Computed radiographyalso known as CR (Computed Radiography), is a technique of image diagnosis which represents a transition between conventional radiology and current digital technologies. Instead of using traditional radiographic film, CR uses photoluminescent phosphor plates that store the energy of the X-rays. This energy is then released and converted into a digital image by a laser readout process.

This system makes it possible to digitize radiographic images without the need to completely transform the X-ray service infrastructure. It is therefore considered to be a intermediate solution between analog and direct digital technology (DR). It is especially useful in clinics or centers seeking to modernize their equipment without making investments as high as those required by DR. In turn, computed radiography can also be used to facilitates the storage, archiving, distribution and analysis of images in digital format. Therefore, the use of this diagnostic imaging technology provides a increased workflow efficiency in the medical environment.

In the following article, we discuss how computed radiography works and its workflow, its advantages and limitations, as well as its main uses in clinical practice.

Computed radiography: How does it work?

The operation of the RC is based on the use of reusable imaging plates coated with a phosphorous material that reacts to exposure with X-rays. This method combines laser technology, optical detection and digital processing in a single sequence.

As a result, by means of computed radiography, the following are obtained high quality diagnostic imaging without the need for chemical processes. The procedure consists of the following stages:

1. Image captureFirst, the patient is positioned on the medical equipment to begin the scan. The X-ray exposure impacts on a CR plate, also called a cassette, where the energy is stored in the form of electrons trapped in phosphorous crystals.
2. Plate readingAfter exposure, the cassette is inserted into a CR reader. This is a device that uses a laser beam to excite the electrons stored on the plate and then release the energy in the form of visible light.
3. Conversion of light into digital imageThe light generated is captured by sensors (photomultipliers), which transform it into electrical signals. Using an analog-to-digital converter, these signals are converted into a digital image.
4. Visualization and processingThe resulting image is displayed on a workstation, where different parameters can be adjusted. From modifying brightness, contrast and sharpness to adding annotations, measurements or labeling the image.
5. Deletion of the plateAfter the process is completed, the plate is completely erased by intense light to remove any residual information. The process is then completed and the plate can be reused in another study.

Clinical workflow in computed radiography

The workflow in a computed radiography environment is systematic and designed to optimize time and ensure patient traceability. Although it is a more agile and efficient system than traditional development, it is not as immediate as direct digital radiology. Below are the different phases of the computed radiography workflow:

1. Patient identification and study prescriptionIt starts with the loading of the patient's record in the RIS system (Radiology Information System), where the parameters of the request and the type of study required are defined.
2. Image acquisitionThe technician positions the patient and makes the exposure with the CR plate in the cassette, as in a traditional X-ray.
3. Digital reading of the cassetteAfter exposure, the cassette is transferred to the CR reader, where the latent image is digitized through the process described above.
4. Processing and post-productionThe digital image is processed by specific software, allowing the technical parameters to be adjusted to optimize diagnostic visibility.
5. Technical and medical validationThe technician checks the quality of the image before sending it to the radiologist, who will perform the clinical interpretation and generate the diagnostic report.
6. Distribution and archiving: Finally, the image is stored in the PACS system (Picture Archiving and Communication System) and is included in the patient's electronic medical record.

Advantages of computed radiography

The adoption of computed radiography systems brings a number of important benefits to both healthcare personnel and medical facilities:

• Reduction in the use of chemicalsDoes not require the use of liquids or developer, which reduces environmental impact and biohazards.
• Reuse of platesPhosphor plates can be reused. Therefore, it offers great economic savings in the medium term.
• Improved image qualityCompared to analog radiology, CR offers better sharpness and digital adjustability.
• Easy integration into existing digital systemsIt can be connected to workstations such as the PACS system, the RIS system or DICOM printers, facilitating the exchange and management of medical information.
• Adaptability to existing equipment: Many installations of old X-rays Traditional or traditional systems can continue to be used with CR systems, which minimizes the initial costs of digitization.

