Agfa Computed Radiography (CR) Digitizers

• [click] Radiological Imaging Technology (brief)

Despite being the oldest of medical imaging modalities, traditional projection radiography accounts for roughly 60 to 70% of all radiology procedures are diagnostic screen-film X-ray exams. CR systems use photostimulable phosphor imaging plates housed inside of cassettes, which must be taken to a separate CR reader to be scanned and form the digital image. DR images are acquired by a flat panel detector and then immediately digitized. The main advantage of CR and DR in a picture archiving and communications system (PACS) environment over traditional film-based systems is the separation of image capture, processing, storage, and display, allowing for the individual optimization of each of these steps. The ability to convert these exams into a digital format and store them in a PACS system results in increased efficiencies and streamlined workflow. Any move to digital can positively impact facilities and operations, helping to maximize productivity and patient throughput.

Many institutions are trying to increase the productivity of the radiology department. The workflow of a film-based department is quite inefficient compared with that of a filmless and paperless department. Hence efforts were made to redesigning the workflow to utilize CR with the PACS integrated with the hospital/radiology information system (HIS/RIS) to facilitate the automated electronic transport of images and patient medical records. They were able to eliminate say 50 steps from the film-based workflow, requiring reduced staff members for the entire process.

There is continual pressure on the radiology department to increase its productivity. Two important links to productivity in the computed/digital radiography (CR/DR) workflow chain are the post-processing step by technologists and the primary diagnosis step by radiologists, who may apply additional image enhancements to aid them in diagnosis. With the large matrix size of CR and DR images and the computational complexity of these algorithms, it has been challenging to provide interactive image enhancement, particularly on full-resolution images. AGFA’S multiscale image contrast amplification (MUSICA) are typical CR/DR enhancement algorithms, each with several adjustable input parameters. These algorithms tackle the problem of the diagnostically relevant dynamic range of a radiograph being too large to be displayed with good contrast.

Advantages of CR:

a) Decreased Costs

CR uses imaging plates instead of X-ray film. These imaging plates can be re-used 15,000 to 40,000 times, eliminating the need for X-ray film and film processing.

c) Improved Post-Processing Efficiency

Because CR X-ray exposures are digital, they can be post-processed and modified, forwarded via data networks, and archived digitally.

d) More Information in one Image

The imaging plate’s dynamic range enables most diagnostic information to be displayed in a single exposure.

d) Consistent High-Quality Imaging

The advanced imaging plate technology results in consistent, high-quality images.

What is Computed Radiography (CR)?

CR is a cost-effective solution to move from analog to digital imaging. With CR, the transition to digital is completed by installing CR readers and replacing X-ray cassettes (which use X-ray film) with CR cassettes (which use imaging plates). The imaging plates are exposed and inserted into the CR reader. The reader scans the plates, digitally displays the image on the workstation, and erases the imaging plate for reuse.

A complete range of digitizers is offered for computed radiography (CR), so you are sure to find the one that suits your throughput needs, fits your centralized or decentralized workflow, can grow and adapt to your changing environment, and offers an exceptional price/performance ratio.

Other than the absence of film and chemical processing, computed radiography, works very much like conventional film-screen radiology.

Compared to conventional film-screen capture, CR technology can speed image availability, reduce retakes and duplication costs, and boost workflow productivity. CR also offers more options for displaying, sharing and storing images. Efficiency - better workflow and greater productivity - remains a top priority for healthcare providers.

Combining standard phosphor plates and needle-based detectors

The DX-G and DX-M digitizers are the only ones on the market that have the potential to mix both standard phosphor plates and needle-based detectors. This means you can keep using your existing X-ray systems, and move smoothly from analog to digital without additional expenditure. What's more, the DX-M offers all this, with the high-level quality demanded by mammography(only available outside US and Canada).

DirectriX detector technology:precision image quality and potential dose reduction

DX-M includes an innovative and exclusive DirectriX needle-based detector technology. With the higher Detective Quantum Efficiency (DQE) you get benefit from a combination of high image quality and the potential for reduction in patient X-ray dose. While this is especially critical in neonatal and pediatrics, it is certainly welcome for all your patients!

Workflow wonders

With CR workflow, improvements begin at the point a technologist enters patient information into the system. From then on, patient information is captured electronically and available to access with touch of the screen or keyboard. The number of steps during an exam is reduced because the information is captured and there is no film to physically process, retrieve, review, and deliver.

