Subjective image quality of solid-state and photostimulable phosphor systems for digital intra-oral radiography

OBJECTIVES: To compare subjectively the image quality of intra-oral radiographs from six digital systems. METHODS: Two generations of two different solid-state detectors; Visualix-1 and -2 (Gendex Dental Systems, Milan, Italy), Computed Dental Radiography (CDR) and CDR Active Pixel Sensor (APS) (Schick Technologies Inc., Long Island City, NY, USA), and two photostimulable phosphor (PSP) systems; Digora (Soredex, Orion Corporation, Helsinki, Finland) and DenOptix (Gendex Dental Systems, Milan, Italy) were compared. Tooth-containing specimens from different areas of dried mandibles were radiographed at exposures between 91-9400 microGy. Images were transferred to a personal computer, displayed in random order and evaluated in their original form and after applying a histogram equalisation algorithm. Eight observers graded subjective image quality using a 5-point scale. RESULTS: Both CDR systems scored highest for image quality but within the narrowest exposure range. The Visualix images received the lowest scores. The PSP systems produced acceptable image quality at both lower and higher exposures than the solid-state systems. Enhanced images were generally considered to be inferior to the original images, except for those produced by the four solid-state systems at very low exposures. CONCLUSIONS: (i) the PSP systems provided a clinically acceptable image quality over a wide exposure range; (ii) the CDR systems had the best image quality but over the narrowest exposure ranges; (iii) the Visualix systems had the lowest image quality; and (iv) histogram equalisation did not generally improve image quality.     

Physical properties of a photostimulable phosphor system for intra-oral radiography

OBJECTIVES: To determine physical properties of the Digora digital intra-oral radiographic system (Soredex Orion Corporation, Helsinki, Finland) for different calibration settings and beam energies. METHODS: The line spread function (LSF) and the modulation transfer function (MTF) were determined from radiographs of a slit. Noise power spectra (NPS) were determined from radiographs exposed to homogeneous radiation fields at 10, 50 and 100% of the calibration exposure for three tube potentials. All calculations were performed using relative values of exposure comprised of gray level, the signal at the photomultiplier tube and the amplified signal in order to confirm agreement between these different approaches. Noise equivalent quanta (NEQ) were calculated from the one-dimensional NPSs and the MTF. Detective quantum efficiencies (DQE) were determined from the NEQs and representative values of the photon fluence. Signal-to-noise ratios (SNR) were calculated for different signal contrasts applying the NEQs. RESULTS: The MTF of the system exhibited typical characteristics and falls to a value close to zero at the Nyquist frequency of about 7 cycles/mm. Noise as expressed by the NPS was found to be relatively low, i.e. about 10(-5) to 10(-6) mm2 depending on exposure and frequency. There was no significant difference between data obtained at different beam energies. The NEQ and hence the DQE were relatively high. DQE decreased with increased exposure. For exposures in the clinical range of the DQE reached a peak value of about 25%. SNRs are favorable. CONCLUSION: The physical properties of the Digora intra-oral system indicate that it is suitable for digital intra-oral radiography.     

Benefits of using a photostimulable phosphor plate protective device

Objectives:To develop and test a protective device (PD) to increase the resistance of photostimulable storage phosphor (PSP) plate to compressive load, and assess the resulting image quality.Methods:Two prototypes, polyvinylchloride sheets of 0.3 mm and 0.7 mm each, were developed for PSP plate size 2. The resistance to compressive load was tested using eight new PSPs divided into four test groups: (1) PSP, (2) PSP and paperboard protector, (3) PSP and 0.3 mm PD, and (4) PSP and 0.7 mm PD. The resulting images were analyzed by three oral radiologists, based on the consensus for image artifacts. Additionally, the objective image quality test was performed with four new PSPs, using an 8-step wedge aluminum scale. The mean gray values and standard deviation were measured in a total of 240 images, and the data were analyzed using analysis of variance with Bonferroni post-hoc test.Results:Artifacts were seen in the PSP control group starting at 40 n, and at 150 n, 175 n and 300 n in 0.3 mm PD, paperboard protector and 0.7 mm PD, respectively. Although there was no statistical difference among groups, there were differences between exposure times (0.06–0.25 s, 0.06–0.40 s, and 0.10–0.40 s). Scanning resolution of 20 lp/mm showed higher mean gray value than 25 and 40 lp/mm (p < 0.05)Conclusion:The developed PDs improved the PSP resistance to compressive forces, with low interference on the pixel gray values, regardless of exposure time and spatial resolution. Nevertheless, the 0.7 mm PD could withstand the maximum compressive load.     

