Dual-energy subtraction radiography (DES) has long been recognized for its ability to improve visualization by separating bone and soft tissue in X-ray images. However, despite its clinical value, DES has historically been difficult to access outside of specialized imaging environments.
What Is Dual-Energy Subtraction Radiography (DES)?
Dual-energy subtraction radiography (DES) is an advanced X-ray imaging technique that separates anatomical structures by their energy absorption characteristics.
By capturing low-energy and high-energy X-rays, DES generates distinct images that isolate soft tissue and bone structures. For Reveal 35C specifically, three images are generated — the soft tissue image, the bone image, and a traditional radiograph.
DES allows clinicians to “subtract” overlapping anatomy, which is important for diagnostic accuracy. Bones often overlap with soft tissue, such as the ribs overlapping the lungs and heart. With a soft-tissue view, operators can acquire diagnostic data living behind the bone, which can’t be seen in conventional radiographs.
Why Does DES Matter?
DES may improve diagnostic confidence by enhancing visualization of anatomical structures that overlap in conventional radiography.
Studies have demonstrated improved visualization of conditions such as pneumonia, lung cancer, pulmonary nodules, pneumothorax, coronary artery calcification (CAC), and tuberculosis. This makes subtle abnormalities easier to detect. Earlier visualization of subtle findings may support clinical decision-making when used alongside standard diagnostic pathways.
That’s beginning to change.
With the introduction of Reveal 35C, integrated with patented SpectralDR technology, DES is less constrained by traditional workflow and infrastructure requirements. KA Imaging has created DES technology that is affordable, practical, portable, and designed to integrate into a variety of clinical settings.
How Reveal 35C is Making DES More Accessible than Ever Before
The logistical demands of traditional dual-energy subtraction radiography (DES) have limited its adoption considerably, making it unsuitable for areas like intensive care units, emergency departments, and bedside imaging environments. Ironically, these are a few of the places where access to advanced imaging tools, such as dual-energy capabilities, could provide additional clinical insight.
Reveal 35C was built to overcome these challenges. Here are some ways it’s making DES more accessible than ever before:
Reveal 35C Makes Portable Dual-Energy Possible
Conventional DES: Typically Fixed
Conventional DES systems require fixed installations, X-ray grids, complex acquisition, and multiple exposures. These requirements contribute to the historical impracticality of DES, increasing setup time, complicating workflows, and escalating the need for careful radiation management.
Reveal 35C: Portable & Fixed Applications
Reveal 35C offers the capabilities of dual-energy subtraction radiography in a flexible, mobile application. The system is light-weight with hot-swappable batteries, meaning there’s no need for it to be attached to a main power source. This makes DES feasible in environments where portability and safety are essential.
You may be wondering how this is possible, the secret lies in the layered detection and post-processing capabilities. The detector is multi-layered, and each layer senses X-rays of different energy ranges. Software algorithms then separate them into useful views.
Reveal 35C is designed to support both portable and fixed imaging workflows while maintaining dual-energy image generation using the same detector technology.
See Reveal in Action: Request a Demo today!
Reveal 35C Creates a Less Costly Path to DES
Conventional DES: Higher Costs + Higher Risks
Cost has been a consistent barrier to DES. Not only are there upfront costs, but it’s also costly to maintain. Traditional systems often require specialized hardware, dedicated rooms, fixed installations, and complex acquisition. This disrupts workflows instead of enhancing them, and medical facilities will often avoid investing in DES technologies as a result.
Reveal 35C: Lower Cost Than Conventional DES
Reveal 35C is positioned within the premium detector category while adding dual-energy subtraction capabilities. With this, Reveal 35C can potentially reduce the need for specialized DES infrastructure and integrate into existing workflows.
Reveal 35C Does Not Require Increased Radiation
Conventional DES: More Exposures, More Radiation
Conventional DES systems rely on two exposures at different energy levels to achieve dual-energy subtraction. This does achieve material separation, but it comes at the cost of more radiation and motion artifact risks.
In addition to dual-exposure, conventional DES utilizes X-ray grids. X-ray grids are useful for scattering radiation, but can also block useful X-rays and cause grid cut-off in the final image. If something goes wrong, repeat scans might not be an option since it calls for even more radiation.
Reveal 35C: Single Exposure, Standard Radiation
Reveal 35C achieves dual-energy subtraction using a single exposure at standard radiation levels. Instead of requiring two separate X-ray shots, the detector captures low- and high-energy information simultaneously through its layered design.
As a result, a single exposure can be used to generate dual-energy images at radiation levels comparable to standard radiography, depending on clinical technique. Reveal 35C enables dual-energy subtraction imaging using a single exposure at radiation levels comparable to standard chest X-ray protocols, depending on clinical technique.
Additionally, Reveal’s single-exposure acquisition reduces the risk of motion artifacts associated with dual-exposure techniques.
Where Reveal 35C is Showing Promise
Clinical studies using the Reveal 35C detector with SpectralDR® technology have demonstrated improved visualization in specific clinical study settings for applications such as pneumonia, pneumothorax, lung nodules, and tuberculosis, compared to conventional radiography, in specific clinical study settings. Additional research is exploring its potential utility in bone density assessment.
Expanding Use Cases for Dual-Energy Subtraction Radiography
By combining portability, single-exposure acquisition, and standard radiation levels, Reveal 35C is expanding where and how DES can be used, including:
- ICU and bedside imaging, where speed, mobility, and motion robustness are critical
- Emergency and trauma environments, where rapid decision-making is essential and repeat scans are undesirable
- Facilities seeking advanced imaging capabilities without increasing radiation dose or investing in fixed DES infrastructure
These capabilities position Reveal 35C as a practical pathway for bringing dual-energy subtraction radiography into everyday clinical workflows.
See Reveal in Action: Request a Demo today!