Performance of a flat-panel detector in the detection of artificial erosive changes: comparison with conventional screen-film and storage-phosphor radiography

The purpose of this study was to compare a large-area, direct-readout, flat-panel detector system with a conventional screen-film system, a storage-phosphor system, and a mammography screen-film system with regard to the detection of artificial bone erosions simulating rheumatoid disease, and to assess its diagnostic performance with decreasing exposure dose. Six hundred forty regions were defined in 160 metacarpophalangeal and proximal interphalangeal joint specimens from 20 monkey paws (4 regions per joint). Artificial bone erosions were created in 320 of these 640 regions. Specimens were enclosed in containers filled with water to obtain absorption and scatter radiation conditions similar to those of a human hand. Imaging was performed using a flat-panel system, a speed class 200 screen-film system, a mammography screen-film system, and a storage-phosphor system under exactly matched conditions. Different exposure doses equivalent to speed classes of S=100, 200, 400, 800, 1600, and 3200 were used. In all images the presence or absence of a lesion was assessed by three radiologists using a five-level confidence scale. Receiver operating characteristic (ROC) analysis was performed for a total of 21,120 observations (1920 for each imaging modality and exposure level) and diagnostic performance estimated by the area under the ROC curve (A_z). The significance of differences in diagnostic performance was tested with analysis of variance. The ROC analysis showed A_z values of 0.809 (S=200), 0.768 (S=400), 0.737 (S=800), 0.710 (S=1600), and 0.685 (S=3200) for the flat-panel system, 0.770 for the speed class 200 screen-film system, 0.781 (S=200), 0.739 (S=400), 0.724 (S=800), 0.680 (S=1600) for the storage-phosphor system, and 0.798 for the mammography screen-film system. Analysis of variance showed significant differences between different combinations of imaging modalities and exposure doses ( p <0.05). The diagnostic performance of the flat-panel detector system is superior to that of a screen-film system and a storage-phosphor system for the detection of erosive lesions at clinical exposure settings (S=200). Using the flat-panel system the exposure dose can be reduced by 50% to obtain a diagnostic performance comparable to a speed class 200 screen-film system. Electronic Publication     

Detection of subtle undisplaced rib fractures in a porcine model: radiation dose requirement--digital flat-panel versus screen-film and storage-phosphor systems

PURPOSE: To compare a large-area direct read-out flat-panel detector radiography system with screen-film and storage-phosphor systems with regard to detection of subtle undisplaced rib fractures and to assess the diagnostic performance of the flat-panel system with decreasing exposure level. MATERIALS AND METHODS: Subtle fractures were created artificially in 100 of 200 porcine rib specimens. Specimens were enclosed in containers of water to generate absorption and scatter radiation conditions similar to those of a human chest wall. Imaging was performed with flat-panel, screen-film, and storage-phosphor systems with conditions that were exactly matched. Different exposure levels equivalent to speed classes (S) of 400, 800, 1,600, and 6,400 were used. All images were independently assessed for the presence of fracture by three radiologists with a five-level confidence scale. Receiver operating characteristic (ROC) analysis was performed for a total of 4,200 observations (600 for each imaging system and exposure level). Diagnostic performance was estimated with area under the ROC curve (Az). Significance of differences in diagnostic performance was tested with analysis of variance. RESULTS: ROC analysis yielded mean Az values for the flat-panel system of 0.879 (S = 400), 0.833 (S = 800), 0.765 (S = 1,600), and 0.576 (S = 6,400). Az values were 0.834 (S = 400) for the screen-film system and 0.789 (S = 400) and 0.729 (S = 800) for the storage-phosphor system. Analysis of variance revealed significant differences in diagnostic performance between various combinations of imaging system and exposure levels (P <.05). CONCLUSION: The flat-panel system is superior to the screen-film and storage-phosphor systems for detection of subtle undisplaced rib fractures at clinical exposure settings (eg, S = 400). With the flat-panel system, radiation dose can be reduced by 50% to achieve diagnostic performance comparable to that of a speed class 400 screen-film system.     

