Advances in Chest Radiography Techniques: CR, DR, Tomosynthesis, and Radiation Dose Optimization

  • Charles E. Willis
  • Steven Don
Part of the Medical Radiology book series (MEDRAD)


A revolution in radiography has occurred in the last three decades; digital radiography has replaced screen-film radiography. To understand digital radiography, one must begin with the fundamental principles, which have not changed since Roentgen’s time. The conversion of X-rays into a visible image, however, has changed from screen-film to digital radiography. A discussion on the characteristics of digital radiography and its most common forms, computed radiography (CR) and digital flat-panel radiography follows. The fundamentals of digital image processing are discussed, including preprocessing, latitude reduction, and contrast modification. Advanced technologies are also described, including structured phosphors, slot scanners, dual-sided CR, irradiation side sampling flat panels, and gaseous avalanche detectors. The potential application of dual energy subtraction radiography and tomosynthesis to pediatric thoracic radiography is also considered. The chapter concludes with a discussion on radiation dose optimization in pediatric chest radiography including the newest standards for exposure indicators, dose area product, dose reporting, and informatics initiatives to support dose reporting.


Compute Radiography Digital Radiography Image Receptor Dose Area Product International Electrotechnical Commission 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. AAPM position statement on radiation risks from medical imaging. PP-25. 12/13/2011 Accessed 29 April 2013
  2. Cohen MD, Long B, Cory DA, Broderick NJ, Smith JA (1989) Digital imaging of the newborn chest. Clin Radiol 40:365–368PubMedCrossRefGoogle Scholar
  3. Cohen MD, Katz BP, Kalasinski LA, White SJ, Smith JA, Long B (1991) Digital imaging with a photostimulable phosphor in the chest of newborns. Radiology 181(3):829–832PubMedCrossRefGoogle Scholar
  4. Deschênes S, Charron G, Beaudoin G, Labelle H, Dubois J, Miron MC, Parent S (2010) Diagnostic imaging of spinal deformities: reducing patients radiation dose with a new slot-scanning X-ray imager. Spine 35:989–994PubMedCrossRefGoogle Scholar
  5. Després P, Beaudoin G, Gravel P, de Guise JA (2005) Physical characteristics of a low-dose gas microstrip detector for orthopedic x-ray imaging. Med Phys 32(4):1193–1204PubMedCrossRefGoogle Scholar
  6. Don S, Whiting BR, Rutz LJ, Apgar BK (2012) New exposure indicators for digital radiography simplified for radiologists and technologists. Am J Roentgenol 199(6):1337–1341. doi: 10.2214/AJR.12.8678 CrossRefGoogle Scholar
  7. Don S, Macdougall R, Strauss K, Moore QT, Goske MJ, Cohen M, Herrmann T, John SD, Noble L, Morrison G, Lehman L, Whiting BR (2013) Image gently campaign back to basics initiative: ten steps to help manage radiation dose in pediatric digital radiography. Am J Roentgenol 200(5):W431–W436. doi: 10.2214/AJR.12.9895 CrossRefGoogle Scholar
  8. Heller RM, Erickson JJ, Price RR (1982) Pediatric non-angiographic applications of digital radiography. In: Price RR, Rollo FD, Mo-nahan WG, James AE Jr (eds) Digital radiography: a focus on clinical utility. Grune & Stratton, New York, pp 267–277Google Scholar
  9. Kogutt MS, Jones JP, Perkins DD (1988) Low-dose digital computed radiography in pediatric chest imaging. Am J Roentgenol 151:775–779CrossRefGoogle Scholar
  10. Kroft LJM, Geleijns J, Mertens BJA, Veldkamp WJH, Zonderland HM (2004) Digital slot-scan charge-coupled device radiography versus AMBER and bucky screen-film radiography for detection of simulated nodules and interstitial disease in a chest phantom. Radiol 231(1):156–163CrossRefGoogle Scholar
  11. Kroft LJM, Veldkamp WJH, Mertens BJA, Boot MV, Geleijns J (2005) Comparison of eight different digital chest radiography systems: variation in detection of simulated chest disease. Am J Roentgenol 185:339–346CrossRefGoogle Scholar
  12. Kushner DC (1983) Scanning beam low dose digital radiography: initial clinical trials relevant to pediatric radiology [abstr]. Am J Roentgenol 141:847Google Scholar
