Direct radiography (DR) and computed radiography (CR) are the two kinds of digital imaging systems used in general medical radiology. With DR, the image is transferred from a solid-state plate or a charge coupled device (CCD) camera directly into the computer. With CR, the latent image is captured on a reusable phosphor storage plate, which then must be read by a scanner. CR is analogous to dry processing. Since DR has fewer operator steps than CR, it is capable of handling more patients in the same amount of time. Chiropractic offices generally use CR systems because DR systems are much more expensive—with a starting cost of approximately $65,000—and handling large numbers of patients is not normally an issue.

Quality Images

Both DR and CR produce high-quality images, and you could benefit in cost savings and efficiency with either modality. You will no longer have to work with x-ray film or chemistry, and with digital imaging you can x-ray a patient and have the image available for interpretation in a minute or less. Digital imaging enables easy storage and retrieval of images. And, images can be sent via the Internet to colleagues or radiologists for over reading. Digital images can be displayed in different parts of your office, but you must provide the necessary computer infrastructure. You can also provide patients with copies of their x-rays by just burning them on a CD. In addition, both DR and CR systems have wider exposure latitude than x-ray film. So it is almost impossible to overexpose or underexpose an image, because the software will compensate. With traditional x-rays, you would have to shoot another film.

Digital x-rays provide better images. In addition, digital x-rays afford you the advantage of being able to enhance them to bring forth the diagnostic detail. With digital x-rays, you can do the following:

• Via colorization, each density can be shown in a different color, which makes it easier to explain the diagnosis to your patient;
• X-rays can be magnified;
• X-rays can be contrast-enhanced or edge-enhanced;
• The images can be inverted (white and black rather than black and white); and
• Specific areas of density can be brought out by window leveling.

Traditional x-ray film does have the benefit of being portable. You can bring the film anywhere (to a colleague's office or the treatment room, for example). However, with the necessary computer network infrastructure, you can actually do the same thing with digital images.

You have two choices:

1) Your office can be hard-wired with a central server and different computers in different rooms.

2) You can use a laptop or Tablet PC

ALLPRO Imaging’s ScanX® 14 In-Counter with In-Line Erase is a computed radiography system designed for chiropractic offices. It eliminates the need for film, chemicals, a film storage area, film duplication, processors, and a darkroom.

in wireless mode to bring the images anywhere in your facility. Just be sure that you have a secure wireless network so there's no problem in terms of Health Insurance Portability and Accountability Act (HIPAA) regulations.

Most machines produce similar image quality. The US Food and Drug Administration controls both the imaging software and the devices. They are allowed on the market only if they produce diagnostic-quality images. However, some systems may require more radiation dose to the patient than others.

A digital system makes it much quicker and easier to file and access your x-rays, since you will be storing them in your computer. You won't have to rummage through files, and it saves you filing space in your office. And, you won't need a darkroom or chemistry because you can use your digital system in regular office lighting.

CR: The System of Choice

DR makes life simpler and more productive, but the additional expense must be offset by an increased patient load to make the switch to DR economically feasible. However, the average price for a CR system, which ranges from $20,000 to $50,000, is making CR the system of choice for chiropractic offices. For the office that uses approximately 25 x-rays or fewer per day, CR is the most cost-effective option. A CR system can reduce film and processing expenses while providing the benefits of digital imaging.

Generally, the simplest way to pay for a digital system is to purchase a 5-year lease with a buyout provision. With a digital imaging system, there is no cost per image. To ascertain how much time it will take for your office to pay for a digital system in cost savings, you should determine how many x-rays you currently take per month, noting that each x-ray costs approximately $4.

CR systems use reusable phosphor storage plates (PSP) instead of film. The x-ray is taken using a PSP, and then it is transmitted to a reader/scanner, which delivers the image to your computer. The most economical system for most

chiropractors would be a CR system with a manually fed scanner. You can spend more money to get a more automated Asystem, but since most offices don't take more than 25 x-rays per day, you will find the price of a manually fed scanner to be the most cost-effective.

For a roundtable discussion on this topic, go to "Go Digital" in our July 2006 issue.

It is not difficult for a chiropractic office to convert to CR from traditional film. Storage phosphor plate cassettes will take the place of x-ray film cassettes; you expose generally as though it were 400-speed film; then, instead of processing the film, you will scan the plate.

It is quite simple to learn CR because the imaging chain is so much like x-ray film. CR software is intuitive. I suggest a few hours of software training with follow-up at a later time. It is a straightforward process. If you can use e-mail, you should have no problem running CR software. Please note: When buying a digital imaging system, it is important to ascertain how much and what kind of support will be offered by the company. After you purchase the system, will you receive in-office or telephone support? CP

Fred Fischer is vice president of sales for ALLPRO Imaging, a manufacturer of x-ray imaging products. He has more than 30 years of experience with medical radiographic systems, initially with film and processors and the last 15 with digital imaging systems. A frequent lecturer at medical and dealer groups on digital imaging technology for the private office, Fischer has also published numerous articles in medical magazines. He is coholder of a patent for a computed radiography scanner. He is a graduate of Manhattan College with a degree in electrical engineering. Contact him at (516) 214-5611.