DIGITAL RADIOGRAPHY

Tahleel Altaf
DIGITIAL SYSTEM
• A digital system is a data technology that uses discrete values. By contrast,
non-digital (or analog) systems represent information using a continuous
function.
• The term digitization is often used when diverse forms of information, such as
text, sound, or image , are converted into a single binary code. Digital
information exists as one of two digits, either 0 or 1. These are known as bits
and the sequences of 0s and 1s that constitute information are called bytes.
• Analog signals are continuously variable, both in the number of possible
values of the signal at a given time, as well as in the number of points in the
signal in a given period of time. However, digital signals are discrete in both
of those respects – generally a finite sequence of integers – therefore a
digitization can, in practical terms, only ever be an approximation of the
signal it represents.
There are three basic means of rendering plain radiographic
images digital:

1. Digitizing conventional analogue film

2. Computed radiography (CR) utilizing Photostimulable phosphor
detector systems.
3. Direct digital radiography.
COMPUTED RADIOGRAPHY
• Computed radiography (CR) is a marketing term for photostimulable
phosphor detector (PSP) systems.
• CR was introduced in the 1970s,.
• When x-rays are absorbed by photostimulable phosphors, some light
is also promptly emitted, but much of the absorbed x-ray energy is
trapped in the PSP screen and can be read out later. For this reason,
PSP screens are also called storage phosphors or imaging plates.
• CR imaging plates are made of Europium activated Barium
Fluorohalide (a mixture of 85% BaFBr and 15% BaFI ) on a flexible
screen enclosed in a cassette similar to a screen-film cassette.
• The imaging plate is exposed in a procedure identical to screenfilm radiography, and the
CR cassette is then brought to a CR reader unit. The cassette is placed in the readout
unit, and several processing steps then take place:
1. The cassette is moved into the reader unit and the imaging plate is mechanically
removed from the cassette.
2. The imaging plate is translated across a moving stage and scanned by a laser beam.
3. The laser light stimulates the emission of trapped energy in the imaging plate, and
visible light is released from the plate.
4. The light released from the plate is collected by a fiber optic light guide and strikes a
photomultiplier tube (PMT), where it produces an electronic signal.
5. The electronic signal is digitized and stored.
6. The plate is then exposed to bright white light to erase any residual trapped energy.
7. The imaging plate is then returned to the cassette and is ready for reuse.
COMPUTED RADIOGRAPHY
COMPUTED RADIOGRAPHY
• The similarity in handling of CR and screen-film cassettes contributed
to the initial wide adoption of CR.
• One of the advantages that CR over screen-film radiography is its
much larger dynamic range i.e. the exposure latitude with CR is much
wider than with screen-film systems. Consequently, retakes due to
overexposure or underexposure are rare with CR..
• CR images exposed to low exposure levels, while maintaining proper
gray scale in the image, have higher levels of x-ray quantum noise
("radiographic mottle").
• CR images produced at high exposures have low quantum noise but
result in higher x-ray dose to the patient.
COMPUTED RADIOGRAPHY
• One of clinical advantages of CR is its cassette-based operation - easy
retrofitting of existing equipment, convenient positioning, portability (c.f
FPD).
• Furthermore, a single scanning system can serve multiple examination
rooms, thus providing an added economic advantage.
• However, CR has historically offered lower image quality than flat-panel-
based digital radiography systems due to dispersion of the laser energy
within the bulk of the turbid phosphor material causing loss of resolution.
• The DQE of CR systems at x-ray energies used for chest radiography is
within the 15-25% range.
• The spatial resolution of CR is lower (approx 2.5 line pairs/mm) than that of
film (approx 5 l-p/mm), but its superior contrast resolution more than
compensates for its limited spatial resolution.
COMPUTED RADIOGRAPHY
• In recent years, there have been multiple developments in improving
the DQE of CR systems.
• Better control of the distribution of the sizes of phosphor
particulates in the screen,
• Use of structured CsBr or CsI phosphor to enable thicker
phosphor screens without concern about the loss of resolution as
in turbid phosphor screens
• Collection of the light from both sides of the phosphor screen
• These developments have generally led to a more favorable standing
of CR among digital radiographic systems in terms of image quality
and dose efficiency
DIRECT DIGITAL RADIOGRAPHY

