The technology of bedside radiographic imaging

The supine anteroposterior bedside chest radiograph, performed using conventional film-screen systems, has been the standard examination of the thorax in the critical care patient. The details of these examinations are beyond the scope of this chapter, but the importance of the delivery of consistently high quality examinations to the clinical management of these patients cannot be overstated.

Film digitization and storage phosphor computed radiography are now challenging conventional film as the gold standard in bedside radiography. The advantages of transmitting images directly to the ICU as well as the increased reliability of image library management are enabling these systems, despite their cost, to be strong challengers to conventional film.

However, digital systems also bring practical challenges. The video monitors commonly available in the ICU are adequate for clinical use, such as monitoring life-support apparatus, but the ICU team should be aware of the limits of these systems for detecting pneumothorax, interstitial lung disease, etc. Clinicians should also realize that video monitors are not as bright as conventional light boxes and that excess ambient light can seriously degrade the images.

The redundancy, reliability, and capacity of any digital system must be assured before full implementation is accomplished. The system should be capable of handling very large amounts of data, remembering that a single chest radiograph may require up to 10 megabytes of data, and that up to a week's worth of images should be immediately available for review (MacMahonand GigerJ996).

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