Film Screen Radiography and Computed Radiography in Hospitals - Research Paper Example

Why should Saudi hospitals switch from Film Screen Radiography to Computed Radiography? Corresponding Academic Degree: and Address of Institution: Corresponding Author Contact Details: Abstract Background: Radiography is an imaging technique, which assists in getting medical images by utilizing various techniques of medical imaging that can be divided based on the type of imaging they provide, such as conventional x-ray, computed radiography and digital radiography. Objective: The main objective of this study is to find why Saudi hospitals should switch from film screen radiography to computed radiography by comparing computed radiography and film screen radiography. Methods: A questionnaire was prepared that covered various areas concerning computed radiography and filmed radiography related to image quality, cost and productivity and was sent to various hospitals in Riyadh in Kingdom of Saudi Arabia. Result: The results suggested that that the image quality of the computed radiography is better than the conventional filmed screen X-ray. The overall cost (installation and operating) of the computed radiography is less as compared to filmed radiography. In addition, productivity increased after installation of computed radiography. Conclusion: It is clear from research analysis on the basis of image quality, cost, and productivity that computed radiography is better than the filmed radiography, therefore, the Saudi filmed radiography department should not delay in switching to computed department. Introduction Radiography is an imaging technique, which assists in getting medical images by utilizing various techniques of medical imaging. The techniques of radiography can be divided based on the type of imaging they provide, such as conventional x-ray, computed radiography and digital radiography (Don et al., 1999). Film radiography refers to the imaging technique, which utilizes films and provides the films of the parts of the body for medical imaging for taking medical ailments (Merritt et al., 1985). Computed radiography refers to the imaging technique, which uses reusable phosphor imaging plates. The imaging quality of computed radiography is better than film radiography. The productivity of computed radiography is effective and efficient than the film radiography. The costing of computed radiography is more in comparison to film radiography (Patel, 2005). The utilization of computed radiography assists in providing quality ailments to the patient in comparison to film radiography. Computed radiography improves the efficiency of the radiographer and assists in providing better picture quality and three-dimensional images. The radiation dose is less in computed radiography as compared to film radiography to the patients. The contrast resolution of computed radiographs is better than the film radiographs, which increases the visualization of the soft tissues. The main objective of this paper is to find why Saudi hospitals should switch from film screen radiography to computed radiography by comparing computed radiography and film screen radiography. Literature Review Initially, the filmed radiography was used to examine the anatomy of human body. To view the images captured by film based radiography needed to be exposed and developed by the radiologists (Parks & Williamson, 2002). The images produced by using filmed radiography or conventional x-ray were not as detailed as the images captured using digital technology. Today, the digital imaging technology has enabled the medical professionals to get the images of human anatomy displayed instantly on a computer screen without processing and development of film. Computed radiography is less time consuming and more accurate than the conventional systems. There are a number of benefits using computed technology as compared to filmed radiography as described in below paragraphs. On the Basis of Image Quality According to Erickson et al. (1981), the conventional x-ray technology was unable to provide two-dimensional image and sometimes it used to be quite confusing and difficult to analyze the three-dimensional part of human body. On the other hand, according to Sree Ram (2003), computed radiography is more accurate in generating clear and easily visible images of human body. In the case of filmed screen based radiography, the soft tissues of human body such as liver and pancreas cannot be shown clearly and to view these images radio-opaque dyes were used. Whereas, computed radiography uses wider exposure latitude that means a wide range of acceptance of exposure factors to generate an acceptable image. There is a need of less precise setting in digital imaging than filmed radiography. According to Lu et al. (2003), it is easier to analyze the three-dimensional images of the soft tissues of human body with the help of computed radiography. According to Garmer et al. (2000), computed radiography provides higher image signal to noise ratio. That means in digital imaging, more x-ray photons strike the detector and generate strong signals to produce better image in comparison to filmed radiography. On the Basis of Cost Cost factor always carries a critical position but at the cost of quality and convenience, it may not be considered. Cost of the filmed radiography is less in comparison to the cost of computed radiography. Due to the use of computers and latest machinery, the initial expenditure in this technique is high. According to Dr. Christensen (2004), the new technology is more costly than the film screen radiography but its advantages justify its initial cost. According to Don et al. (1995), the cost of setting up a filmed radiography system is less but the operating cost is high, whereas the cost of setting up the computed radiography system is high but reusable plates reduces the cost by many other ways and thus, the operating becomes less costly. The key cost benefits of computed radiography as compared to filmed radiography are less cost of image plate, cost saving on storage, cost saving on time, and decrease retakes (Duerinckx & Grant, 1998; Christensen, 2004). On the Basis of Productivity The research study done by Pavlicek (1985) lights up the aspect related to the productivity of the modalities such as computed radiography and filmed radiography. With the help of the computed radiography, the medical professionals are able to analyze better view in very short period of time. On the other hand, the previous technology of radiography, and filmed radiography is not convenient as compared to the computed radiography because it needs to be processed and developed before viewing. The computed radiography uses less time to generate the pictures in comparison to film radiography (Pavlicek, 1985). According to the Siemens Medical Solutions (2006), the data stored on phosphor image plates can be kept secure in encrypted form and saved on disk for off-site viewing. It is quite easy to organize and retrieve the images from computer file storage. It was quite cumbersome to organize, handle and find the radiographs and charts of filmed or conventional radiography. It was very difficult for the patients also, who need to have a regular radiography. Computed radiography has made this problem easily manageable for the patients as well as medical professionals (Siemens Medical Solutions, 2006). Based on these facts, it can be considered that computed radiography produce more image in less time with better picture quality than filmed radiography. Although the cost of digital technique is higher than the cost of filmed radiography but productivity, fast speed and image quality are excellent in respect to film radiography. From the above-mentioned points, it can be said that productivity and speed is the main issue that can be considered by the Saudi Department of film-screen radiography to enhance the quality and better satisfy its patients. Research Methodology For this study, a questionnaire was prepared that is available in appendix. Through this questionnaire, various areas concerning computed radiography and filmed radiography related to image quality, cost and productivity in hospitals of Riyadh in Kingdom of Saudi Arabia were targeted. The questionnaire consisted of three sections; general information, maintenance at computed radiography department, and comparison between computed radiography and filmed radiography. The research team formed for this purpose gathered data from various hospitals in Riyadh. The questionnaire was sent to about 70 people from various hospitals in Riyadh and 50 (71.4 %) responses were received that consisted of 10 female (20%) and 40 male (80%) respondents. As shown in figure 1, the highest qualifications of respondents were Diploma (40%), BSc (40%), and MSc (20%). As shown in figure 2, majority of the respondents (60%) were technologist (specialist) while 40% of the respondents were radiologists. As shown in figure 3, the total years of experience in their profession of respondents were 0-5 years (14%), 6-10 years (70%), and 10-ablove (16%). The experience level of the respondents in this field was low as only 16 percent of the respondents had an experience level of above 10 years while nearly 84 percent of the respondents have experience from 0 -10 years. Results As shown in figure 4, majority of the respondents (70%) believed that the duration of maintenance and replacement of devices has reduced after the implementation of computed radiography in the hospitals in Riyadh. As shown in figure 5, majority of the respondents (80%) believed that it is necessary to take care of the room designing where computed radiography instruments are supposed to be installed. As shown in figure 6, majority of the respondents (80%) believed that the computed radiography system decreases the examination time when compared to the filmed radiography. As shown in figure 7, majority of the respondents (90%) believed that the repeated examinations/rejected films reduced largely in comparison to the filmed radiography. As shown in figure 8, majority of the respondents (80%) believed that the computed radiography system decreases the number of lost image as compared to the filmed radiography. As shown in figure 9 majority of the respondents (76%) believed that the computed radiography system decreases delivery time in comparison to filmed radiography. As shown in figure 10, majority of the respondents (70%) believed that the computed radiography system decreases the overall operating and maintenance expenses as compared to the filmed radiography. As shown in figure 11, majority of the respondents (60%) believed that the computed radiography system improves the quality of images in comparison to the filmed radiography. As shown in figure 12, majority of the respondents (76%) believed that the productivity has increased after the implementation of computed radiography. As shown in figures 13 to 18, it appears that there was strong or very strong association between increase in productivity and variables decrease in cost, decrease in lost images, increase in quality of images, decrease in repeated examination/rejected films, and examination time. The correlation matrix table (table 1) also confirms this. Discussion On the Basis of Image Quality The results show that the image quality of the computed radiography is better than the conventional filmed screen X-ray. As shown in figure 11, nearly 60% of the respondents believed that image quality improves using computed radiography. On the Basis of Cost As shown in figure 4, the duration of maintenance and replacement of devices has come down drastically. This view has been endorsed by 70 % of the respondents. The decrease in duration means less cost involved in maintaining this technology, which is also confirmed by the view of respondents as 70 % respondents agreed that the overall operating and maintenance expenses have decreased after the installation of the computed radiography system (see figure 10). As shown in Figure 8, most of the respondents (90%) were of the opinion that there is a decrease in lost image, while using computed technology. Decrease in lost images means lower operating costs, as there is reduction in wastages. As shown