The significance of efficient scatter removal in chest radiography

The conventional approach to the removal of secondary radiation in chest radiography is by using an air gap or a radiographic grid. However, grids become ineffective at high kVp levels. This study evaluated efficient scatter removal by radiographic scanography versus the conventional technique. Nylon spheres simulating lung nodules were attached to a standard radiographic thorax phantom and to a special chest phantom of our own design. Conventional and scanographic films were made of the phantoms using the same conditions. The films were read in a double-blind fashion. The results indicated that scanograms permitted appreciation of the simulated nodules over the lungs better than did the conventional films, particularly at higher kVp levels. However, the marked increase of contrast resulted in an underpenetration of the mediastinum. If properly penetrated, the lung fields were overexposed, which resulted in a decrease of the detectability of lesions in spite of a higher normalized contrast. Scanography is a promising technique for improving the detection rate of lung nodules on chest films, provided that means can be found to penetrate the mediastinum without overexposing the lungs.