PHILADELPHIA - Prospective purchasers looking to enter the world of digital x-ray must first decide which technique to choose. And the choice isn’t always clear cut, as indicated by a debate between proponents of competing digital technologies on June 3 at the Symposium for Computer Applications in Radiology.
Computed radiography systems have been commercially available since the early 1980s, and there are thousands of units installed around the world. CR readers allow healthcare institutions to take advantage of existing x-ray equipment, and the capital equipment costs of a CR installation are far lower than current digital radiography (DR) systems. In addition, CR is quite adaptable for smaller scale environments and for portable implementations.
DR units, on the other hand, offer a more direct approach to digitization, avoiding the cassette-based approach used in most CR systems. Although approaches to DR vary, ranging from flat-panel amorphous silicon or amorphous selenium to charge-coupled device (CCD)-based detectors, DR detectors generate digital images as radiographic studies are performed. DR vendors also claim a higher level of image quality than CR systems, as well as enhanced productivity and improved workflow from their units.
Despite the initial hoopla generated from the introduction of the DR systems, actual purchasing has been limited to date, hampered by a number of factors, including stiff system prices and DR’s status as a relatively new technology.
Representatives of CR vendors Agfa and Fuji Medical Systems USA, as well as DR providers Direct Radiography Corp. (a Hologic subsidiary) and Swissray, were on hand at SCAR to discuss the merits of each approach during a point-counterpoint debate.
Not surprisingly, CR representatives highlighted the cost-effectiveness of their technology. In fact, CR has benefited more than DR from growing adoption of PACS, owing to its lower cost, according to Todd Minnigh of Stamford, CT-based Fuji.
"Most people doing PACS today are going with CR because they have a very big nut to crack, and (CR) has the best cost-benefit ratio of all of the digital x-ray products available," Minnigh said. "CR has tracked the PACS market in growth, while DR has tracked the (x-ray) room replacement market."
While conceding that the up-front capital cost for a DR system may never come down to CR levels, DRC president Thomas Umbel pointed out that estimates of CR systems do not factor in the cost of consumables and other requirements associated with CR. In addition, purchasers need to evaluate the long-term future of CR technology, he said.
"(You have to ask if) you believe the technology you buy will be there 12 years from now to get the full value from your investment," Umbel said. "I don’t think CR will be there 12 years from now. If you buy a brand new (x-ray) room today, you may wind up buying it twice once DR makes the transition and becomes the dominant player in the radiology department."
Productivity improvements possible only with DR technology have been a draw for many customers, according to Rex Harmon of New York City-based Swissray America. In addition, CR images require a significant level of image processing to achieve a diagnostic-quality image, while DR requires far less, Umbel said.
CR vendors take pride in their level of experience with image processing, however, and they also emphasized that CR technology development has by no means ceased. Minnigh and Agfa’s Ted Ciona each discussed ongoing R&D efforts at their respective firms to dramatically improve the detective quantum efficiency ratings (DQE) of CR systems. At the 1999 RSNA meeting, Fuji highlighted its dual-side reading capability, while Ridgefield Park, NJ-based Agfa showcased work-in-progress efforts underway, such as scanhead and needle storage phosphor technology.
In addition, CR will benefit from market dynamics favoring distributed imaging environments over a centralized imaging location, Ciona said. A number of companies have also introduced relatively inexpensive and small, even desktop-based, CR readers, broadening the utility and applications of CR technology.
Many market watchers believe that DR and CR systems will co-exist for the foreseeable future. In fact, Swissray’s Harmon envisions a situation where a DR system handling high image volume requirements is complemented by desktop CR units in low-volume and outlying locations.
"A complete digital solution includes both," he said.
By Erik L. Ridley
AuntMinnie.com staff writer
June 4, 2000
Disclosure notice: AuntMinnie.com is a subsidiary of Lumisys, a provider of desktop CR systems.
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