Limitations compared to other techniques

Despite its advantages, computed radiography has certain limitations when compared to more advanced technologies, such as direct digital radiology (DR) systems:

• Increased processing timeThe technician must physically handle the cassette, which lengthens the time between exposure and image display.
• Increased operational burden for technical staffThe reading and handling of the cassettes involves additional steps that do not exist in the DR technique, where the image appears automatically.
• Slightly lower image qualityIn situations where maximum resolution and diagnostic accuracy is required, such as in fine lung studies or mammography, DR usually offers better results.
• Maintenance costs of CR readersAlthough CR technology is more affordable than DR, it requires a specific reader that involves maintenance, calibration and, in some cases, replacement of parts.

What are the differences between computed radiography (CR) and direct digital radiography (DR)?

Main uses of computed radiography in clinical practice

Computed radiography (CR) is used both in medical centers, hospitals and clinics as in mobile units. It offers a wide versatility, has a low operating cost and provides high compatibility with conventional equipment. These are its main applications in clinical practice:

General radiology

It is used for routine studies such as X-rays of the chest, abdomen, spine, pelvis and extremities. It is an ideal technique for initial and follow-up examinations.

Emergency and traumatology

In emergency departments, CR allows rapid imaging of fractures, dislocations or bone injuries without the need for chemical processing. It is very useful in the rapid evaluation of polytraumatized patients.

Postoperative control

It is used to verify the correct placement of prostheses, screws or osteosynthesis material after orthopedic surgery, as well as for the evolutionary follow-up of injuries.

Thoracic and pulmonary evaluation

Chest radiography is one of the most frequent applications. It can detect infections, pleural effusions, nodules or signs of heart failure. CR facilitates digital contrast adjustment to improve the visualization of lung structures.

Dentistry and orthodontics

In some centers, computed dental radiography is used for orthopantomography, cephalometric studies or periapical radiographs, especially when compatible digital adapters are available.

Veterinary applications

Many veterinary centers use computed radiography as their primary imaging system because of its economy and ease of use, especially for radiographs of small and large animals.

Mobile units and health campaigns

Because of its portability and ease of installation, computed radiography is used in radiology trucks or mobile units.

In conclusion, computed radiography is an effective, flexible and versatile medical technique which has been key in the digitization process of diagnostic imaging services. It offers an efficient alternative for centers that wish to modernize without replacing all their equipment, adapting to multiple clinical environments.

Newer technologies, such as direct digital radiology, provide more automated and streamlined processes. Nevertheless, CR is still a viable alternative that can be used especially in small and medium-sized medical centers, mobile units or services with limited budgets that require a progressive transition to digital systems.

Kiko Ramos

CEO of 4D Médica. Expert in marketing and distribution of medical equipment.

The fluoroscopy is a technique of diagnostic imaging which uses X-rays to observe the inside of the human body in real time. It is a type of X-ray that shows the internal structures of the organism in motion.. Unlike conventional X-rays, which generate static medical images, fluoroscopy creates dynamic images to analyze the functioning of different organs, tissues and other internal structures.

During a fluoroscopy, the fluoroscopea medical equipment that allows visualization of the patient's organs in motion. The dynamic images that are generated are projected on a monitor in video format so that medical professionals can diagnose and evaluate various medical conditions. This procedure is used to observe the structures and organs in operation. From seeing how the heart beats and how the lungs are inflamed to examining how food moves through the intestine. Therefore, it is very useful in studies of anatomy and physiology, as well as a support technique in certain interventions.

In the following article, we analyze fluoroscopy as a medical technique. From how a fluoroscopy examination is performed, the use of the fluoroscope and its different types to its main medical applications.

Fluoroscopy

Fluoroscopy is a technique that allows you to see the inside of the body in motion and in real time. It combines X-ray technology, image detectors and digital processing to show what is happening inside the body. To do this, it is necessary to use specific medical equipment: the fluoroscope, also known as a C-arm.

Using continuous or pulsed X-rays, this device generates a set of dynamic images of the different organs, bones, tissues and joints in order to evaluate how certain structures of the body behave during a specific action. The different functions and parts of an arc in C allow radiological and fluoroscopic images to be taken.

