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Gossye T, Buytaert D, Smeets PV, Morbée L, Vereecke E, Kellens P, Achten E, Bacher K. Evaluation of Virtual Grid processed clinical pelvic radiographs. J Appl Clin Med Phys 2024; 25:e14353. [PMID: 38693646 PMCID: PMC11163484 DOI: 10.1002/acm2.14353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/24/2023] [Accepted: 03/13/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND A physical scatter grid is not often used in pelvic bedside examinations. However, multiple studies regarding scatter correction software (SC SW) are available for mobile chest radiography but the results are unclear for pelvic radiography. PURPOSE We evaluated SC SW of Fujifilm (Virtual Grid) on gridless pelvic radiographs obtained from a human Thiel-embalmed body to investigate the potential of Virtual Grid in pelvic bedside examinations. METHODS Gridless, Virtual Grid, and physical grid pelvic radiographs of a female Thiel-embalmed body were collected with a broad range of tube loads. Different software (SW) grid ratios-6:1, 10:1, 13:1, 17:1, and 20:1-were applied on the gridless radiographs to investigate the image quality (IQ) improvement of 13 IQ criteria in a visual grading analysis (VGA) setup. RESULTS Gridless radiograph scores are significantly lower (p < 0.001) than Virtual Grid and physical grid scores obtained with the same tube load. Virtual Grid radiographs score better than gridless radiographs obtained with a higher tube load which makes a dose reduction possible. The averaged ratings of the IQ criteria processed with different SW ratios increase with increasing SW grid ratios. However, no statistically significant differences were found between the SW grid ratios. The scores of the physical grid radiographs are higher than those of the Virtual Grid radiographs when they are obtained with the same tube load. CONCLUSION We conclude that Virtual Grid with an SW ratio of 6:1 improves the IQ of gridless pelvic radiographs in such a manner that a dose reduction is possible. However, physical grid radiograph ratings are higher compared to those of Virtual Grid radiographs.
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Affiliation(s)
- Tim Gossye
- Department of Human Structure and RepairGhent UniversityGhentBelgium
| | - Dimitri Buytaert
- Department of Human Structure and RepairGhent UniversityGhentBelgium
| | - Peter V. Smeets
- Department of RadiologyGhent University HospitalGhentBelgium
| | - Lieve Morbée
- Department of RadiologyGhent University HospitalGhentBelgium
| | - Elke Vereecke
- Department of RadiologyGhent University HospitalGhentBelgium
| | | | - Eric Achten
- Department of RadiologyGhent University HospitalGhentBelgium
| | - Klaus Bacher
- Department of Human Structure and RepairGhent UniversityGhentBelgium
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Sayed M, Knapp KM, Fulford J, Heales C, Alqahtani SJ. The impact of X-ray scatter correction software on abdomen radiography in terms of image quality and radiation dose. Radiography (Lond) 2024; 30:1125-1135. [PMID: 38797045 DOI: 10.1016/j.radi.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/24/2024] [Accepted: 05/13/2024] [Indexed: 05/29/2024]
Abstract
INTRODUCTION The conventional anti-scatter grid is widely used in X-ray radiography to reduce scattered X-rays, but it increases patient dose. Scatter-correction software offers a dose-reducing alternative by correcting for scattered X-rays without a physical grid. Grids and software correction are necessary to reduce scatter radiation and improve image quality especially for the large body parts. The scatter correction can be beneficial in situations where the use of grid is challenging. The implementation of grids and advanced software correction techniques is imperative to ensure that radiographic images maintain high levels of clarity, contrast, and resolution, and ultimately facilitating more accurate diagnoses. This study compares image quality and radiation dose for abdomen exams using scatter correction software and physical grids. METHODS An anthropomorphic phantom (abdomen) underwent imaging with varying fat and lean tissue layers and body mass index (BMI) configurations. Imaging parameters included 70 kVp tube voltage, 110 cm SID, and Automatic Exposure Control (AEC) both lateral and central chambers. AP abdomen X-ray projections were acquired with and without an anti-scatter grid, and scatter correction software was applied. Image quality was assessed using contrast to noise ratio (CNR) and signal to noise ratio (SNR) metrics. The tube current mAs was considered an exposure factor that affected radiation dose and was used to compare the VG software and physical grid. Radiation dose was measured using Dose Area Products (DAP). The effective dose was estimated using Monte Carlo simulation-PCXMC software. Paired t-tests were used to investigate the image quality difference between the Gridless and VG software, Gridless and PG, and VG software and PG approaches. For the DAP and effective dose, paired t-test was used to investigate the difference between VG software and PG. RESULTS Images acquired with a grid had the highest mean CNR (71.3 ± 32) compared to Gridless (50 ± 33.8) and scatter correction software (59.3 ± 37.9). The mean SNR of the grid images was (82.7.3 ± 38.9), which is 18% higher than the scatter correction software images (70.4 ± 36.7) and 29% higher than in the Gridless images (62.9.3 ± 34). The mean DAP value was reduced by 81% when the scatter correction software was used compared to the grid (mean: 65.4 μGy.m2 and 338.2 μGy.m2, respectively) with a significant difference (p = 0.001). Scatter correction software resulted in a lower effective dose compared to physical grid use, (mean difference± SD = -0.3 ± 0.18 mSv) with a significant difference (P = 0.02). CONCLUSION Scatter correction software reduced the radiation dose required but images employing a grid yielded higher CNR and SNR. However, the radiation dose reduction might affect the image quality to a level that impacts the diagnostic information available. Thus, further research needs to be conducted to optimise the use of the scatter correction software. IMPLICATION FOR PRACTICE Objectively, X-ray scatter correction software might be promising in conditions where a grid cannot be applied.
