计算机/数字放射学:数字革命遇到计算机阻力

与数字放射照相(DR)的供应商和支持者交谈，你会听到它是未来的浪潮，最终将取代它的前辈兄弟，计算机放射照相(CR)技术的发展方向。然而，在CR人群中提出这一前景，你可能会听到一些截然不同的东西。他们会告诉你，DR可能很棒，但CR至少要长期存在。为什么?因为数字化胶片往往前期成本较低，涉及较少的兼容性和现有设备的配置挑战，需要较少的教育和培训(特别是在终端用户行为修改和整体心态方面)，所以它对设施的破坏性较小，并且可能足以满足设施的需求和目标。即使“下一代”DR在急症护理和门诊护理机构中越来越受欢迎，传统CR仍保留并维持着坚实的粉丝基础，特别是在门诊领域，DR在财政和操作上可能并不合理。显然，CR和DR的制造商都预见了各自技术的光明未来，即使处于新兴的数字技术发展浪潮的背景下，包括收敛性、灵活性、多功能性、额外的功能和速度。由于这两种技术似乎都已在医疗保健行业中得到应用，因此只有探索CR和DR应用程序和功能的当前和未来发展，包括这些发展如何影响总体性能，才是有意义的。因为他们都计划在游戏中玩上一段时间，所以了解他们的前进方向以及他们计划如何达到目标是很重要的。这就是为什么门诊护理技术编辑Rick Dana Barlow冒险去研究下一代CR和DR应用程序将会是什么样子，以及它们在临床、财务和运营绩效方面的功能和作用将如何通过技术发展得到增强。 Barlow asked key executives of leading CR and DR manufacturers to briefly share their insights on the technological progression of their products for outpatient care facilities. With increased interest in and migration to digital radiography but continued reliance on and solid support for computed radiography, what do you foresee as the next big development in both CR and DR applications, specifically as they relate to outpatient settings? Why? How do you envision these next-generation CR and DR applications functioning? Why do these new versions represent an advancement over current versions? What additional capabilities and features will be available to enhance patient care, particularly in the outpatient setting? If you could design and program the most futuristic CR and/or DR application what features would you include? Do you foresee any of these features being valuable to end-users? Finally, how realistic is it to expect cost-conscious outpatient care facilities to use it? Fred Fischer, vice president, ALLPRO Imaging, Hicksville, NY,www.allproimaging.comCR的未来就是现在。磷光储存板(PSP)发明于1947年。CR是工程师们所说的“成熟技术”，因此未来不太可能有任何真正的惊喜。可以开发出从平板上读取潜在图像的新方法，但不太可能改变低容量用户对该设备的基本使用。如果能找到用于DR的板的商业/消费电子应用，可能会彻底改变这个市场，这将降低DR板的价格，并可能意味着CR在大多数医疗应用中的终结。门诊护理是数字成像的下一个大市场，由于成本的考虑，它很有可能主要是CR市场。大公司要么购买并重新命名低成本CR系统，要么开发出自己的低成本新设计。小公司已经开发了他们自己的创新、低成本CR系统。小容量用户，如紧急护理中心、医疗办公室、脊椎按摩师等，都希望在没有胶片、处理、暗房、存储等成本和不便的情况下操作，但他们可以花一些实际的钱来实现数字化。每天拍摄8到16张照片的成本是每年9000到14000美元，因此一个成本超过10万美元的DR底片系统在经济上是不现实的，大多数用户应该同时拥有一个桌子和壁挂式底片。 DR systems using single CCD cameras compromise on image size, resolution and radiation dose. CR alone allows standard image size, good resolution and 400 speed at a cost that can be reasonably amortized. Just expose on the CR plate instead of film. It has been suggested that digitizing an already processed film will allow electronic transmission and storage. While this is true it does not make economic sense since, rather than reducing costs, it just adds on another layer to the cost of film, chemistry and processing. Admittedly, CR is like having a dry processor (without the need for supplies) so that it is not as ergonomic as DR ‘point and shoot.’ In a radiology center where patient throughput is important and there are sufficient patients, DR can make economic sense. But if the point is to eliminate film, chemistry and processors, and to have a digital image that can be enhanced for maximum diagnostic quality and stored and transmitted electronically, CR will be here to stay in the small user market for many years to come. Penny Maier, national marketing manager, digital X-ray, FUJIFILM Medical Systems USA, Stamford, CT,www.fujimed.com在许多方面，数字x射线与个人电脑行业相似——今天的用户在技术方面受过更好的教育，有更复杂的需求，并期望产品运行更快、质量更高、价格更合理。这些需求要求行业进行重大转型。数字x射线也经历了这样的演变。在过去的20年里，仅富士一家公司就推出了25款新的数字x光产品，每一款产品都以更高的图像质量、速度、生产力和占地面积为行业带来了革命，所有这些都证明了我们在工程设计和利用客户反馈方面的核心竞争力。