Mainly, this medical equipment is used in a fluoroscopy examination for analyze the functioning of the organism when swallowing or breathing, as well as inspecting how a contrast liquid flows through the digestive or circulatory system. In turn, the fluoroscope is also used as a support technique in certain interventionssuch as stenting of blood vessels or cardiac catheterization.

How is a fluoroscopy procedure performed?

Although the visual result of fluoroscopy is a moving image, there is a certain process behind this technology. Understanding how it works is essential to evaluate its usefulness in medical diagnostics. Below, we explain step by step how a fluoroscopic examination is performed:

Patient preparation

In most cases, a very complex preparation is not necessary. Depending on the type of study, the patient will have to follow specific indications, such as fasting or temporarily suspending certain medications. Upon arrival at the medical center, the patient should taking off clothes, putting on a gown and removing metal objects such as necklaces, watches or belts, as they may interfere with the images.

Fluoroscopy examination

During the procedure, patient is positioned on a stretcher or standing in front of the fluoroscopethe team in charge of generating the dynamic images by means of the X-rays. The exploration consists of the following steps:

Administration of contrast medium

In many studies, a contrast medium is used to enhance the visibility of certain areas of the body. This contrast helps to highlight structures of interestallowing the physician to see with the functioning of the different organs and tissues more clearly.. This contrast can be administered in different ways, depending on the area to be studied:

• Oral routeIn case the area to be observed is the upper digestive system (esophagus, stomach).
• Intravenous lineWhen the examination is performed to evaluate the blood vessels or internal organs.
• Through a catheterFor bladder or bowel studies.

2. Capture and acquisition of images in real time

Once the contrast has been administered (if necessary), the technician or physician will begin capturing the medical images in real time. Throughout the procedure, it is important that the individual remains as still as possible.. Movement can distort the images, so the patient's cooperation is essential to obtain accurate results. During this phase, the specialist will be able to evaluate:

• The movement of an organThe diaphragm when breathing or the bladder when emptying.
• The passage of a contrast mediumto identify blockages, leaks or reflux in the digestive or urinary systems.
• The position of medical devicessuch as catheters, pacemakers, screws or prostheses.
• The dynamic function of a jointuseful in traumatology and physiotherapy.

This functional and dynamic approach is what distinguishes fluoroscopy from other imaging techniques, such as radiography or computed tomography (CT).

3. Medical image analysis

Modern fluoroscopy equipment is equipped with advanced technologies that enhance the analysis of medical images:

• Digital image processingDigital systems allow you to adjust different elements of the image, such as brightness, contrast, zoom and orientation.
• Recording and archivingThey offer the possibility to document the procedure or to review key sequences.
• On-screen measurementThe technology can be used to calculate lengths, angles or displacements automatically.
• Image overlay (fluoro overlay)It is very useful in image-guided interventions.

In addition, more and more systems are integrating artificial intelligence functions to assist in the automatic detection of anomalies or to improve visual quality in real time. Among the main advantages of using an AI software is that it increases diagnostic accuracy and facilitates medical decision making.

Duration of a fluoroscopic examination

The duration of the study may vary depending on the type of examination, the area to be explored and the complexity of the procedure. However, in general terms, a fluoroscopy usually lasts between 30 minutes and one hour. Once the examination is completed, the patient can return home and, in most cases, resume normal activities, unless otherwise instructed by the physician.

The fluoroscope: Types and characteristics

The fluoroscope, also referred to as a C-arm, is the medical equipment used in a fluoroscopic examination. However, there are different types of fluoroscopes depending on the type of study to be performed and the space available in the clinic or medical center. We can find two modalities and each one has specific characteristics:

Full-Size C-arms

Full-Size C-Arches are designed to cover a wide range of procedures, from the simplest to the most complex.

• Large size: They have a wider field of view and are characterized by a greater ability to adjust to different positions and angles.
• Ample powerX-ray penetration: They provide deeper X-ray penetration, making them ideal for scanning complex structures such as the spine, thorax or pelvis.
• Advanced technologyMany models incorporate advanced technologies, such as 3D reconstruction, surgical navigation and high-resolution image processing.
• Medical applications: This type of arc is common in trauma, neurosurgery, vascular surgery and cardiac surgery operating rooms, where maximum precision and constant visual control are required throughout the procedure.

