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Remains strong, there is nodoubt that advanced imaging capabilities such as dual-energyradiography and digital tomosynthesis volume imaging have resultedin a focus on and greater emphasis of flat-panel DR technologiesfor targeted procedures that can reduce the need for computedtomography, MRI and ultrasound examinations.The American College of Radiology has recently publishedpractice guidelines for digital radiography8,9including a review of digital radiography technologies, clinicalconsiderations for implementation and quality controlrecommendations. This information is an excellent resource for allindividuals responsible for digital radiography in the clinicalenvironment.ConclusionDigital radiography detectors (CR and DR detector systems) arenow in the majority. Cassette-based photostimulable storagephosphor detectors comprise the largest segment of digitaldetectors; however, cassetteless, integrated detectors areincreasing in areas that demand high efficiency and highthroughput. The historical comparison of "CR vs. DR" while still aconsideration for making an informed decision for choice ofadigital radiography system, is of less importance, as the advanceof technology has blurred the differences. Image acquisition speedof AMFPIs is enabling advanced acquisition and processingcapabilities such as dual-energy radiography and digitaltomosynthesis, which will likely become common methods that areused to overcome the superimposition limitations of conventionalprojection radiography and result in more accurat ediagnoses. Justexpect to pay more for advanced technology capabilities, and besure to justify the expense in terms of realistic workloads andthroughput requirements; otherwise do not expect a decent return oninvestment. Knowledge of DR system characteristics, advantages,disadvantages and operational details provide the insight andconfidence to make a reasonable, informed decision on equipmentselection and optimization of digital radiography implementationfor a specific purpose.REFERENCESSeibert JA, Bogucki TM, Ciona T, et.al. Acceptance testing and quality control of photostimulable storage phosphor imaging systems: Report of AAPM Task Group 10. AAPM Report #93. American Association of Physicists in Medicine, College Park, MD. (2006) Available at RPT_93.pdf. Accessed April 27, 2009.Leblans PJ, Struye L, Willems P. New needle-crystalline CR detector. Proc SPIE. 2001;4320:59-67.Baysal MA, Toker E. CMOS Cassette for digital upgrade of film based mammography systems. Proc SPIE. 2006;6142:61421Q.Pisano ED, Yaffe MJ. Digital mammography. Radiology. 2005;234:353-362.Seibert JA. Digital radiographic image presentation: Pre-processing methods. In: Samei E, Flynn MJ, eds. 2003 Syllabus: categorical course in diagnostic radiology physics - Advances in digital radiography. Oak Brook, IL: Radiological Society of North America (RSNA);2003:147-151.Rowlands JA, Yorkston J. Flat panel detectors for digital radiography. In Medical Imaging, Volume 1, Physics and Psychophysics, Beutel J, Kundel HL, Van Metter RL eds. Societyof Photooptical and Instrumentation Engineers (SPIE). Bellingham, WA. 223-328, 2000.Samei E, Saunders RS, Lo JY, et al. Fundamental imaging characteristics of a slot-scan digital chest radiographic system. Med Phys. 2004;31:2687-2698.Williams MB, Krupinski EA, Strauss KJ, et al. Digital radiography image quality: image acquisition. JACR. 2007;4:371-388.Krupinski EA, Williams MB, Andriole K, et al. Digital radiography image quality: Image processing and display. JACR. 2007;4:389-400.

Chest RadiographyLECTURE.2PLEASE TURN ALL CELL PHONES TO SILENT MODELearning Objectives By the end of this Lecture the student will be able to: • List and identify the major anatomical structures of the chest • List the common indications for chest radiography • Identify the common technical factors for chest radiography • List the basic and Optional projections for chest radiography • Discus the correct body position, part position, central ray, and • center point for specific positions for each projection. • Critique and evaluate chest radiographs based on position, • collimation and central ray, exposure, and structure best shown.References • Text book of radiographic positioning and related anatomy; by • Kenneth L.Bontrager • Positioning in Radiography: By k.C.Clarke. • Websites • Anatomy • Thoracic cavity (chest) • Surrounded by boney thorax • Separated from abdomen by diaphragm • Muscular partition • Dome shaped • Lungs drape over diaphragmAnterior Posterior Boney Thorax • ENCLOSE THE ORGANS • STERNUM (breast bone) • 12 PAIR OF RIBS • 12 THORACIC VERTEBRA • ATTACH UPPER EXTREMITY • 2 CLAVICLES • 2 SCAPULAA A H H  B   B  C  C Respiratory System 1. Lungs • Lobes • Right 3 lobes • Left 2 lobes • Terminology • Apex • Hilum • Base • Costophrenic anglesBronchial Tree 2. Bronchi • Air tubes leading into the lung • Right more vertical than left • Branching structure • Primary è 2ndary è • Only primary visible on PA projection PMiscellaneous • Mediastinum contents • Trachea • Major vessels • Esophagus • Lymphatic's • Heart • ThymusTechnical Aspects • For chest radiography, a lead-rubber Gonad shield should be employed so to protect the abdomen below the chest (using vinyl-covered lead apron) around the waist for all patients of reproductive age, children, and pregnant women. • Low contrast ( long-scale contrast) contrast must be adopted using ‘High kV Technique ’ (100 - 130 kVp) with low mAs (3 mAs) at 72 inches (180 cm) FFD (SID). • Higher mA and short exposure times (0.01 s) must be used to reduce movement blur (due to movement

