Improved Calcium Scoring at Dual-Energy Computed Tomography Angiography Using a High-Z Contrast Element and Novel Material Separation Technique.

OBJECTIVES: The aim of this study was to compare the accuracy of existing dual-energy computed tomography (CT) angiography coronary artery calcium scoring methods to those obtained using an experimental tungsten-based contrast material and a recently described contrast material extraction process (CMEP). METHODS: Phantom coronary arteries of varied diameters, with different densities and arcs of simulated calcified plaque, were sequentially filled with water, iodine, and tungsten contrast materials and scanned within a thorax phantom at rapid-kVp-switching dual-energy CT. Calcium and contrast density images were obtained by material decomposition (MD) and CMEP. Relative calcium scoring errors among the 4 reconstructed datasets were compared with a ground truth, 120-kVp dataset. RESULTS: Compared with the 120-kVp dataset, tungsten CMEP showed a significantly lower mean absolute error in calcium score (6.2%, P < 0.001) than iodine CMEP, tungsten MD, and iodine MD (9.9%, 15.7%, and 40.8%, respectively). CONCLUSIONS: Novel contrast elements and material separation techniques offer improved coronary artery calcium scoring accuracy and show potential to improve the use of dual-energy CT angiography in a clinical setting.

Axial or Helical? Considerations for wide collimation CT scanners capable of volumetric imaging in both modes.

PURPOSE: To determine whether axial or helical mode is more appropriate for a 16 cm collimation CT scanner capable of step-and-shoot volumetric axial coverage, in terms of radiation dose, image quality, and scan duration. METHODS: All scans were performed with a Revolution CT (GE Healthcare) operating at 120 kV and 100 mAs. Using calibrated optically stimulated luminescence detectors, radiation dose along the axial scan profile was evaluated at the isocenter, including the overlap region between two axial sections. This overlap region measures 3 cm in the z-axis at the isocenter and is required to obtain sufficient projection data from the relatively large cone-beam angles. Using an image quality phantom (Gammex Model 464), spatial resolution, CT number uniformity, image noise, and low contrast detectability (LCD) were evaluated under five different conditions: in the middle of a helical acquisition, in the middle of a 16 cm axial section, at both ends of an axial section and in the overlap region between two axial sections. Scan durations and dose length products (DLP) were recorded for prescribed scan lengths of 2.5-100 cm. RESULTS: The overlap region between two axial sections received a dose 83% higher than the single-exposure region at the isocenter. Within a single axial section, the dose at the anode end was 37% less than at the cathode end due to the anode heel effect. Image noise ranged from a low of 13 HU for the cathode end of an axial section up to 14.7 HU for the anode end (P < 0.001). The LCD was at lower at the anode end of the axial section compared to both the cathode end (P < 0.05) and the overlap location (P < 0.02). The spatial resolution and CT number uniformity were consistent among all conditions. Scan durations were shorter (0.28 s) for the axial mode compared to the helical mode at scan lengths ≤ 16 cm, and longer at scan lengths ≥ 16 cm where more than one table position was required, up to a difference of 13.9 s for a the 100 cm scan length (3.8 s for helical compared to 17.6 s for axial). DLPs were consistent between scan modes; slightly lower in axial mode at shorter scan lengths due to helical overranging, and slightly higher in axial mode at longer scan lengths due to the axial overlap regions. CONCLUSIONS: To ensure the most consistent radiation dose and image quality along the scan length, we recommend helical mode for scans longer than the 16 cm coverage of a single axial section. For scan lengths ≤ 16 cm, axial scanning is the most practical option, with a shorter scan duration and higher dose efficiency.

An Image-Domain Contrast Material Extraction Method for Dual-Energy Computed Tomography.