Dose reduction in general radiography for adult patients by use of a dual-side-reading photostimulable phosphor plate in a computed radiography system

Our purpose in this study was to evaluate the potential of dose reduction in general radiography for adult patients by use of a dual-side-reading (DSR) photostimulable phosphor plate in a computed radiography system. The image quality and low-contrast detectability in terms of the contrast-detail diagram of the DSR system with use of the X-ray beam quality of the RQA 5 defined by the International Electrotechnical Commission 61267 were compared with those of a conventional single-side-reading (SSR) system. The radiographic noise of the DSR system was lower compared to that of the SSR system under the same exposure conditions. Although there were no statistical differences in low-contrast detectabilities between the SSR system and the DSR system under the same exposure levels, the DSR system showed superior detectability compared to the SSR system. We conclude that the DSR system for general radiography has the potential to reduce the patient dose.     

Radioisotope decontamination of X-ray detector (photostimulable phosphor plate)

We tried to remove contamination of radioisotope (RI) for an X-ray detector (photostimulable phosphor plate; IP) and verified that our procedure suggested by Nishihara et al. was effective for decontamination. The procedure was as follows. First, the IP was kept for approximately twelve hours, and then it was processed [image (A)] as well as a clinical processing mode. Second, using a wet-type chemical wiper, we scavenged the IP to remove the adhered RI on its surface. Then, once again, the IP was kept for approximately fifteen hours and processed [image (B)] in order to check an effect of decontamination. Finally, the two images of (A) and (B) were analyzed using ImageJ, which can be downloaded as a free software, and a percentage of removal was calculated. The procedure was applied to two IPs using the FCR 5501 plus. In the present case, the percentage of removal was approximately 96%. The removed radioisotopes in the chemical wipers were analyzed by Ge detector. Then, (134)Cs and (137)Cs were found with activities of 2.9 4.3 Bq and 3.5 5.2 Bq, respectively. For three months after that, we cannot see black spots on the IPs owing to the contamination of the RI and there are no defects caused by decontamination using a wet-type chemical wiper.     

Computed radiography image artifacts revisited

OBJECTIVE: Computed radiography (CR) has provided a ready cost-effective transition from screen film to digital radiography and a convenient entrance to PACS. This article revisits artifacts encountered in CR systems. These artifacts may obscure abnormalities, mimic a clinical entity, or hamper image quality. CONCLUSION: With the new-generation CR systems, software- and hardware-related artifacts have decreased, making operator errors more evident. The purpose of this study is to establish the current trend of CR artifacts and the new facets in identifying and resolving problems quickly that will help prevent future occurrences. This article also brings to light the importance of constant review required of this extensively studied topic to avoid diagnostic misadventures.     

Energy dependence of photostimulable phosphor

In this study, phantoms were used to illustrate the dependence of photostimulable phosphor's characteristic response on beam quality. These phantoms, consisting of sheets of acrylic and aluminum, represented an extremity, an abdomen, a skull and a chest. Images were taken with 50 to 65 kVp, 60 to 110 kVp, 65 to 80 kVp and 70 to 120 kVp, respectively. In general, the amount of resulting luminescence of the photostimulable phosphor per unit of air kerma (exposure) increased with kVp.     

