DIGITAL

RADIOGRAPHY
 INTRODUCTION

 Radiology is divided into two main fields the

Diagnostic and the Therapeutic

 Radiology applied to the art of diagnosis, is

usually termed as Diagnostic Radiology or

Diagnostic Roentgenology
 The application of computer technology to

radiography has allowed for image

acquisition, storage and transmission
(teleradiography) to remote sites in a
digital format

 The use of computer in radiography has

given rise to new diagnostic method,

'THE DIGITAL RADIOGRAPHY'

 Light reacts with photographic film to create a

photograph, and x-rays interact with x-ray film to

make a radiograph-'film based imaging', where in
the image is recorded on a film as an invisible
latent image until processed in a dark room
 The replacement of this film based technology with

computer based devices that use electronic x-ray

detectors to record the x-ray image which is then
processed by the computer, and is called as
electronic image
 Film based images or radiographs are analog

images whereas electronic images seen on computer

screen are digital image.

 The use of term 'Digital' simply means that the

computer has processed the image

 Analog and digital images

 Conventional image or analog images consist of the

arrangement of silver grains in photographic
emulsion .
 Density of silver grains depends on intensity of the
x ray beam.
 When viewed on transmitted light ,the pattern of
different density is transmitted to the
eyes ,perceived as different shades of gray.
 In digital imaging large number of small light
sensitive elements is used.
 The digital image results from the conversion of
analog data to digital data which is done by the
analog to digital converter or FRAME GRABBER
 Thus the digital information can be stored 'in the
computer for further use.
 In digital radiography the images are acquired by
using the electronic image receptors called the
- CHARGE COUPLED DEVICE or THE CCD
- CMOS
- storage phosphor plate
 The digital information is contained in and
presented as discrete units of information and is
represented by either a 0 or 1 as the computer
language is based on the binary number system in
which two digits (O and 1) are used to represent
information
 These two characters are called as BITS, for
Binary Digits
 In a typical computer language the characters
form words, eight or more BITS in length called
BYTES
The image receptors are
made up of number of units
called as PIXELS that actually
stores the information until
processed by the computer
 WHY DIGITAL X-RAY?

1. Digital X-ray Saves time

 There is no delay between exposure and image

appearance on computer screen.
 There is no need for time-consuming manual
handling of film.
2. Digital X-ray is COST EFFICIENT

 Elimination of costs related to X-ray consumables

and the maintenance costs of film processing make

running a digital practice highly economical

 The increased efficiency through time savings allow

for increased patient yield and income.

 Free of chemical processing

 No chemical X-ray film processing,

 No darkroom

 No safelight/daylight arrangements

 No continuous maintenance and quality control

 No odors and difficult to dispose chemical waste.

 No film storage

 No manual handling of film

3. RADIATION HYGIENIC

 Patient dose decreases dramatically (up to 95%)

compared to film based imaging.

4. ENHANCED DIAGNOSTIC QUALITY

 Digital image enhancement provides new dimensions

for diagnostics
5. CONSISTENT IMAGE QUALITY:

 Digital images are not subject to variations and

errors typical to film processing (time,

replenishment of processing chemicals,

temperature, light leaks)

6. DECISION SUPPORT:

 Digital images can benefit from automatic decision

support systems.
7. SECURE STORAGE:

 Reliable electronic database with minimal

administration provides an automatic, systematic and

practical way to store and archive digital images.

 The user can easily make copies of the images

without decreasing the diagnostic quality and the

original images are always available.

8. COMMUNICATIVE:

 Presenting digital images for the patient on a computer

screen allows unlimited possibilities to procedure

presentations

9. TRANSFERABLE:

 Images can be sent electronically to insurance

companies and social security for faster reimbursement

10. PRACTICE IMAGE:

The practice using digital equipment is perceived as

quality oriented.

[Link] X-ray supports quality oriented working

practices with detailed documentation of the

treatment
 ASSEMBLY AND COMPONENTS

The basic components of digital radiographic imaging

system are

[Link] electronic sensor or detector/camera

[Link] to digital convertor

[Link] processing unit

[Link] and printer

 CCD SENSOR OR DETECTOR

A CCD is an x-ray or a light sensitive array of

semiconductors in a silicon chip
 2 main types of sensor arrays
1. Linear arrays
2. Area or two dimensional arrays: The area arrays
CCD sensors fall into two categories
- Fibro-optically coupled sensors
- Direct sensors
 "CHARGE COUPLING" is simply a process by which

accumulated light or x-ray photons are

transferred from one electron well to the next in

a sequential manner and finally to the readout

amplifier
 Fibro-optically coupled sensors use a scintillation

screen (an intensifying screen like lanex) coupled

to a CCD

 When x-rays strike the screen material to produce

photo electrons, and one x-ray photon will produce

hundreds of light photons which are then sensed

and stored by the CCD

X-rays

DIGITAL SENSOR
SCINTILLATOR
Scintillator
 Converts X-rays into
light (photons)