OBJECTIVES: Conventional material decomposition techniques for dual-energy computed tomography (CT) assume mass or volume conservation, where the CT number of each voxel is fully assigned to predefined materials. We present an image-domain contrast material extraction process (CMEP) method that preferentially extracts contrast-producing materials while leaving the remaining image intact. MATERIALS AND METHODS: Image processing freeware (Fiji) is used to perform consecutive arithmetic operations on a dual-energy ratio map to generate masks, which are then applied to the original images to generate material-specific images. First, a low-energy image is divided by a high-energy image to generate a ratio map. The ratio map is then split into material-specific masks. Ratio intervals known to correspond to particular materials (eg, iodine, calcium) are assigned a multiplier of 1, whereas ratio values in between these intervals are assigned linear gradients from 0 to 1. The masks are then multiplied by an original CT image to produce material-specific images. The method was tested quantitatively at dual-source CT and rapid kVp-switching CT (RSCT) with phantoms using pure and mixed formulations of tungsten, calcium, and iodine. Errors were evaluated by comparing the known material concentrations with those derived from the CMEP material-specific images. Further qualitative evaluation was performed in vivo at RSCT with a rabbit model using identical CMEP parameters to the phantom. Orally administered tungsten, vascularly administered iodine, and skeletal calcium were used as the 3 contrast materials. RESULTS: All 5 material combinations-tungsten, iodine, and calcium, and mixtures of tungsten-calcium and iodine-calcium-showed distinct dual-energy ratios, largely independent of material concentration at both dual-source CT and RSCT. The CMEP was successful in both phantoms and in vivo. For pure contrast materials in the phantom, the maximum error between the known and CMEP-derived material concentrations was 0.9 mg/mL, 24.9 mg/mL, and 0.4 mg/mL for iodine, calcium, and tungsten respectively. Mixtures of iodine and calcium showed the highest discrepancies, which reflected the sensitivity of iodine to the image-type chosen for the extraction of the final material-specific image. The rabbit model was able to clearly show the 3 extracted material phases, vascular iodine, oral tungsten, and skeletal calcium. Some skeletal calcium was misassigned to the extracted iodine image; however, this did not impede the depiction of the vasculature. CONCLUSIONS: The CMEP is a straightforward, image-domain approach to extract material signal at dual-energy CT. It has particular value for separation of experimental high-Z contrast elements from conventional iodine contrast or calcium, even when the exact attenuation coefficient profiles of desired contrast materials may be unknown. The CMEP is readily implemented in the image-domain within freeware, and can be adapted for use with images from multiple vendors.

Evaluation of a Net Dose-Reducing Organ-Based Tube Current Modulation Technique: Comparison With Standard Dose and Bismuth-Shielded Acquisitions.

OBJECTIVE: The purpose of this study was to compare the dose and image noise associated with two methods of radiation dose reduction to the superficial anterior organs: bismuth shielding and a net dose-reducing organ-based tube current modulation TCM technique. MATERIALS AND METHODS: Three scanning modes-the reference dose, bismuth-shielded, and organ dose-modulated modes-were evaluated. With the use of an anthropomorphic phantom, surface doses to the eye, thyroid, and female breast were measured using optically stimulated luminescence detectors. A CT dose index (CTDI) phantom was used to compare doses with the overall phantom volume in the different modes. RESULTS: The dose to the anterior surface was reduced by 35%, 42%, and 37% in the head, neck, and chest regions, respectively, when the bismuth-shielded scanning mode was used, whereas surface dose reductions of 20%, 34%, and 38%, respectively, were noted for the organ-based TCM scanning mode. The CTDI-type dose was reduced by 13%, 14%, and 17% in the head, neck, and chest regions, respectively, when the bismuth-shielded mode was used, whereas dose reductions of 9%, 18%, and 20%, respectively, were observed for the organ-based TCM mode. Anterior image noise increased by 0.1, 9.5, and 0.7 HU in the head, neck, and chest regions, respectively, when the bismuth-shielded mode was used. These findings compared with increases in image noise of 0.1, 0.5, and 0.6 HU, respectively, for the organ-based TCM mode. CONCLUSION: The implementation of organ-based TCM reduces the net tube current per rotation, so no body region receives increased radiation exposure. The use of this method allows the dose to the anterior surface to be reduced to an extent similar to that observed with the use of the bismuth shield, yet it does not produce the image quality degradation associated with bismuth shielding.

Reduction of peristalsis-related gastrointestinal streak artifacts with dual-energy CT: a patient and phantom study.

OBJECTIVE: The purpose of the study was to assess the ability of rapid-kV switching (rs) dual-energy computed tomography (DECT) to reduce peristalsis-related streak artifact. METHODS: rsDECT images of 100 consecutive patients (48 male, 52 female, mean age 57 years) were retrospectively evaluated in this institutional review board-approved study. Image reconstructions included virtual monochromatic 70 and 120 keV images, as well as iodine(-water) and water(-iodine) material decomposition images. We recorded the presence and severity of artifacts qualitatively (4-point scale) and quantitatively [iodine/water concentrations, Hounsfield units, gray scale values (GY)] and compared to corresponding unaffected reference tissue. Similar measures were obtained in DECT images of a peristalsis phantom. Wilcoxon signed-rank and paired t tests were used to compare results between different image reconstructions. RESULTS: Peristalsis-related streak artifacts were found in 49 (49%) of the DECT examinations. Artifacts were significantly more severe in 70, 120, and water(-iodine) images than in iodine(-water) images (qualitative readout P < 0.001, each). Quantitative measurements were significantly different between the artifact and the reference tissue in 70, 120 keV, and water(-iodine) images (P < 0.001 for both HU and GY for each image reconstruction), but not significantly different in iodine(-water) images (iodine concentrations P = 0.088 and GY P = 0.111). Similar results were seen in the peristalsis DECT phantom study. CONCLUSIONS: Peristalsis-related streak artifacts seen in 70, 120 keV, and water(-iodine) images are substantially reduced in iodine(-water) images at rsDECT.

