Experiences with computed radiography: can we afford the cost?

In summary, we believe that the CR system adds significantly to our department. The film quality is superb, and the learning curve for radiologists to adapt to the added noise from anatomic structures on chest radiographs is short. The inherent film latitude and flexibility add a new dimension to interpretation and film management. System costs are significantly greater than for traditional film-screen systems. Recurring operational costs are yet to be determined but certainly will be greater with the shorter expected life span of the imaging plates. Film cost savings cannot be a justifiable reason for using a CR system. Film cost savings must await the ultimate conversion to soft imaging through networks and workstations. Technical issues are significant and require structured and specific courses of study and workshops for users before implementation of the CR system. As CR owners, we were frustrated by the lack of published protocols and guides for the CR user. Most of our experiences were learned in practice, and we believed published guides would be useful for both existing users and future buyers. Careful attention to accuracy, histogram selection, positioning, collimation, and patient data input is critical to the success of CR. The persistent lack of a CR information system interface has led to occasional labeling errors and requires added vigilance on the part of both the technologist and the radiologist. Other important user problems we experienced with CR included the RVS. When images are reprinted from the RVS, they can be printed on 10 x 14 inch (26 x 36 cm) film only. Images that were acquired on the larger cassettes are printed on this smaller film, minified by one third from the original size. Minified images are unacceptable to our orthopedic colleagues. Networking problems have still not been resolved, and this resolution remains an important goal. The manipulation and transfer of images without loss of data were major reasons for our switch to electronic imaging and have still not been achieved. Unique image artifacts were encountered, as were new parameters to judge the quality of an image. The final issue is radiation dose. To assign dose reduction as an attribute of CR would be misleading. We have found that in many instances the reverse is true. Many examinations have required more radiation exposure than traditional film-screen techniques. At the least, to harvest the benefits of CR one must significantly alter technical exposure factors and understand how the system operates. The problems we encountered were not minor. Our technologists and radiologists and the Fuji personnel have put in many hours to implement and optimize our system. The image quality is superb, and we continue to work on the important networking and archival goals.