推动技术的能力是满足市场需求的关键，富士致力于成为最好的供应商。削减报销费用已促使医疗保健行业的参与者提高效率。数字x射线技术的发展应该有助于各种规模的设施应对这些压力。CR和DR系统都能做到这一点。这两种技术都可以消除薄膜并增加患者的吞吐量。通过用户反馈，富士了解到生产力的提高是由系统吞吐量以及其他影响技术人员工作速度的因素驱动的。 Fuji’s new Carbon products were designed to address these factors – high throughput, image access beginning in 10 seconds, only three steps to process an exam and easy selection of an unlimited set of anatomical menus to ensure optimal display of every image. And since the same technologist workstations are used with all of Fuji’s CR and DR systems, user familiarity and proficiency are maintained in all environments. While image quality will be an important focus of technological developments in the future, digital X-ray systems will also need to quickly adapt to advancements made in other industries. As processors become faster and networks are expanded, CR and DR systems will need to be designed in such a way to take advantage of these developments. Fuji’s digital X-ray systems are well-positioned for these changes. As they do today, CR and DR will continue to co-exist in coming years because each brings distinct and complementary advantages to users. CR offers flexibility for positioning and cost-effectiveness while DR offers higher throughput and the promise of better workflow. As we’ve seen over the past two decades, digital X-ray has undergone a dramatic transformation, and there’s no doubt that as we continue into the future, both CR and DR will evolve to offer even greater productivity gains, further improvements in image quality, and better outcomes for facilities of all sizes. Claus Grill, vice president, angiography & X-ray division, Siemens Medical Solutions, Malvern, PA,www.medical.siemens.com包括西门子医疗解决方案在内的成像供应商将致力于提高DR系统的灵活性，以满足或超过目前CR的灵活性。常规x射线照相仍占成像的70%以上。由于它的商品地位，它的成本效益在这一点上是持续的。此外，整形外科和急救医学/创伤等利基市场需求的增加迫使成像供应商开发DR系统，以满足这些医学领域的患者舒适度和定位需求。CR因其在病人定位上与基于胶片/盒式系统的病人定位相似而受到欢迎。在很大程度上，CR已经被技术人员所接受，因为它的基本工作流程模仿了传统的放射照相技术。在西门子，我们有很大的机会设计出满足或超过技术专家认可的DR系统，同时创造出提供出色图像质量的技术。西门子未来的DR系统将继续根据技术人员、医生和患者的不同需求进行设计。随着这些需求的变化，无论是硬件还是软件，都会对某些组件进行微调。西门子正在设计其DR产品组合，以满足已成为更广泛客户群的客户需求。骨科和创伤科，以及儿科和肿瘤科，都需要针对特定的工作流程和患者需求定制解决方案和选项。 There will be increased flexibility in the detector positioning and organ programming, advanced image processing, improved patient and staff security standards and software targeted to the specialties mentioned above. All of these facets will consistently improve productivity for staff and increase patient satisfaction as well. In the next 10 years and beyond, CR will most likely be a technology of the past. Siemens will continue its goal of manufacturing DR systems that enhance productivity and patient throughput. Advanced applications, as they continue to be developed, will also aid in the diagnosis and treatment of diseases. In addition, Siemens will continue its goal of providing DR systems with patient comfort and radiation reduction features without sacrificing image quality. Connectivity will also play a large part in our system designs. Siemens already has DR systems with these features. Image quality, dose reduction and connectivity are and will continue to be what drives our design strategy. When completing a pro forma, outpatient facilities planning on increasing patient census and specialties while decreasing operating costs, such as human resources, supplies, space, etc. will see that in the long term, DR is the technology of choice. These centers may need a higher initial investment, but they should be able to efficiently accommodate more patients with fewer resources. This is surely a wonderful way to pull in new patients, retain current patients and grow the center. Satisfied patients, staff and physicians are the end goal. Ted Ciona, senior marketing manager, CR/DR Solutions, Agfa HealthCare, North America, Ridgefield Park, NJ,www.agfa.com/healthcareCR和DR都需要满足医疗机构(包括门诊中心和医院)的不同需求，从寻求经济CR解决方案的单间设施到需要大批量解决方案的多室设施。