The introduction of Fuji's FCR Pocket ID PDA eliminates steps in a technologist's workflow by permitting him or her to download patient information from the workstation and then move throughout the facility to perform exams.

For a lead technologist or radiologist, reading reports no longer means handling stacks of film. Like a radiology manager or medical physicist, he or she can sit at a desk to review the exam. From there, the reports are sent electronically to practitioners — eliminating the need for more handling and a courier service.

The storage of CR images is one of the final workflow improvements. CR systems integrate with PACS allowing for electronic storage of files. Hooper says he likes the efficiency and ease of storing CR images in their PACS at UVA Health System.

With decentralization and the ability to capture the patient information and exam at point-of-care, the workflow is more manageable than if the patient has to be moved around the hospital. The exam is done where it is needed, saving time and energy, and improving workflow.

The centralization of the electronic management for decentralized CR imaging provides an efficient way to communicate information. Running to different rooms, floors, and buildings is replaced by gathering and transmitting information from a single workstation.

Compact Digitizers and their performant

The CR family of digitizers offers you exceptional convenience for a broad range of applications. If you're looking for aversatile, small-footprint digitizer for your decentralized CR environment, the 35-X offer just what you need. And if you need a high-throughput, centralized digitizer, then the CR 85-X may fit the bill. Whichever one you pick, you can be sure it will give you high quality and throughput, even in limited spaces.

Because of the portability and decentralization of CR units, patients do not necessarily have to move throughout a facility for radiology exams. A CR system in an emergency room area not only means a quicker diagnosis during a critical time, it also means less stress on the patient without having to leave the area.

Agfa HealthCare recently presented its entire Computed Radiography (CR) solutions family range at Radiological Society of North America (RSNA: is the platform for world firsts: New products and solutions, not just for the imaging sector, attracted interest from physicians and decision makers), composed of four leading solutions all of which have been installed around the world: a desktop, compact and convenient CR solution which is easy to install, use and maintain, ideal for decentralized environments; a highly versatile digitizer specially designed for decentralized CR environments and with a small footprint; a multi-user digitizer, featuring a unique 10 cassette drop-and-go buffer that eliminates waiting times and maximizes productivity; a groundbreaking CR system that has created a new threshold in CR. It fills the gap in the current range of Digital Radiography solutions, by providing a unique combination of image quality, potential for dosereduction, speed and flexibility that exceeds traditional CR solutions.

(1) CR30-X

The CR 30-X digitizer for computed radiography (CR) is a compact, tabletop digitizer for decentralized CR environments. It combines high image quality with high throughput. Easy to install, use and maintain, it provides seamless integration, from X-ray exposure to print or soft copy. Flexible and robust, it uses proven technologies to ensure uncompromising and consistent image quality and reads at 10 pixels/mm for all image plate sizes.

Using dedicated cassettes that are inserted horizontally, the CR 30-X requires minimal space and easily integrates in vans, trucks and other mobile facilities, or anywhere that space is an issue.

AGFA CR MD4.0T General Set 35x43cm or a Set 24x30 cm

CR MD4.0T General cassette with imaging plate for image processing in high-resolution mode. The plate has been pre-initialized. Demographic and examination-related patient data are transferred without contact to a memory chip integrated in the cassette. The cassette is used with the CR 30-X Digitizer for general radiographic applications.

When you combine it with the optional universal X-ray shielding, the CR 30-X can also be used inside the X-ray room.

CR 30-X offers an ideal solution for any private and decentralized CR environment, including decentralized hospital departments, orthopedics and chiropractics, dental, military and veterinary applications.

Cassettes with memory

CR 30-X uses dedicated cassettes with an embedded memory that stores the data entered during identification. The built-in antenna card identifies the data by no-touch radio-frequency tagging. ID data and images are linked from the beginning throughout the entire electronic processing system.

NX

CR 30-X is available in combination with NX, Agfa’s image identification and quality control tool, for a highly efficient and optimized radiology workflow.

Low total cost of ownership

Installing the CR 30-X can be done in a single day. With the special LED technology in the erasure unit, no additional electricity is required, so standard electrical outlets are sufficient. No preliminary electrical work means a lower set-up cost and simpler installation. With its modular, component-based design, it offers faster, easier and more cost-effective maintenance.