Comparison of a digital flat-panel versus screen-film, photofluorography and storage-phosphor systems by detection of simulated lung adenocarcinoma lesions using hard copy images

The purpose of this study was to compare hard copy images from a flat-panel detector digital radiography system with conventional radiography, photofluorographic radiography and storage phosphor radiography for the detection of simulated lung adenocarcinoma lesions and also for radiation dose. To test the diagnostic performance of these four systems, the authors used 15 types of lung adenocarcinoma phantom according to Noguchi's classification and an anthropomorphic chest phantom. The visual evaluation of tumour detectability by four radiologists and two general thoracic surgeons was examined with a five-level confidence scale. Lung doses were measured with glass dosemeters for the chest radiology systems under the conditions used by each hospital and centre. Our results indicated that flat-panel detector digital radiography and storage phosphor radiography are not necessarily superior to conventional radiography and photofluorographic radiography for detecting lung adenocarcinomas when only hard copy images are used, and this suggests a need to carefully optimize chest radiography.     

Clinical evaluation of digital radiography based on a large-area cesium iodide-amorphous silicon flat-panel detector compared with screen-film radiography for skeletal system and abdomen

The aim of this clinical study was to compare the image quality of digital radiography using the new digital Bucky system based on a flat-panel detector with that of a conventional screen-film system for the skeletal structure and the abdomen. Fifty patients were examined using digital radiography with a flat-panel detector and screen-film systems, 25 for the skeletal structures and 25 for the abdomen. Six radiologists judged each paired image acquired under the same exposure parameters concerning three observation items for the bone and six items for the abdomen. Digital radiographic images for the bone were evaluated to be similar to screen-film images at the mean of 42.2%, to be superior at 50.2%, and to be inferior at 7.6%. Digital radiographic images for the abdomen were judged to be similar to screen-film images at the mean of 43.4%, superior at 52.4%, and inferior at 4.2%; thus, digital radiographic images were estimated to be either similar as or superior to screen-film images at over 92% for the bone and abdomen. On the statistical analysis, digital radiographic images were also judged to be preferred significantly in the most items for the bone and abdomen. In conclusion, the image quality of digital radiography with a flat-panel detector was superior to that of a screen-film system under the same exposure parameters, suggesting that dose reduction is possible with digital radiography.     

Digital radiography with a large-scale electronic flat-panel detector vs. screen-film radiography: observer preference in clinical skeletal diagnostics

The imaging performance of a recently developed digital flat-panel detector system was compared with conventional screen-film imaging in an observer preference study. In total, 34 image pairs of various regions of the skeleton were obtained in 24 patients; 30 image pairs were included in the study. The conventional images were acquired with 250- and 400-speed screen-film combinations, using the standard technique of our department. Within hours, the digital images were obtained using identical exposure parameters. The digital system employed a large-area (43x43 cm) flat-panel detector based on amorphous silicon (Trixell Pixium 4600), integrated in a Bucky table. Six radiologists independently evaluated the image pairs with respect to image latitude, soft tissue rendition, rendition of the periosteal and enosteal border of cortical bone, rendition of cancellous bone and the visibility of potentially present pathological changes, using a subjective five-point scale. The digital images were rated significantly (p=0.001) better than the screen-film images with respect to soft tissue rendition and image latitude. Also the rendition of the cancellous bone and the periosteal and enosteal border of the cortical bone was rated significantly (p=0.05) better for the flat-panel detector. The visibility of pathological lesions was equivalent; only large-area sclerotic lesions (n=2) were seen superiorly on screen-film images. The new digital flat-panel detector based on amorphous silicon appears to be at least equivalent to conventional screen-film combinations for skeletal examinations, and in most respects even superior.     