in figure 7, 90 % of the respondents believed that there is reduction in repeated examination/rejected films in case of computed technology. The reduction in repeated examination/rejected films indicates decrease in operating costs. All these factors indicate that there is a considerable decline in cost, while using computed radiography. On the Basis of Productivity The decrease in average examination time taken by a patient in the detection room is an indicator of productivity, as lower examination time result in higher patient throughput. This means more people can be observed in the same time. Most of the respondents of the survey (80%) believed that computed radiography decreases the examination time in comparison to filmed radiography (see figure 6). The decrease in delivery time is another indicator of productivity. The delivery time taken by the computed technology is less than film/ screen radiography. This opinion is shared by nearly 76% of the respondents who believe that use of computed technology decreases the delivery time in comparison to filmed Technology (see figure 9). Repeated Examination is another measure of determining productivity of the technology. As shown in figure 7, 90% of the respondents believe that the computed radiography system reduces repeated examination /rejected films in comparison to filmed radiography. Lastly, as shown in figure 12, most of the respondents (76%) agreed that after the installation of Computed radiography the productivity of images has increased Recommendations Based on three parameters productivity, cost and image quality, it can be seen that the image quality was found to be better in case of computed radiography. The productivity of the machine in case of computed radiography is found to be better than the digital radiography. This is seen when the comparison is done in terms of number of customers handled per hour and second comparison is done in terms of time taken. The cost factor seems to be more initially in case of computed radiography but when maintenance and other costs are considered then this figure is less in case of computed radiography. Thus, based on these three factors and the whole research, it is recommended that computed radiography should be preferred over film radiography in the hospitals of Saudi Arabia. The film/screen technology has become obsolete over these years, as the new technologies have entered the scene. In order to produce better results the computed radiography technology should be used. In addition, other new technologies like digital radiography should be considered as a possible option as it is one of the new emerging technologies in this field. Research should be done so that the implementation of this technology can be made more productive. Limitations The various limitations of this research are given below: There might be biases in the questionnaires answered by the respondents. It is quite difficult to determine whether the selected sample is a true representative of the population or not. The cost available for the research was a limited factor. The response to the questionnaire depends upon the respondent’s honesty, motivation, memory, and responsiveness ability. Sometimes the answers given by the respondents might be not motivated to give accurate answers, as they want to show themselves in favorable light. The questionnaire, which has closed ended questions like this, has low validity. Errors due to non-response are quite possible. Researcher’s greater control over the environment in which the survey is conducted may lead to errors in the accuracy of the results. Conclusions In conclusion, the Saudi filmed radiography department should switch to computed radiography because the computed radiography renders many favorable points over filmed radiography. Conventional x-ray or filmed radiography is an old technique and it does not suit the requirements of the modern world. Filmed radiography is a time consuming technology and every image has to be processed and developed before viewing. The images captured using computed radiography are of high quality as compared to conventional imaging technologies. Computed radiography increases the productivity by reducing the time of image development. These pictures are more clearly visible and can be altered for more clarification. The set up cost is the only factor that is higher than conventional filmed radiography. Filmed radiography system is less expensive to set up but its operational cost is high. On the other hand, the initial cost of computed system is more but its operational cost is low. Thus, the Saudi filmed radiography department should not delay in switching to computed department because it is fast, better imaging quality, productivity and convenient for the radiographers as well as the patients. References Christensen, G.J. (2004). Why switch to digital radiography? Journal of American Dental Association, 135, 1437-1439. Don, S., Albentina, M.J., Ammann, D.L., Evens, R.G., & Siegel, M.J. (1995, November). Soft-Copy Computed Radiography in Neonatal and Pediatric Intensive Care Units: Cost Saving Analysis. Radiology, 197, 501-505 Don, S., Hildebolt, C.F., Sharp, T.L., Lau, D.M., Herman, T.E. & McAlister, W.H. (1999). Computed Radiography versus Screen film Radiography: Detection of Pulmonary Edema in a Rabbit Model that Simulates Neonatal Pulmonary Infiltrates. Journal of Radiology, 213(2), 455-460. Duerinckx, A.J., Grant, E.G. (1998, August). Cost of PACS and Computed Radiography in the United States. Journal of Radiology, 208 (2), 554-555. Erickson, J.J., Price, R.R., Rollo, F.D., Pendergrass, H.P., Gerlock, J., Partain, C.L. & James, A.J. (1981). A digital radiographic analysis system. Journal of Radio Graphics, 1(2), 49-60. Garmer, M., Hennigs, S.P., Jäger, H.J., Schrick, F., Loo, T., Jacobs, A., Hanusch, A., Christmann, A. & Mathias, K. (2000, January) Digital Radiography versus Conventional Radiography in Chest Imaging Diagnostic Performance of a Large-Area Silicon Flat-Panel Detector in a Clinical CT-Controlled Study. Journal of American Radiology, 174, 75-80. Lu, J.F., Nickoloff, E.L., So, J.C. & Dutta, A.K. (2003). Comparison