By: Deborah R. Dakins

ny imaging department that moves toward a film-free existence must eventually ask some hard questions about radiography. Can monitors match the familiar convenience of viewing multiple full-size chest images on a light box? Can the network store and retrieve massive radiography files efficiently? Do filmless radiography setups offer the flexibility to make them practical?

While ultrasound lends itself to filmless imaging, and CT and MR make a convincing case with their mountains of data and computer-aided reconstructions, the ubiquitous radiography seems to be the hardest to convert. Only a few hundred sites in the U.S. have gone to direct, digital radiography. Many others fall somewhere along an expanding continuum of computed, digital, and traditional imaging.

Going filmless has some distinct advantages: One digital suite can do the work of three conventional x-ray rooms. Processing, chemicals, storage, and lost files go by the wayside. Filmless imaging can also be more forgiving of operator variability, and it allows electronic enhancements to highlight hard-to-read pathology.

Early adopters told Diagnostic Imaging about increased efficiency and clinical flexibility. They cautioned that the technology, like any other, has a learning curve, and it can challenge the most carefully designed PACS. But they also said they would never go back to the old days.