Can be used with following products and services

- CR MD4.0T

- MUSICA 2

- NX

- SE

- DRYSTAR 5300

- DRYSTAR 5302.

Key benefits

- Small footprint

- Three resolution modes

- For a broad range of applications

- Also suitable for mobile applications

- CR User Station.

• Table-top digitizer

• Broad range of applications

• Low cost of ownership

• Horizontal cassette insertion

• Mobile.

The CR30-X digitizer obtains patient data and image data output from the NX workstation. Based on these data CR30-X scans the phosphor plate and produces an image. This image is automatically post-processed and optimized on the basis of your desired programmed parameters. The image is then automatically sent to the NX workstation sent. Automatically, or after release by the Radiographers the images are sent to the archive to the printer and any other desired station.

The CR30-X is a tabletop digitizer. The CR30-X has a throughput of up to 82 cassettes per hour.

Broad range of applications

CR 30-X is a highly versatile digitizer. It offers an ideal solution for any private and decentralized CR environment. CR 30-X can handle general radiology and dental applications.

Full data

The CR 30-X makes no compromises in image quality: it reads imaging plates at the high resolution of 10 pixels/mm for all image plate sizes.

Table-top

With its table-top size, the CR 30-X digitizer can be placed easily at any location. It works with dedicated cassettes and was designed with ease of use in mind, for optimal handling, comfort and maintenance. When combined with the optionally available universal X-ray shielding, the CR 30-X can be used inside the X-ray room.

Low total cost of ownership

Installing the CR 30-X can be done in a single day. With the special LED technology in the erasure unit, no additional electricity is required, so standard electrical outlets are sufficient. No preliminary electrical work means a lower set-up cost and simpler installation. With its modular, component-based design, it offers faster, easier and more cost-effective maintenance.

CR 30-X is available in combination with NX, Agfa’s image identification and quality control tool, for the most efficient and optimized radiology workflow.

Cassettes with memory

CR 30-X uses dedicated cassettes with an embedded memory that stores the data entered during identification. The built-in antenna card identifies the data by no-touch radiofrequency tagging. ID data and images are linked from the beginning throughout the entire electronic processing system.

(2) CR35-X

Small footprint digitizer for the complete range of clinical applications

• multi-application digitizer

• Three different image resolution modes (pixel pitch [micro meter] : 50 - 100 - 150)

Features :

CR 35-X is a highly versatile small footprint digitizer that is specially designed for decentralized CR environments.

CR 35-X is a multi-application digitizer, benefiting from three different image resolution modes. Suitable for following market segments

In combination with application-specific plates and cassettes, CR 35-X supports a broad range of applications:

- General Radiology

- Orthopaedics

- Extremities

- Dental

- Peadiatrics

- Radiotherapy.

- Mammography (not available in the US)

Full data

CR 35-X reads imaging plates at a standard resolution of 6 pixels/mm. The high resolution mode of 10 pixels/mm is available for all image plate sizes. The maximum resolution mode of 20 pixels/mm is available for dedicated 18 x 24 cm and 24 x 30 cm extremities cassettes and plates.

Small footprint

The small CR 35-X footprint allows it to be placed easily at any location. Designed with ease of use in mind, it requires only a standard wall outlet. Together with a universal X-ray shielding, optionally available, the CR 35-X can be used inside the X-ray room. In combination with a mobile kit, it is also fit for mobile use (vans, ships, military, etc.).

CR user station

Its modular and ergonomic design includes:

- Cassette identification functions

- Space for:

• Workstation for image handling, processing and dispatching

• Monitor, network switches and UPS

• Cassette storage.

(3) CR85-X

The CR85-X digitizer reads the patient data and image data from the identified cassette. The NX workstation integrated with an ID tablet. Based on these data, scans an image is produced on the phosphor plate.

This image is automatically post-processed and optimized on the basis of the preferred programmed parameters. The image is then automatically sent to the NX workstation. Automatically, or after release by the Radiographers, these images are dispatched to the archive to the printer and/or to any other desired station.

The CR85-X system is Agfa's third generation phosphor plate systems. It is a very compact system with a footprint of only 0.7 m2.

