Visual grading analysis of digital neonatal chest phantom X-ray images: Impact of detector type, dose and image processing on image quality.

OBJECTIVES: To evaluate the impact of digital detector, dose level and post-processing on neonatal chest phantom X-ray image quality (IQ).

METHODS: A neonatal phantom was imaged using four different detectors: a CR powder phosphor (PIP), a CR needle phosphor (NIP) and two wireless CsI DR detectors (DXD and DRX). Five different dose levels were studied for each detector and two post-processing algorithms evaluated for each vendor. Three paediatric radiologists scored the images using European quality criteria plus additional questions on vascular lines, noise and disease simulation. Visual grading characteristics and ordinal regression statistics were used to evaluate the effect of detector type, post-processing and dose on VGA score (VGAS).

RESULTS: No significant differences were found between the NIP, DXD and CRX detectors (p>0.05) whereas the PIP detector had significantly lower VGAS (p< 0.0001). Processing did not influence VGAS (p=0.819). Increasing dose resulted in significantly higher VGAS (p<0.0001). Visual grading analysis (VGA) identified a detector air kerma/image (DAK/image) of ~2.4 μGy as an ideal working point for NIP, DXD and DRX detectors.

CONCLUSIONS: VGAS tracked IQ differences between detectors and dose levels but not image post-processing changes. VGA showed a DAK/image value above which perceived IQ did not improve, potentially useful for commissioning.

KEY POINTS: • A VGA study detects IQ differences between detectors and dose levels. • The NIP detector matched the VGAS of the CsI DR detectors. • VGA data are useful in setting initial detector air kerma level. • Differences in NNPS were consistent with changes in VGAS.