This paper examines the evolution of digital imaging in hospital radiology departments, focusing on the two primary technologies: computed radiography (CR) and digital radiography (DR). It discusses the factors driving adoption — including improved access to images and elimination of film libraries — as well as the barriers to widespread implementation, particularly high equipment costs and slower-than-expected return on investment. The paper compares CR and DR in terms of technical capabilities, image quality, and practical considerations for hospitals of varying sizes, drawing on industry announcements and peer-reviewed literature to illustrate where each technology excels and where trade-offs must be made.
The paper effectively uses a compare-and-contrast structure to evaluate two closely related technologies (CR vs. DR) across multiple dimensions — cost, image quality, accessibility, and clinical utility — before synthesizing those comparisons into a practical recommendation. This technique allows readers to understand not just what each system does, but why a hospital might rationally choose one over the other.
The paper opens with a broad overview of digital imaging adoption trends, then narrows into separate sections on CR and DR before converging on a shared concern — image quality — in the final analytical section. This funnel-then-synthesis structure is well suited to technology comparison papers, as it allows each subject to be fully introduced before being evaluated side by side.
Digital imaging in hospital radiology departments came about for several reasons. The most important of these, however, was the idea that digital images could be viewed by any authorized person at any time, thus making it much easier and faster for those who needed to see them to gain access (Gillespie, 1999). These digital images eliminate the need for films and film libraries, thereby freeing up physical space. However, problems remain that have prevented digital imaging in hospital radiology departments from progressing as quickly as was hoped. The major concern for these departments is the cost of digital imaging equipment, which is considerably more expensive than the older methods previously used to take X-rays and perform related functions (Gillespie, 1999).
The hoped-for return on investment has not materialized in many of these departments, making them slow to transition to a filmless system. When coupled with the high cost of the technology, digital imaging has been relatively slow to evolve — yet its importance for the future should not be discounted. Despite its slower-than-expected start, studies and other evidence show that the use of digital imaging in radiology departments and other areas of medical practice is growing (Zesearch, 2001; Newman, 2003; Revolution, 2003). Larger hospitals and departments are generally able to afford this technology more easily and therefore tend to expand their capabilities more quickly, but smaller hospitals are also showing interest in digital imaging for their radiology departments, provided they can secure funding for the initial equipment purchase.
There are two main types of systems: computed radiography (CR) and digital radiography (DR). The remainder of this paper discusses these two types of digital imaging systems as they relate to hospital radiology departments, followed by an analysis of image quality and its significance.
Both computed radiography and digital radiography are significant to this field, but there are important differences between the two. One of the main issues with CR is that the density and other parameters necessary to produce a high-quality image differ from those used in older systems (Cesar, 1997). This can leave radiographers feeling frustrated, and some hospitals are already having difficulty retaining enough radiographers and attracting new people to the field. Some of this reluctance stems directly from the challenges associated with CR.
Individuals trained in diagnostic radiography and related specialties — such as CT scanning or mammography — are typically paid more and find employment more readily than those with only a single skill. It is becoming increasingly important for radiology professionals to keep pace with new technology. Despite the growing need for radiologists, however, relatively few people pursue this career path. This is thought to be partly due to inadequate funding for quality equipment, which creates frustration among those simply trying to do their jobs effectively.
Prototypes of today's CR machines were installed in some hospitals as early as the 1980s, but there have been many changes since then, most notably improvements in portability (Moehring, 1997). Several companies manufacture CR equipment, including Fujifilm (Fujifilm, 2002) and Kodak (Kodak, 2003), which are among the top competitors in the CR technology market and are generally considered leaders in quality. Kodak (2003), for example, made the following announcements about its new imaging technology:
Kodak DirectView PACS System 5 architecture, currently under development, will expedite the efficient storage, reading, and review of radiology reports and imaging studies. It will scale to support a small hospital, one or more imaging centers, or a large healthcare facility. The Kodak DirectView Web Distribution System provides a foundation for the transition to the new PACS System 5 architecture, and Kodak's well-developed migration path includes a series of upgrades designed to leverage customers' existing PACS equipment.
Kodak DirectView Web Distribution System distributes imaging studies and radiology reports to referring physicians using the Internet. It includes the new database that will be used with PACS System 5 architecture and presents both new and existing customers with the opportunity to begin migration. The Web system supports clinical review by physicians on dual-monitor, high-resolution workstations; provides both lossless and lossy (wavelet) compression; and supports both Macintosh and PC platforms using an Internet Explorer or Netscape browser.
Kodak DirectView CR 950 System, demonstrated for the first time at ECR, supports the productivity needs of busy radiology departments and clinics by processing up to 81 plates (35 × 43 cm) per hour and accepting eight cassettes at a time. In addition to faster processing speeds, the start/pause button is located on the device so that one technologist can load cassettes while another enters information at the workstation.
Kodak DirectView CR 850 System is a single-cassette system offering throughput of up to 103 cassettes per hour. In addition to exceptional image quality and ease of use, the speed of the CR 850 system can improve technologists' productivity and patient throughput across a variety of environments. The system's all-in-one design offers a footprint of just 63 × 73 cm, making it ideal for emergency rooms, ICUs, and other areas with limited floor space.
Kodak DirectView CR Long-Length Imaging System, a digital image capture system that includes a wall-mounted vertical cassette holder, provides hospitals and diagnostic imaging centers with digital image capture of full leg and full spine images. Kodak's fully automatic stitching software delivers images of up to 43 × 129 cm that can be viewed in softcopy or printed onto radiographic film. This system significantly reduces the most frequent causes of exam retakes — poor stitching, incorrect alignment, or images that are out of order.
Kodak DryView 8900 Laser Imager, the flagship product in Kodak's dry laser imaging line, produces more than 180 films per hour at 650 dpi laser resolution. This resolution applies to all film sizes, including 35 × 43 cm and 35 × 35 cm — a significant advantage over other imagers that print at high resolution only on smaller film sizes and at slower speeds. The imager contains three film drawers and supports five film sizes; its ability to place any film size in any drawer makes it an excellent choice for centralized printing in busy multi-modality areas.
Kodak DirectView DR 5100 System is a digital radiography system for the direct digital capture of images. The system is built on a compact platform that includes a new integrated touch-screen operator console, a new generator, bucky and tube stand, and Kodak DirectView PTS software (Kodak, 2003).
It is clearly remarkable what Kodak (2003) has accomplished, but other companies are also making significant advances in the direction that digital imaging is taking within hospital radiology departments. While CR is important, digital radiography (DR) is also highly significant and merits separate discussion.
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