CR System with imaging plate reader with input/output buffer. Acquisition Workstation that receives and processes raw images from the CR 85-X Digitizer. This package includes software for network communication. It has already been prepared for integration in a PACS solution via Dicom. Connection of a laser imager via Dicom Print for film printouts is possible and has already been prepared for.

Despite its small size, the system concept has the provision to accept a buffer to process and a collection of 10 cassettes. The exposed and identified cassettes can be mixed in the buffer placed. By means of this buffering concept, the CR system is very efficient. By placing a CR85-X, the highest productivity of a bucky chamber is achieved. I.e. there is no waiting period for laboratory personnel during each changeover of the plates.

The CR85-X has a maximum throughput of 115 plates per hour.

Key benefits

- No waiting times for improved patient care

- Input/output buffer for maximized productivity

- For a broad range of applications

- Compact footprint.

Features:

CR 85-X is a multi-user digitizer featuring a unique drop-and-go buffer that eliminates waiting times and maximizes productivity.

CR 85-X is a multi-application digitizer, benefiting from three different image resolution modes and maximizing productivity for the complete clinical application range.

Suitable for following market segments

- General radiography

- Orthopaedics-Extremities

- Dental

- Paediatrics

- Optimal accessibility.

Maximizing productivity for the complete range of clinical applications

• No waiting times for improved patient care

• Input/output buffer for maximized productivity

• For a broad range of applications

• Three different image resolution modes (pixel pitch [¼m] : 50 - 100 - 150).

CR 85-X is a multi-user digitizer featuring a unique drop-and-go buffer that eliminates waiting times and maximizes productivity CR 85-X is a multi-application digitizer, benefiting from three different image resolution modes.

Highest productivity

The cassette buffer eliminates waiting times and allows for a continuous workflow within the department. Zero-button operation with automated cassette handling makes CR 85-X a highly productive and user-friendly system with a throughput of up to 112 plates an hour, depending on size and application. Using CR 85-X as a central digitizer in the radiology department, multiple examination rooms can be supported. The CR 85-X digitizer requires no manual interaction and all the user has to do is to deposit the cassettes in the input buffer (up to 10 cassettes). The digitizer automatically takes cassettes from the input buffer and reads the demographic data from the memory on the cassette. It then scans the imaging plate, digitizes the image and returns the cassette to the output buffer for new exposures.

CR 85-X reads imaging plates at a standard resolution of 6 pixels/mm. The high resolution mode of 10 pixels/mm is available for all image plate sizes.

The maximum resolution mode of 20 pixels/mm is available for dedicated 18 x 24 cm and 24 x 30 cm mammography and extremities cassettes and plates.

Broad range of applications

In combination with the application-specific plates and cassettes, CR 85-X supports a broad range of applications :

• General radiography

• Orthopaedics – Extremities

• Dental

• Paediatrics

• Mammography (outside US).

Compact footprint & optimal accessibility

CR 85-X occupies a very small floorspace and at the same time provides unhindered access to several users, both at the input and the output buffer, resulting in a smooth flow of operations. This concept makes CR 85-X the state-of the- art solution for centralized CR environments.

CR user station

Its modular and ergonomic design includes:

- Cassette identification functions

- Space for:

• Workstation for image handling, processing and dispatching

• Monitor, network switches and UPS

• Cassette storage.

(4) CR Mammography

Agfa CR Mammography provides a cost effective and user-friendly solution for moving to digital mammography. The familiar cassette-based workflow requires minimal training and facilities can reuse existing analog X-ray modalities for maximum affordability. Key components like the CR 85-X can also be configured to support mixed use between Mammography and General Radiology. This unique approach offers imaging for all digital mammography, while providing productivity benefits throughout a facility. Specific to your unique needs and the existing components you have, Agfa can deliver a seamlessly integrated digital mammography workflow.

The Agfa CR Mammography Solution consists of all the components of a digital mammography workflow :

- CR 85-X : workflow efficiency in an ideal multi-user, multi-application digitizer

- CR 35-X: a perfect single plate digitizer for decentralized use

- CR MM 3.0 Plates and Cassettes : Improved sharpness and reduced structure noise.