  13. Leblans P, Struye L, Willems P (2000) A new needle-crystalline computed radiography detector. J Digit Imaging 13(2)Suppl 0031:117–120Google Scholar
  14. Liu X, Shaw CC, Lai CJ, Altunbasa MC, Chen L, Han T, Wang T (2008) Scatter rejection and low-contrast performance of a slot-scan digital chest radiography system with electronic aft-collimation: a chest phantom study. Med Phys 35(6):2391–2402PubMedCentralPubMedCrossRefGoogle Scholar
  15. Luckey GW (1975) Apparatus and method for producing images corresponding to patterns of high-energy radiation. US Patent 3,859,527, 01 Jan 1975Google Scholar
  16. Medical electrical equipment—Exposure index of digital X-ray imaging systems—Part 1: Definitions and requirements for general radiography, International Electrotechnical Commission (IEC), international standard 62494-1-08 Geneva, Switzerland, 2008Google Scholar
  17. Merlo L, Bighi S, Cervi PM, Lupi L (1991) Computed radiography in neonatal intensive care. Pediatr Radiol 21:94–96PubMedCrossRefGoogle Scholar
  18. Rowlands JA (2002) The physics of computed radiography. Phys Med Biol 47:R123–R166PubMedCrossRefGoogle Scholar
  19. Romlein J (2007) CR versus DR? Blurred lines of distinction. Applied Radiol December Suppl:8–10Google Scholar
  20. Samei E, Saunders RS, Lo JY, Dobbins JT III, Jesneck JL, Floyd CE, Ravin CE (2004) Fundamental imaging characteristics of a slot-scan digital chest radiographic system. Med Phys 31(9):2687–2698PubMedCrossRefGoogle Scholar
  21. Schaefer-Prokop C, Neitzel U, Venema HW, Uffmann M, Prokop M (2008) Digital chest radiography: an update on modern technology, dose containment and control of image quality. Eur Radiol 18:1818–1830PubMedCentralPubMedCrossRefGoogle Scholar
  22. Seibert JA (2007) Digital radiography: CR versus DR? Time to reconsider the options, the definitions, and the current capabilities. Applied Radiol December Suppl:4–7Google Scholar
  23. Seibert JA, Morin RL (2011) The standardized exposure index for digital radiography: an opportunity for optimization of radiation dose to the pediatric population. Pediatr Radiol 41:573–581PubMedCentralPubMedCrossRefGoogle Scholar
  24. Shepard SJ, Wang J, Flynn M, Gingold E, Goldman L, Krugh K, Leong DL, Mah E, Ogden K, Peck D, Samei E, Wang J, Willis CE (2009) An exposure indicator for digital radiography: AAPM Task Group 116 (Executive Summary). Med Phys 36(7):2898–2914PubMedCentralPubMedCrossRefGoogle Scholar
  25. Tarver RD, Cohen M, Broderick NJ, Conces DJ Jr (1990) Pediatric digital chest imaging. J Thorac Imaging 5(1):31–35PubMedCrossRefGoogle Scholar
  26. Uffmann M, Prokop M, Eisenhuber E, Fuchsjager M, Weber M, Schaefer-Prokop C (2005) Computed radiography and direct radiography: influence of acquisition dose on the detection of simulated lesions. Invest Radiol 40(5):249–256PubMedCrossRefGoogle Scholar
  27. Uffmann M, Schaefer-Prokop C (2009) Digital radiography: the balance between image quality and required radiation dose. Eur J Radiol 72(2):202–208PubMedCrossRefGoogle Scholar
  28. Vastagh S (2011) Statement by MITA on behalf of the MITA CR-DR group of the X-ray section. Pediatr Radiol 41:566. doi: 10.1007/s00247-010-1961-7 PubMedCrossRefGoogle Scholar
  29. Vult von Steyern K, Björkman-Burtscher IM, Bozovic G, Wiklund M, Geijer M (2012) Description and validation of a scoring system for tomosynthesis in pulmonary cystic fibrosis. Eur Radiol 22:2718–2728PubMedCrossRefGoogle Scholar
  30. Willis CE (2002) Computed radiography: a higher dose? Pediatr Radiol 32:745–750PubMedCrossRefGoogle Scholar
  31. Willis CE (2008) Digital radiography: CR versus DR? Sometimes recognizing the distinction in technologies makes a difference. Applied Radiol January:25–28Google Scholar
  32. Willis CE (2009) Optimizing digital radiography of children. Eur J Radiol 72(2):266–273PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.Department of Imaging PhysicsUniversity of Texas M D Anderson Cancer CenterHoustonUSA
  2. 2.Mallinckrodt Institute of Radiology, Washington University School of MedicineSt. LouisUSA

Personalised recommendations