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Digital Idol (Part 1 of 2)

THE COMPETITION:

If CR (computed radiography) and DR (direct radiography) were on a reality show today - let's say an American Idol of the medical world - the two would very likely be facing each other in the finals. DR would be the contestant with fresh appeal and a faster tempo. CR would be the contender whose range and abilities show more flexibility but whose style is not necessarily next generation. Unlike the American Idol winner who will be chosen by summer and selected more because of popularity than ability, the CR versus DR competition is likely to play out for some time to come and will, in the end, be judged by performance.

The competition between the two modalities is as tough as that among the singers on television. From the technologist's perspective, CR and DR are fairly well matched. Both are digital modalities and offer related advantages. "The advantage of having a digital image, whether CR or DR, is that you have a wider dynamic range and can take advantage of advanced processing tools that can enhance the image," said Penny Maier, director of marketing for imaging systems at FUJIFILM Medical Systems USA Inc, Stamford, Conn. The postprocessing functions are often the same, whether CR or DR.

"Every time I took one image with CR, I handled the cassette six times."

Fredrick Walker, a radiology technologist at Sharp Rees-Stealy in San Diego, offers an example. "If an image is too dark, we can now window it or shadow it or make it lighter without having to reshoot," he said. This exposes the patient to less radiation and permits faster exams than was achieved with traditional x-ray film technology.

Depending on the vendor, the workstation and interface may be the same for both CR and DR. "Techs have the convenience of using the same tools, and radiologists see images with the same look and feel regardless of where the image was acquired," Maier said. But the process of getting to that point is quite different. The most obvious contrast between CR and DR is image acquisition. Cassettes, standard to CR, are eliminated in the DR workflow, resulting in two major advantages for the technologist: fewer repetitive motion injuries and faster acquisition times.

Alan Hill, lead technologist at Kaiser Fair Oaks in Fairfax, Va, experienced degenerative changes in the bases of his thumbs using CR, which prompted a switch to a DR system by Canon USA Inc, Lake Success, NY. "Every time I took one image with CR, I handled the cassette six times. Since switching to DR, the problem has disappeared," Hill said.

"The turnaround time for physicians receiving images using DR versus CR is a lot faster, so by the time a patient leaves our department and goes to see the physician upstairs or down the hall, the images are readily accessible to the providers," Hill said. Sally Grady, director of imaging services for Florida Hospital Celebration Health, Celebration, Fla, doesn't believe that the timing makes that much of a difference for providers, however. "A radiologist doesn't really care if it takes 2 minutes or 5 minutes to produce an image. All they care about is quality," Grady said.

In this area, however, there is no clear winner. Some, like Grady, believe that CR provides better quality images. "With our new software [MUSICA2-Multi-Scale Image Contrast Amplification-from Agfa Healthcare, Mortsel, Belgium], the images are so detailed, I can see toenails on a foot x-ray or braided hair down someone's back on a chest x-ray," Grady said. Martin, also an Agfa customer, has experienced exactly the opposite. "In my experience, DR gives you better image details, and although doctors for the most part do not regularly bring it up, they have commented that DR image quality is a little better than CR," Martin said.

Where CR still holds a clear advantage is in its flexibility and portability. "The big advantage CR can provide to a technologist in a clinical application is the flexibility the cassette brings in a trauma environment or the OR, where you need to position a cassette to record an anatomical area in an unusual place or as a lateral," Maier said. Grady concurs. "You can do any exam type using CR: portable, cross table, cubitus," Grady said. Patients who can't be moved or can't move easily, such as those in wheelchairs or wearing casts, benefit from the increased flexibility of the cassette, possibly experiencing greater comfort during the exam.

Here too, however, the differences are narrowing as DR manufacturers debut new systems. Canon offers portable DR systems that extend DR applications to neonatal and trauma. Fujifilm also offers a portable system, the FCR Go, as well as the new Unity SpeedSuite system that features a u-arm that can rotate around the patient to accommodate lateral views.

CONTINUED: Read Digital Idol (Part 2 of 2) for Votes and Results

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<a href="http://www.awalshimaging.com/article03.htm">Digital Idol (Part 1 of 2)</a>: Part 1 of a 2 part series detailing x-ray technicians take on Computed Radiography versus Direct Radiography.