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Affiliation(s)
- M Sayed
- Diagnostic Radiology Department, College of Applied Medical Sciences, Najran University, Najran 61441, Saudi Arabia; Department of Medical Imaging, College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter EX1 2LU, UK.
| | - K M Knapp
- Department of Medical Imaging, College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter EX1 2LU, UK
| | - J Fulford
- Department of Medical Imaging, College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter EX1 2LU, UK
| | - C Heales
- Department of Medical Imaging, College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter EX1 2LU, UK
| | - S J Alqahtani
- Diagnostic Radiology Department, College of Applied Medical Sciences, Najran University, Najran 61441, Saudi Arabia; Department of Medical Imaging, College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter EX1 2LU, UK
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Rossignol J, Bélanger G, Gaudreault D, Therrien AC, Bérubé-Lauziére Y, Fontaine R. Time-of-flight scatter rejection in x-ray radiography. Phys Med Biol 2024; 69:055027. [PMID: 38232398 DOI: 10.1088/1361-6560/ad1f85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/17/2024] [Indexed: 01/19/2024]
Abstract
Objective.Time-of-flight (TOF) scatter rejection allows for identifying and discarding scattered photons without the use of an anti-scatter grid (ASG). Although TOF scatter rejection was initially presented for cone-beam computed tomography, we propose, herein, to extend this approach to x-ray radiography. This work aims to evaluate with simulations if TOF scatter rejection can outperform ASGs for radiography.Approach.GATE was used to simulate the radiography of a head and a torso and a water cylinder with bone inserts in a system with total timing jitters from 0 ps up to 500 ps full-width-at-half-maximum. The transmission factor of TOF scatter rejection for primary and scattered photons was evaluated as if it were a virtual ASG.Main results.With a total timing jitter of 50 ps, TOF scatter rejection can reach a selectivity of 4.93 with a primary photons transmission of 99%. Reducing the timing jitter close to 0 ps increases the selectivity up to 15.85 for a head and torso radiography, outperforming typical ASGs which usually have a selectivity from 2.5 to 10 with a primary photons transmission from 50% to 70%.Significance.This suggests that TOF scatter rejection may be suitable to replace ASGs in applications requiring lower radiation exposure if sufficiently low timing jitter is achieved.
