Moving from CR to DR: The Practical Perspective

Before deciding to make the switch from CR to DR, it is important to understand what the differences between the technologies mean to you and your practice. Rather than taking pages and pages answering this question from a technical approach, let’s look at what it means practically.

The most valuable resource Let’s explore how DR can save your department one of its most precious assets: Time.

If you currently are working with CR in your department, you have probably worn out a few pairs of shoes with the amount of steps you’ve taken between the bucky and the processor; and you’ve probably become better at shuffling cassettes than a blackjack dealer shuffling cards. This is where the first advantage of DR comes in. Rather than swapping cassettes between the bucky and the processor, the image transfers electronically and automatically to the workstation once the x-ray is taken. That’s right, you can just leave the cassette right where it is until the exam is done or you need to move the cassette for another view. Flexibility and portability The next advantage brings us to your portable x-ray unit. Traditionally, with both film and CR, you didn’t know what your x-ray looked like until you got back to your department. With DR, because your workstation goes with you, there is immediate knowledge on your positioning and technique. This is also helpful for those bedside interpretations by physicians, say, in the ICU when they are checking for placement of a line or intubation, the image is visible in seconds, as opposed to waiting for the film to be processed and sent to your PACS for them to see. Additionally, if a positioning change is needed, a small adjustment can be made and the image may be repeated, rather than the long walk of shame back to the patient’s room where the entire exam must begin again. Lowering radiation dose and achieving higher image quality Outside of the time savings to the department and the staff, there is also an arguably more important savings happening with DR when compared to CR, and that is radiation dose.

Two mainstream DR panel technologies exist today, which are CsI (Cesium Iodide) and Gadox (Gadolinium Oxysulfide). Between the two, CsI requires less radiation to get an equivalent image when compared with Gadox. Depending on which type of DR panel, dose reduction can be as much as 2 to 3 times when compared to CR. Not only are CsI detectors capable of lower dose requirements, they also have the potential for the highest image quality, which will make reads faster and more accurate.

While the CsI detector is a major part of this equation, the software of the vendor you choose has great influence on the final image, as well. The investment mindset

So, is there any reason not to switch to DR? That comes down to really one thing: upfront cost. While cost is always a concern, it is important to consider upgrading to DR as an investment. As mentioned earlier, saved time can directly translate into money saved, usually due to the ability to perform a greater number of exams each day. There is also the cost of maintaining CR cassettes to consider. Because the processor disassembles and reassembles CR cassettes with each use, this results in inevitable--and not insignificant--wear and tear. Remember, the DR panel requires no manual processing. Avoid reimbursement reduction Finally, there is the upcoming Medicare reimbursement reduction slated to begin in this year for facilities that have not made the switch to DR. As part of an initiative to encourage U.S. healthcare providers to adopt DR, Medicare began reducing payments for analog x-ray exams in 2017. This year, even sites using CR will begin to see reimbursement fall—first by seven percent for five years, and then by ten percent. Changing from CR to DR is a decision every radiology department must consider, eventually, if they haven’t already. At a certain level, the question isn’t as much if, but when, and understanding the differences between CR and DR and even amongst differing DR systems is vital.

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