• CCD/CMOS-based Systems
• Indirect Flat-Panel Systems
• Direct Flat-panel Systems
• Fan-beam Radiography Systems
CCD/CMOS BASED DETECTORS
• Charged-coupled devices (CCDs) and Complementary metal–oxide–semiconductor
(CMOS) form images from visible light. CCD detectors are used in most modern
videocameras and in digital cameras.
• The principal feature of CCD/CMOS detectors is that the chip itself is an integrated
circuit with discrete pixel electronics etched into its surface; for example, a 2.5x2.5
cm CCD chip may have 1024x1024 to 2048x2048 pixels on its surface.
• The surface of the chip is photosensitive- as visible light falls on each pixel,
electrons are liberated and build up in the pixel. More electrons are produced in
pixels that receive greater light intensity.
• The electrons are kept in each pixel because there are electronic barriers on each
side of the pixel during exposure.
• Once the CCD chip has been exposed, the electronic charge that resides in each
pixel is read out.
CCD/CMOS BASED DETECTORS – COUPLING DEVICES
• In these devices, the amplified light
generated by the image intensifier is focused
with the use of coupling devices (lenses or
fiberoptics) onto the CCD chip.

• For small field-of view applications such as dental radiography (25 X 50 mm detector),
the chip is placed directly in front of the intensifying screen and the system is exposed.
The light emitted from the screen is directly collected by the chip, and results in
excellent coupling because the screen and the chip are in contact with each other
• Only a relatively small amount of the light generated in the screen is wasted (i.e., does
not reach the CCD).
 CCD/CMOS BASED DETECTORS – COUPLING DEVICES
• For applications in which the field of view is only slightly larger
than the area of the Chip, such as in digital sterotactic biopsy
systems for mammography (50x50mm vs 25x25mm), a
fiberoptic taper is placed between the intensifying screen and
the CCD/CMOS Chip. Light lost in the fiberoptic taper is not
trivial,but a substantial fraction of the light reaches the CCD
chip.

• When there is a need to image a large field of view, such as in

chest radiography, it is impossible to focus the light emitted from
the large screen (approx 35 X 43 cm) onto the surface of the
CCD/CMOS chip without losing a very large fraction of the light
photons, which is proportional to the minification factor. Even
with perfect lenses in such a system, the light loss is
approximately 99.7% forming a secondary quantum sink
CCD/CMOS BASED DETECTORS
• Less costly
• However, they have generally lower performance when compared to flat-
panel systems.
• Poor light collection efficiency; the majority of light photons generated by x-
rays at the screen are not collected by the CCD/CMOS sensor due to the
fact that the sensor is generally smaller than the screen
• Newer systems have tried to remedy this issue to some extent, but the
performance of these systems still falls short of that of flat-panel systems.
• The DQE of current CCD/CMOS systems at x-ray energies used for chest
radiography is within 15-20% range.
FLAT PANEL DETECTORS

• Indirect Flat Panel Detector • Direct Flat Panel Detector

INDIRECT FLAT PANEL DETECTORS
• The term "indirect" comes from the fact that x-rays are absorbed in the intensifying
screen, and the absorbed x-ray energy is then relayed to the photodetector by visible
light photons.
• Analogous to a screen-film system.
• The intensifying screen is layered on the front surface of the flat panel array.
• Light emanating from the back of the intensifying screen strikes the flat panel
• Light that is released in the screen has to propagate relatively large distances
through the screen- may result in lateral spread and blurring
• To improve this situation, most flat panel detector systems for general radiography
use CsI screens. CsI is grown in columnar crystals, and the columns act as light
pipes to reduce the lateral spread of light.

CsI phosphor Amorphous Phosphor e.g Gd2O2S.