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Affiliation(s)
- J Rossignol
- Institut Interdisciplinaire d'Innovation Technologique (3IT), Université de Sherbrooke, Sherbrooke, Québec, Canada
- Département de Génie Électrique et Génie Informatique, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - G Bélanger
- Institut Interdisciplinaire d'Innovation Technologique (3IT), Université de Sherbrooke, Sherbrooke, Québec, Canada
- Département de Génie Électrique et Génie Informatique, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - D Gaudreault
- Institut Interdisciplinaire d'Innovation Technologique (3IT), Université de Sherbrooke, Sherbrooke, Québec, Canada
- Département de Génie Électrique et Génie Informatique, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - A C Therrien
- Institut Interdisciplinaire d'Innovation Technologique (3IT), Université de Sherbrooke, Sherbrooke, Québec, Canada
- Département de Génie Électrique et Génie Informatique, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Y Bérubé-Lauziére
- Département de Génie Électrique et Génie Informatique, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - R Fontaine
- Institut Interdisciplinaire d'Innovation Technologique (3IT), Université de Sherbrooke, Sherbrooke, Québec, Canada
- Département de Génie Électrique et Génie Informatique, Université de Sherbrooke, Sherbrooke, Québec, Canada
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Seeber M, Lederer KA, Rowan C, Strohmayer C, Ludewig E. Image processing setting adaptions according to image dose and radiologist preference can improve image quality in computed radiography of the equine distal limb: A cadaveric study. Vet Radiol Ultrasound 2024; 65:19-30. [PMID: 38098240 DOI: 10.1111/vru.13321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 11/19/2023] [Accepted: 11/22/2023] [Indexed: 02/07/2024] Open
Abstract
Image processing (IP) in digital radiography has been steadily refined to improve image quality. Adaptable settings enable users to adjust systems to their specific requirements. This prospective, analytical study aimed to investigate the influence of different IP settings and dose reductions on image quality. Included were 20 cadaveric equine limb specimens distal to the metacarpophalangeal and metatarsophalangeal joints. Images were processed with the Dynamic Visualization II system (Fujifilm) using five different IP settings including multiobjective frequency processing, flexible noise control (FNC), and virtual grid processing (VGP). Seven criteria were assessed by three veterinary radiology Diplomates and one veterinary radiology resident in a blinded study using a scoring system. Algorithm comparison was performed using an absolute visual grading analysis. The rating of bone structures was improved by VGP at full dose (P < .05; AUCVGC = 0.45). Überschwinger artifact perception was enhanced by VGP (P < .001; AUCVGC = 0.66), whereas image noise perception was suppressed by FNC (P < .001; AUCVGC = 0.29). The ratings of bone structures were improved by FNC at 50% dose (P < .05; AUCVGC = 0.44), and 25% dose (P < .001; AUCVGC = 0.32), and clinically acceptable image quality was maintained at 50% dose (mean rating 2.16; 95.8% ratings sufficient or better). The favored IP setting varied among observers, with higher agreement at lower dose levels. These findings supported using individualized IP settings based on the radiologist's preferences and situational image requirements, rather than using default settings.
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Affiliation(s)
- Matthias Seeber
- Clinical Unit of Diagnostic Imaging, Department for Companion Animals and Horses, University of Veterinary Medicine, Vienna, Austria
| | - Kristina A Lederer
- Clinical Unit of Diagnostic Imaging, Department for Companion Animals and Horses, University of Veterinary Medicine, Vienna, Austria
| | - Conor Rowan
- Clinical Unit of Diagnostic Imaging, Department for Companion Animals and Horses, University of Veterinary Medicine, Vienna, Austria
| | - Carina Strohmayer
- Clinical Unit of Diagnostic Imaging, Department for Companion Animals and Horses, University of Veterinary Medicine, Vienna, Austria
| | - Eberhard Ludewig
- Clinical Unit of Diagnostic Imaging, Department for Companion Animals and Horses, University of Veterinary Medicine, Vienna, Austria
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Sayed M, Knapp KM, Fulford J, Heales C, Alqahtani SJ. The principles and effectiveness of X-ray scatter correction software for diagnostic X-ray imaging: A scoping review. Eur J Radiol 2023; 158:110600. [PMID: 36444818 DOI: 10.1016/j.ejrad.2022.110600] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/17/2022] [Accepted: 11/06/2022] [Indexed: 11/18/2022]
Abstract
PURPOSE An anti-scatter grid is often used in X-ray radiography to reduce the scattered X-rays generated from the patient. However, the presence of a grid means the patient dose subsequently increases. Recently,severalmanufacturers have developedsoftwarethat is capable of correctingfor scattered X-rays withouttheuse ofa conventional grid. This scoping review aims to systematically map the research assessing scattering correction software and to identify any existing knowledge gaps. METHODS This scoping review involved conducting a systematic search in PubMed, Scopus, and Web of science to reveal studies that were relevant to the research question. Articles published between 01.01.2000 and 31.12.2021 examining X-ray scatter correction software for X-ray imaging were included. A part of the PRISMA model and PICO framework were utilised to establish eligibility criteria. A structured summary table was utilised to extract data from the selected articles. RESULTS In this scoping review, 20 years of literature in X-ray conventional radiography. 11 articles were included in the data synthesis. The study populations of the included studies were varied: patients, image quality phantoms and anatomical phantoms. The clinical applications of X-ray scatter correction software were found to be limited to specific body parts (cervical spine, chest, shoulder, lumbar spine, hip and pelvis). The scatter correction software appears to be effective in terms of image quality and in reducing the radiation dose. However, the conventional grid still provides a higher image quality. CONCLUSIONS X-ray scatter correction software can be effective and provides potentialbenefits for some circumstances or clinical scenarios.