Mini bows

Mini C-arms are intended for more localized and less invasive procedures.

• Compact size: Their small size is ideal for small operating rooms, outpatient clinics or specialized practices, as they are much easier to transport and handle.
• Procedures of superficial areas of the bodyThese machines are optimized to work on more superficial areas of the body, such as hands, wrists, feet and ankles.
• Sharpness and lower powerAlthough their power is lower compared to full-size models, they offer clear and detailed images of the extremities. Therefore, it is recommended for minor surgeries or low complexity orthopedic interventions.
• Fast and easy operationFluoroscopes of this type are simpler to operate, as they have shorter start-up and positioning times. This improves efficiency in work environments where there is a high flow of patients.
• Medical applicationsMini C-arms are especially useful in extremity surgery, outpatient trauma, hand and foot surgery, minor image-guided procedures and pediatric interventions.

What is fluoroscopy used for? Main medical applications

Fluoroscopy is used in many types of diagnostic imaging procedures. Among its main medical applications, we can highlight:

Examination of the digestive system

One of the most common applications of fluoroscopy is the study of the digestive system. By means of this procedure, the physician can observe how food or liquid moves through the digestive tract in real time. In this type of diagnostics, a contrast medium (such as barium) to be able to analyze more clearly the functioning of the esophagus, stomach or intestines.

Main applications

• Gastroesophageal reflux
• Hiatal hernias
• Ulcers or stenosis
• Swallowing disorders (dysphagia)

Cardiovascular system studies

In cardiology and interventional radiologyfluoroscopy is a key fundamental technique for visualizing blood flow through the heart and blood vessels. In these studies, fluoroscopy is used to act with greater precision during delicate interventions, reducing risks and complications. In addition, fluoroscopy is used to iodinated contrast agents that are injected intravenously to generate medical images of different tissues with greater clarity and sharpness.

Main applications

• Cardiac catheterization: Allows to see coronary arteries and detect obstructions.
• Angiography: Visualizes blood vessels in different parts of the body.
• Placement of stents or pacemakers: Fluoroscopy is used to guide the physician during these procedures.

Support in orthopedic surgeries and traumatology.

During bone or joint surgeryfluoroscopy helps surgeons to checking the position of pins, screws, prostheses or bone fragments. This allows interventions to be more precise and safe, reducing postoperative complications.

Main applications

• Spine surgeries
• Repair of complex fractures
• Image-guided joint infiltrations
• Arthrography (joint examination with contrast)

Minimally invasive procedures

Fluoroscopy is essential for performing image-guided procedures in which needles, catheters or probes are inserted into the body without the need for open surgery. By providing a real-time display, it allows to accurately access the area of interestThis reduces risks and improves the efficiency of the procedure.

Main applications

• Directed biopsies
• Abscess drainage
• Placement of central catheters
• Pain treatments (nerve blocks)

Use in pediatrics

Fluoroscopy, when performed in children, is used with reduced doses and special protocols to ensure its safety. Therefore, in the field of pediatrics, it is of great use for observe developing bodily functions.

Main applications

• Swallowing or reflux problems in infants
• Urinary tract malformations
• Evaluation of intestinal transit
• Follow-up of pediatric orthopedic surgeries

Functional evaluation of organs

In addition to detecting structures, fluoroscopy allows for the following see and analyze how certain organs function. In these cases, not only to detect abnormalities, but also to study how the body works in action.

Main applications

• To analyze how the bladder contracts during urination (cystography).
• Examine how the diaphragm moves when breathing.
• Perform an evaluation of gastric emptying.

The fluoroscopy procedure is a safe, non-invasive and highly effective technique for observing the body in motion. By combining X-rays and contrast media, medical professionals can obtain clear and accurate images that facilitate diagnosis and clinical decision making.

If you are looking for a fluoroscope for your clinic or hospital and you need more information, we help you to choose the medical equipment according to your needs. Contact us and we will answer all your questions.

Contact 4D Médica

Kiko Ramos

CEO of 4D Médica. Expert in marketing and distribution of medical equipment.