The versatility of consumer digital cameras has revolutionized casual picture taking as we know it. Not only can people take pictures of anything they have a mind to, but they also can see and share those pictures immediately. When asked if they would ever go back to using film, most folks answer with a definite “no.”

The same can be said of the medical community, which is slowly but surely edging its way into a predominantly digital or filmless imaging world—“slowly” because costs can be prohibitive, and certain diagnoses are more accurately made with current methods; “surely” because digital imaging offers reduced cost per image, faster imaging, greater throughput, fewer consumables, and a lower X-ray dosage to the patient.

Darryl Stein, president and CEO of Imaging Dynamics Co (Calgary, Alberta), says that most hospitals report a 2 to 2.5 times increase in productivity after going digital. Golden Capital (Vancouver, British Columbia), a brokerage firm offering research services to clients, found that “as the cost of direct-to-digital-image capture devices has become lower, the payback period for these technologies has become shorter. Most companies claim cost payback to be within 18–24 months. With a typical product life span of 7–10 years, total cost savings over traditional film technology to the institution can be great.”

However, the initial outlay for a complete DR room can be prohibitive for some facilities at a potential cost of more than $800,000, with service contracts that can run $40,000–$50,000 per year. Those who find this price tag cost-inefficient might opt instead for a gradual conversion, either through retrofits or upgrades. According to Golden Capital, these solutions typically fall within the $100,000–$400,000 price range.

In addition to offering the benefits of a digital process at a reduced cost, retrofits allow a facility to maximize its analog investment. Beth Bernier, marketing and communications specialist at Infimed Inc (Liverpool, NY), points out that a retrofit can extend the life of a room and, therefore, the facility’s return on investment for as many as 10 years.

Golden Capital estimates that the potential market for retrofit technology in North America, which includes about 200,000 traditional X-ray rooms, is $10 billion–$20 billion over the next 10 years.

What Is a Retrofit?
Retrofit options vary, but the basic idea is to keep some of a facility’s existing X-ray equipment while replacing other pieces that provide digital image capture. Typically, the film receptacle or bucky tray of an analog X-ray system is replaced with a new detector that is accompanied by the computer and software to run it. Current options on the market include flat-panel detectors and charged couple device (CCD) cameras.

Elaine Proseus, MBA, RT(R), assistant manager of sales at Canon Medical Systems, (Lake Success, NY), part of Canon USA Inc, notes that the X-ray table, wall stand, and tube housing and support structure from the analog system remain with a Canon retrofit. “Canon’s offerings are compatible with most manufacturers’ equipment, so the facility can retain much of its current room through the end of its useful life,” she says. “Once it reaches the end of that usefulness, they can then upgrade, replacing specific components as necessary or desired.”

Brian Beardslee, VP of medical business at VIDAR Systems Corp (Herndon, Va), suggests that some people might consider CR a retrofit. “You’re not changing tables, tubes, or workflow; rather, instead of a photochemical process, you have digital development.”

Stein of Imaging Dynamics believes that CR can be a step in the conversion process, but not necessarily a wise one. “With CR, you still have the same limitations on workflow,” he says. This sentiment has been echoed in the industry, which is why many facilities look into a direct conversation to digital.

Upgrades are another option. Stein believes this more accurately describes his company’s product line. “We do not put our technology onto the existing table but rather remove the fixed table and install a new detector and mobile table,” he explains. “The facility retains its tube, ceiling mount, and generator.”

Of course, facilities also can complete a full-room replacement, choosing the tube, ceiling mount, and generator of their choice. Imaging Dynamic products work with a range of manufacturers’ equipment.

How Dynamic!
The product line from Imaging Dynamics employs a very high-resolution CCD camera that has been in development for 14 years. “This technology is found everywhere from digital cameras to the Hubble telescope,” Stein says. “Riding on the back of the commercial technology, we’ve been able to incorporate a chip—with a reduced price and a high resolution—into medical imaging applications.”

As a result, service and maintenance are less expensive than traditional flat-panel technology. “We offer a 5-year warranty,” he adds.

Products include the Xplorer 1800 and the Xplorer 1500. The 1800 is a multi-position general radiographic unit detector designed for upright shots and table work; it is intended for upgrades or full-room replacements for hospitals with heavy workloads. The 1500 is ideal for chest and head-to-toe upright examinations. It also is available for upgrades or full-room replacements, usually incorporating a floor-mounted tube, which is less expensive.

This fall, the company will expand its product offerings to include the Xplorer 1600, a wall-mounted unit with vertical and horizontal positioning. It is intended for clinics, typically in rooms with a floor-mounted base.

Infinite Options
Infimed’s PlatinumOne product line also employs CCD technology. “We’ve redesigned and manufactured this camera ourselves to offer very high image quality and ease of maintenance,” Bernier says.

The Innovision camera is featured throughout the family, which includes systems for R/F, angiography, and urology rooms. Like many of its competitors, PlatinumOne can interface with virtually all of the analog equipment currently in place today.

The GoldOne Cardiac and GoldOne SwingLab offer CCD technology for cardiology applications. And Infimed also offers a flat-panel product, the StingRay DR, which can be used with both table and chest stands.

“The products are designed for use in all facilities, including large and small hospitals, as well as in urban and rural areas,” Bernier notes.

Bringing DR Bedside
By introducing portability, Canon’s products offer a bit more flexibility than its competitors. The company’s newest product is the Canon CXDI-50G Portable DR System. Weighing just 10.6 lbs and featuring a 14- x 17-inch imaging area, the system is large enough for chest and abdominal X-rays but flexible enough for the lateral and axial imaging of limbs and other body segments. Intended for general radiography, trauma, and bedside care, the product also can be used in the X-ray room for maximum flexibility.

