Towards image quality, beam energy and effective dose optimisation in digital thoracic radiography

This paper outlines how objective measurements of both image quality, in terms of signal-to-noise ratio, and effective dose may be used as tools to find the optimum kVp range for a digital chest radiography system. Measurements were made with Thoravision, an amorphous selenium-based digital chest X-ray system. The entrance surface dose and the effective dose to an anthropomorphic chest phantom were determined demonstrating how effective dose is related to beam quality. The image quality was measured using detective quantum efficiency, threshold contrast and a radiologist preference trial involving 100 patients. The results show that, despite the fact that the entrance surface dose decreases as the kVp increases, the effective dose, a better measure of the risk, reaches a minimum value between 90 and 110 kVp; however, the image quality decreases as the kVp increases. In this study the optimum kVp for chest radiography, using a selenium-based radiography system, is in the range 90-110 kVp. This is contrary to the 120- to 150-kVp range that is commonly used. Also, this study shows how objective measurements can be used to optimise radiographic technique without prolonged patient trials.