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Computed Radiography
(CR) Computed radiography is an imaging technique that uses similar equipment to conventional radiography except that films are replaced by imaging plates. An imaging plate contains photostimulable storage phosphors, which store the radiation level received at each point in local electron energies. The imaging plate is placed under the patient in the same way as conventional film cassettes. After x-ray exposure, the imaging plate is run through a special scanner to read out the image. The digital image can then be processed to optimize contrast, brightness, and zoom. Computed Radiography can be seen as halfway between film-based conventional technology and current direct digital radiography.
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Contrast Enhanced Computed Tomography
(CECT) Contrast agents are used during contrast enhanced computed (or computerized) tomography examinations to highlight specific tissues and parts of the body. Bones can be clearly seen on x-ray images, the visualization of some other organs and soft tissues is more difficult. Sufficient contrast is important in perceiving a difference in the density between areas of a CT image. The identification of a disease may be challenging due to very low contrast between pathological tissues (for example tumors, metastases and abscesses), normal organ structures and surrounding tissues.
Contrast agents are used in CT angiography (CTA) to delineate vessels, in multiphasic CT studies to provide dynamic information of blood supply (e.g., liver CT) and in CECT studies of various body parts to achieve opacification of tissue of interest (e.g., kidney CT) in relation to the background tissue. Contrast enhanced multi-detector row CT (MDCT) replaces several conventional diagnostic imaging methods such as intravenous urography, cholangiography, or catheter angiography, due to advanced CT studies with fast examination times, high contrast enhancement, perfusion measurement and multiplanar reformatting capabilities.
See also Contrast Media Injector, Single-Head CT Power Injector, Multi-Head Contrast Media Injector, Syringeless CT Power Injector, CT Power Injector.
Contrast Media Injector
Contrast media injectors are part of the medical equipment used to deliver fluids in examinations such as CT, MRI, fluoroscopy and angiography. Many of these diagnostic imaging procedures include the administration of intravenous contrast agents to enhance the blood and perfusion in tissues.

Mainly there are two types of injector technology:
Piston-based systems use a plunger/piston to move a piston in the cylinder of a reservoir, which works in two directions to first fill the reservoir and then deliver the fluid from the reservoir to the patient, similar to a hand-held syringe.
Peristaltic-pump-based systems operate as rotary pumps that use rollers to compress sections of flexible tubing, drawing fluid directly from the supply source and delivering it to the patient.

See also Single-Head Contrast Media Injector, Dual-Head CT Power Injector, Syringeless CT Power Injector.

The use of x-ray contrast agents in computed tomography (CT) began with a hand injection by the radiologist in the scan room. During its history, CT scanners have made great improvements in speed and image quality. Actual CT systems with multiple detectors allow scan times of a few seconds per body region. Some CT protocols require multiphase scans, where a body region is imaged with a single bolus of contrast in different blood flow phases. Automatic power (pressure) contrast media injectors are required to provide precise control of flow rate, volume and timing of injection. The use of a saline bolus following contrast administration reduces the volume of contrast required.

Most relevant topics for the use of a power injector in medical imaging procedures such as contrast enhanced computed tomography (CECT):
Avoidance of microbiologic contamination;
workflow efficiency in the use of the contrast media injector;
contrast cost and waste volume;
reimbursement.

Must have basic injector control options:
Flow rate with a usual range from 0.1 to 10 mL/sec in 0.1 mL/sec increments; some injectors can be set to inject in ml/min or ml/hour;
volume range from 1 mL to 200 mL for contrast and saline phases;
pressure limit typically programmable from 50 psi to 300 psi in 1 psi increments (also displayable in kPa and kg/cm²).

Examples of other injector control options:
Warmer/heater; an increase in temperature of the contrast medium results in a decrease in its viscosity; warmed contrast media are less viscous and offer lesser resistance;
pre-filled syringes; the compatibility with many selected syringes makes it easy to change and select the appropriate contrast medium for each patient;
injection reports accessible via RIS/PACS for dose management systems and records of prior injections.

Conventional Radiography
Conventional (also called analog, plain-film or projectional) radiography is a fundamental diagnostic imaging tool in the detection and diagnosis of diseases. X-rays reveal differences in tissue structures using attenuation or absorption of x-ray photons by materials with high density (like calcium-rich bones).
Basically, a projection or conventional radiograph shows differences between bones, air and sometimes fat, which makes it particularly useful to asses bone conditions and chest pathologies. Low natural contrast between adjacent structures of similar radiographic density requires the use of contrast media to enhance the contrast.
In conventional radiography, the patient is placed between an x-ray tube and a film or detector, sensitive for x-rays. The choice of film and intensifying screen (which indirectly exposes the film) influence the contrast resolution and spatial resolution. Chemicals are needed to process the film and are often the source of errors and retakes. The result is a fixed image that is difficult to manipulate after radiation exposure. The images may be also visualized on fluoroscopic screens, movies or computer monitors.
X-rays emerge as a diverging conical beam from the focal spot of the x-ray tube. For this reason, the radiographic projection produces a variable degree of distortion. This effect decreases with increased source to object distance relative to the object to film distance, and by using a collimator, which let through parallel x-rays only.
Conventional radiography has the disadvantage of a lower contrast resolution. Compared with computed tomography (CT) and magnetic resonance imaging (MRI), it has the advantage of a higher spatial resolution, is inexpensive, easy to use, and widely available. Conventional radiography can give high quality results if the technique selected is proper and adequate. X-ray systems and radioactive isotopes such as Iridium-192 and Cobalt-60 for generating penetrating radiation, are also used in non-destructive testing.

See also Computed Radiography and Digital Radiography.
Coronary Angiogram
A coronary angiogram (or cardiac catheterization) is the radiographic visualization of the coronary arteries after the introduction of a contrast agent. A coronary angiography can be performed for both diagnostic and interventional (treatment) purposes.
A catheter, inserted into a major blood vessel has to be maneuvered up to the coronary arteries to inject a blood compatible iodinated contrast material (dye). The x-ray visible catheter allows injecting a small amount of contrast agent selectively in the coronary arteries or the heart chambers. Continuous images are recorded (movies or cineangiogram) in multiple views from different angles are in order to ascertain the precise location and severity of coronary artery blockages. Digitized images are also saved on computer and replayed onto a video screen as needed.
A coronary angiogram is more invasive and requires more patient recovery time than coronary CT angiography. In the past, the gold standard for detecting atherosclerotic plaque was a coronary angiography and intravascular ultrasound. Today, the American Heart Association considers CT scanning to be one of the most effective, non-invasive methods for the detection of calcification in the coronary arteries.

See also Interventional Radiology.
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