Image quality and dose optimisation for infant CT using a paediatric phantom.

OBJECTIVE: To optimise image quality and reduce radiation exposure for infant body CT imaging. METHODS: An image quality CT phantom was created to model the infant body habitus. Image noise, spatial resolution, low contrast detectability and tube current modulation (TCM) were measured after adjusting CT protocol parameters. Reconstruction method (FBP, hybrid iterative and model-based iterative), image quality reference parameter, helical pitch and beam collimation were systematically investigated for their influence on image quality and radiation output. RESULTS: Both spatial and low contrast resolution were significantly improved with model-based iterative reconstruction (p < 0.05). A change in the helical pitch from 0.969 to 1.375 resulted in a 23% reduction in total TCM, while a change in collimation from 20 to 40 mm resulted in a 46% TCM reduction. Image noise and radiation output were both unaffected by changes in collimation, while an increase in pitch enabled a dose length product reduction of ~6% at equivalent noise. An optimised protocol with ~30% dose reduction was identified using model-based iterative reconstruction. CONCLUSIONS: CT technology continues to evolve and require protocol redesign. This work provides an example of how an infant-specific phantom is essential for leveraging this technology to maintain image quality while reducing radiation exposure. KEY POINTS: • A size-specific phantom is critical in protocol development for infant CT. • New reconstruction technology enables ~30% dose reduction at equivalent image quality. • A consistent performance is observed for this scanner system across protocol changes. • A tradeoff exists between reducing exposure time and enabling tube current modulation.

How Much Does Lead Shielding during Fluoroscopy Reduce Radiation Dose to Out-of-Field Body Parts?

BACKGROUND: Fluoroscopy technologists routinely place a lead shield between the x-ray table and the patient's gonads, even if the gonads are not directly in the x-ray field. Internal scatter radiation is the greatest source of radiation to out-of-field body parts, but a shield placed between the patient and the x-ray source will not block internal scatter. Prior nonfluoroscopy research has shown that there is a small reduction in radiation dose when shielding the leakage radiation that penetrates through the collimator shutters. The goal of this in vitro study was to determine if there was any radiation dose reduction when shielding leakage radiation during fluoroscopy. METHODS: This was an in vitro comparison study of radiation doses using different collimation and shielding strategies during fluoroscopy. Ionization chamber measurements were obtained during fluoroscopy of an acrylic block with and without collimation and shielding. Ionization chamber readings were taken in-field at 0 cm and out-of-field at 7.5, 10, and 12.5 cm from beam center. RESULTS: Collimation reduced 87% of the out-of-field radiation dose, and the remaining measurable dose was because of internal scatter. The radiation dose contribution from leakage radiation was negligible, as there was not any measurable radiation dose difference when shielding leakage radiation, with P value of .48. CONCLUSION: These results call into question the clinical utility of routinely shielding out-of-field body parts during fluoroscopy.

Radiation dose reduction in intra-arterial chemotherapy infusion for intraocular retinoblastoma.