Fiber optic FIBER OPTIC

 Transmits light to chip
 Stops X-rays
Semiconductor SEMICONDUCTOR CHIP
chip (CCD/CMOS)
 Converts light into
electrical signal
Image readout (charge/voltage)
SIGNAL READOUT
 Dedicated electronics
 Conversion to digital
 Transmitted to computer
Direct data link to
the computer
WORKING MECHANISM:

 The CCDs are arrays of x-rays or light sensitive

pixels

 A pixel or (picture element) is a small "box" or

square into which electrons produced by the

incident x-ray or light photons are deposited.
This is also called as electron well

 Image made of small dots, pixels and the

information presented as digital data
 IMAGING PROPERTIES OF AREA ARRAY CCDS

1. High resolution (10 line pairs per mm)

[Link] x-ray sensitivity (exposure time 80% less
than E type x-ray films)
[Link] dynamic range
[Link] accuracy
[Link] signal-to-noise ratio (SN ratio) (contrast
scale is similar to CT that is 256 levels of gray)
 ADVANTAGES

1. Instant images (elimination of the dark room)

2. Consistent quality
3. High SN ratio (better detection)
4. Image manipulation
5. greater exposure latitude
6. Tele-transmission capability
7. Reduced x-ray absorbed dose to patient
8. Elimination of hazardous chemicals used in film
processing
 DISADVANTAGES

1. High initial cost system

2. Unknown life expectancy of CCD sensor

 CCD SENSOR CMOS SENSOR
Charge coupled device Complementary metal-oxide semiconductor

+ Stable and mature technology + Cheaper chip design

for X-ray imaging + Technology used in widely in
+ Good light gathering capacity, consumer electronics, video
high signal to noise ratio cameras etc., chips are cheaper
+ No on-chip electronics, whole to manufacture
surface available for imaging, (+) Very low power consumption
lower patient dose
+ Excellent image quality
- Challenging design - New technology in X-ray imaging
- Expensive to manufacture - Poor light gathering capacity,
- Becomes very expensive if large low signal to noise ratio
size needed - Requires on-chip electronics
that do not detect X-rays –
“BLIND SPOTS”
- Requires optics on top of the
chip that make the sensor as
expensive as CCD
- Becomes very expensive if large
size needed
 OVERALL (mm) ACTIVE (mm)
B0: 19 x 33 15 x 27
B1: 23 x 41 20 x 35
B2: 30 x 43 26 x 37
SENSOR THICKNESS 4 MM
SENSOR CABLE DIAMETER 3 MM
APPLICATIONS OF CCD IMAGING X-RAY

A. 2D/3D reconstruction

1. Bone loss

2. Implant sites

3. Pulp canal anatomy

4. Condylar - bone changes

B. Digital subtraction

C. Remote electronic consultation

 IMAGING PLATE (IP)
(Photostimulable Phosphor system)
 The digital images are obtained on a flat imaging plate (IP)
with photostimulable phosphor
 This is referred to as COMPUTED RADIOGRAPHY.
 The use of imaging plate as an x-ray imaging sensor is
based on the principle of photostimulable luminescence.
 The imaging plate system was first applied to panoramic
radiography and now recently used for intra oral
radiography
 The imaging plate is a polyester base sprayed and coated
with a crystalline halide composed of Europium activated
barium fluorohalide compounds (BaF Br:Ee2+).
 WORKING MECHANISM
 Imaging plate electrons are excited to higher energy

levels by primary excitation radiation and are trapped in

halogen ion vacancies that exist in phosphorcrystals
 These crystals are called luminescence centers

 When the phosphor crystal which the luminescence

centers absorb are irradiated by a second excitation the
trapped electrons are released and recombined
 This recombination energy is transmitted to the centers

of luminescence to create photostimulated luminescence.

 The processed digital radiographic information is

recorded on a single coated film

 The output images are the same size as the

conventional periapical radiograph.

 Unlike the conventional systems which use CCD

sensors this new system provides higher quality

digital images in similar settings

When x-ray beams are irradiated on to the IP, the x-ray energy
us temporarily stored within the crystals

A He-Ne laser beam scanning light is irradiated on to the IP

The x-ray energy stored in the crystals is emitted

as fluorescent blue light

The resulting fluorescent optical signals are then

converted to time-serial electric signals

A very small amount ofthe stored x-ray energy remains in the IP

even after the latent image has been converted to light.

