Direct Digital Radiography (DR) traditionally have been priced so high that only large medical facilities could afford to install them. The alternative for digital x-ray output has been Computer Radiography (CR). Typically a new X-ray system equipped with two fixed DR detectors (one for the table bucky and one for the wall bucky) were priced in the $ 250K – $ 300K range. If you wanted to retrofit an existing system, you were faced with a expenditure of around $ 90K per DR detector. The logical alternative was CR. You could purchase a CR system for $ 30K- $ 90K and it could accommodate multiple buckys or even multiple systems.
Of course, when offered a less expensive solution, there generally are several downsides, and CR is no exception. The first and most obvious down side is throughput time. Whereas DR can produce an image in less than 10 seconds, CR needs to be manually manipulated which takes time. First the CR cassette / plate needs to be inserted into the bucky. After the exposure is completed, it needs to be removed, walked over to the CR reader and inserted in the reader. Within 30-60 seconds the reader will produce an image, then it will erase the image from the plate and then needs to be returned to the bucky for the next exposure. This process can take anywhere from 3-5 minutes, a far cry from the 10 second DR time. The second downside is that the CR plates have a limited life and after 1000-2000 exposures will need to be replaced at a cost of about $ 1000 each. The last and maybe most concern downside is the dose requirements of CR. DR and even film require less exposure than CR, this could become a problem as x-ray exposure is continuously being scrutinized by the FDA and ACR.
The good news is high performance DR is now available at prices which compete with mid range CR systems. As the price of DR continues to come down and CR remains relatively the same, competition is becoming real. However, it's not just the price of DR that has reduced, but the application has become different. Instead of using two fixed DR panels in a system, many facilities are opting for one portable DR detector. The least expensive is the tethered detector which has a cable attached that can allow it to me moved from bucky to bucky without plugging in or unplugging the cable, it simply stays with the panel. Starting at $ 55,000, this solution is much faster than CR, is less expensive than a high end CR and about the same price as mid range CR. The alternative choice is a portable DR with a wireless detector. This solution is similar to the tethered DR detector but with no cable. It can be moved from bucky to bucky without moving a cable with it. The wireless DR subsytem begins at about $ 69,000 again competing with high end CR.
DR systems – fixed, tethered and wireless – have pretty much the same components – DR detector (s), PC console workstation, acquisition / manipulation / viewing software with full Dicom capability as well as full workflow interface capability, including PACS, RIS, HIS and EHR.
The good news does not stop with fixed x-ray systems. Portable DR is the main component of portable digital x-ray. The pricing to retrofit a portable x-ray unit with a tethered or wireless DR system is pretty much the same as for a fixed system. A portable x-ray unit can be upgraded to Tethered DR for about $ 55,000 and to wireless DR for about $ 69,000.
The question is will CR go the route of Beta video tape and DR become the VHS of the digital diagnostic imaging world or will they both remain viable in their particular applications?
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