BACKGROUND AND PURPOSE: Retinoblastoma (RB) is a rare malignancy affecting the pediatric population. Intravenous chemotherapy is the longstanding delivery method, although intra-arterial (IA) chemotherapy is gaining popularity given the reduced side effects compared with systemic chemotherapy administration. Given the sensitivity of the target organ, patient age, and secondary tumor susceptibility, a premium has been placed on minimizing procedural related radiation exposure. MATERIALS AND METHODS: To reduce patient x-ray dose during the IA infusion procedure, customized surgical methods and fluoroscopic techniques were employed. The routine fluoroscopic settings were changed from the standard 7.5 pulses/s and dose level to the detector of 36 nGy/pulse, to a pulse rate of 4 pulses/s and detector dose to 23 nGy/pulse. The angiographic dose indicators (reference point air kerma (Ka) and fluoroscopy time) for a cohort of 10 consecutive patients (12 eyes, 30 infusions) were analyzed. An additional four cases (five eyes, five infusions) were analyzed using dosimeters placed at anatomic locations to reflect scalp, eye, and thyroid dose. RESULTS: The mean Ka per treated eye was 20.1±11.9 mGy with a mean fluoroscopic time of 8.5±4.6 min. Dosimetric measurements demonstrated minimal dose to the lens (0.18±0.10 mGy). Measured entrance skin doses varied from 0.7 to 7.0 mGy and were 73.4±19.7% less than the indicated Ka value. CONCLUSIONS: Ophthalmic arterial melphalan infusion is a safe and effective means to treat RB. Modification to contemporary fluoroscopic systems combined with parsimonious fluoroscopy can minimize radiation exposure.

Template-driven computed tomography radiation dose reporting: implementation of a radiology housestaff quality improvement project.

RATIONALE AND OBJECTIVES: Radiation exposure from medical imaging has received increasing attention in recent years. Ongoing calls to report radiation doses received during radiology studies as a means of recording cumulative exposure and identifying rare over-exposures have culminated in the State of California passing a mandatory reporting requirement effective July 1, 2012. Herein we describe a radiology housestaff-led quality improvement project to track radiation dose reporting a full year prior to state reporting mandates using a template-driven reporting system and our results over the first 12 months of its implementation. MATERIALS AND METHODS: Effective July 2011, all radiology trainees were instructed to use a standard computed tomography (CT) report template that included a CT dose measurement derived from dose information routinely displayed on our picture archiving and communication system. Consecutive reports from July 1, 2011, to June 30, 2012, of patients who underwent CT examinations at our institution were then retrospectively reviewed. Compliance of each study with the reporting requirement was assessed based on the presence or absence of a radiation dose statement within the finalized report. RESULTS: A total of 36,217 eligible consecutive CT reports were identified within the review period. Of these, 91.9% reported the radiation dose for the examination, greatly exceeding the initial goal of 80% compliance with the dose reporting requirement. CONCLUSION: Successful reporting of CT radiation doses resulted from template-driven reporting, readily accessible calculation tools to facilitate dose calculation, and minimization of reporting burden on the radiologist a full year prior to state regulatory mandates.

Myocardial blood flow measurement with a conventional dual-head SPECT/CT with spatiotemporal iterative reconstructions - a clinical feasibility study.

Cardiac single photon emission computed tomography (SPECT) cameras typically rotate too slowly around a patient to capture changes in the blood pool activity distribution and provide accurate kinetic parameters. A spatiotemporal iterative reconstruction method to overcome these limitations was investigated. Dynamic rest/stress (99m)Tc-methoxyisobutylisonitrile ((99m)Tc-MIBI) SPECT/CT was performed along with reference standard rest/stress dynamic positron emission tomography (PET/CT) (13)N-NH3 in five patients. The SPECT data were reconstructed using conventional and spatiotemporal iterative reconstruction methods. The spatiotemporal reconstruction yielded improved image quality, defined here as a statistically significant (p<0.01) 50% contrast enhancement. We did not observe a statistically significant difference between the correlations of the conventional and spatiotemporal SPECT myocardial uptake K 1 values with PET K 1 values (r=0.25, 0.88, respectively) (p<0.17). These results indicate the clinical feasibility of quantitative, dynamic SPECT/CT using (99m)Tc-MIBI and warrant further investigation. Spatiotemporal reconstruction clearly provides an advantage over a conventional reconstruction in computing K 1.

Depth-of-Interaction Compensation Using a Focused-Cut Scintillator for a Pinhole Gamma Camera.

Preclinical SPECT offers a powerful means to understand the molecular pathways of drug interactions in animal models by discovering and testing new pharmaceuticals and therapies for potential clinical applications. A combination of high spatial resolution and sensitivity are required in order to map radiotracer uptake within small animals. Pinhole collimators have been investigated, as they offer high resolution by means of image magnification. One of the limitations of pinhole geometries is that increased magnification causes some rays to travel through the detection scintillator at steep angles, introducing parallax errors due to variable depth-of-interaction in scintillator material, especially towards the edges of the detector field of view. These parallax errors ultimately limit the resolution of pinhole preclinical SPECT systems, especially for higher energy isotopes that can easily penetrate through millimeters of scintillator material. A pixellated, focused-cut (FC) scintillator, with its pixels laser-cut so that they are collinear with incoming rays, can potentially compensate for these parallax errors and thus improve the system resolution. We performed the first experimental evaluation of a newly developed focused-cut scintillator. We scanned a Tc-99m source across the field of view of pinhole gamma camera with a continuous scintillator, a conventional "straight-cut" (SC) pixellated scintillator, and a focused-cut scintillator, each coupled to an electron-multiplying charge coupled device (EMCCD) detector by a fiber-optic taper, and compared the measured full-width half-maximum (FWHM) values. We show that the FWHMs of the focused-cut scintillator projections are comparable to the FWHMs of the thinner SC scintillator, indicating the effectiveness of the focused-cut scintillator in compensating parallax errors.

