Opening New Frontiers in X-ray Technology

Opening New Frontiers in X-ray Technology

Latest innovations in DR include advanced applications like tomosynthesis that is being offered by several OEMs with general radiographic suites, and on remote RF systems to provide improved detail visibility.

Medical technology is progressing at a rapid pace, and the advancements play an ever-increasing role in health and wellness treatments. This effects many healthcare fields, and arguably one that is most impacted is radiography. It is undeniable that X-ray technology has changed the medical field forever and as the X-ray film moved to computed radiography (CR), patients and providers saw tremendous benefits from the resulting enhanced image quality and speed of imaging results. After all, the technology eliminated the likelihood for reshooting an image, therefore lessening the exposure to additional ionizing radiation, reducing costs, and streamlining diagnosis. Later, the advent of digital radiography (DR) ushered in further improvements to image quality, speed, and dose efficiency. Today, DR is helping to drive improvements in the cost of healthcare; while digital imaging incurs some expense, the elimination of film delivers significant cost-savings to the hospital in terms of equipment and space to store films.

This new realm for X-ray is just a beginning. A decade ago, for example, tomosynthesis was cumbersome and not easy to use. Today with direct digital, it delivers the rapid sequence of images that makes the technology clinically useful. Emerging image processing technologies, such as bone suppression for separating soft tissue from bone, are designed to deliver new or additional diagnostic information to the physician. And there are other tools under development that allow us to use X-ray in a new, more dynamic way, including the ability to quantify data from the X-ray image and use that information to accelerate the time to diagnosis and improve clinical confidence. Such innovations are perhaps not surprising, considering how far technology has come in the past decades.

Technological Advances

There are several notable new and emerging technologies. First, the introduction of automatic exposure detection (AED) will have revolutionary effects on the radiographic image capture world. With AED, DR is now as adaptable as CR in that without any other modification DR can be used with any system. Other advances in digital include new image stitching techniques that combine multiple images into on continuous image, dual energy imaging that can help with specific tissue image enhancement, and tomosynthesis that creates images that can be viewed in three-dimensional decks and reduce superimposition.

Direct readout radiography. The most important advancements in DR regarding patient care include the introduction of true direct readout radiography. In the beginning, digital referred to CR, and required the X-ray technicians to run the phosphorus plates through a CR processor before the image was ready to be read. By going to CCD, gadox, and most recently cesium, the images are available to be read by the radiologist in 3–5 seconds. This saves the patient and facility a huge amount of time.

Post-processing software. Over the last 10 years, the biggest advancements in patient care would arguably have been the enhancement to post processing software. Today’s acquisition suites have come a long way since their introduction in the early 1990s. Using advanced algorithms, technicians are able to use less radiation to obtain the same image detail and quality. Lowering the doses is one of the most valuable advancement that can be done in radiography.

AED. Digital panels have been around for a while; the newest and most popular technology available today is the AED. Excess dose is a real hot subject that has been virtually eliminated now by panels that react and acquire at blistering speeds. Less than a 5 millisecond response time is very common. The market is now seeing dynamic panels with very fast reaction and reconstruction time so that positioning and techniques can be verified. Even during fluoroscopy studies, these panels can be utilized.

Wireless DR detectors. The introduction of wireless DR detectors has revolutionized X-ray imaging. Some of the latest detectors offer advanced image quality, greater reliability, and faster capture speeds. The ability to register all DRX detectors with all DRX portable and room-based systems delivers exceptional flexibility and redundancy.

Tomosynthesis. The latest innovations in DR include advanced applications such as tomosynthesis where the X-ray tube sweeps across the patient and makes a series of exposures during the pass and the imaging computer compiles a 3D image from the views acquired. Several OEMs are now offering this feature with general radiographic suites, and on remote RF systems. This functionality can provide improved detail visibility, over CT. Currently tomosynthesis is used in mammography but it would have application in many imaging scenarios. Standing and weight-bearing studies can also be done with tomosynthesis.

Dual energy. Dual-energy imaging is becoming more popular as well. Thanks to advances in image processing, two images can be taken of the same anatomy at different energies. For example, from a chest X-ray, there would be three possible images produced by subtractive software, just the bones or just the soft tissues and internal organs and both together.

Sharing equipment. Using Bluetooth, the most advanced detectors are designed to connect automatically to equipment that controls the X-ray tube and generator. Installation is accomplished with a wireless access point through which images can be sent for display or storage, image processing software, and a display screen. Auto detect features are staples in new products and can be used to control detectors and other X-ray components at multiple locations in a facility.

