Cesium Iodide vs. Gadolinium Oxysulfide

If you're looking to upgrade from CR (Computed Radiography) to DR (Direct Radiography), you may have seen different "scintillator" technologies as referred to as Gadolinium Oxysulfide (Gad/Gadox) and Cesium Iodide (Cesium/Csl). So, what's the difference? How do I decide which panel to choose? Here I will list the main differences between the two and you can decide for yourself;

Radiation Exposure

To start, Cesium panels require less radiation exposed to the panel to receive a high quality image than a Gadox panel. Although the radiation dose will decrease very slightly with Cesium technology, less radiation to patients is always an advantage to you and your patients.

Image Clarity & Quality

Gadox and Cesium both produce very high image clarity. Imaging software also has a big role in producing high quality images without pixelating the image (Gadox or Cesium panels are best paired with Opal-RAD software). The difference is very subtle; It is only slightly noticeable while zooming into or blowing up the x-ray image by ~3 - 5x normal size. Images taken on a Cesium panel will infact pixelate as well, although image quality is higher to a trained technician or radiologists eye.


Gadox panels are not significantly cheaper, but nevertheless they sell at a cheaper price than Cesium. While both technologies provide very high image quality, Cesium panels run about ~$2,000 more than Gadox. While this can play a huge factor while deciding between technologies, especially with radiology budgets and budget cuts, only you can decide which is a better solution for your practice.

Medicare Reimbursement

I won't get too in-depth about this subject; I will leave it to some credible sources to explain it (which you can read more about here, here and here). If your practice is still using traditional standard film processors, medicaid reimbursement for those studies are cut to practically nothing. CR reimbursements will also decrease in the very near future as the standard for radiography exams push harder for DR.


Both Gadox and Cesium produce very high image quality for exams. Image quality is slightly noticeable between Gadox and Csl, although Csl takes the win. Gadox panels are somewhat cheaper, which is more than likely a main concern while searching around for a digital detector. Medicaid reimbursement is the exact same for Gadox and Csl while both panels are in the Direct Radiography category.

If there are any further questions and would like to speak to the experts at Great Lakes Imaging, give us a call at (586) 268-9200.

This article was written by dennis hansinger at great lakes imaging. thanks to advisory board, american college of radiology and "Aunt Minnie" for their explanations and information regarding medicare reimbursement laws, and block imaging as they have a similar article online explaining the difference between these two technologies.