Evaluation of edge enhancement effect of phase contrast imaging using newly-developed photostimulable phosphor plate

We investigated whether the use of a newly developed columnar-crystal-type photostimulable-phosphor plate (CP1M200, referred to as system C) helps to provide improved edge-enhanced effect in phase contrast imaging. Physical characteristics of 2 conventional particulate-crystal-type photostimulable-phosphor plates (RP-5PM, referred to as system A and RP-6M, referred to as system B) and system C were measured. Then, an acrylic plate phantom and RMI152 phantom were imaged using 3 types of plates, and the edge-enhancement effects were evaluated based on the profile curve of the acrylic plate phantom. Visual evaluation of the RMI152 phantom images was conducted. The results showed that the modulation transfer function (MTF) of system C was superior to those of the other systems. The WS of system C was superior to those of the other systems in the low frequency band region, and inferior to those of the other systems in the high frequency band region. The presence of an edge-enhanced image was not detectable in the profile curve of the acrylic plate in system A, although that was shown in systems B and C due to their excellent sharpness. In the visual image evaluation of the RMI152 phantom, image quality of system C was superior to those of the other systems. Phase contrast imaging with a digital detector of a columnar-crystal-type photostimulable-phosphor plate is considered to provide improved edge-enhancement over that of conventional plates.     

Effect of alternative photostimulable phosphor plates erasing times on subjective digital image quality

Objective

To evaluate the influence of alternative erasing times of DenOptix® (Dentsply/Gendex, Chicargo, IL) digital plates on subjective image quality and the probability of double exposure image not occurring.

Methods

Human teeth were X-rayed with phosphor plates using ten different erasing times. Two observers evaluated the images for subjective image quality (sharpness, brightness, contrast, enamel definition, dentin definition and dentin-enamel junction definition) and for the presence or absence of double exposure image. Spearman''s correlation analysis and ANOVA was performed to verify the existence of a linear association between the subjective image quality parameters and the alternative erasing times. A contingency table was constructed to evaluate the agreement among the observers, and a binominal logistic regression was performed to verify the correlation between the erasing time and the probability of double exposure image not occurring.

Results

All 6 parameters of image quality were rated high by the examiners for the erasing times between 25 s and 130 s. The same erasing time range, from 25 to 130 s, was considered a safe erasing time interval, with no probability of a double exposure image occurring.

Conclusions

The alternative erasing times from 25 s to 130 s showed high image quality and no probability of double image occurrence. Thus, it is possible to reduce the operating time of the DenOptix® digital system without jeopardizing the diagnostic task.     

Comparing image quality of flat-panel chest radiography with storage phosphor radiography and film-screen radiography

OBJECTIVE: To evaluate image quality of a large-area direct-readout flat-panel detector system in chest radiography, we conducted an observer preference study. A clinical comparative study was conducted of the flat-panel system versus the storage phosphor and standard film-screen systems. MATERIALS AND METHODS: Routine chest radiographs (posteroanterior) of 30 patients that were obtained using flat-panel, storage phosphor, and film screen systems were compared. The visibility of 10 anatomic regions and the overall image quality criteria were rated independently by three radiologists using a 5-point scale. The significance of the differences in diagnostic performance was tested with a Wilcoxon's signed rank test. Dose measurements for the three modalities were performed. RESULTS: The flat-panel radiography system showed an improved visibility in most anatomic structures when compared with a state-of-the-art conventional film-screen system and an equal visibility when compared with a storage phosphor system. The flat-panel system showed the greatest enhancement in the depiction of small detailed structures (p < 0.05) and achieved this with a reduction in overall radiation dose of more than 50%. CONCLUSION: The visibility of anatomic structures provided by this flat-panel detector system is as good as if not better than that provided by conventional or storage phosphor systems while emitting a reduced radiation dose.     

Storage phosphor radiography

LANGUAGE="EN">Summary. Storage phosphor radiography is a digital technique that uses photo-stimulable phosphor screens to substitute for conventional screen-film combinations. While the technique is more than 15 years old, it is only recently that technological and economic aspects of these systems have become favourable enough to envisage a more widespread clinical application.     

