DIGITAL RADIOGRAPHY

MS.LAURENCIA PHILIPO
DIGITAL RADIOGRAPHY is a “filmless” imaging system introduced in
1987.
Digital imaging uses electronic sensor instead of a “film”
Requires a computerized imaging system to produce an image no film
is used no processing chemicals are required.
In other words:
 Digital radiography is defined as “radiographic imaging technology
producing digital projection images such as those using
photostimulable storage phosphor (computed radiography, or CR),
amorphous selenium, amorphous silicon, charge coupled device
(CCD), or metal oxide semiconductor-field effect transistor (MOSFET)
technology”.
These technologies can produce acceptable image quality over a
wider range of exposure techniques compared to film-screen
radiography.
HOW THE DIGITAL IMAGE IS FORMED
Digital detectors capture and convert X-ray attenuation data from the
patient into electronic signals (analog signals)
The electronic signals are then subsequently converted into digital
data for processing by a digital computer.
 The result of processing is a digital image that must be converted
into one that can be displayed on a computer monitor for viewing by
an observer
Image formation and acquisition system
FILM-BASED RADIOGRAPHY
The production of a film-based radiographic image involves several steps.
X-rays pass through the patient and fall upon the film to form a latent
image.
 The latent image is then rendered visible using chemical processing and
subsequently displayed on a light view box for viewing and interpretation
by a radiologist.
The film image appears with varying degrees of blackening as a result of
the amount of exposure transmitted by different parts of the anatomy.
While more exposure produces more blackening, less exposure produces
less blackening,
The basic steps in the production of a film-
based radiographic image
The visual image quality feedback in film-based
radiography as a result of low and high exposures
Additionally, while the blackening is referred to as the film density,
the difference in densities in the image is referred to as the film
contrast.
Film therefore converts the radiation transmitted by the various types
of tissues (tissue contrast) into film contrast.
An image displayed on a light view box transmits light into the eyes of
the radiologist who interprets the image.
This transmitted light can be measured using a densitometer and is
referred to as the optical density (OD)
A DENSITOMETER (also called absorptiometer)
is a device used to measure the density of a film by the amount of light
which shines through; or tissue density (e.g., bone, lung) by the amount of
radiation transmission.
OPTICAL DENSITY
Is the log of the ratio of the intensity of the view box (original intensity) to
the intensity of the transmitted light.
The OD is used to describe the degree of film blackening as a result of
radiation exposure.
FILM CHARACTERISTIC CURVE
The film contrast can be described by what is popularly known as the
film characteristic curve or the Hurter-Driffield (H and D) curve.

The curve is a plot of the optical density (OD) to the radiation

exposure used in imaging processes.

The purpose of the curve is to indicate the degree of contrast or

different densities that a film can display using a range of exposures.
An idealized characteristic curve used in film-screen has three main
segments as follows:
The toe
The slope (straight line portion)
 The shoulder
The idealized characteristics curve(H&D CURVE)
The toe represents underexposed
shoulder indicate represents overexposure
The slope represents the useful portion of the curve and reflects
acceptable exposure or the range of useful densities.
This simply means that if an exposure falls at the toe region
(OD = 0.12–0.20), the image will be light and generally useless.
If the exposure falls in the shoulder region of the curve (OD = about
3.2), the image will be black and serve no useful purpose in providing
a diagnosis
If the exposure falls within the slope of the curve (OD  =  0.3–2.2), the
image contrast (density) will be acceptable, and this region of the
curve contains the useful range of exposures.
FACTORS AFFECTING QUALITY AND QUANTITY OF X-RAY BEAM
COMING FROM X-RAY TUBE
i) EXPOSURE FACTOR TECHNIQUE
These factors are set by the technologist on the console and are
specifically selected for the patient size and type of examination.
The exposure factors include:
The tube current or Milliamperage (mA)
The exposure time in seconds (s).
The kilovoltage peak(KVp)