 INDIRECT FLAT PANEL DETECTORS
• The flat panel comprises a large number of
individual detector elements, each one capable of
storing charge in response to x-ray exposure.
• Each detector element has a light-sensitive region,
and a small corner of it contains the electronics
• The light-sensitive region is a photoconductor, and
electrons are released in the photoconductor region
on exposure to visible light.
• During exposure, charge is built up in each detector
element and is held there by the capacitor.
• After exposure, the charge in each detector
element is read out using electronics.
• Each detector element in a flat panel
detector has a transistor associated with it;
and because the device is manufactured
using thin-film deposition technology, these
flat panel systems are called thin-film
transistor (TFT) image receptors.
• The Transistor is involved in initially storing
the chrage in each element during exposure
and later on in sequential row-wise read-out
of the array.
• A multiplexer then sequentially connects
each element via switches to the digitizer,
allowing each detector element along each
row to be read out.
• By this sequential readout approach, the
charge from each detector element is read
out from the flat panel, digitized, and stored,
forming a digital image.
• The size of the detector element on a flat panel largely
determines the spatial resolution of the detector system.
• To have high spatial resolution,small detector elements
are needed.
• Electronics takes up a certain amount of the area, so, for
panels with smaller detector elements, a larger fraction
of the detector element's area is not sensitive to light
• The ratio of the light-sensitive area to the entire area of
each detector element is called the fill factor
• It is desirable to have a high fill factor, because light
photons that are not detected do not contribute to the
image and result in degrading of contrast and lower
signal to noise ratio
• Choice of the detector element dimensions requires a trade off between
spatial resolution and contrast resolution.
• The DQE of current systems at x-ray energies used for chest radiography is
within 45-55% range for indirect detectors with CsI and about half of that for
those with turbid phosphor.
• CsI Phosphor
• Amorphous Sillicon Dectector
• Maximum size of 43x43 cm
• 3000x3000 matrix
• Maximum image size of 9,000,000 pixels
43𝑐𝑚
• Pixel size 143 µm
3000
DIRECT FLAT PANEL DETECTORS
• Direct flat panel detectors are made from a layer of Selenium photo conductor
material on top of a TFT array.
• The TFT arrays of these direct detection systems make use of the same row-
and-column readout logic, as described for indirect detection systems.
• With direct detectors, the electrons released in the detector layer from x-ray
interactions are used to form the image directly.
• A negative voltage is applied to a thin metallic layer (electrode) on the front
surface of the detector, and therefore the detector elements are held positive in
relation to the top electrode.
• During x-ray exposure, x-ray interactions in the selenium layer liberate electrons
that migrate through the selenium matrix under the influence of the applied
electric field and are collected on the detector elements. After exposure, the
detector elements are read out as described earlier for indirect systems.
DIRECT FLAT PANEL DETECTORS
COMPARISON WITH INDIRECT FPD
• With indirect systems, the light that is released in the intensifying screen
diffuses as it propagates to the TFT array
• Although usage of CsI as phosphor reduces this, a significant amount of
lateral blurring does still occur.
• In direct detection systems, in contrast, electrons are the secondary quanta
that carry the signal which can be made to travel with a high degree of
directionality by the application of an electric field . Therefore, virtually no
blurring occurs in direct detection flat panel systems.
• Because electrons do not spread laterally in selenium direct detectors
due to the electric field, selenium detectors are made much thicker
than indirect detection systems, to improve x-ray detection efficiency.
• Furthermore, electric field lines can be locally altered at each detector
element to divert the electrons away from the insensitive electronics
containing area towards the sensitive area, increasing the effective fill
factor, thereby improving contrast and signal to noise ratio
• Because of the ability to direct the path of electrons in direct detection
flat panel systems, the spatial resolution is typically limited only by the
dimensions of the detector element.
• However, the “cost” of this sharpness is the artifactual enhancement of
radiographic noise that is no longer blurred by the limited resolution of
the detector. This enhancement, known as noise aliasing, limits the
DQE of direct systems . Current direct flat-panel systems offer high
resolution and DQE in the 20-30% range for x-ray energies applicable
to chest radiography.
• In addition to selenium, other materials such as mercuric iodide (Hgh),
cadmium telluride (CdTe), and lead iodide (Pbh) are beingstudied for
use in direct detection flat panel systems.
DIGITAL MAMMOGRAPHY
• Mammography presents some of the greatest challenges for digital detectors because of
the high spatial resolution that are required to detect and characterize microcalcifications.
• Small field-of-view digital mammography utilizing a single CCD/CMOS with a fibreoptic
taper as described earlier has been used for digital stereotactic biopsy.
• Full-field digital mammography systems based on CCD cameras make use of a mosaic of
CCD systems. The use of several CCD chips is necessary to increase the area of the light
sensor and thereby keep the demagnification factor low (similar tothat of digital biopsy) in
order to avoid a secondary quantum sink.
• With mosaic CCD systems, the individual images from each
camera are stitched together with the use of software to
produce a seamless, high-resolution digital mammographic
image.
DIGITAL MAMMOGRAPHY
• Full-field mammography systems (18 X 24 cm) are available that utilize TFT/flat panel
detector technology.
• Flat panel mammography devices are high-resolution versions (thinner screens and
smaller detector elements) of standard flat panel systems, which were described
previously.
• Currently, indirect detection (CsI scintillator) flat panel array systems are available with
100- X 100 µm detector elements
• Flat panels (indirect and direct) with smaller detector elements are being developed.
• Another technology that is used for full-field digital mammography is the Slotscan system
also called Fan-beam Radiography Systems
FAN-BEAM RADIOGRAPHY SYSTEMS
• Scattered radiation is an ever-present source of image quality degradation in x-ray
imaging.
• The common solutions to reducing that influence involve the use of anti-scatter grid and
air gap. However, the former leads to increased patient dose due to attenuation of the
primary beam, and the latter necessitates the use of smaller focal spots and larger
detectors to provide adequate coverage of the anatomy of interest.
• An alternative approach involves the use of a fan beam (as opposed to a cone beam) to
acquire the image.