Chest radiography with a digital flat-panel detector: experimental receiver operating characteristic analysis

PURPOSE: To evaluate the influence of different detector radiation doses and peak kilovoltage settings on diagnostic performance and radiation dose at posteroanterior (PA) chest radiography performed with an amorphous silicon flat-panel detector (FPD). MATERIALS AND METHODS: All examinations were performed by using a digital FPD. PA chest radiographs of an anthropomorphic chest phantom were obtained with detector radiation doses of 2.50 microGy (system speed, 400), 1.56 microGy (speed, 640), and 1.25 microGy (speed, 800) and with peak kilovoltage values of 100, 120, and 140 kVp. Four types of simulated lesions-nodules of different sizes, polylobulated lesions, interstitial-nodular lesions, and interstitial-reticular lesions-were superimposed on the phantom. After four radiologists assessed all of the images, receiver operating characteristics analysis was performed. In addition, the entrance surface dose was measured and the effective dose was calculated. RESULTS: Reduced detector dose led to significantly decreased diagnostic performance in overall lesion detection (P <.05). However, over pulmonary areas only, this effect could not be seen. With use of the same kilovoltage values, reducing the detector dose, even to 1.25 microGy (speed, 800), did not lead to significantly decreased lesion detectability. In terms of diagnostic performance and effective dose, 120 kVp was the most effective. CONCLUSION: Standard PA chest radiographs should still be acquired at a detector dose of 2.50 microGy (speed, 400) with 120 kVp to yield the highest diagnostic performance. However, when the present analysis was focused on the lung fields only, no significant loss in diagnostic performance could be demonstrated, even after a 50% reduction in radiation dose.     

Dual-energy chest radiography with a flat-panel digital detector: revealing calcified chest abnormalities

OBJECTIVE: The aim of this study was to assess the value of dual-energy chest radiography obtained using a cesium iodide flat-panel detector in addition to standard posteroanterior chest radiography for the detection of calcified chest abnormalities. MATERIALS AND METHODS: The study included 20 patients with a total of 37 calcified chest lesions (16 pulmonary nodules, 17 mediastinal calcifications, and four pleural calcifications) as confirmed on CT. Twenty-eight locations in the chests of the same patients who were free of lesions were used as negative controls. Four radiologists reviewed posteroanterior chest radiographs in a blinded manner alone and in conjunction with dual-energy soft-tissue and bone images. We calculated sensitivity, specificity, the negative predictive value (NPV), and the positive predictive value (PPV) for lesion prediction. The Wilcoxon's and the Brunner and Langer's tests were performed for statistical analysis. RESULTS: For posteroanterior chest radiography, sensitivity was 36%, the PPV was 64%, and the NPV was 47%. When dual-energy images were added, sensitivity increased significantly to 66% (p < 0.05), the PPV to 76%, and the NPV to 62%. The specificity remained constant at 73%. Brunner and Langer's test revealed a highly significant difference between posteroanterior chest radiography and dual-energy imaging in the detection of calcified chest abnormalities (p < 0.01). CONCLUSION: Dual-energy images added to standard posteroanterior chest radiographs significantly improve the detection of calcified chest lesions.     

非晶硒平板探测器DR与CR模拟病变描述和剂量降低的对比研究

目的 比较非晶硒平板探测器DR与CR对模拟肺部病变的描述,并对剂量降低情况进行评价。方法 模拟线状、网状和结节病变结构置入仿真胸部体模内,应用DR和CR分别对不同mAs设置的体模曝光,记录体模的入射体表剂量。收集不同剂量的硬拷贝照片,由4位放射医师随机地实施模拟肺部病变显示度评价。采用秩和(Wilcoxon)检验进行统计学分析。结果 用2.0、3.2 mAs曝光时,DR与CR对模拟线状、网状病变的显示度差异有统计学意义(模拟线状病变:Z=-2.032,P=0.042;Z=-2.375, P=0.018。模拟网状病变: Z=-2.680, P=0.007;Z=-2.670, P=0.008)。用5.0、6.3 mAs曝光时,两者对模拟线状、网状病变的显示度差异无统计学意义(P＞0.05)。2.0、3.2、5.0、6.3 mAs曝光档,对于小结节(直径小于10 mm)的检测DR均优于CR(Z=-2.237, P=0.018; Z=-2.384, P=0.017; Z=-2.388, P=0.017; Z=-2.366, P=0.018)。当3种模拟肺部病变都显示清楚时,用非晶硒DR系统的入射体表剂量降低约65%。结论 对微小低对比病变的描述,非晶硒平板探测器DR优于CR且明显地降低曝光剂量。     

Skeletal applications for flat-panel versus storage-phosphor radiography: effect of exposure on detection of low-contrast details