Radiation-shielding screen. The radiation-shielding screen not only provides protection from harmful radiation, it also provides a workspace for radiographers to carry out their work efficiently and with complete confidence that they are protected. The screen today is modern, durable, up-to date with hospital infection control, and of course, aesthetically pleasing, for not only staff, but patients too. The next-generation screen now introduces a modular system that can be installed anywhere and with less installation down time. Due to the new structure with steel workings within the screen, the aluminum trim has been removed so the top of the screen is completely lead X-ray glass, leaving a futuristic look.

Looking to the Future

Despite all of the innovations the DR sector has seen as of late, even more progress is slated for the future. For one, the industry envisions a future with even more advanced software applications. Technicians will continue to see the physical characteristics of the flat panels evolve. And may also see different sizes and shapes of DR panels made available, along with fused or hybrid imaging like it has been seen within the modalities of CT, MRI, and PET. The industry will also see the potential for exploring new options in how DR panels are manufactured. Manufacturers are considering how to make things lighter, more water-resistant, sturdier, less costly, and anti-microbial, since infection control is an important issue in hospitals today.

X-ray is often the start of a patient’s care journey and supports critical clinical decisions from prevention through treatment across the care continuum. It affects productivity, workflow, and care team satisfaction. It is more than equipment and more than an image. X-ray is an imperative. There is yet untapped opportunity in DR. No one yet knows where this will take the market, but it is believed that X-ray will find new avenues of clinical usefulness in the future.

Second Opinion

Current Trends in X-ray Imaging – A Radiologist’s Perspective

With continued growth and development in the field of radiography, we have progressed from conventional wet radiography to computed radiography (CR systems) to digital radiography (DR systems) in the last one century. These developments enable us to view X-ray images on computer screens, substituting the conventional films, and making it possible to use digital image modification. We can get high-resolution images as soon as the technician hits the exposure button without wasting any moment in processing. These images can also be modified digitally as per the requirement of diagnosis.

Modification in obtained images not only helps to diagnose or rule out particular pathologies but also helps to avoid repeat exposure to patient, in case exposure given by technician is suboptimal. Though this journey has lots of advantages but most significant are better imaging quality, reduced radiation dose and scan time. The demand for portable and mobile X-ray equipment has increased tremendously in the last few years and will continue to show an upper trend due to convenience in its use.

Being a radiologist my views are more centered on growth of X-ray technology providing better image quality and imaging capabilities, as well as on awareness and radiation dosage reduction.

Current trends are toward reducing time in acquisition of scan and in reducing radiation doses. Not only by application of the ALARA (as low as reasonably achievable) principle can we reduce radiation exposure to patient but by modifications in equipment and technical expertise of radiation technologist we can also significantly reduce radiation exposure and time. However, in one way reducing time of scan is itself a measure to reduce radiation dose because time is a dominant factor in total radiation dose given to patient during scan. CAD (computer aided detection) is an advancement in improving diagnostic accuracies. Artificial intelligence in radiology, 3D imaging, and IoT (Internet of Things) are fields of continuous research.

In conclusion, I think the greatest challenge in using modern radiation devices is to use them wisely. With the right guidance and training to effectively use medical radiology devices, we can optimize use of imagining modalities for mankind.

Dr Madhur Saxena
Consultant Radiologist,
Rukmani Birla Hospital and Research Institute

Second Opinion

X-ray Technology – Expanding Horizons

1895 is a landmark year in the history of medicine for mankind. Dr Wilhelm Conrad Roentgen discovered X-rays and in 1901 was awarded the very first Nobel Prize in medicine for his discovery. This discovery revolutionized the way medical fraternity looked at human anatomy and there has been no looking back. When I opted for radiology I was asked by all the interviewing team why I was keen to pursue a waning modality with newer technology on the horizon; however, over time the basic X-ray technology is far from becoming obsolete.

Today the X-ray technology has advanced to new horizons and is breaking newer barriers. From conventional to CR and now DR there has been a tremendous refinement in the processes for viewing the images of the human body from inside out. Truly speaking even the computerized tomography is but an evolvement of how X-rays can be used.

In computerized radiography and digital radiography newer trends are being witnessed. Latest flat panel detectors are being manufactured with the capability of faster and sharper acquisitions and transmission and viewing of images. A single wireless digital radiography detector can be used universally for several machines thus lowering the cost of such detectors across the vendors.

X-ray technology is also used for mammography and the latest machines use technology for providing digital breast tomosynthesis images leading to better and earlier detection of small lesions. Radiation dose limitation is also taken care of in all latest advances.

Radiology technology has advanced by leaps and bounds to a stage where the vendors too understand the impact of the developments toward patient advantage and therefore cost-effective solutions are being offered. This will go a long way in helping to promote technology and provide its benefits to Tier II and Tier III townships of countries like ours and other developing countries.

Dr Dinesh Kapoor
Director and HOD of Radio Diagnosis,
Fortis Healthcare

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