This residual energy can easily be eliminated by exposing

the IP to sunlight consequently the IP can be used repeatedly
 IMAGING PLATE

1. Exposure

2. Prosphor plate stores a

latent image

3. Laser beam releases the

stored information
2
 Image readout in a
1 3
special scanner
4
A/D  Conversion to digital

data

4. Erasure of the plate for

reuse
 SENSOR OR IMAGING PLATE
Digital sensor Imaging plate
+ Instantaneous + Thin
+ Very high image quality + Same sizes as film
+ Very high sensitivity, + Wireless
low patient dose
+ Durable and long-lasting
+ Direct digital imaging
+ Smooth, round corners
- Flexible, but bending damages
- Thicker than film, rigid
the plate
- Cable - Plates wear in use and thus have
- Limited sensor sizes a fairly short life span
- Sharp edged
- Manual handling of plate,
protective sheet, scanner
- Time consuming scanning process
- Image quality inferior to film
and to sensor systems
- Indirect digital imaging
 A/D converter or Analog-Digital
converter or Frame grabber
 An important component of digital radiographic system
 In case of the units using the CCD as a sensor, the
continuous analog data is converted into digital data by the
help of a A/D converter or a frame grabber as computers
cannot display an image of analog data
 The analog information is converted into discrete units of
information
 The digitization of conventional radiographic image involves
continuous scale of grays into pattern of squares
 Each pixel is given a number value that corresponds to a
certain gray or optical density
 Only this digitized data can be stored in the computer
 digital image data is sent via a cable to the

computer for further processing

 In case of the photostimulable phosphor system or

imaging plate system, the read out of x-ray

information is converted by a photomultiplier into
electrical signals which are then converted into
digital signals by an A/ D converter

 Once this conversion is done the data can be

either stored or displayed on the monitor

 Central processing unit or the
personal computer

 The central processing unit or a personal computer

should be equipped at least with 640 KB internal

memory and a fixed dise along with its software
 The software is divided into two components

 The first is a data base handler which uses a

binary tree structure that keeps track of

radiographic images stored for individual patient
 The second component runs in a graphic mode and
controls
- the exposure, capture, display, storage and
retrieval of radiographic images
- digital image processing routines such as automatic
or interactive contrast and density control;
contrast window; pseudo color; digital spatial
filtering that permits noise reduction and edge
enhancement;
- measurement of distances, density histograms of
density values, density profile presented as a 3-
dimensional graph and zoom of an area of
interest
 MONITOR AND PRINTER
 The images are stored in a image, data base on a

hard disc or on a magneto-optical device for a long

term archiving
 Images can be hard copied by a laser printer,
thermal paper printer or dry processing film printer
 Electronic images can also be transferred by
telecommunication technology to other locations for
viewing and study by several people at the same time.
 Types of digital radiography

1. Direct Digital Intra-oral /Extra-oral Radiography

2. Indirect Digital Radiography

3. Digital Panoramic Radiography

4. Digital Subtraction Radiography

 Direct digital intra-oral/
Extra-oral radiography

There are fundamentally two different concepts for

direct digital image acquisition.

1. The CCD based (charge coupled device)

2. Storage phosphor (SP) system

Systems functioning on CCD technology
R V G : RADiOVISIOGRAPHY :
 In this system an intensifying screen is used for
energy conversion from x-ray radiation to light
 A prismatic bundle of fibre optics conveys the light to
a CCD detector
 The use of conical fibre optics makes it possible for
the system to have a sensitive area on the intensifying
screen approximately 17 x 26 mm2 despite the smaller
size of the detector
 The fibre optics limit the minimum thickness of the
detector to approx. 14 mm
RVG device is composed of 3 major components:
1. The "Radio" part consists of conventional x-ray generator
connected to a highly precise micro processor timer for a
very short exposure times and an anatomically adapted
sensor with rounded edge.
2. The "Visio" part of the RVG unit stores the incoming signals
during exposure and converts them point by point into one
of 256 discrete grey levels
3. The "Graph" part of RVG unit consists of a digital mass
storage unit that can be connected to various video printout
devices or direct photographs of the screen may be made to
provide opportunity to access the radiographic information
further
ADVANTAGES :
 The RVG system is able to produce -radiographic
images immediately after exposure and at
considerably lower dose than necessary for x-ray
films.
 Image manipulation is possible with the ability to
cause contrast enhancement or gray scale reversal.
 Necessary magnification is possible

DISADVANTAGES :
 Decreased image resolution and contrast as
compared with conventional films
 INDIRECT DIGITAL RADIOGRAPHY

 One system uses a photomultiplier tube with a

small aperture of 100 x 100 Um to scan an
illuminated radiograph
 An analog output from a photomultiplier is
digitized by an analog-to-digital converter and
the data is processed by the computer and fed
into the digital to a analog converter whose
output is used to modulate the light intensity
of a glow tube.
 The light output from the glow tube is directed to

a sheet of radiographic film and an image is

recovered following standard processing procedures

 The second system for acquiring indirect digital

image employs a television camera as a sensor and

a monitor or a printer for display.