Multi-Material Decomposition using Low-Current X-Ray and a Photon-Counting CZT Detector.

We developed and evaluated an x-ray photon-counting imaging system using an energy-resolving cadmium zinc telluride (CZT) detector coupled with application specific integrated circuit (ASIC) readouts. This x-ray imaging system can be used to identify different materials inside the object. The CZT detector has a large active area (5×5 array of 25 CZT modules, each with 16×16 pixels, cover a total area of 200 mm × 200 mm), high stopping efficiency for x-ray photons (~ 100 % at 60 keV and 5 mm thickness). We explored the performance of this system by applying different energy windows around the absorption edges of target materials, silver and indium, in order to distinguish one material from another. The photon-counting CZT-based x-ray imaging system was able to distinguish between the materials, demonstrating its capability as a radiation-spectroscopic decomposition system.

Temperature dependent operation of PSAPD-based compact gamma camera for SPECT imaging.

We investigated the dependence of image quality on the temperature of a position sensitive avalanche photodiode (PSAPD)-based small animal single photon emission computed tomography (SPECT) gamma camera with a CsI:Tl scintillator. Currently, nitrogen gas cooling is preferred to operate PSAPDs in order to minimize the dark current shot noise. Being able to operate a PSAPD at a relatively high temperature (e.g., 5 °C) would allow a more compact and simple cooling system for the PSAPD. In our investigation, the temperature of the PSAPD was controlled by varying the flow of cold nitrogen gas through the PSAPD module and varied from -40 °C to 20 °C. Three experiments were performed to demonstrate the performance variation over this temperature range. The point spread function (PSF) of the gamma camera was measured at various temperatures, showing variation of full-width-half-maximum (FWHM) of the PSF. In addition, a 99mTc-pertechnetate (140 keV) flood source was imaged and the visibility of the scintillator segmentation (16×16 array, 8 mm × 8 mm area, 400 µm pixel size) at different temperatures was evaluated. Comparison of image quality was made at -25 °C and 5 °C using a mouse heart phantom filled with an aqueous solution of 99mTc-pertechnetate and imaged using a 0.5 mm pinhole collimator made of tungsten. The reconstructed image quality of the mouse heart phantom at 5 °C degraded in comparision to the reconstructed image quality at -25 °C. However, the defect and structure of the mouse heart phantom were clearly observed, showing the feasibility of operating PSAPDs for SPECT imaging at 5 °C, a temperature that would not need the nitrogen cooling. All PSAPD evaluations were conducted with an applied bias voltage that allowed the highest gain at a given temperature.

Phantom experiments on a PSAPD-based compact gamma camera with submillimeter spatial resolution for small animal SPECT.

We demonstrate a position sensitive avalanche photodiode (PSAPD) based compact gamma camera for the application of small animal single photon emission computed tomography (SPECT). The silicon PSAPD with a two-dimensional resistive layer and four readout channels is implemented as a gamma ray detector to record the energy and position of radiation events from a radionuclide source. A 2 mm thick monolithic CsI:Tl scintillator is optically coupled to a PSAPD with a 8mm×8mm active area, providing submillimeter intrinsic spatial resolution, high energy resolution (16% full-width half maximum at 140 keV) and high gain. A mouse heart phantom filled with an aqueous solution of 370 MBq (99m)Tc-pertechnetate (140 keV) was imaged using the PSAPD detector module and a tungsten knife-edge pinhole collimator with a 0.5 mm diameter aperture. The PSAPD detector module was cooled with cold nitrogen gas to suppress dark current shot noise. For each projection image of the mouse heart phantom, a rotated diagonal readout algorithm was used to calculate the position of radiation events and correct for pincushion distortion. The reconstructed image of the mouse heart phantom demonstrated reproducible image quality with submillimeter spatial resolution (0.7 mm), showing the feasibility of using the compact PSAPD-based gamma camera for a small animal SPECT system.