随着对更高图像质量和性能的需求不断增加，特别是在儿科和骨科应用领域，像爱克发的DirectriX基于针的图像探测器和DX-S Scanhead读取器系统这样的新技术，将以更有吸引力的价格比提供与许多DR设备相同或更高的功能和性能。除了推出经济的单板/单间解决方案外，CR最引人注目的趋势是推出高性能模型。未来，高性能CR单元将与x射线单元控制紧密集成，以实现自动曝光设置，并将x射线曝光数据包含在DICOM图像中。放射科医生在工作站上查看诊断图像时，将受益于获取患者剂量、kvp和ma。创造更小的桌面设备的能力是基于光学、激光二极管组件和更有效的光收集技术的改进。检测器设计中的新技术可以显著提高图像质量和系统性能(速度、图像访问等)，达到以前专用容灾系统所能达到的水平。由于行业经验，以及计算机和软件的不断进步，传统CR随着时间的推移不断变得更具成本效益。支持在检查室内或靠近检查室的应用程序，同时允许高级处理和图像控制的系统将成为常态。虽然先进的控制和图像处理并不总是需要的，但当需要时，它们将是至关重要的。 For example, availability of raw image data for advanced reprocessing and image enhancements, specialty annotation and measurement tools for orthopedic and pediatric applications, security logging to facilitate HIPAA compliance and management functions. Experience has proven that a lightweight cassette-based solution offers the best efficiency and workflow in an X-ray room. Additionally, if we use the new high-speed and rapid image access needle IP and Scanhead designs, along with interoperability with the X-ray generator for exposure controls, systems will gain even more performance and cost advantages. In the future, systems will take greater advantage of [radiofrequency] tag and proximity detection technology to automate the patient identification process, use image processing software capabilities to identify the exam or view and to automatically process the image to an optimum level with no interaction from the technologist. John Ross, vice president, Marketing, Anexa Corp., Peabody, MA,www.anexanow.comCR技术已经有近30年的历史，是一项成熟的技术。DR定位系统是门诊位置的主要问题，是供应商对供应商的问题。有些是相当多功能的，有些甚至还没有从经典的桌子和墙壁bucky系统演变而来，需要CR来发挥作用。这使得他们在财务上站不住脚。DR面板技术还有很多工作要做，以渗透到固定的低到中容量门诊应用。价格必须降低，功能必须增加(快速序列成像，实时成像等)CR比胶片/屏幕慢，对患者的辐射是胶片或dr的两倍。门诊研究倾向于代表健康家庭x光;这个问题即使很少被提及，也是显而易见的。如果ALARA有任何意义，我们需要一个选择。如果价格和多功能性接近低容量CR，并且没有辐射剂量或像目前的“低端”系统那样牺牲图像质量，它们将成为门诊患者的默认选择。能够快速扫描急诊患者进行AP和横向全身检查，或能够进行常规检查，如吞钡检查，可以减轻旧的透视机的工作量，或增加所需的创伤功能，将增加价值和价格合理。 Tomosynthesis and other more esoteric applications are near as well. At a basic level, on some systems two detectors and CR are required just to be full service. Other systems can be a challenge just to position. New ‘Designed for DR’ approaches dramatically improve this issue. Film changer-like operation and positioning flexibility fix the basic issues with many of today’s systems. Most ‘single detector’ systems are optimized now. With the exception of low-end CCD systems, DR has a 2:1 radiation dose advantage. The only issue is patient volume because of price. Flat panel systems and CT are growing together in terms of basic receptor hardware. Various versions of these fully evolved systems will cover the basic radiograph to the full cardiac exam. The value will be the ability to target the machines feature set to the task at hand and pay for what you use. In the near term a properly priced, versatile system without a severe dose or function penalty, as it is now with low-end systems, will be the default. More futuristic flat panel systems referred to earlier will be extremely cost effective from an outcomes point of view.