 
The best possible image at the lowest possible cost!
Producing quality radiographs can be a very expensive proposition. Millions of advertising dollars are spent each year in an attempt to convince the clinical practitioner that he needs to purchase special branded products in order to meet his needs. Radiographic film processors are notorious in their ability to consume expensive replacement parts and cause even more expensive and disruptive downtime. Over the years, a very large number of X-Ray companies have produced a seemingly endless assortment of X-Ray generating equipment, each with it's own unique service requirements. Radiographic chemicals, which are actually no more complex than those used by every one-hour photo shop, are offered up as "Magic Elixirs".
The complexities of the radiographic consumable market, combined with the obvious fact that the clinical practitioner is far more concerned with providing quality services than solving a "Rubik's Cube" of technical quandaries, can make cost effective radiology an elusive goal. In this brief guide and the ones that follow, we will address some of the potential pitfalls that confront those who seek the best possible radiographs at the lowest possible cost.
Evaluating the variables that impact quality and drive costs.
The patient is the biggest single variable in any radiograph, and is beyond anyone's control. The next largest variable is the technologist. The professional societies have done an outstanding job of promoting technical consistency throughout their membership. Therefore the remaining variables can be categorized as follows: Film, Chemicals, Processors, Service, and Procurement Methods.
The Film
In recent years clinical practitioners have been bombarded with offers for X-Ray films that would supposedly cost less, be more "forgiving," or otherwise lower the cost of radiology. If all the promotions were to be believed, one would think that there was some secret ingredient in the various "white box" or generic film products that somehow made them more suitable for the private practice than the Hospital. Given that the technical perimeters in both places are basically the same, determining just what that ingredient might be is left for the buyer to ponder.
In reality, the difference between white box or generic film products and their branded counterparts has far more to do with finances than technical or sensitometric properties. Film manufacturers need to run their equipment at capacity to be profitable. Packaging certain films in the white box format helps them meet that objective by expanding their market.
White box products are presented devoid of advertising, but imbued with the same technical proprieties as their hospital market counterparts. There is generally no local service provided by the manufacturer. Therefore the cost of marketing these products is reduced and a portion of that savings is generally passed on to the buyer.
It is important to note that not all generic or white box film products are created equal. Film products produced in third world countries, film that failed to meet the manufacturers main line product specs, and film sold in overseas tender markets all appear in "white boxes" on a regular basis. So while it true that white box or generic film products can be a very cost effective alternative, it also true that selecting the appropriate white box product is critical.
 The most costly radiograph is the one that must be repeated!
The use of substandard film products can cause exams to be repeated, thus increasing costs dramatically. Consider the following analysis:
The average fully allocated two-view chest examination performed in the clinical practitioner's environment is generally something more than $40.00. The film accounts for something less than $3.00 of that total. If the exam must be repeated, the additional cost will be very close to the original $40.00. It follows that substandard film products present a very unacceptable risk.
The question then becomes "If all these products come in white boxes with the only difference being the distributors label, how is the user to identify the best product?"
At Comp-Ray, Inc., we use a very straightforward criteria:
1. The film should be manufactured by one of the dominant film companies.
2. The manufacturer must be willing to identify themselves to the user. Vague terms like "made in the USA by a major manufacturer" make us wonder if the manufacturer is ashamed to be associated with the product.
3. The film must come to us straight from the manufacturer. Many films are offered through brokers. This only serves to add middlemen, limited availability, and hinder service.
4. The manufacturer must produce a full line of full and half speed film products to complement our customers needs and to be comparable with the existing intensifying screens in today's clinical practice market.
5. The film products must be of first quality, devoid of speed and contrast variations, and able to match existing film/screen industry standards.
6. The product must be consistently available at reasonable terms and pricing.
7. The manufacturer must willing to offer technical support and back up as required.
 Comp-Ray, Inc. has nearly 20 years of experience with the Carestream. They have performed against our criteria in a flawless manner, and we offer these products to our customers with absolute confidence.
The Carestream product line includes a full offering of blue sensitive and green sensitive films in both full and half speed versions. Also included are Laser, Duplicating, Extra Oral Dental, and Video Imaging films. A Carestream system can easily be designed to meet every imaging requirement of the clinical practitioner, and provide consistent results of unsurpassed quality.
Why do manufacturers make both green and blue films? And which one is best for your use?
The color designation associated with X-Ray films designates the color of light it is designed to detect and use in the creation of an image. Originally all film was blue (panchromatic), meaning that they were best suited to detect blue light being emitted from the intensifying screens. In the early eighties, screen manufacturers began using some new phosphors (Rare Earth) that emitted primarily green light. These new phosphors only worked with films designed to detect green emissions. Hence "green" (orthochromatic) films were developed.
The two films are made in essentially the same manner, except that photosensitive dye must be added to the process to create green sensitive films. Both color designations are available in a full range of film speeds and contrast levels. Both will produce radiographs of essentially the same quality. Neither type offers any real benefit over the other. The only real consideration is that the Green systems are marginally more sensitive to processing conditions as the photo sensitive dye needs to be flushed out in the fixing process or the resultant film is left with an objectionable pink tint. This problem is never seen under proper processing conditions.
With all due apologies to the mountains of available advertising hype, neither film is more "demanding" or more forgiving." In summary, the only legitimate consideration in choosing green or blue is "what kind of screens will be used?"
Selecting the proper film/screen combination
Determining the film screen combination or combinations that best suit your needs requires a basic understanding of film speed, film contrast, and how those factors impact the type of procedures that you wish to perform.
All film/screen combinations are assigned an arithmetic speed number. The number is determined by calculating how much radiation the combination in question requires compared to the combination that were prevalent in hospital market of the early seventies. That system was assigned a speed of 100 and was designated "par speed".
With the introduction of "Rare Earth" screen phosphors in the early eighties, much faster film screen combination became available. Today the standard of the industry for general radiography is a 400-speed system. Faster systems require less radiation to the patient, and less wear and tear of the X-Ray tube. A 400-speed system requires one forth of the MAS to obtain equal film density. An 800 speed system requires only one eighth as much as a 100 speed system, etc. As might be expected, there is a sensitometric penalty that comes with the additional system speed of the faster systems. Fast systems can be impacted by quantum mottle, a grainy appearing artifact that accompanies increased speed and shorter exposures.
Therefore, the selection of the appropriate speed is a balance of many factors. Generally, 400 speed systems are selected for general radiography and 800 speed systems are used for large patients, lateral lumbar exams etc. Systems slower than 400 (200, 100, 50) are generally limited to extremity work. Your Comp-Ray, Inc. representative would be happy to help you select the right system speed for your facility.
The degree of contrast required is dependent upon the type of procedures that you perform most often. High contrast films offer a high level of readily apparent detail in general exams. They are particularly good for extremities as the stark difference from black to white makes things like small fractures, hairline cracks etc. more readily visible. Low contrast films (also called wide latitude) are helpful when trying to detect subtle changes in similar densities. For example, many practitioners use latitude films for chest work. While it is true that less exact techniques will result in a better result with latitude films than with their high contrast counter parts, evidence of the incorrect technique will still be apparent in the finished product For best results ask your Comp-Ray, Inc. representative to help guide you to the optimum combination.
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