Physiology of renal medullary tip hyperattenuation at unenhanced CT: urinary specific gravity and the NaCl concentration gradient.

PURPOSE: To retrospectively investigate the physiology of renal medullary tip hyperattenuation at unenhanced computed tomography (CT). MATERIALS AND METHODS: This retrospective single-institution study was IRB approved and HIPAA compliant. Informed consent was waived. One hundred consecutive patients (53 women, mean age, 52 years; 47 men, mean age, 48 years; P = .39) without and 34 (11 women, mean age, 49 years; 23 men, mean age, 45 years; P = .54) with unilateral ureteral obstruction underwent contemporaneous urinalysis and unenhanced CT. At CT, bladder urine attenuation was measured and two readers recorded the presence of renal medullary tip hyperattenuation. For obstructed kidneys (n = 34), renal pelvic urine attenuation was also recorded. The presence of medullary tip hyperattenuation was correlated with urinary specific gravity. To investigate the physiologic basis of medullary tip hyperattenuation, attenuations for NaCl and urea phantoms (range, 0-2000 mosm/kg) were recorded and correlated to solute concentrations by using linear regression. RESULTS: Patients with renal medullary tip hyperattenuation seen at CT had higher mean urinary specific gravity (1.023 and 1.022 for readers 1 and 2, respectively) than those without (1.015 and 1.016, respectively, both P < .05). The specific gravity correlated with higher urine attenuation (r = 0.40, P < .001). For the 34 patients with unilateral urinary obstruction, medullary tip hyperattenuation was less commonly seen in obstructed (two kidneys each for both readers) than nonobstructed (11 and 15 kidneys, respectively, both P < .005) kidneys and mean urine attenuation was lower in the obstructed renal pelvis (7.4 HU) than in the bladder (11.4 HU) (P < .005). Phantoms showed a 3.6-HU increase per 100-mosm/kg increase in NaCl concentration (r = 0.99, P < .001) but no change in attenuation with different urea concentrations. CONCLUSION: Renal medullary tip hyperattenuation at unenhanced CT reflects increased urinary specific gravity, likely related to high medullary tip NaCl concentrations.

Gallstone detection at CT in vitro: effect of peak voltage setting.

This study was a retrospective single-institutional study approved by the Committee on Human Research and was HIPAA compliant. A waiver for informed consent was granted. The purpose of the study was to evaluate the effect of four peak voltage settings on the in vitro conspicuity of gallstones in an anthropomorphic phantom at computed tomography (CT). An anthropomorphic phantom was scanned with (n = 86) or without (n = 85) gallstones at CT by using 80, 100, 120, and 140 kVp. The sensitivity for gallstone detection was significantly higher at 140 kVp (86% [74 of 86] for reader 1 and 81% [70 of 86] for reader 2) than at lower voltage settings (up to 67% [58 of 86] for reader 1 and 63% [54 of 86] for reader 2, P < .05 for each reader), regardless of gallstone size (<1.0 cm vs > or =1.0 cm in diameter, P < .05 for each reader). CT attenuation measurements were not useful for determination of gallstone composition. Abdominal CT performed at 140 kVp may be useful when gallstone disease is of clinical concern.

Workflow assessment of digital versus computed radiography and screen-film in the outpatient environment.

An objective assessment and comparison of computed radiography (CR) versus digital radiography (DR) and screen-film in terms of workflow, productivity, speed-of-service, and potential cost justification for imaging ambulatory patients is presented. Perceived ease-of-use and workflow of each device is collected via a technologist opinion survey. Productivity is measured as the rate of patient throughput from normalized timing studies. The overall speed-of-service is calculated from the time of examination ordering as stamped in the radiology information system (RIS), to the time of image availability on the picture archiving and communication system (PACS), to the time of interpretation rendered (from the RIS). Comparative results of screen-film (analog) versus a CR reader and a DR dedicated chest unit show a higher patient throughput for the digital systems. A mean of 10.7 patients were moved through the DR chest room per hour, and 9.2 patients per hour using CR, versus 8.2 patients per hour for the analog device. Measured time to image availability for interpretation is much faster for both DR and CR versus screen-film, with the mean minutes to image availability calculated as 5.7 +/- 2.5 minutes for DR, 6.7 +/- 1.5 minutes for CR, and 29.2 +/- 14.3 minutes for screen film. DR and CR can improve workflow and productivity over analog screen-film in a PACS for delivery of projection radiography services in an outpatient environment, but DR requires high volume to be cost effective over CR.