<title>Single-image hard-copy display of the spine utilizing digital radiography</title>

Abstract

Regions of the entire spine contain a wide latitude of tissue densities within the imaged field of view presenting a problem for adequate radiological evaluation. With screen/film technology, the optimal technique for one area of the radiograph is sub-optimal for another area. Computed radiography (CR) with its inherent wide dynamic range, has been shown to be better than screen/film for lateral cervical spine imaging, but limitations are still present with standard image processing. By utilizing a dynamic range control (DRC) algorithm based on unsharp masking and signal transformation prior to gradation and frequency processing within the CR system, more vertebral bodies can be seen on a single hard copy display of the lateral cervical, thoracic, and thoracolumbar examinations. Examinations of the trauma cross-table lateral cervical spine, lateral thoracic spine, and lateral thoracolumbar spine were collected on live patient using photostimulable storage phosphor plates, the Fuji FCR 9000 reader, and the Fuji AC-3 computed radiography reader. Two images were produced from a single exposure; one with standard image processing and the second image with the standard process and the additional DRC algorithm. Both sets were printed from a Fuji LP 414 laser printer. Two different DRC algorithms were applied depending on which portion of the spine was not well visualized. One algorithm increased optical density and the second algorithm decreased optical density. The resultant image pairs were then reviewed by a panel of radiologists. Images produced with the additional DRC algorithm demonstrated improved visualization of previously 'under exposed' and 'over exposed' regions within the same image. Where lung field had previously obscured bony detail of the lateral thoracolumbar spine due to 'over exposure,' the image with the DRC applied to decrease the optical density allowed for easy visualization of the entire area of interest. For areas of the lateral cervical spine and lateral thoracic spine that typically have a low optical density value, the DRC algorithm used increased the optical density over that region improving visualization of C7-T2 and T11-L2 vertebral bodies; critical in trauma radiography. Emergency medicine physicians also reviewing the lateral cervical spine images were able to clear 37% of the DRC images compared to 30% of the non-DRC images for removal of the cervical collar. The DRC processed images reviewed by the physicians do not have a typical screen/film appearance; however, these different images were preferred for the three examinations in this study. This method of image processing after being tested and accepted, is in use clinically at Georgetown University Medical Center Department of Radiology for the following examinations: cervical spine, lateral thoracic spine, lateral thoracolumbar examinations, facial bones, shoulder, sternum, feet and portable chest. Computed radiography imaging of the spine is improved with the addition of histogram equalization known as dynamic range control (DRC). More anatomical structures are visualized on a single hard copy display.