Tuesday, June 30, 2009

CR Image Plate

With all of the new curriculum material being added to the Registry in the coming years, it is required for us to have good working knowledge of how the photostimulable phosphor plates work with CR cassettes. Most curriculums are encorporating this into study now, and I won't bother going into those details, but I would like to post about an observation I made when reading up on the topic and preparing for some lab sessions with my current students.

According to the Carlton and Addler textbook that our students are required to purchase, the active layer is the photostimulable phosphor layer, which is responsible for retaining a latent image after x-ray exposure. This happens when x-rays ionize the plate, releasing electrons to be collected by an "electron trap" in the conductive layer of the phosphor screen.





This image, taken from the FUJI website (an excellent source for information by the way), depicts the electrons collected in the trap, and representing a stored charge that is now our latent image.

During development of the cassette, a helium-neon laser (a really intense light source), sweeps the cassette during the forward motion of plate travel through the reader, and that charge is released in the form of light photons (following picture also from FUJI).




As you can see, there is a "light guide" which collects the visible light emitted from the plate and transfers it to a photomultiplier tube, which amplifies the light signal. Later it goes to an analog to digital converter to be interpreted into an electrical signal that the monitor can display as our radiograph at our QC station, and so on and so forth.

If you have ever opened one of the CR cassettes, even after a radiographic exposure has been made on it, you might notice that the room light does not fog the image plate. So knowing that an intense light (helium-neon laser) is used to release the charge on the plate during image processing, I wondered if I could reproduce that effect outside of the image processor myself.

Here's what I decided to do... I received two laser pens for my birthday recently (green in luminance) that my wife and I jokingly use to point out things when we watch TV, i.e., physical flaws possessed by contestants on the television show "The Bachelorette," crooked nostrils, stains on clothing, you get the picture (way beside the point, but fun).



I wondered if the laser pens were intense enough to cause a change in the radiographic density on the image plate.

First, I took an unexposed plate and removed it from the cassette and turned out the room lights. I thought "it's photostimulable, so what would happen if I simply shine my laser light on it? Would it emit a visible light? Would it produce a density on my developed image?" Uh... no. After trying this in an unexposed image plate, there was no visible light produced except what was caused by my own laser pen, and no visible density was recorded on the developed image after processing.

So next, I tried a relatively small exposure (about a finger technique) on a cassette, then tried removing the image plate from the cassette to see if I could observe visible light when shining my pen on it. I was not able to perceive visible light when I tried this... why? Probably because the light would be very dim, and the brightness of my laser pen interfered with any that I might have been able to see. There is, after all, a photomultiplier tube which enhances the light emitted by the screen inside the reader. However, when I developed the image, this was the result:



It appears as if my laser light, in fact did have enough intensity to release the trapped electrons from their place in the conductive band. We have an area of decreased density on the image where the my laser pen interacted with the plate and released the electrons. The reader was not able to detect any light emitted from these regions with the helium-neon laser because the electrons had already been released, and no density was provided in that area.

Does this help us in our formation of the image? Probably not, but it does help to understand the process of turning our latent image into the manifest image using CR. I highly reccommend purchasing a laser-pen, even if you never use it for radiography-related purposes, it's still good fun for television. A special shout to my wife - thanks for my laser-pens!

Wednesday, June 10, 2009

Semi-X

Semi-X is one of the EDR options that can be selected on FUJI CR prior to image processing. You can select this after you have prescribed a specific projection/view, but prior to scanning the barcode for the cassette ID. In this example, I attempted an axillary view of the shoulder on our phantom in the lab:

When selecting the Semi-X option, you will be given a choice of cells (1-9) as seen on the prior post, but it is crucial to properly orient your cassette, and remember how your numbered regions correspond to the green orientation bar.

For my phantom images, I decided to perform a left axillary shoulder, so I placed my green orientation bar (on a crosswise 10 x 12 cassette) closest to the "patient's" neck. This changes the layout of my numbered regions as shown:


I decided to expose my first image without the use of the Semi-X option... the following image was taken on the default "Auto" setting, which forms a histogram based on either the entire image plate, or whatever pixels lie within the recognized collimated field. It is important to note that sometimes on actual patients, the greater the soft tissue density around the patient's shoulder, the more scatter will be produced... especially in comparison with my images from a phantom. The scatter could lead to software being unable to recognize the collimated borders, thus the inclusion of more data in your histogram than what was actually in the collimated field.

This image was shot at 60 kVp, 4.2 mAs, and the resulting S# was 280 on the Auto setting:



My second image utilized identical exposure factors, but I selected the Semi-X option and chose field #7, which should be aligned with the humeral head. This gave me a much more desirable image with an S# of 159, and much better contrast with less density than on the Auto setting:



My third image utilized identical exposure factors again, but I selected the Semi-X option and chose field #4, which should be aligned with the surgical neck and proximal humerus. This gave me an even better image with an S# of 132, and even more contrast with less slightly less density than image 2:



And just for kicks, I decided to perform one more image with the same exposure factors and simulated a common error - improper selection of the numbered region. This error would occur with either improper cassette orientation, or if there was any confusion of where the green orientation bar was located. The following was set to field 6, which is outside the original collimated border, with an S# of 2968. As you can tell, the software is attempting to equalize the histogram for that region on the cassette, allowing us to see the mottle pattern of the scatter, but preventing us from visualizing the anatomy itself... it's telling us that we're severely underexposed - and that would be true if we are trying to visualize something over #6.



All in all, this is a valuable tool to utilize with exams like axillary shoulder, cross-table hip, perhaps trauma and OR views and anything which would prevent you from placing the anatomy of interest in the center of the cassette. Just remember to always know where your green orientation bar is, and how the numbered regions lie in relationship to it.

Sunday, June 7, 2009

Exposure Data Recognition

If you've ever wondered what the "EDR" button on your FUJI CR system is for, it stands for "Exposure Data Recognition." In order to properly utilize this unique feature, we need to know how it works.

FUJI CR plates have 9 sections on them divided equally. If you've ever noticed the green horizontal orientation bar, that should be either placed at the head of your patient (for lengthwise exposures) or at the patient's right (for crosswise exposures). This is important to remember when using the EDR feature.



When using the EDR option, it can only be applied before image processing, and additionally, needs to be selected prior to scanning your cassette bar code associating it with the desired view. The EDR has four modes:

AUTOMATIC
SEMI-AUTO
SEMI-X
FIXED

Automatic - this is the default setting on most IIP's. This mode will sample the entire cassette if it is exposed in its entirety. It also, however, should detect collimated fields and if collimated properly, will only include the exposed areas inside that field as part of the "values of interest" in the histogram (see "Anatomy of a Histogram").

Semi-Auto - this mode will only take a sample from the central partition of the cassette (#5 in the above diagram). As you can suspect, positioning is key when selecting this option, but should be familiar to you if you are comfortable with utilizing the center cell with AEC.

Semi-X - allows you to select one of the nine partitions of the IP. Depending on the anatomical part or projection you are attempting to perform, selection of the proper partition is crucial, as is the need for proper cassette orientation.

Fixed - for those of us who were once comfortable utilizing film/screen combination radiography, this may just be an equally comfortable option to choose. Instead of a histogram and software equalization, whatever technical factors you select will be represented by the density and contrast on your image. A double in mAs will actually be a double in density, and you have the option of choosing a speed class (which is representative of the film/screen speed combo with conventional radiography).

This can be a lot to swallow or to know how to use appropriately... more specific posts for each option to come!

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