InfiMed’s Platinum One upgrades existing rooms to digital and is compatible with almost any generator, table laser, or PACS. The system includes the Innovision camera (inset), which features the most current CCD technology. Also from the company is the StingRay DR System, which can transform two radiographic rooms into digital suites for about the same cost as replacing an entire system in just one room.

Canon introduced portability roughly a year ago with the CXDI-31 Portable System, which, according to Proseus, was the first system to bring DR bedside. Smaller than the CXDI-50G—with an image size of 9 x 11 inches and a weight of 6.2 lbs—it can be freely positioned and is, therefore, ideal for neonatal, pediatric, and specialty imaging, such as orthopedics.

The CXDI-40G is intended to replace the bucky tray in a permanent installation for use in a range of general radiography applications. It is the largest of the three, capable of capturing 17- x 17-inch images from almost any position or angle.

All three products use the Canon Amorphous Silicon flat-panel sensor, which consists of a precision amorphous silicon metal-insulator-semiconductor sensor and a thin film transistor array. The sensor has been used in Canon products for more than a decade. “The CXDI-50G is our seventh generation of detector, and with every generation, we have continued to make improvements. Components have become smaller and faster,” Proseus says.

Though uncertain where development is headed, she suggests that products will evolve as electronics and computers speed progress. Once we reach the next step, chances are, there will be no looking back.

Straddling Two Worlds “Let’s say the whole world is digital tomorrow. DR is dominant. CR is gone,” hypothesizes Brian Beardslee of VIDAR Systems Corp. “You would still need digitizers to bring in prior exams.” Until the medical community has gone completely digital and done so long enough for all prior images to also be digital, there will still be a need for transitional technology. Film digitizers fill this role. They also can be used to print duplicate film directly or to burn the image to a CD, which can be used for storage or refers. Prior exams are frequently used in orthopedics to check healing processes, in oncology to verify treatment success, and in mammography to determine change. “Radiologists want to be able to compare images because they look at change,” Beardslee says. Thomas Nardozzi, president of Array Corp USA (Brentwood, NH), adds that it is inefficient for radiologists to try to make comparisons between analog and digital images. “It’s counterproductive,” he states. “Even brand-new, all-digital facilities have found that they need digitizers to convert older films brought in by patients.” He says that this fact is no surprise. “We still have one foot in each world,” he says. However, he was surprised when he discovered that some clients, particularly those in rural areas with smaller budgets, use the technology for primary diagnosis. “We didn’t anticipate this usage, but the capture is good enough that it provides an alternative for facilities where the cost of moving to digital is an issue,” he explains. Janet Sterritt, VP of product management for iCAD Inc (Nashua, NH), believes this situation is more commonplace than one would expect. “CR has come a long way, but it is not capable of handling everyone who needs imaging,” she says, offering obese patients and the ground-glass effect as instances when film imaging is needed. “Some day, CR probably will handle everything, but it’s not quite there yet.” She believes DR does a better job than CR, but to handle all situations, special equipment is often needed at an increased cost. “Because most facilities already have the analog X-ray equipment in place they can extend the life of the investment with a digitizer.” Citing AMA research that indicates X-ray procedures outpace all others by more than two to one, Sterritt says, “Even though hospitals have digital media, they are still shooting more film than ever before. Digital is helping with more specific medicine, but it doesn’t fulfill all needs. The first broad stroke still belongs to X-ray.” Echoing the sentiments of her counterparts elsewhere, she adds, “It’s still a hybrid world.” Gettin’ Digi With It Looking to purchase a film digitizer for your facility? Check out these offerings. Array Corp USA • The Array 2905 Medical Laser Film Digitizer, representing fifth-generation technology, is designed to scan all images, offering varying pixel spacing and optical density (up to 4.0). Array USA Corp’s 2905 medical laser film digitizer represents fifth-generation technology. • The Array 2905HD Industrial Laser Film Digitizer, with optical density available up to 4.7, is a nice fit for those who want to use full Kodak film, according to Nardozzi. iCAD The Fulcrum film digitizer is iCAD’s most popular model. • Fulcrum, the company’s most popular digitizer, is designed specifically for mammography applications and, according to the company, features a “new intense red gas illuminator to penetrate even the darkest of films.” The iCAD MultiRAD860 film digitizer is used in mammography and orthopedics. • The MultiRAD 860 is intended for mammography and orthopedics and is frequently used in orthopedic clinics and remote sites; it also can be employed as an image-capture station for CAD. The iCAD MultiRAD460 is designed for emergency rooms, film libraries, and clinics. • The MultiRAD 460, which is used in emergency rooms, film libraries, and clinics, works well with chest procedures, fractures, and GI series. VIDAR Systems Corp VIDAR products are not available directly to facilities; rather, they’re sold to such companies as Siemens Medical Solutions (Malvern, Pa) and Philips Medical Systems (Bothell, Wash), which deliver solution sets. The digitizers feature high-definition CCD technology and automatic digitizer calibration. VIDAR Systems’ DosimetryPRO Advantage (left) offers greater dose resolution with 16-bit film. The company’s DiagnosticPRO Advantage (center) is used in PACS, teleradiology, and orthopedic surgery. And the CAD PRO Advantage (right) is designed for mammography CAD. • DiagnosticPRO Advantage meets the needs of PACS, teleradiology, and orthopedic surgery. • CAD PRO Advantage is designed for mammography CAD. • DosimetryPRO Advantage provides greater dose resolution with 16-bit film. • SIERRA plus, which is small enough to be wall mounted, is the company’s lowest cost digitizer for remote primary diagnosis. —RD

Renee DiIulio is a contributing writer for Medical Imaging.