片,对肺内模拟病变进行评分。结果成人胸片和肺内模拟病变的显示均随管电压增高,图像质量降低;80 kV对比度最好,但外观略接近低千伏摄影胸片。结论间接DR拍摄正位胸片的适宜管电压为80~100 kV,高千伏摄影不再适用于DR。     

双能量数字减影胸片对肺内小结节检出的意义

目的探讨双能量数字减影胸片对肺内小结节检出的意义。方法27例病理证实恶性肿瘤伴肺内转移的患者,分别行增强CT扫描、双能量数字减影胸片与常规DR胸片。使用柯达质量控制检测仪比较双能量数字减影DR与常规DR胸片的图像质量。再以CT扫描结果为金标准,由2位高年资放射科医师采用双盲法对双能量数字减影胸片与常规DR胸片进行分析,比较两者对肺内转移瘤的检出有无显著差异。结果双能量数字减影DR与常规DR图像在噪声上(均匀度)无差异,但清晰度稍差。双能量数字化减影的胸片对肺内小结节的检出率为91.2%;而常规DR胸片对肺转移瘤的检出率为85.0%,两者之间有显著差异(P<0.05)。结论双能量数字减影技术可减少肺野内骨骼及其它钙化影响,对肺内结节的检出能力高于常规DR胸片。