Conventional screen/film vs reduced exposure photostimulable phosphor plate imaging in lower extremity venography: an ROC analysis

Half-exposure phosphor plates used in venography substantially reduce the total X-ray exposure to a patient while increasing the chance that all images will be of excellent diagnostic quality. Simultaneous half-exposure phosphor plate and full-exposure conventional screen/film venograms were obtained of 35 patients and compared by using receiver operating characteristic (ROC) analysis. The area under the ROC curve ranged from 0.67 to 0.78 for conventional films and 0.68 to 0.91 for phosphor plates. Group performances on conventional films vs phosphor plates were not statistically different. No statistically significant difference in individual performance with the two techniques was seen in seven of the eight interpreters at the 95% confidence level. The eighth interpreter performed significantly better with phosphor plates than with conventional films. Interpreters with and without specific experience in phosphor plate venography were grouped separately, and performance of the two groups was compared in each technique. No difference in performance was found between the groups when interpreting conventional venograms, but, when interpreting phosphor plate venograms, the group with specific experience performed significantly better than they had with conventional venograms, and significantly better than the other group did at interpreting either conventional or phosphor plate venograms. We conclude that phosphor plate venograms made at a 50% reduction in X-ray exposure are equal to, and may surpass, conventional screen/film venograms for diagnosing acute venous thrombosis of the calf and thigh. We recommend expanding the indications for phosphor plate radiography to include contrast venography of the lower extremities.     

Relationship between radiation dose reduction and image quality change in photostimulable phosphor luminescence X-ray imaging systems

Objectives

The aim of the study was to clarify the change in image quality upon X-ray dose reduction and to re-analyse the possibility of X-ray dose reduction in photostimulable phosphor luminescence (PSPL) X-ray imaging systems. In addition, the study attempted to verify the usefulness of multiobjective frequency processing (MFP) and flexible noise control (FNC) for X-ray dose reduction.

Methods

Three PSPL X-ray imaging systems were used in this study. Modulation transfer function (MTF), noise equivalent number of quanta (NEQ) and detective quantum efficiency (DQE) were evaluated to compare the basic physical performance of each system. Subjective visual evaluation of diagnostic ability for normal anatomical structures was performed. The NEQ, DQE and diagnostic ability were evaluated at base X-ray dose, and 1/3, 1/10 and 1/20 of the base X-ray dose.

Results

The MTF of the systems did not differ significantly. The NEQ and DQE did not necessarily depend on the pixel size of the system. The images from all three systems had a higher diagnostic utility compared with conventional film images at the base and 1/3 X-ray doses. The subjective image quality was better at the base X-ray dose than at 1/3 of the base dose in all systems. The MFP and FNC-processed images had a higher diagnostic utility than the images without MFP and FNC.

Conclusions

The use of PSPL imaging systems may allow a reduction in the X-ray dose to one-third of that required for conventional film. It is suggested that MFP and FNC are useful for radiation dose reduction.     

Flat panel digital radiography compared with storage phosphor computed radiography: assessment of dose versus image quality in phantom studies

RATIONALE AND OBJECTIVE: To assess and quantify the dose reduction by use of a CsI-flat panel digital radiography (DR)-system compared with digital computed radiography (CR). MATERIALS AND METHODS: A TCDD-test using the CDRAD-phantom was performed at mAs-values of 5, 4, 2.5, 2, 1, and 0.5 mAs for both digital systems. Entrance surface doses were recorded for all images. Images were presented to four independent observers. For quantitative comparison the image quality figure (IQF) was calculated. Statistical analysis was performed using the Pearson correlation and the Wilcoxon test. A ROC analysis was performed using the TRG-phantom. Settings of 4, 2.5, 2 mAs for both systems were used. In addition, 1 and 0.5 mAs were used for the DR system only. Statistical significance was evaluated using Student test. RESULTS: The DR system provided equivalent results compared with CR with respect to high frequency information and superior results with respect to low contrast details. Compared with computed radiography, the flat panel detector demonstrated significantly lower IQFs, ensuring a better image quality with respect to contrast and detail detectability. IQFs for DR and CR were equal at a surface dose reduction of 87% for DR. ROC analysis revealed significantly higher values under the curve for DR up to a surface dose reduction of 70%. CONCLUSIONS: Image quality of DR proved to be far superior to CR in particular for low contrast details. The image quality of CR is similar to that of DR only at high dose levels.     