PURPOSE: To compare exposure requirements for similar detection performance with flat-panel detectors and the most recent generation of storage-phosphor plates in the simulated scatter of typical skeletal radiographic examinations. MATERIALS AND METHODS: A contrast-detail test object was covered with varying thicknesses of acrylic to simulate skeletal exposure conditions in the wrist, knee, and pelvis. Three series were obtained with increasing thicknesses of a simulated soft-tissue layer (5, 10, and 20 cm) and increasing tube voltage (50, 70, and 90 kVp). A fourth series was obtained with exposure conditions adapted to the phantom instructions (75 kVp). Images were acquired with a flat-panel detector (cesium iodide scintillator) and storage-phosphor plates at five exposure levels (speed class range, 100-1,600). Five readers evaluated 84 images to determine the threshold contrast of 12 lesion diameters (range, 0.25-11.1 mm). Statistical significance of differences between the two digital systems was assessed with two-way analysis of variance. RESULTS: A linear relationship was found between the number of detected lesions and the logarithm of exposure (R(2) > 0.98 for all series). On average, the flat-panel system required 45% less exposure than did the phosphor plates when 20-cm-thick acrylic was superimposed on the test object. Differences in exposure requirements were smaller with decreasing thicknesses of simulated soft-tissue layers and lower tube voltages (39% at 10 cm and 70 kVp, and 17% at 5 cm and 50 kVp). All differences were statistically significant. CONCLUSION: Flat-panel radiography provides improved contrast detectability and a potential for exposure reduction compared with those with storage-phosphor radiography. The best performance was achieved with conditions comparable to those for radiography of the trunk and lowest for conditions that simulate radiography of the extremities.     

Dose efficiency of screen-film systems used in pediatric radiography

Twenty-one screen-film systems were examined using contrast-detail-dose methods in order to determine which were most dose-efficient for use in pediatric radiography. With a given screen, dose efficiency in the noise-limited region (contrast approximately equal to 0.05) was more or less constant (within the range of experimental error) with changes in film speed. When screens with decreased phosphor thickness were used, dose efficiency deteriorated markedly. For a given speed of up to two times Par, rare-earth phosphors offered no advantage over calcium tungstate systems with regard to low-contrast dose efficiency; however, they did increase the speed of the system. Anti-crossover film proved to be an effective means of improving high-contrast detail while maintaining low-contrast dose efficiency.     

Simulated bone erosions in a hand phantom: detection with conventional screen-film technology versus cesium iodide-amorphous silicon flat-panel detector

PURPOSE: To assess the diagnostic performance of an active-matrix flat-panel x-ray detector for reduced-dose imaging of simulated arthritic lesions. MATERIALS AND METHODS: A digital x-ray detector based on cesium iodide and amorphous silicon technology with a panel size of 43 x 43 cm, matrix of 3,000 x 3,000 pixels, pixel size of 143 micrometer, and digital output of 14 bits was used. State-of-the-art screen-film radiographs were compared with digital images obtained at doses equivalent to those obtained with system speeds of 400, 560, and 800. The phantom was composed of a human hand skeleton on an acrylic plate with drilled holes simulating bone erosions of different diameters and depths. Results of four independent observers were evaluated with receiver operating characteristic curve analysis. RESULTS: The cesium iodide and amorphous silicon detector resulted in better diagnostic performance than did the screen-film combination, with the dose being the same for both modalities (P <.05). For digital images obtained at reduced doses, no significant differences were found. CONCLUSION: The improved diagnostic performance with digital radiographs obtained with the cesium iodide and amorphous silicon detector suggests that this detector technology holds promise in terms of dose reduction for specific diagnostic tasks, without loss of diagnostic accuracy.     