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Affiliation(s)
- Mohammad Sayed
- Diagnostic Radiology Department, College of Applied Medical Sciences, Najran University, Najran 61441, Saudi Arabia; Department of Medical Imaging, College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter EX1 2LU, UK.
| | - Karen M Knapp
- Department of Medical Imaging, College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter EX1 2LU, UK.
| | - Jon Fulford
- Medical School, University of Exeter, Medical School Building, St Luke's Campus, Magdalen Road, Exeter EX1 2LU, UK.
| | - Christine Heales
- Department of Medical Imaging, College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter EX1 2LU, UK.
| | - Saeed J Alqahtani
- Diagnostic Radiology Department, College of Applied Medical Sciences, Najran University, Najran 61441, Saudi Arabia.
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Lawson M, Qian L, Lau KK, Lau T, Massey D, Badawy M. Efficacy of the scatter correction algorithm in portable chest radiography. Emerg Radiol 2022; 29:809-817. [PMID: 35612644 PMCID: PMC9130995 DOI: 10.1007/s10140-022-02063-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/17/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Portable chest radiographs (CXRs) continue to be a vital diagnostic tool for emergency and critical care medicine. The scatter correction algorithm (SCA) is a post-processing algorithm aiming to reduce scatter within portable images. This study aimed to assess whether the SCA improved image quality (IQ) in portable CXRs. METHODS Objective and subjective IQ assessments were undertaken on both phantom and clinical images, respectively. For objective analysis, attenuators were placed on the anterior surface of the patient's thorax to simulate pathologies present within uniform regions of the phantom's lung and heart. Phantom CXRs were acquired with three different tube-current-times (mAs). Phantom images were processed with different SCA strengths. Contrast to noise ratios (CNR) within the attenuator were determined for each algorithm strength and compared to non-SCA images. For subjective analysis, two independent radiologists graded 30 clinical images with and without the SCA activated. The images were graded for IQ in different anatomical structures and overall diagnostic confidence. RESULTS Objectively, most strengths of the SCA improved the CNR in both regions. However, a detrimental effect was recorded for some algorithm strengths in regions of high contrast. Subjectively, both observers recorded the SCA significantly improved IQ in clinical CXRs in all anatomical regions. Observers indicated the greatest improvement in the lung and hilar regions, and least improvement in the chest wall and bone. All images with and without the SCA were deemed diagnostic. CONCLUSION This study shows the potential radiation dose neutral IQ improvement when using an SCA in clinical patient CXRs.
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Affiliation(s)
- Michael Lawson
- Monash Imaging, Monash Health, Clayton, VIC 3168 Australia
- Centre for Medical and Radiation Physics, School of Physics, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, NSW 2500 Australia
| | - Lijun Qian
- Monash Imaging, Monash Health, Clayton, VIC 3168 Australia
| | - Kenneth K. Lau
- Monash Imaging, Monash Health, Clayton, VIC 3168 Australia
- Department of Medicine, Monash University, Clayton, VIC 3168 Australia
| | - Theo Lau
- QScan Radiology Clinics, Aspley, QLD Australia
| | - David Massey
- Monash Imaging, Monash Health, Clayton, VIC 3168 Australia
| | - Mohamed Badawy
- Monash Imaging, Monash Health, Clayton, VIC 3168 Australia
- Department of Medical Imaging and Radiation Sciences, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3800 Australia
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Hansson J, Månsson LG, Båth M. EVALUATION OF VGC ANALYZER BY COMPARISON WITH GOLD STANDARD ROC SOFTWARE AND ANALYSIS OF SIMULATED VISUAL GRADING DATA. RADIATION PROTECTION DOSIMETRY 2021; 195:378-390. [PMID: 33940628 PMCID: PMC8507457 DOI: 10.1093/rpd/ncab066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 03/09/2021] [Accepted: 04/03/2021] [Indexed: 06/12/2023]
Abstract
The purpose of the present work was to evaluate the use of resampling statistical methods for analysis of visual grading data-implemented in the software VGC Analyzer-by comparing the reanalyzed results from previously performed visual grading studies with the results calculated by gold standard receiver operating characteristic (ROC) methodology, Obuchowski-Rockette (OR)-Dorfman-Berbaum-Metz (DBM) multiple-readers and multiple-case (MRMC) and by analysis of simulated visual grading data where the true distribution was presumed to be known. The reanalysis was performed on two multiple-reader studies with non-paired data and paired data, respectively. The simulation study was performed by simulating a large number of visual grading characteristics (VGC) studies and by analyzing the statistical distribution of null hypothesis (H0) rejection rate. The comparison with OR-DBM MRMC showed good agreement when analyzing non-paired data for both fixed-reader and random-reader settings for the calculated area under the curve values and the confidence intervals (CIs). For paired data analysis, VGC Analyzer showed significantly lower CIs compared with the ROC software. This effect was also illustrated by the simulation study, where the VGC Analyzer, in general, showed good accuracy for simulated studies with stable statistical basis. For simulated studies with unstable statistics, the accuracy in the H0 rejection rate decreased. The present study has shown that resampling methodology can be used to accurately perform the statistical analysis of a VGC study, although the resampling technique used makes the method sensitive to small data sets.