Digital imaging with a photostimulable phosphor in the chest of newborns

To evaluate use of a digital photostimulable phosphor imaging system in the neonatal nursery, 150 newborns were divided into three groups of 50. In the first two groups, screen-film and computed radiographs of the chest were obtained at the same radiation exposure; in the third group, computed radiographs were obtained with a 50% dose reduction (half-exposure computed radiographs). All images were blindly evaluated by three readers who scored the quality of visualization of the mediastinum, lung, bone, soft tissues, and endotracheal and nasogastric tubes, and also image density. No statistical differences in visualization of tubes existed among the three groups. Visualization of the mediastinum, lung, bones, and soft tissues was statistically significantly better on computed radiographs than on half-exposure computed radiographs; visualization of the lungs, bones, and soft tissues was statistically significantly better on screen-film radiographs than half-exposure computed radiographs. Image density was statistically better on computed and half-exposure computed radiographs than on screen-film radiographs.     

Computed and conventional chest radiography: a comparison of image quality and radiation dose

The aim of this study was to compare the image quality and entrance skin dose (ESD) for film-screen and computed chest radiography. Analysis of the image quality and dose on chest radiography was carried out on a conventional X-ray unit using film-screen, storage phosphor plates and selenium drum direct chest radiography. For each receptor, ESD was measured in 60 patients using thermoluminescent dosemeters. Images were printed on 35 x 43 cm films. Image quality was assessed subjectively by evaluation of anatomic features and estimation of the image quality, following the guidelines established by the protocols of the Commission of the European Communities. There was no statistically significant difference noted between the computed and conventional images (Wilcoxon rank sum test, P > 0.05). Imaging of the mediastinum and peripheral lung structures were better visualized with the storage phosphor and selenium drum technique than with the film-screen combination. The patients' mean ESD for chest radiography using the storage phosphor, film-screen combination and selenium drum was 0.20, 0.20 and 0.25 mGy, respectively, with no statistically significant difference with P > 0.05 (chi(2) tests).     

Evaluation of thyroid calcification using computed radiography with image plate

The value of lateral magnification soft x-ray roentgenography using a Computed Radiography (CR) system was studied. ROC curve analysis revealed that a CR system has virtually the same, or a better ability than a screen-film system for detecting thyroid calcification. According to our criteria the CR system an accuracy rate of 77.1% in malignant/benign diagnosis was obtained.     

Clinical experience in the use of photostimulable phosphor radiographic systems.

The experience with CR systems gained at the three institutions described in this report demonstrates numerous advantages over the conventional screen-film system. These include: (1) a reduction in the radiation exposure delivered to the patient (25% to 50%); (2) a decrease in the number of repeat examinations needed, especially in portable units where technical difficulties are common with screen-film examinations; this is attributable to the linear, wider dynamic range of CR systems compared with screen-film combinations; (3) the capability to archive electronically all images by means of a digital optical storage system; (4) automatic electronic setting of the laser scanner for the latitude and sensitivity on each image; (5) the digital images are available for transmission to all image display workstations on a local or wide-area network; and (6) the ability to adjust interactively the display parameters to best depict images and pathology as well as salvage technically suboptimal examinations. Several disadvantages of CR systems compared with conventional screen-film examinations have also been identified.(ABSTRACT TRUNCATED AT 250 WORDS)