• Fan-beam imaging can be undertaken with any type of imaging sensor listed above with
certain hardware and software modifications. The current commercial offering uses a CsI-
capture element optically coupled to a CCD sensor to capture the image from a moving
fan beam
• Because the largest CCD arrays are only 6 - 8 cm2, full-field mammography using a single
CCD is not possible. However, the slot-scan system requires a detector array with
dimensions of about 4 mm X 18 cm, and several long, narrow CCD chips can meet this
need.
• The breast remains stationary and under compression while the x-ray beam is scanned
across it. At any time during theacquisition sequence, only a narrow slot of tissue is being
exposed to the highly collimated x-ray beam. Consequently, little scattered radiation is
detected due to thenarrow beam geometry.
• The geometric efficiency of the slot-scan system is quite low compared with that of full-
field systems, because only the x-rays that pass through the narrow collimation into the
slot are used to make the image. To acquire images in clinically realistic time frames (1 to
2 seconds), the x-ray tube in this system uses a tungsten anode and is operated at higher
peak kilovoltage (kVp) than in conventional mammography (about 45 kV).
• The resolution is comparable to other phosphor-based systems, and system DQE ranges
from 15-20% range for chest x-ray beams.
• However, the imaging geometry cuts the scatter fraction by 2-3 times compared to
alternative cone-beam geometry, leading to a significant enhancement of eDQE and the
image quality per unit incident exposure
Technology Capture element Coupling Sensor Typical pixel size