- CR 25.0 : a perfect single plate digitizer for decentralized use

- CR Mammography Workstation with dedicated MUSICA ; NX with NX Mammography license or CR Quality System (QS) software

- IMPAX Breast Imaging Workstation ; IMPAX MA3000 ; high contrast, high resolution multi-modality display station

- DRYSTAR imagers with A#Sharp; DRYSTAR 5503 for centralized use or DRYSTAR 4500M for dedicated mammography

Both CR 35-X and CR 85-X, in combination with CR MM3.0 plates, passed the physico-technical and clinical tests

- This certification is the first of its kind for a CR Full Field Digital Mammography provider

- Proven solutions: Agfa HealthCare has over 3000 mammography installations.

- CR35-X and CR85-X can be used for both breast imaging and general radiography.

Agfa HealthCare, a leading provider of diagnostic imaging and healthcare IT solutions, announces today that its CR 35-X and CR 85-X computed radiography (CR) digitizers, combined with the company's CR MM3.0 mammography plates, received Mammographic Type Test certification by EUREF, the European Reference Organisation for Quality Assured Breast Screening and Diagnostic Services. This certification is the first of its kind for a CR Full Field Digital Mammography provider and supports Agfa HealthCare's dedication to this important specialty, backed by over 3000 mammography installations around the world.

Promoting standards to meet the quality standards for image quality, dose and stability

EUREF is a pan-European, not-for-profit organization whose mission is to promote European standards for breast cancer screening and care. Its certifications give healthcare providers confidence that the solutions and products tested meet the quality standards for image quality, dose and stability.

Agfa HealthCare solutions pass rigorous testing

Agfa HealthCare's CR 35-X is a very versatile, small-footprint digitizer, while the CR 85-X is a multi-user, multi-application digitizer. Used with the CRMM 3.0 dedicated storage phosphor plate for diagnostic mammography applications, each provides increased sharpness, for excellent image quality.

Both solutions passed EUREF's physico-technical and clinical tests, demonstrating that they meet the rigorous quality control requirements for the physical and technical aspects of mammography screening, and perform reliably in a screening environment. The testing process took three months.

(5) DX-S for Digital Radiography

Precision image quality and reduced X-ray dose

- DirectriX

DirectriX needle-based detector technology uses a crystal phosphor that allows higher packing density and layer thickness than is offered by powder phosphor when used in a binding material. In addition, the crystal phosphor’s reduced light spread increases sharpness. As a result, the detector’s X-ray absorption and conversion efficiencies are greater, leading to signifi cant patient X-ray dose reduction. High speed imaging - Scanhead Scanhead technology enables high resolution scanning of the DirectriX detector with a scanning resolution equal to 50 ¼m (20 pixel/mm). This line-to-line scanning provides an accelerated read-out resulting in a fast preview image and a high cassette throughput of up to 130 cassettes per hour. Furthermore, unlike point-to-point scanning, the very compact design integrates stimulation and light collection into one, convenient Scanhead module.

Flexible, compact, cassette-based design : DX-S has a compact, cassette-based design that makes it the flexible solution for decentralized environments and in-room use. The easy arrangement of the DX-S cassette results in a perfect fi t between the anatomy and the positioning, and reduces the time spent posing patients for diffi cult exams. Thanks to the portability of the cassettes, DX-S is the ideal application in places such as neonatal intensive care. At the same time, the digitizer covers a wide range of diffi cult exams. This combination of portability and flexibility make the DX-S an excellent digitizer for GenRad, Paediatrics and Emergency use.

Patient proximity

By locating the DX-S digitizer in examination rooms, technologists are able to remain with their patients during image acquisition, processing and quality control, for a higher patient satisfaction, especially for children. Additionally, the technologist benefi ts from the efficient and practical usage, for a better time management.

DX-Si: Integration for better interoperability

The DX-S interfaces with both the NX workstation and the DX-Si X-ray system to create Agfa HealthCare’s integrated digital radiography solution: DX-Si. DX-Si provides state of-the-art image quality, versatility, integration, high throughput, patient proximity and a solid return on investment. The result is the high image quality, greater workflow efficiency and improved patient care healthcare facilities want.

The versatile DX-Si X-ray system can handle a very comprehensive range of X-ray exams, from general radiography to emergencies and paediatrics. At the same time, its flexibility allows the creation of a system configuration to handle almost any facility’s specific diagnostic needs. It can be tailored with a radiographic table and wall stand, a radiographic table only or a wall stand only.

