The so-called "dynamic DR" debate

Release date: 2015-05-15

The author listened to a friend in the line saying that a company has developed a "dynamic DR" product, which has the functions of DR, fluoroscopy, gastrointestinal angiography, etc. The image quality is very good, and the price is not expensive, and it has more high-end tablets than the major manufacturers on the market. Functional gastrointestinal tract is not much more than let. It is now being promoted in grassroots hospitals across the country. The publicity articles on the Internet are also popular with Siemens, kicking Philips, and the traditional strong enterprises of Shimazu, Shimadzu and Wandong. I have been very fond of the first time. I have been engaged in radiological imaging for more than 30 years. I am always looking forward to the development of innovative technologies in China. The world-class products and the domestic enterprises can challenge the industry with innovative technologies.遂 Deliberately pay attention to this product and go to the hospital for a field visit. The results of the investigation made the author disappointed, and found that the so-called dynamic DR is just to put the CCD detector in the photography DR system, which is eliminated, onto the gastrointestinal bed, and attach a low frame rate perspective with extremely poor performance. Such a product Ten years ago, Russia's Dira company had been sold in China. It had not been recognized by the market and had to give up. How is it now a new technology? This product is just a marketing concept packaged with outdated technology, which is misleading to users. The sage cloud "examines carefully, deliberately, and eloquently, in good words". It is common for manufacturers to exaggerate publicity in the market. As a practitioner, it is inconvenient to talk about it, but there is a lot of advocacy on the Internet recently, as a so-called Someone who knows something about new technology is like a sigh in the throat. I would like to talk about the so-called dynamic DR from what I know and what I know. The author is neither an expert nor an authority. If you are not correct, you are willing to correct me.

First, the so-called dynamic DR is a concept of fabrication.
Medical imaging equipment originates from the clinic, and ordinary radiological equipment is divided into two major categories of photography and gastrointestinal contrast according to clinical application. The so-called DR refers to the digital imaging equipment. Its fundamental application is to obtain still human body images through X-ray irradiation. It is commonly used in the respiratory system and the skeletal system. The most basic requirement is to have high definition and low dose to achieve the patient's Slight radiation damage in exchange for the purpose of disease diagnosis, radiography from film to CR, from CCD-DR to flat panel DR fully reflects the industry's pursuit. Flat-panel DR is becoming more and more mainstream, and its own law of technological development is not mentioned here. The so-called gastrointestinal examination equipment is a clinical application developed on the basis of fluoroscopy. It uses X-ray transmission as a guide and positioning to achieve a momentary image of a specific time point of acquiring a moving organ for the purpose of disease diagnosis and treatment. It is often used in conjunction with angiography to examine and treat diseases such as the digestive system, the genitourinary system, and the circulatory system. The most basic requirements of this device are: 1) Dynamic: It is necessary to continuously observe the image of a specific part in order to capture the information of the lesion, whether it is a blood vessel or a digestive tract. This is why major manufacturers must develop real-time perspectives of 30 frames per second. Only in this way can the tracking of the moving parts be realized, and the technical difficulty of the equipment is greatly increased. 2) Quickly capture high-resolution images: Compared with traditional DR, exposure to high-resolution images must be completed in about one-tenth of the time, otherwise the image will be blurred due to organ motion. This is why dynamic detectors are more expensive than ordinary DR detectors. 3) Low dose: dynamic examination of the patient's dose is tens of times more than DR photography, in order to minimize the patient's radiation, usually the single exposure dose of gastrointestinal examination is only about one-fifth of the DR exposure, so multi-function System vendors use low-noise detectors and design different combinations of modes to meet the requirements of different clinical applications. The underlying goal is to meet diagnostic requirements with minimal patient radiation costs.

What is the so-called "dynamic DR" product, it must be judged from what clinical requirements it can meet, and how the level of these requirements is met. From its propaganda, first of all, it is a DR, which can do digital photography. Secondly, it can be used for perspective angiography, gastrointestinal angiography and urography, and can be guided. Is this the case? I want to talk about it.

Second, the so-called dynamic DR has the basic functions of ordinary DR, but the technology is inconvenient to use.
"Dynamic DR" uses CCD detectors for digital acquisition, while CCD detectors cannot obtain high-quality clinical images. CCD detectors are already a technology that will be phased out in the industry, replacing it with a more high-end flat panel detector. technology. Although the manufacturers that can produce flat panel detectors are still limited to a few companies such as Siemens, Philips, Shimadzu, and Wandong, flat panel DR is rapidly eliminating low-quality CCD products that are easily misdiagnosed because of its excellent image quality.

Third, the so-called dynamic DR is difficult to achieve contrast examination, there is a risk of excessive radiation and missed diagnosis.
For fluoroscopic images, there is a key acquisition data of 30 frames per second, and dynamic slabs and shadowed fluoroscopic images can meet this basic perspective requirement. The "Dynamic DR" acquisition rate is only 8 frames / sec, far below the clinical needs of fluoroscopy. Too low acquisition rate is prone to image artifacts and image inconsistencies, resulting in missed frames and missed lesions, leading to misdiagnosis. This is also why many domestic and foreign manufacturers with strong R&D capabilities do not produce this type of product.

In the use of such "dynamic DR" for gastrointestinal examinations, in order to avoid these drawbacks, the hospital needs to continue to swallow, continuously fluoroscopy the patient thousands of frames, and pulse fluoroscopy brings unnecessary dose hazards to patients. The dose is 1.4 times that of the conventional image intensifier, 1.8 times that of the dynamic flat panel detector, and the subject receives 30% more radiation than the dynamic tablet device.

From the above analysis, it can be seen that the so-called dynamic DR is just a DR with poor performance, and a photographic equipment with a low frame rate perspective function is quite different from the digital multi-function product that truly meets the clinical requirements. Compared with CCD-DR, it can provide little added value, and it is worth more than the price of DR. From the perspective of health economics, if you want to be powerful, you can buy a multi-functional flat tube. If you want to meet the basic requirements, you can buy a flat-panel DR and buy a digital gastrointestinal. If you have a small workload, you can purchase a double-tube product. If the perspective function is available, you can purchase a DR. After all, even if you add a shed to a tricycle, you can't change into a car. Because there is no engine without safety, you will have experience on the road. The wishes of the family are discussed with the leaders of the industry.

Source: Kexun Medical Network

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