CR Barium halide PMT light-guide PMT 0.1-0.2 mm

CCD or CMOS- Lens or fiber-optic

Gd2O2S or CsI CCD or CMOS 0.06-0.2 mm
based taper

Indirect flat-panel Gd2O2S or CsI Contact layer TFT array 0.14-0.2 mm

Direct flat-panel a-Se None TFT array 0.12-0.15 mm
Fan-beam CsI Fiber-optic taper CCD 0.162 mm
Film digitization Gd2O2S/film digitizer Variable Variable
DIGITAL IMAGE PROCESSING
• Digital Image Correction
• Dead pixels-certain number of detector elements that do notwork-they generate
no response to light input and are called "dead pixels."Software uses the dead
pixel map to correct the images produced by that detector: The gray scale
values in the pixels surrounding the dead pixel are averaged, and this value
replaces the gray scale of the dead pixel.
• Dark noise- Certain amount of electronic noise associated with each detector
element in the absence of x-rays.large number of dark images can be acquired
and averaged together, generating an average dark image which is then
subtracted from the images produced by the detector array.
• Differential Detector Sensitivity-Even for properly functioning detectors, there
are subtle differences in the sensitivity of each detector element. To correct for
differences in gain between the detector elements in the array, a gain image or
flat field image is acquired by exposing the array to a homogenous signal (a
copper filter). Which is then used to correct the raw image data.
DIGITAL IMAGE PROCESSING
• Global processing-One of the most common methods of image processing in radiology is
performed by altering the relation between digital numbers in the image and displayed
brightness with the aim of improving contrast.
• Windowing and leveling of a digital image are common examples of this type of global
image processing. Windowing and leveling are simple procedures performed routinely;
however, the consequences on the displayed image are profound. It is seen in the figure
that the level controls the threshold value below which all pixels are displayed as black
and the window controls a similar threshold value for a white output. Subtle gray-level
changes within images can therefore be enhanced so that they are displayed with greater
clarityReversing the contrast
• Histogram Processing - Manipulating such histogram data can be used for contrast
enhancement by redistributing the pixel values to generate, for instance, a better utilisation of
the grey scale.
• Pseudo-coloured display, Background subtraction, Unsharp Masking, Spatial Frequency
Processing, Spatial Domain Processing, Multi resolution processing, Noise reduction by
frame addition or averaging, Noise reduction by 'low-pass spatial filtering‘, Edge
enhancement by 'high-pass spatial filtering‘ etc
Unprocessed Windowing and levelling Contrast Reversal

Histogram Processing
PATIENT DOSE CONSIDERATIONS
• When film-screen image receptors are used, an inadvertent overexposure of the
patient will result in a dark film, which provides immediate feedback to the
technologist regarding the technique factors (and relative dose) used.
• However, when digital image receptors are used, overexposure of the patient can
produce excellent images because the electronic postprocessing systems
compensate for (and essentially mask) large fluctuations in exposure.
• Detectors with high DQEs make more efficient use of the x-rays and therefore
require less exposure for adequate signal-to-noise ratios.
• X-ray exposure levels should be tailored to the needs of the specific clinical
examination, in consideration of the digital detector and its DQE.
• Flat panel detectors can reduce radiation dose by about twofold to threefold for adult
imaging, compared with CR for the same image quality, owing to the better quantum
absorption and conversion efficiency associated with that technology.
ADVANTAGES
• Contrast resolution (at equivalent radiation dose levels i.e better DQE) is superior for
most digital radiographic systems compared with screen-film systems.
• Ability to manipulate the image post-acquisition.
• Markedly wider dynamic range than that of screen-film systems
• Better “tolerance” of some level of under- or over-exposure
• Information in digital format, enabling quantification and computer analysis of image
features
• Electronic archival and distribution
DISADVANTAGES
• Digital detector systems may not produce spatial resolution equal to that of film
• The flexibility of image appearance is not effectively used to provide superior
visualization, i.e. that advantage is not realized.
• Potential for images to be processed in a sub-optimal fashion.
• The flexibility of digital radiography systems can lead to inconsistent image
appearance, inconsistent clinical decision-making, and possible misdiagnosis.
• The “tolerance” of digital systems enables technologists to capture higher quality
images at increased dose to the patient leading to a documented “exposure creep” in
digital operations in multiple clinical operations, thus leading to patient over-
exposure.
• Increased tendency for retake of inadequate images
THANK YOU