Digital radiography refers to all non-film-based methodologies to capture radiological information. Digital imaging has been used in the practice of dentistry since the 1980s to diagnose diseases of the paranasal sinus and TMJ disorders. However, dentists in North America have been slow to adopt digital radiography. Estimates by manufacturers place the number of dentists who have purchased these systems to be approximately 7,000. In a survey conducted in 1998, 67% of the dentists responding to the question of their next major purchase wish, if “money was no object,” said that they would buy a digital radiography system.1Digital imaging offers several advantages. Information obtained in digital form can be processed, stored, and transmitted from one place to another using communication networks. The lower dose of radiation and time saved in acquisition and viewing of an image is an improvement over conventional radiography. Images produced by digital systems can also be manipulated using computer software applications to increase diagnostic utility and electronically transmitted for referrals. In addition, digital imaging does not require chemical processing. Other advantages include image analysis and image reconstruction. There is also evidence that utilization of digital radiography is not only more economical to establish than a conventional radiographic system, but also less expensive to maintain.2The purpose of this article is to review technologies basic to digital imaging that enable acquisition and viewing of an image, and to recognize limitations of the technology. ELEMENTS OF DIGITAL IMAGING CYCLEThere are five basic elements of an imaging cycle: acquisition of a digital image; processing the acquired image using image analysis, and image manipulations using software applications; storage for easy access and retrieval; communication or image transmission between peers; and presentation or viewing of the image using monitors or workstations. This article examines each these elements and also identifies concerns that are essential to the clinical practice of dentistry.Figure 1. Elements of imaging.The steps involved in a digital imaging cycle are illustrated in Figure 1. There are three basic components of a digital imaging system: computers (desktops, viewing stations), detectors (image acquisition devices) (Figures 2a and 2b), and scanners (Figures 3a and 3b). The computer controls acquisition, storage, processing, retrieval, and display of a digital image. Detectors are primarily used to capture or acquire images from the source and store them until they are processed. A detector converts the x-ray beam into an electronic signal. Scanners are used to process the image

The preparation of this manuscript.References1. Miles DA, Razzano MR. The future of digital imaging in dentistry. Dent Clin North Amer. 2000; 44:427-438.2. Miles DA, Langlais RP, Parks ET. Digital x-rays are here doctor. Why aren’t you using them? J Can Dent Assoc. 1999;27:926-934.3. Horner K, Shearer AC, Walker A, et al. Radiovisiogrpahy: an initial evaluation. Br Dent J. 1990;168:244-248.4. Shearer AC, Horner K, Wilson NHF. Radiovisiography for imaging root canals: an in vitro comparison with conventional radiography. Quintessence Int. 1990;21:789-794.5. Brettle DS, Workman A, Elwood RP. The imaging performance of a storage phosphor system for dental radiography. Br J Radiol. 1996;72:256-261.6. Wenzel A. Digital radiography and caries diagnosis. Dentomaxillofac Radiol. 1998;27: 3-11.7. Yoshioka T, Koboyashi C, Suda H, et al. Correction of background noise in direct digital dental radiography. Dentomaxillofac Radiol. 1996; 25:256-262.8. Reddy MS, Jeffcoat MK. Methods of assessing periodontal regeneration. Periodontol. 2000;19:87-103.9. Cederberg RA, Tidwell E, Frederiksen NL, et al. Endodontic working length assessment: comparison of storage phosphor digital imaging and radiographic film. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1998;85:325-328.10. Gotfredsen E, Kragskov J, Wenzel A. Development of a system for craniofacial analysis from monitor-displayed digital images. Dentomaxillofac Radiol. 1999;28:123-126.11. Battenburg RH, Meijer HJ, Geraets WG, et al. Radiographic assessment of changes in marginal bone around endosseouses implants supporting mandibular overdentures. Dentomaxillofac Radiol. 1998;27: 221-224.12. Delano EO, Tyndall D, Ludlow JB, et al. Quantitative radiographic follow-up of apical surgery: A radiometric and histologic correlation. J Endod. 1998;24:420-426.13. Wenzel A, Gotfredsen E, Borg E, et al. Impact of lossy image compression on accuracy of caries detection in digital images taken with a storage phosphor system. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996; 81:351-355.14. Van der Stelt PF, Sanderink GCH, Dula K. Lossy file compression and diagnostic image quality of digital intraoral radiographic images [abst 1010]. J Dent Res. 1996;75(spec iss):128.15. Lim KF, Loh E E-M, Hong YH. Intra-oral computed radiography: an in vitro evaluation. J Dent. 1996;24:359-364.16. Kundel HL. Visual perception and image display terminals. Radiol Clin North Am. 1986;24:69-78.Dr. Pai is an assistant professor of clinical dentistry and director of clinical information systems at the Columbia University School of Dental and Oral Surgery in New York City.Dr. Zimmerman is an associate professor of clinical dentistry and assistant dean for information resources at the Columbia University School of Dental and Oral Surgery in New York City.

