Time to Upgrade

Over the last decade, the field of medical imaging has evolved from analog technology toward the digital age. This shift in medical imaging has seen the emergence of flat-panel detector (FPD) technology in everything from cardiology systems to portable X-ray equipment. Now, more than ever, hospitals and imaging clinics are trying to maximize the value of their imaging equipment, and digital radiography (DR) solutions in particular are proving to be a source of profit for many organizations. Doing more with less is the goal, and DR systems are providing beneficial reductions in the three most important areas – money, time, and dose.

Although CR is not likely to disappear soon, the need for these systems will shrink. In some instances, CR equipment will continue to be used as backup or by departments that otherwise do not have access to DR. They may even continue for specialty applications, as in the case of spine or long-leg imaging. Scoliosis patients, for example, may be imaged in a single exposure using several CR plates whose images are digitally stitched together.

Digital solutions have already begun to revolutionize medical imaging by offering improved image quality, faster processing time, and dose reduction advantages over their analog predecessors. Those who have already adopted digital imaging are part of a market that continues to grow and is expected to reach a value of more than USD 35 billion by 2019.

Technology Trends
Over the past decade, a great percentage of hospital purchases for new X-ray systems have gravitated toward DR. This shift is expected to continue, especially now that DR detectors have evolved in big leaps in several key dimensions – high image quality at low dose, enhanced ease of use, less expensive, lightweight, more portable, and wireless. Most of these improvements have been made possible by technological advances.

X-ray generators. Sophisticated power electronics and digital controls have come together in creating high-frequency DC X-ray generators. These enable the control of X-ray acquisition technique parameters and exposure duration to an extraordinary level of precision, resulting in minimal scattered X-rays that reduce image noise. This also results in optimal X-ray dose all of which contributes to imaging.

Flat-panel detectors. The technology behind radiographic and fluoroscopic flat-panel detectors has seen big leaps, enabled by the high manufacturing-process yields used in the processes common to commercial flat-panel displays. Flat-panel detectors with pixel count of 16 mega pixels and pixel pitch as small as 100 microns are now able to create HD-quality X-ray images of very-high-spatial and grey-level resolution. The sensitivity and dynamic range of these detectors are superior to film and CR plates, enabling the use of a much lower dose for acquisition. In addition, these flat-panel detectors yield a diagnostic-quality image over a wide range of technique factors, enabling ease-of-use of the X-ray imaging device similar to a point-and-shoot camera.

Image processing software. Today, software image-processing algorithms have matured to a point that can autocorrect for many deficiencies at the time of acquisition – they can rebalance and enhance contrast, sharpen edges and features, remove noise, and even act as a virtual anti-scatter grid. In addition, advanced functionality such as automated image stitching, digital subtraction angiography, dual-energy chest radiography, respiration, or ECG gated acquisition enables sophisticated clinical investigations and perfusion studies.

Size, weight, and portability. The form factor of most imaging devices has morphed to become smaller and lighter, enabled by advances in capabilities of electronic components in handling power and heat with increased processing power. Control consoles have become integrated and enabled by touch-screens that can be used for setting as well as viewing the acquired images. Mobile systems have become much more maneuverable. Some models are equipped with batteries and have the capability to acquire hundreds of X-rays from a full charge, thus avoiding use of lengthy cables to the closest wall power socket.

Looking Ahead
One thing is certain – the future of DR is wide open. Beyond dose issues, most customers’ checklists of needs focus on three points: extremely reliable direct DR solutions, flat-panel detectors providing excellent image quality, and systems with flexible usability. Hospitals and healthcare facilities are looking to be more efficient and to keep patients moving, which is where we see a growing market for mobile solutions and all-in-one units. Over the next few years, what they are really looking for is more utilization in leveraging the equipment that they have in place to do more things. So the radiology department has to become more competitive and be able to do more things for doctors.

In the near future, DR upgrades will soon be available for multiple imaging labs utilizing a common server, instead of multiple individual consoles for each room.

Currently, DR upgrades are offered as an enhancement to a single X-ray room and often include a single DR panel and console. However, facilities normally have multiple X-ray systems, so purchasing multiple upgrades can add up quickly. Soon, X-ray departments will be able to purchase multiple DR upgrades, including multiple DR panels, but utilize several receivers and a central server instead of multiple consoles, which will reduce the overall costs for facilities to upgrade multiple systems while still allowing a single-panel type to be used across multiple systems.

The radiology department will be forced to minimize the actual equipment costs and try to increase the actual asset utilization and department utilization of a particular system. Doing more with less is what facilities will aim for more in the next 5 to 10 years.

The future of DR is rapidly heading toward features and products that articulate value-based, cost-measuring, and patient-centric benefits.

It is important that we begin to realize the significance of access and ease-of-access to data that is also evolving. DR will need to become more data driven and data intelligent to gather and track these benefits, quantifying savings in costs, time, patient dose, retakes, mistakes, and every measure that benefits patient outcomes and satisfaction and the hospital’s bottom line.