Digital radiography: image quality and radiation dose

Digital radiography devices, rapidly replacing analog screen-film detectors, are now common in diagnostic radiological imaging, where implementation has been accelerated by the commodity status of electronic imaging and display systems. The shift from narrow latitude, fixed-speed screen-film detectors to wide latitude, variable-speed digital detectors has created a flexible imaging system that can easily result in overexposures to the patient without the knowledge of the operator, thus potentially increasing the radiation burden of the patient population from radiographic examinations. In addition, image processing can be inappropriately applied causing inconsistent or artifactual appearance of anatomy, which can lead to misdiagnosis. On the other hand, many advantages can be obtained from the variable-speed digital detector, such as an ability to lower dose in many examinations, image post-processing for disease-specific conditions, display flexibility to change the appearance of the image and aid the physician in making a differential diagnosis, and easy access to digital images. An understanding of digital radiography is necessary to minimize the possibility of overexposures and inconsistent results, and to achieve the principle of as low as reasonably achievable (ALARA) for the safe and effective care of all patients. Thus many issues must be considered for optimal implementation of digital radiography, as reviewed in this article.