of computed radiography and film/screen combination using a contrast-detail phantom. Journal of Applied Clinical Medical Physics, 4 (1), 91-98. Merritt, C.R.B. et al (1985). Clinical application of digital radiography: Computed radiographic imaging. RadioGraphics 5 (3), 397-414 Parks, E.T. & Williamson, G.F. (2002). Digital Radiography: An Overview. Journal of Contemporary Dental Practice, 3(4), 1-13. Patel, R.J. (2005, November). Digital Applications of Radiography. Retrieved September 23, 2008, from http://www.ndt.net/article/mendt2005/pdf/08.pdf Pavlicek, W. (1985, January). Computers in Digital Imaging. Journal of Radio Graphics 5(1), 83-104. Siemens Medical Solutions (2006). Computed Radiography Systems: An Easy Step from Analog to Digital. USA: Siemens Medical Solutions USA, Inc. Sree Ram, M.N. (2003). Film-less Radiology - A Future Perspective. MJAFI 59(3), 187-188. Appendix Questionnaire for the participants to find out that should Saudi filmed Radiography Department switch to Computed Radiography: Section A- General Information and health knowledge Please tick the boxes which best describe your situation. 1. What is your gender? □ Male □ Female 2. What is your highest qualification? Diploma  BSc  MSc  Other please specify ………………… 3. What is your present employment status?  Radiographer  Specialist  Other please specify …………… 4. What is your total years of experience in this profession?  0-5  2-10  10-above 5. How long the Computed radiography system has been installed in this hospital?  0-5  2-10  10-above 6. How can you say that computed radiography is better in comparison to filmed radiography? …………………………………………………………………………………………………………………………………………………………………………………………………… Section B – Maintenance at computed radiography department Please tick the boxes which best describe your situation. 1. Did the duration of maintenance and replacement of devices has reduced after the implementation of computed radiography? Yes No Don’t know 2. Is it necessary to take care of the room designing where these instruments are supposed to be installed? Yes No Don’t know _____________________________________________________________ Section C- Comparison between Computed Radiography and Filmed Radiography Please tick the boxes which best describe your situation. 1. Do you agree that computed radiography system decreases delivery time in comparison to filmed radiography? Agree Unsure Disagree 2. Do you agree that the computed radiography system decreases examination time in comparison to filmed radiography: Agree Unsure Disagree 3. Do you agree that the computed radiography system reduces repeated examination /rejected films in comparison to filmed radiography: Agree Unsure Disagree 3. Do you agree that the Computed radiography system improves the quality of image in comparison to filmed radiography: Agree Unsure Disagree 4. Do you agree the computed radiography system reduces the number of lost images in comparison to filmed radiography: Agree Unsure Disagree 5. Do you agree that computed radiography provides less harmful technique when compared to film-screen radiography in term of radiation dose: Agree Unsure Disagree 6 Do you agree that the overall operating and maintenance expenses have decreased after the installation of the computed radiography system: Agree Unsure Disagree 7 Do you agree that after the installation of Computed radiography the productivity of images has increased? Agree Unsure Disagree Any comments: ………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………............................................................................................ Thank you for participating. Your help in our study is appreciated. Figures and Tables Figure 1: Highest qualification of respondents Figure 2: Employment status of respondents Figure 3: Total years of experince of respondents Figure 4: Reduction in maintainance and replacement duration of devices Figure 5: Neccessity to take care room designing for computed radiography instruments Figure 6: Decrease in examination time Figure 7: Reduction in repeated examination/rejected films Figure 8: Reduction in the number of lost images Figure 9: Decrease in delivery time Figure 10: Decrease in the overall operating and maintenance expenses Figure 11: Improved image quality Figure 12: Response towards impact on Productivity Figure 13: Scatterplot of increase in productivty versus delivery time Figure 14: Scatterplot of increase in productivty versus decrease in cost Figure 15: Scatterplot of increase in productivty versus decrease in lost images Figure 16: Scatterplot of increase in productivty versus increase in quality of images Figure 17: Scatterplot of increase in productivty versus decrease in repeated examination Figure 18: Scatterplot of increase in productivty versus decrease in examination time Table 1 Correlations Matrix Productivity Delivery Time Cost Lost Images Quality of Images Repeated Examination Examination Time Productivity Pearson Correlation 1 .929(**) .892(**) .754(**) .843(**) .754(**) .897(**) Sig. (2-tailed) .000 .000 .000 .000 .000 .000 N 50 50 50 50 50 50 50 Delivery Time Pearson Correlation .929(**) 1 .861(**) .593(**) .907(**) .593(**) .834(**) Sig. (2-tailed) .000 .000 .000 .000 .000 .000 N 50 50 50 50 50 50 50 Cost Pearson Correlation .892(**) .861(**) 1 .804(**) .866(**) .804(**) .895(**) Sig. (2-tailed) .000 .000 .000 .000 .000 .000 N 50 50 50 50 50 50 50 Lost Images Pearson Correlation .754(**) .593(**) .804(**) 1 .538(**) 1.000(**) .885(**) Sig. (2-tailed) .000 .000 .000 .000 .000 .000 N 50 50 50 50 50 50 50 Quality of Images Pearson Correlation .843(**) .907(**) .866(**) .538(**) 1 .538(**) .756(**) Sig. (2-tailed) .000 .000 .000 .000 .000 .000 N 50 50 50 50 50 50 50 Repeated Examination Pearson Correlation .754(**) .593(**) .804(**) 1.000(**) .538(**) 1 .885(**) Sig. (2-tailed) .000 .000 .000 .000 .000 .000 N 50 50 50 50 50 50 50 Examination Time Pearson Correlation .897(**) .834(**) .895(**) .885(**) .756(**) .885(**) 1 Sig. (2-tailed) .000 .000 .000 .000 .000 .000 N 50 50 50 50 50 50 50 ** Correlation is significant at the 0.01 level (2-tailed). Read More