Evaluation, annotation and transferto PACS (Figure 1). Most often, the storage phosphor is layered ona flexible or solid substrate in a cassette enclosure, which allowsfor the ability to directly replace a screen-film cassette in aconventional radiography room. Thus there is the flexibility andportability of a cassette with digital radiography acquisitioncapability using existing X-ray equipment; this is CR's greatestasset. CR cassettes of various size and number, together with ahigh-speed imaging plate reader can service multiple X-ray rooms,resulting in a relatively low initial acquisition cost. However,the technologist must handle the cassettes and process the imagingplates in a manner similar to film, which can reduce patientthroughput in a busy clinical room and increase labor costs, as thetime to handle the exposed imaging plate to the reader and outputof the X-ray image can often take several minutes (about 45 to 60seconds to "read" the plate with the moving laser beam). Otherexpenses to consider are the need for high-frequency (e.g., 170lines per inch) antiscatter grids for stationary (non-Bucky)applications such as portable bedside imaging and fixed gridcassette holders, and for readjusting phototimer sensitivity toaccount for the lower detection efficiency of the conventional PSPimaging plate compared to 400 speed screen-film detectors.Long-term costs include cassette and imaging platelongevity,maintenance and cleaning of the imaging plates and reader assembly,replacement of damaged detectors, and continuous oversight with aquality control program.1An alternate description of CR as "cassette radiography" in lieuof "computed" is a sign of the technological changes that areoccurring-PSP technologies are now being implemented in enclosedhousings, with high-speed parallel laser beam stimulation andphotodiode array acquisition that fully reads the exposed storagephosphor in as little as 5 seconds, comparable to many "direct" DRdetectors. Available a reportable flat-panel radiography detectorsin a cassette form, some with wireless technology, which canprovide active readout at the point of service without subsequentuser interactions.Technological developments of storage phosphors includecompounds with less intrinsic lag during stimulation for fasterreadout times,"dual-side" phosphor deposition on a transparentsubstrate to improve X-ray detection and stimulated luminescenceefficiency for a higher signal-to-noise ratio (SNR) with the sameexposure, and "structured PSP" materials such as cesium bromide(CsBr) that simultaneously improve spatial resolution and detectionefficiency.2Cassette-based CR detectors are available for digital mammographywith special adjustments to the reader device and laser beam (e.g.,50 micron pixel sampling), and are a viable consideration forconverting from screen-film particularly for operations that have alow patient volume and/or have relatively new mammography X-rayequipment. Initial capital outlay is certainly lower than acorresponding integrated digital radiography (or digitalmammography) flat-panel detector system.Charge-coupled device detectorsThe design of a charge-coupled device (CCD)-based DR system isstraightforward. The detector is comprised of a large FOV (e.g., 43cm by 43 cm) scintillator that converts absorbed X-ray energy intolight. It also includes an optical lens assembly to focus the lightonto the photosensitive CCD array,

Imaging What imaging program do you currently use? AnatoCeph Anatomage InVivo Dental Dolphin Imaging Edge Imaging FYI Technologies Dr. Ceph/Dr. View Quick Ceph VistaDent VP Imaging None Other What imaging program do you plan to use with Edge Cloud? AnatoCeph Anatomage InVivoDental Dolphin Imaging Edge Imaging FYI Technologies Dr. Ceph/Dr. View Quick Ceph VistaDent None Other Are you currently storing 3D images? Yes No If yes, which of the following are you storing? Check all that apply. 3D X-Rays Intraoral Scans Models Financial What financial program do you currently use? Element Payment Services ACH Element Payment Services Credit Card OpenEdge (X-Web) Credit Card OpenEdge (X-Web) ACH OrthoBanc Vanco Services ACH Vanco Services Credit Card ViewPoint 'Other' Auto-Receipt Integration None Other What financial program do you plan to use with Edge Cloud? Element Payment Services ACH Element Payment Services Credit Card OpenEdge (X-Web) Credit Card OpenEdge (X-Web) ACH OrthoBanc Vanco Services ACH Vanco Services Credit Card ViewPoint 'Other' Auto-Receipt Integration None Other Case Planning/Presentation What presentation program do you currently use? ClinCheck Edge Animations OrthoMation ScreenPlay SureSmile None Other What presentation program do you plan to use with Edge Cloud? ClinCheck Edge Animations OrthoMation ScreenPlay SureSmile None Other Radiography What radiography program do you currently use? Gendex DenOptix Gendex Orthoralix 9200 Instrumentarium CliniView Planmeca Devices Sirona Sidexis Soredex Cranex D Kodak 8000C and 9000C Gendex VixWin Kodak Software Planmeca Dimaxis Soredex Digora Visix None Other What radiography program do you plan to use with Edge Cloud? Gendex DenOptix Gendex Orthoralix 9200