KILOVOLTAGE PEAK(KVP)
controls the X-ray beam quality or the penetrating power of the X-ray beam
MILIAMPERAGE (MA)
the mA controls the X-ray beam quantity that is the number of photons in the beam.
THE EXPOSURE TIME
on the other hand determines the length of time that the X-ray beam is
on during the exposure to the patient.
The combination of mA and s results in the mAs which controls the X-
ray beam quantity, in the same manner as mA and s used separately.
Exposure technique factors affect the contrast and density of the
images on film.
ii) AUTOMATIC EXPOSURE CONTROL
The use of manual selection of exposure technique factors
sometimes results in poor exposures that ultimately affected the
image on the film.
The problem is solved with the use of automatic exposure control
(AEC) in which a preset quantity of radiation reaching the film image
detector (cassette) is automatically measured and terminated when a
preset optical density (degree of blackening, in the case of film) or
signal-to-noise ratio (SNR) in the case of a digital detector is reached.
iii) IMAGE QUALITY FACTORS
The overall goal of radiographic imaging is to produce optimum image
quality.
The characteristics of a film that determine its quality are:
Resolution
Contrast
Noise
Distortion
Artifacts
Resolution
refers to a characteristic that allows an observer to see separate objects on a film.
There are two types of resolution
 spatial resolution
contrast resolution.

SPATIAL RESOLUTION
Spatial resolution in radiology refers to the ability of an imaging system to differentiate
between two near-by objects. In digital imaging, it depends on the size of the pixel
used. A large pixel size will be unable to resolve two near-by structures as compared to
a small pixel size.
CONTRAST RESOLUTION
It is the ability of an imaging system to distinguish between multiple
densities in the radiographic image.

Contrast
It is the density differences on a radiographic image. A high-contrast image
is characterized by regions of high density (dark) and low density (light).
Several factors affect the contrast of a radiographic image, including the
object, energy of the beam, scattered radiation, grids, and the film
The main controlling factor for image contrast, however, is kVp.
Optimum contrast is produced when low kVp techniques are used.
A grid improves radiographic contrast by absorbing scattered radiation
before it gets to the film.
Noise
on an image appears as mottle, and the image has a grainy appearance
(quantum mottle).
 This occurs when few photons are used to create an image on the X-
ray film, since the main controlling factor for the number of photons
from the X-ray tube is mAs.
 Low mAs will result in more noise compared to high mAs techniques.
Furthermore there are other factors that affect noise such as the kVp.
Less noise is produced when higher kVp techniques are used for the
same mA settings.
The technologist must therefore select the best possible factors in
order to produce optimum image quality.
Artifacts
 refer to something seen on an image that are not present in reality
but appear due to a quirk of the modality itself.
Artifact is also used to describe findings that are due to things outside
the patient that may obscure or distort the image, e.g. clothing,
external cardiac monitor leads, body parts of career, etc.
Example of artifact are:
Screen marks
Pressure marks
Static marks
Finger marks
Chemical staining
Surface damage
Radio opaque artefact
Distortion
It refers to the non-proportional increase in the dimensions of a
radiographed object relative to the actual dimensions of that object.
 It can be seen when there is a change in the angle of the incidence x-
ray beam or when the receptor is not parallel to the object
AN IDEAL CONDITION FOR UNDISTORTED
IMAGE
FORESHORTENING OF THE IMAGE
Radiographic image distortion appears either in the form of
foreshortening or elongation.
Foreshortening
Assuming the image plane remains at right angles to the beam, any
rotation of the object plane away from its initial position produces
foreshortening along one axis of the image
For example, failure to position the feet in internal rotation causes
foreshortening of the femoral necks on an antero-posterior projection
of the pelvis. Internal rotation sets the neck of femur horizontally, i.e.
parallel to the film
Elongation
Assuming the object plane remains at right angles to the beam, any
rotation of the image plane away from its initial position produces
elongation along one axis of the image.
For example, the characteristic elongated egg-shaped appearance of
the cranium on a 30° fronto-occipital (Townes or half-axial)
projection.
ELONGATION OF IMAGE
Avoidance of distortion
Rotation of both the object plane and image plane by the same angle and in
the same direction, such that they remain mutually parallel, eliminates
distortion of structures in the object plane.
But note that structures lying outside the object plane are subject to
distortion. Rotation of the object plane and image plane by the same angle in
opposite directions also produces an undistorted image because under these
conditions, foreshortening created by the object plane rotation is exactly
counterbalanced by elongation resulting from the image plane rotation.
This is the origin of the strategy adopted to avoid image distortion during
intra-oral radiography of the teeth
RADIATION DOSE CONSIDERATIONS