Digital radiography versus conventional radiography in chest imaging: diagnostic performance of a large-area silicon flat-panel detector in a clinical CT-controlled study

OBJECTIVE: The objective of this study was to compare the diagnostic performance of a digital large-area silicon flat-panel detector with that of a conventional screen-film system in clinical chest imaging using abnormal findings documented by CT as the reference standard. SUBJECTS AND METHODS: Eighty patients (46 men and 34 women; age range,18-91 years; mean age, 63 years) who underwent CT of the chest were examined with the new digital radiography system, which is based on a 43 x 43 cm silicon flat-panel detector, and with a conventional screen-film system, which is used routinely in clinical practice. Posteroanterior and lateral radiographs were obtained. Four radiologists analyzed the digital and conventional images separately for chest abnormalities and rated the images using a five-level scale of confidence; CT was used as the reference standard. Diagnostic value was assessed using receiver operating characteristic curves for each abnormality. RESULTS: No significant differences were found between the area under the receiver operating characteristic curve of the digital and that of the conventional radiography method for almost all investigated criteria. The only exception was mediastinal abnormalities, for which the digital method provided better results than the conventional method (p < 0.05). CONCLUSION. The diagnostic performance of the new large-area silicon flat-panel detector is equivalent or superior to that of the conventional screen-film system for clinical chest imaging and can replace conventional radiography systems. This new technology offers transmission and storage possibilities inherent to digital radiology that would facilitate daily practice and reduce the initial high costs in the long-term.     

Reducing the radiation dose during excretory urography: flat-panel silicon x-ray detector versus computed radiography

OBJECTIVE: The purpose of the study was to examine the possibilities for reducing radiation exposure in uroradiology using digital flat-panel silicon X-ray detector radiography. We compared the subjectively determined image quality of abdominal radiographs and urograms obtained on a digital flat-panel detector radiography system with those obtained on a computed radiography system. SUBJECTS AND METHODS. Fifty patients who had a clinical indication for urography underwent unenhanced abdominal imaging that was alternately performed using flat-panel silicon X-ray detector radiography or computed radiography. For patients who required a second radiograph with contrast medium, the examination modality was changed to avoid exposing the patients to excess radiation. The images obtained on flat-panel X-ray detector radiography were obtained at half the radiation dose of the images obtained on computed radiography (800 speed vs 400 speed). The resulting 50 pairs of images were interpreted by four independent observers who rated the detectability of structures of bone and the efferent urinary tract relevant to diagnosis and compared the image quality. RESULTS: At half the radiation dose, digital flat-panel X-ray detector radiography provided equivalent image quality of the liver and spleen, lumbar vertebrae 2 and 5, pelvis, and psoas margin on abdominal radiographs. The image quality obtained with digital flat-panel X-ray detector radiography of the kidneys, the hollow cavities of the upper efferent urinary tract, and the urinary bladder was judged to be statistically better than those obtained with computed radiography. CONCLUSION: With half the exposure dose of computed radiography, the flat-panel X-ray detector produced urograms with an image quality equivalent to or better than computed radiography.     

Digital chest radiography with a selenium-based flat-panel detector versus a storage phosphor system: comparison of soft-copy images

OBJECTIVE. We compared the soft-copy images produced by a digital chest radiography system that uses a flat-panel X-ray detector based on amorphous selenium with images produced by a storage phosphor radiography system for the visualization of anatomic regions of the chest. MATERIALS AND METHODS. Two chest radiologists and two residents analyzed 46 pairs of posteroanterior chest radiographs on high-resolution video monitors (2560 x 2048 x 8 bits). In each pair, one radiograph was obtained with a storage phosphor radiography system, and the other radiograph was obtained with a selenium-based flat-panel detector radiography system. Each pair of radiographs was obtained at the same exposure settings. The interpreter rated the visibility and radiographic quality of 11 different anatomic regions. Each pair of images was ranked on a five-point scale (1 = prefer image A, 3 = no preference, 5 = prefer image B) for preference of technique. Statistical significance of preference was determined using the Wilcoxon's signed rank test. RESULTS. The interpreters had a statistically significant preference for the selenium-based radiography system in six (unobscured lung, hilum, rib, minor fissure, heart border, and overall appearance) of 11 anatomic regions (p<0.001) and for the storage phosphor system in two regions (proximal airway and thoracic spine) (p<0.05). Chest radiologists strongly preferred selenium-based images in eight regions, and they did not prefer storage phosphor images in any region. CONCLUSION. The soft-copy images produced by the selenium-based radiography system were perceived as equal or superior to those produced by the storage phosphor system in most but not all anatomic regions.