Prospective study of digital radiographs versus conventional screen films in Small Bowel Follow-Through examination

To prospectively compare subjective radiological quality, radiation dose and effect on workflow using digital radiography (DR) vs. conventional screen film (SF) radiography in the Small Bowel Follow-Through (SBFT) examination.

Five attending and four resident radiologists compared hard-copy images from 11 SBFT examinations, for which every patient had a defined pair of SF and DR images taken 20-30 min apart. SF and DR were performed with equivalent exposure data. Overall image quality, intestinal mucosa definition and bone visualization were graded on a 5-point scale, with 5 being the highest value. Thus, 11 patients had three criteria judged by nine observers in two modalities for a total of 594 observations of image quality. The radiation doses and effect on workflow were also compared. Statistical analysis was performed with the Mann-Whitney U test.

The mean scores on DR and SF for overall image quality, intestinal mucosa definition and bone visualization were 4.49 vs. 3.17, 4.38 vs. 3.4, and 4.5 vs. 2.4, respectively (p<0.001 in all cases). The average radiation dose with DR was 0.93+/-0.54 cGy, and -1.58+/-0.63 cGy with SF (p=0.016), reflecting a 41% dose reduction. Production of a DR image by technicians took 3.5+/-1.3 min vs. 5.5+/-1.5 min for SF (p=0.002).

Subjective image quality of hard-copy digital radiographs of the small bowel through examination is superior to images obtained with conventional radiographs, with an associated reduction of 41% in radiation dose and increased efficiency.