A comparison of dual-energy digital radiography and screen-film imaging in the detection of subtle interstitial pulmonary disease

Recent Advances in Chest Radiography

There have been many remarkable advances in conventional thoracic imaging over the past decade. Perhaps the most remarkable is the rapid conversion from film-based to digital radiographic systems. Computed radiography is now the preferred imaging modality for bedside chest imaging. Direct radiography is rapidly replacing film-based chest units for in-department posteroanterior and lateral examinations. An exciting aspect of the conversion to digital radiography is the ability to enhance the diagnostic capabilities and influence of chest radiography. Opportunities for direct computer-aided detection of various lesions may enhance the radiologist's accuracy and improve efficiency. Newer techniques such as dual-energy and temporal subtraction radiography show promise for improved detection of subtle and often obscured or overlooked lung lesions. Digital tomosynthesis is a particularly promising technique that allows reconstruction of multisection images from a short acquisition at very low patient dose. Preliminary data suggest that, compared with conventional radiography, tomosynthesis may also improve detection of subtle lung lesions. The ultimate influence of these new technologies will, of course, depend on the outcome of rigorous scientific validation.

Comparison of dual energy detector system performance

Dual energy detector systems are combinations of x-ray detectors, x-ray source spectrum switching, and x-ray filter attenuation that provide two measurements of transmitted flux through the object with different effective spectra. We describe technology independent methods to measure and compare the quantum noise and sensitivity to motion artifacts of these systems. The experimental methods use relatively simple phantoms to measure the parameters in the general mathematical expressions for the noise in the subtracted image. The parameters are used to compute an x-ray energy spectrum quality factor and a subtracted image noise per unit patient dose quality factor. Patient motion causes artifacts in switched spectrum systems, particularly with the heart in chest radiography. We describe a method to measure effective interexposure time using subtracted image data of a uniformly moving object. This parameter measures the sensitivity to patient motion artifacts. We use these methods to compare three examples of systems with different dual energy detector technologies: a passive, "sandwich" detector with two computed radiography plates separated by a copper filter, an "active" detector that uses voltage switching with an electro-optical system and computed radiography plates, and a flat-panel, solid state detector with voltage switching.

The digital imaging workstation. 1990

Picture archiving and communication systems (PACS) are expected to convert film-based radiology into a computer-based digital environment, with associated cost savings and improved physician communication. The digital workstation will be used by physicians to display these “soft-copy” images; however, difficult technical challenges must be met for the workstation to compete successfully with the familiar viewbox. Issues relating to image perception and the impact on physicians’ practice must be carefully considered. The spatial and contrast resolutions required vary according to imaging modality, type of procedure, and class of user. Rule-based software allows simple physician interaction and speeds image display. A consensus appears to be emerging concerning the requirements for the PACS workstation. Standards such as the American College of Radiology/National Electrical Manufacturers’ Association Digital Imaging and Communication Standard are facilitating commercial applications. Yet much careful study is needed before PACS workstations will be fully integrated into radiology departments.