The radiation dose in film-screen radiography is affected by several

factors including exposure technique factors, filtration, collimation
and field size, scattered radiation grids, image receptors (detectors),
and source-to-image receptor distance (SID)
 however, only the first factor will be reviewed here. While the dose is
directly proportional to the mAs, meaning that if the mAs is doubled,
the dose is doubled, it (dose) is proportional to the square of the
change of the kVp.
Higher kVp techniques will result in less absorbed dose in the patient
LIMITATIONS OF FILM-SCREEN
RADIOGRAPHY

Film-based radiography has been the workhorse of radiology ever

since the discovery of X-rays in 1895, and despite the successful use
for over 100 years and its present use in many departments today,
one of the major problems with the radiographic imaging process is
poor image quality if the initial radiation exposure has not been
accurately determined. For example, if the radiation exposure is too
high, the film is overexposed ,and the processed image appears too
dark, thus, the radiologist cannot make a diagnosis from such an
image. Alternatively, if the radiation exposure is too low, the
processed image appears too light and not useful to the radiologist, as
In both of these situations, the images lack the proper image density
and contrast and would have to be repeated to provide an acceptable
image quality needed to make a diagnosis.
Additionally, the patient would be subjected to increased radiation
exposures due to repeat exposures..
There are other problems associated with film-based radiography
For example:
As a radiation detector, film-screen cannot show differences in tissue
contrast less than 10%. This means that film-based imaging is limited
in its contrast resolution. For example, while the contrast resolution
(mm at 0.5% difference) for film-screen radiography is 10, it is 20 for
nuclear medicine, 10 for ultrasound, 4 for computed tomography, and
1 for magnetic resonance imaging.
As a display medium, the optical range and contrast for film are fixed
and limited. Film can only display once, the optical range and contrast
determined by the exposure technique factors used to produce the
image.
 In order to change the image display (optical range and contrast),
another set of exposure technique factors would have to be used,
thus increasing the dose to the patient by virtue of a repeat exposure.
As an archive medium, film is usually stored in envelopes and housed
in a large room. It thus requires manual handling for archiving and
retrieval by an individual.
These problems can be overcome by a digital radiography imaging
system.
DIGITAL RADIOGRAPHY IMAGING
SYSTEM
Major Components of a Digital Radiography Imaging System
The major technical components of a digital radiography system are
include
The data acquisition
Computer data processing
 image display and post-processing
Image storage
Image and data communications
Image and information management.
Data Acquisition
Data acquisition refers to the collection of X-rays transmitted through the patient. It is the first
step in the production of the image.
 For digital radiography, special electronic detectors (digital detectors) are used and replace the X-
ray film cassette used in film-based radiography.
These detectors are of several types that utilize technologies to convert X-rays to electrical signals
(analog signals).
For example, while one type of detector will first convert X-rays into light, followed immediately by
the conversion of the light into electrical signals
Another type of digital detector will avoid the light-electricity conversion process and convert X-
rays directly into electrical signals.
The analog signals must be converted into digital data for processing by a digital computer.
The conversion of analog signals is a function of the analog-to-digital converter (ADC).
Computer Data Processing
The ADC sends digital data for processing by a digital computer. The computer uses
special software to create or build up digital images using the binary number system.
While humans use the decimal number system (which operates with computers use
the binary number system (which operates with base 2, that is, 0 or 1).
These two digits are referred to as binary digits or bits. Bits are not continuous but
rather, they are discrete units. Computers operate with binary numbers, 0 s and 1 s,
discrete units that are processed and transformed into other discrete units.
 To process the word Euclid, it would have to be converted into digital data (binary
representation).Thus the binary representation for the word Euclid is 01000101
01010101 0100001101001100 01001001 01000100.
Image Display and Post-processing
The output of computer processing, that is, the output digital image must
first be converted into an analog signal before it can be displayed on a
monitor for viewing by the observer. Such conversion is the function of the
digital-to-analog converted (DAC).
The image displayed for initial viewing can be processed using a set of
operations and techniques, referred to as post-processing techniques, to
transform the input image into an output image that suits the needs of the
observer (radiologist) in order to enhance diagnosis.
 For example, these operations can be used to reduce the image noise,
enhance image sharpness, or simply change the image contrast
Image Storage
The vast amount of images generated for the wide range of digital radiology