The contrast resolution of computed radiographs is better than the film radiographs, which increases the visualization of the soft tissues. The main objective of this paper is to find why Saudi hospitals should switch from film screen radiography to computed radiography by comparing computed radiography and film screen radiography. Literature Review Initially, the filmed radiography was used to examine the anatomy of human body. To view the images captured by film based radiography needed to be exposed and developed by the radiologists (Parks & Williamson, 2002).

The images produced by using filmed radiography or conventional x-ray were not as detailed as the images captured using digital technology. Today, the digital imaging technology has enabled the medical professionals to get the images of human anatomy displayed instantly on a computer screen without processing and development of film. Computed radiography is less time consuming and more accurate than the conventional systems. There are a number of benefits using computed technology as compared to filmed radiography as described in below paragraphs.

On the Basis of Image Quality According to Erickson et al. (1981), the conventional x-ray technology was unable to provide two-dimensional image and sometimes it used to be quite confusing and difficult to analyze the three-dimensional part of human body. On the other hand, according to Sree Ram (2003), computed radiography is more accurate in generating clear and easily visible images of human body. In the case of filmed screen based radiography, the soft tissues of human body such as liver and pancreas cannot be shown clearly and to view these images radio-opaque dyes were used.

Whereas, computed radiography uses wider exposure latitude that means a wide range of acceptance of exposure factors to generate an acceptable image. There is a need of less precise setting in digital imaging than filmed radiography. According to Lu et al. (2003), it is easier to analyze the three-dimensional images of the soft tissues of human body with the help of computed radiography. According to Garmer et al. (2000), computed radiography provides higher image signal to noise ratio. That means in digital imaging, more x-ray photons strike the detector and generate strong signals to produce better image in comparison to filmed radiography.

On the Basis of Cost Cost factor always carries a critical position but at the cost of quality and convenience, it may not be considered. Cost of the filmed radiography is less in comparison to the cost of computed radiography. Due to the use of computers and latest machinery, the initial expenditure in this technique is high. According to Dr. Christensen (2004), the new technology is more costly than the film screen radiography but its advantages justify its initial cost. According to Don et al. (1995), the cost of setting up a filmed radiography system is less but the operating cost is high, whereas the cost of setting up the computed radiography system is high but reusable plates reduces the cost by many other ways and thus, the operating becomes less costly.

The key cost benefits of computed radiography as compared to filmed radiography are less cost of image plate, cost saving on storage, cost saving on time, and decrease retakes (Duerinckx & Grant, 1998; Christensen, 2004). On the Basis of Productivity The research study done by Pavlicek (1985) lights up the aspect related to the productivity of the modalities such as computed radiography and filmed radiography. With the help of the computed radiography, the medical professionals are able to analyze better view in very short period of time.

On the other hand, the previous technology of radiography, and filmed radiography is not convenient as compared to the computed radiography because it needs to be processed and developed before viewing. The computed radiography uses less time to generate the pictures in comparison to film radiography (Pavlicek, 1985).

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