 ADVANTAGES:
1. Improved diagnosis because of enhanced perception as
manipulation of digital images in terms of image quality
can be done.
2. Storage of information can be done just as in direct
digital radiography
3. Information transmission.
 DISADVANTAGES:
Digital images processing of direct exposure non-
screen films may result in loss of information because
digitized image represent a second generation.
 DIGITAL SUBTRACTION RADIOGRAPHY
 Subtraction technique is useful mainly to detect subtle

differences between radiographs made of same

structures at different times
 Technically it is an image enhancement method that

removes the structured noise from the image

 SR accomplished by removing or subtracting all the

information that is unchanged from the two images, the

result is a third image, the subtracted image, that
portrays only the differences between first two images
 Method to obtain a subtraction image
 A specialized computer software is used
 The first radiograph is digitized and turned into
positive image in the computer
 The software, then allows the operator to align the
second radiograph under the video camera and the
radiograph is digitized
 The computer then subtracts the digitized gray scale
value at each grid or pixel location to obtain the
subtracted image
 A perfect subtraction with no difference between the
images will have a value of 0 (black) in all pixel
locations
 To facilitate visualization an offset gray value of 128

in added to produce a gray background against any

super imposed change or lesion is more readily available

ADVANTAGES

 Diagnostic accuracy often is described by the terms

sensitivity and specificity

 SENSITIVITY, or the ability to detect a lesion when it

is truly present, - better than 90% using digital SR

 SPECIFICITY, or the ability to rule out lesion when

they are truly absent, - better than 95%

DISADVANTAGES

 It provides a two dimensional representation of the

anatomy as DSR is done with the help of

radiographs.

 To overcome this disadvantage a quantitative digital

subtraction radiography has been developed to see

the lesions in all the three dimensions

 APPLICATIONS DIGITAL
RADIOGRAPHY IN DENTISTRY

 DIRECT DIGITAL INTRA-ORAL RADIOGRAPHY:

1. Caries Detection occlusal & secondary caries

2. Detection of periodontal bone lesions-
even 5% bone loss
3. Used in the endodontics for assessment of
canals and better visualization of root canals
4. Periapical lesions, periapical bone loss and
resorption of roots are better visualized
 DIGITAL PANORAMIC RADIOGRAPHY:

1. To view the entire upper and lower arches

2. To know the exact extent of the lesions
3. Used in the assessment of orthodontic treatment.
4. Used in the determination of the height of the
alveolar bone
5. Used to assess the osteo-integration of implants
6. TMJ view can be better visualized in digital
panoramic images.
7. Process of healing of fractures can be better
assessed
 Replacement of film –based technology with
computer –based device that use electronic or
storage phosphor receptor to record the x ray
image in a digital format.
 Data for successive column of image pixel are
acquired while the x ray source and detector
rotate around the head of the patient.
 Image is displayed on a high resolution video
monitor.
 Sensor has 512 elements with 0.5 mm effictive
width,
 Advantage is reduction of exposure
 In the era of ALARA –as low as reasonably
achievable ,has been accepted ,every effort should
be made to implement new technologies to make a
reality.
 Problem with conventional panoramic radiography is
the difficult in positioning patient in the image
layer ,image may be effected .
 As the system can reconstruct the desired
layer ,this problem is eliminated.
 DIGITAL EXTRAORAL IMAGING:

1. The assessment of skull growth and the

structure are better visualized.

2. It can be used to assess any facial

deformities.

3. It can be used in assessment of

orthodontic

treatment procedures
 DIGITAL SUBTRACTION RADIOGRAPHY:
1. Has been used in assessing periodontal
disease progression and also the response to
therapy (healing),
2. Used in clinical endodontics
3. Used in evaluation of implant success & failure.
4. For assessment of caries progression and
remineralization
5. Plays role in diagnosis and evaluation of TMJ
pathology
6. Continues to show promise for the diagnosis
and evaluation of the results of therapy for a
wide range of dental diseases
 Cross infection control

 In intra oral digital radiography ,receptor is used

indefinitely, so more chances of infection.
 So infection control is more important than the
film.
 Gloves were worn by the radiologist during
procedure.
 Between patient sensors were disinfected using
alcohol tissue .
 Then draped with plastic barrier .
 It will be good to clean the area around the
computer.
 Future of digital imaging

 Increased the access to medical care and remote

monitoring
 Government regulation
 Instant accesses to real- time scientific evidence
 Miniaturization of office equipment
 Remote consultation
 Reduction in storage media
 Patient with a smart card
 wireless technology
 Global education
 Nanotechnology-smart technology
 Bioengineering.
 Thank you

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