examinations must be stored for not only retrospective analysis but also for
medico legal purposes.
 Today, various kinds of storage devices and systems are used for this purpose,
such as magnetic tapes, disks, and laser optical disks, for long-term storage.
In a PACS environment(picture archiving and communication system), for
example, a storage system such as a RAID (redundant array of independent
disks) is not uncommon.
 It is important to note that those images that are stored in a short-term
archival system are deleted after a period of time defined by the institution.
However, the images have to be sent outside the hospital (Internet) to
remote locations, networks such as wide area networks (WANs)must be
used.
Picture Archiving and Communication
Systems (PACS) are being used for storing/archiving and communicating
images in the digital radiology department. In addition, information
systems, such as the radiology information systems (RIS) and the hospital
information systems(HIS), are now being integrated with the PACS via
computer networks, using communications standards such as DICOM
(Digital Imaging and Communications in Medicine) and HL-7(Health Level-
7), for effective management of patient information.
An important element of image and data communications is that of
image compression. The purpose of image compression is to reduce
storage space (and hence costs) and decrease the image transmission
time.
 Two popular compression methods for use in digital radiology are
lossless or reversible compression, and loss or irreversible
compression. While in the former, there is no loss if information when
the image is decompressed, the latter will result in some loss of
information.
 The effect of these two compressionmethods on visual image quality
Image and Information Management
Image and information management refers to the use of PACS and
information systems such as RIS and HIS to manage the vast number
of images and text data produced in a digital radiology department,
using databases and file management software.
While the RIS and HIS handle essentially textual information,
specifically dealing with business operations for the entire hospital,
the PACS handle images generated by the various digital imaging
modalities (to be described subsequently).
COMPONENT OF DIGITAL IMAGE
DIGITAL RADIOGRAPHY MODALITY
Digital radiography includes several imaging modalities coupled to the PACS-
RIS-HIS image and information systems and based on the technologies
mentioned above.
The imaging modalities include:
 Computed radiography (CR),
Flat-panel Digital radiography (FPDR),
Digital mammography (DM),
Digital fluoroscopy(DF).
Imaging modalities and the PACS-RIS-HIS systems must be fully integrated
for overall effective and efficient operations.
Computed Radiography
Computed radiography (CR) makes use of photostimulable or storage
phosphors to produce digital images using existing X-ray imaging
equipment. A digital computer is used to process data collected by
radiographic means to produce digital images of the patient.
In CR, a photostimulable phosphor such as barium fluorohalide is
coated on the plate referred to as an imaging plate (IP) that is housed
in a cassette (similar in appearance to a film-screen cassette) to
protect it from damage and exposure to foreign materials.
The IP then is considered the digital detector in CR
BASIC STEPS OF CR SYSTEM
The IP is exposed to X-rays, which causes electrons in the phosphor to move to
another energy level, where they remain trapped to create a latent image.
 The plate is then taken to the CR reader/processor (digital image processor) where
it is scanned by a laser beam which causes the trapped electrons return to their
original orbit, and in the process, light is emitted.
This light is collected by a light guide and sent to a photomultiplier tube (PMT). The
output electrical signal from the PMT is subsequently converted into digital data.
A digital processor processes the digital data to produce a CR image.
The CR image is subsequently displayed for viewing.
The IP is exposed to a bright light to erase it(remove residual latent image).
The IP can now be used again.
BASIC STEPS IN CR SYSTEM
ADVANTAGES OF COMPUTED
RADIOGRAPHY SYSTEM
No film based chemicals instead computer is used
Exposure times are fractional of a typical of film exposures which
reduces occupational to radiographer in field application and is more
economical
Image acquisition is much faster only one minute instead of seven
minute in convectional radiography
By adjusting brightness and/or contrast a wide range of thickness
may be examined in one exposure unlike convectional based
radiography which may require different exposure or multiple film-
speed in one exposure to cover a wider range in a component.
A computed tomography fewer re-short due to under or over
exposure
Image can be enhanced digitally to aid interpretation
Image can be stored in the disks or transmitted for offsite review.
DISADVANTAGES OF DIGITAL
RADIOGRAPHY
CR is not approved method for most higher radiological application
due to possible of higher digital manipulation to the captured image
the inherent digital unsharpness and lower spatial resolution as
compared to film radiographic images.
Imaging plates are quite expensive and can be easily damaged if
system used require manual handling of the IP’s. theoretically IP’s can
be reused a thousand times but constant reuse can lead to damage to
the IP and image artefact.