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Affiliation(s)
| | - Lars Gunnar Månsson
- Department of Radiation Physics, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg SE-413 45, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg SE-413 45, Sweden
| | - Magnus Båth
- Department of Radiation Physics, Institute of Clinical Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg SE-413 45, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg SE-413 45, Sweden
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Lisson CG, Lisson CS, Vogele D, Strauss B, Schuetze K, Cintean R, Beer M, Schmidt SA. Improvement of image quality applying iterative scatter correction for grid-less skeletal radiography in trauma room setting. Acta Radiol 2020; 61:768-775. [PMID: 31569948 DOI: 10.1177/0284185119878348] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Iterative reconstruction is well established for CT. Plain radiography also takes advantage of iterative algorithms to reduce scatter radiation and improve image quality. First applications have been described for bedside chest X-ray. A recent experimental approach also provided proof of principle for skeletal imaging. PURPOSE To examine clinical applicability of iterative scatter correction for skeletal imaging in the trauma setting. MATERIAL AND METHODS In this retrospective single-center study, 209 grid-less radiographs were routinely acquired in the trauma room for 12 months, with imaging of the chest (n = 31), knee (n = 111), pelvis (n = 14), shoulder (n = 24), and other regions close to the trunk (n = 29). Radiographs were postprocessed with iterative scatter correction, doubling the number of images. The radiographs were then independently evaluated by three radiologists and three surgeons. A five-step rating scale and visual grading characteristics analysis were used. The area under the VGC curve (AUCVGC) quantified differences in image quality. RESULTS Images with iterative scatter correction were generally rated significantly better (AUCVGC = 0.59, P < 0.01). This included both radiologists (AUCVGC = 0.61, P < 0.01) and surgeons (AUCVGC = 0.56, P < 0.01). The image-improving effect was significant for all body regions; in detail: chest (AUCVGC = 0.64, P < 0.01), knee (AUCVGC = 0.61, P < 0.01), pelvis (AUCVGC = 0.60, P = 0.01), shoulder (AUCVGC = 0.59, P = 0.02), and others close to the trunk (AUCVGC = 0.59, P < 0.01). CONCLUSION Iterative scatter correction improves the image quality of grid-less skeletal radiography in the clinical setting for a wide range of body regions. Therefore, iterative scatter correction may be the future method of choice for free exposure imaging when an anti-scatter grid is omitted due to high risk of tube-detector misalignment.
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Affiliation(s)
- Christoph G Lisson
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Ulm, Germany
| | - Catharina S Lisson
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Ulm, Germany
| | - Daniel Vogele
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Ulm, Germany
| | - Beatrice Strauss
- Department of Orthopedic Trauma, Hand, Plastic and Reconstructive Surgery, Ulm University Medical Center, Ulm, Germany
| | - Konrad Schuetze
- Department of Orthopedic Trauma, Hand, Plastic and Reconstructive Surgery, Ulm University Medical Center, Ulm, Germany
| | - Raffael Cintean
- Department of Orthopedic Trauma, Hand, Plastic and Reconstructive Surgery, Ulm University Medical Center, Ulm, Germany
| | - Meinrad Beer
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Ulm, Germany
| | - Stefan A Schmidt
- Department of Diagnostic and Interventional Radiology, Ulm University Medical Center, Ulm, Germany
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