Patient comfort is on everybody’s mind, and the DX-Si X-ray system’s slim, lightweight detector makes positioning quick and easy, even for the most difficult exams, with less-mobile patients, for example.

Radiographers will also appreciate the simple, ergonomic design, which allows one-hand operation of the system. The integration of the X-ray system with the NX workstation translates into improved overall workflow efficiency.

Ceiling suspension: ultimate ease of operation

The overhead tube crane suspended from the ceiling operates with a touch sensor keypad, for complete flexibility, whatever image is needed. It can be operated with just one hand and lowered a full 1500 mm. The compact, telescopic design allows it to be installed even on low ceilings. It offers both automatic or manual tracking and collimation.

Radiographic table: accessibility for all patients

With its foot-operated brakes and motorized height adjustment, the DX-Si X-ray system’s radiographic table leaves the radiographer’s hands free for cassette handling and patient positioning. Its narrow table base provides excellent accessibility for all patients, including children and severly injured patients. The table bucky can be operated with one hand and allows easy removal of the grid.

Tiltable wall stand: versatile and comfortable operation in both upright and prone position

The DX-Si X-ray system’s wall stand bucky can tilt from +90º to -20º. The vertical travel range extends from 350 mm to 1900 mm above the floor level. This considerable movement provides the radiographer with remarkable versatility for any exam positioning. The wall stand also offers grid and AEC, as well as cassette size sensing, all for a more efficient operation.

Integration with the NX workstation: a more efficient workflow

Within the DX-Si solution, the DX-Si X-ray system interfaces with Agfa HealthCare’s NX workstation, for an integrated workflow. When a specific type of exam is selected, the appropriate X-ray settings are automatically transferred and displayed on the X-ray generator console. NX automatically adds the exposure settings used to the digital image file, and communicates seamlessly with PACS, HIS and RIS, eliminating manual data entry and typographical errors.

How can the DX-Si with the examination be deployed for efficient workflow, let us assume the trauma unit in the hospital? A typical Accident & Emergency (A & E) Department which is fully process-orientated and divided into four areas: recovery room for trauma patients, emergency area for responsive patients, an area specifically for follow-up examinations, and the plaster cast room. Dividing the workflow into acute and follow-up cases allows emergency patients to be seen faster because there is no overlap with less urgent, non-emergency studies. Waiting times are virtually eliminated.

A&E Department earlier studies showed by precisely timing of its patient flow, the results showed that about 80% of waiting time was associated with obtaining x-rays, which are crucial in planning further patient care.

Solution: use DX-Si in combination with the bed.

Waiting times have been cut more than 50 percent, resulting in less stress for the technologists; also noted was a significant increase in overall patient care. There is no need for staff to unnecessarily hurry back and forth. This all leads to a noticeable reduction in stress.

Finally, the radiologists themselves benefit from the new digital system thanks to its MUSICA2 image processing software that automatically adjusts density and contrast to optimize the anatomic detail being studied, providing excellent visualization. Physicians and staff spend less time manipulating images by hand, which streamlines workflows while increasing diagnostic confidence. Increased productivity results in faster patient turn-around. And thanks to the software’s new processing algorithms, the balanced presentation of bones and soft tissue within an image allows different studies to be completed using one image.

(6) Radview CR system

(7) NX

• [click] Agfa NX Workstation

For identification, the NX workstation consisting of a Windows XP workstation, equipped with an LCD touch screen display. The cassette in the CR30-X or the ID and the tablet placed examination research data are thereby coupled with the excellent picture.

In combination with a RIS, all relevant patient and examination data automatically fed via a DICOM Modality Worklist to the NX workstation. The data can of course, also be manually fed.

All images that one identifies on a NX workstation, appear by viewing the phosphor plate monitor of the appropriate drive. The NX drive can store the images (or forward) to an archive. One can choose to automatically archive images in a PACS, or manually forward these. The system can even provide an image or images to multiple destinations. For example a standard PACS archive destination, even in JPEG format.

NX makes image editing for the use of Agfa's patented imaging software MUSICA. Thanks to the MUSICA software, each image the maximum detail visibility guaranteed.

of course also be manually entered.

Almost immediately after placement of the cassete in the image digitizer, a technical inspection is conducted by the lab technician. Also, corrections in the letter placement, mirror / rotation, window / level, etc. collimation adjustments can be made, and also corrections to the identification.