CR and DR: Replacing screen film systems

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Technological advances in computed radiography and digital radiography systems have begun to make digital projection radiography more prevalent in the clinical area, with CR currently having the greater clinical install base, according to speakers at a fundamentals of CR and DR educational session yesterday at the Society for Imaging Informatics in Medicine (formerly SCAR) annual meeting in Austin, Texas.

“Technological advances in hardware and software have contributed to the acceptance of CR and contributed to a great promise for DR,” said Katherine Andriole, PhD of Brigham & Women’s Hospital, Harvard Medical School. CR refers to projection x-ray imaging with photostimulable or storage phosphors, whereas DR refers to devices for direct digital acquisition of projection radiographs in which the digitization of the x-ray signal takes place within the detector itself.

CR hardware and software advancements that have helped the digital imaging modality gain popularity and empower its clinical utility include improved image quality, faster imaging speeds, compact designs and decreased cost.

However, DR does have unique advantages, including direct energy exposure for immediate exposure, which leads to enhanced productivity, as well as the possibility to take more dynamic images, according to Andriole. Although DR has been shown to increase patient throughout, further adoption of DR has been hindered by the lack of literature that cost-justifies the technology for low volume healthcare settings.
Additional problem areas for DR include ease of use and portability. “DR is referred to as the one-room-at-a-time technology,” Andriole said.

Despite the differences, CR and DR eliminate film from the image acquisition process, resulting in the separation of image capture from image display and image storage. Digital imaging benefits include remote access to images and clinical information by multiple users simultaneously, permanent storage and subsequent retrieval of image data, expedient information delivery to those who need it, and workflow enhancements with the elimination of film.  
Vendors also have made significant advancements to their image-processing algorithms. “There are a lot of post-processing techniques out there,” Andriole said. “Go to the vendors and have them show these techniques to you as well as to referring physicians.”
When selecting and purchasing digital image acquisition devices, end-users must have thorough knowledge, learning and understanding as to how these systems work and change workflow, since cultural changes may make CR and DR more difficult to use than screen film systems.  
At the end of the day, it does not look like either technology will replace the other, but rather act in a complementary fashion. “I predict that CR and DR are going to co-exist for sometime, but how long remains to be seen,” Andriole said.