title: Chest radiography with a digital flat-panel detector: experimental receiver operating characteristic analysis.
abstract: OBJECTIVE
  To evaluate the influence of different detector radiation doses and peak kilovoltage settings on diagnostic performance and radiation dose at posteroanterior (PA) chest radiography performed with an amorphous silicon flat-panel detector (FPD).
  
  
  METHODS
  All examinations were performed by using a digital FPD. PA chest radiographs of an anthropomorphic chest phantom were obtained with detector radiation doses of 2.50 microGy (system speed, 400), 1.56 microGy (speed, 640), and 1.25 microGy (speed, 800) and with peak kilovoltage values of 100, 120, and 140 kVp. Four types of simulated lesions-nodules of different sizes, polylobulated lesions, interstitial-nodular lesions, and interstitial-reticular lesions-were superimposed on the phantom. After four radiologists assessed all of the images, receiver operating characteristics analysis was performed. In addition, the entrance surface dose was measured and the effective dose was calculated.
  
  
  RESULTS
  Reduced detector dose led to significantly decreased diagnostic performance in overall lesion detection (P <.05). However, over pulmonary areas only, this effect could not be seen. With use of the same kilovoltage values, reducing the detector dose, even to 1.25 microGy (speed, 800), did not lead to significantly decreased lesion detectability. In terms of diagnostic performance and effective dose, 120 kVp was the most effective.
  
  
  CONCLUSIONS
  Standard PA chest radiographs should still be acquired at a detector dose of 2.50 microGy (speed, 400) with 120 kVp to yield the highest diagnostic performance. However, when the present analysis was focused on the lung fields only, no significant loss in diagnostic performance could be demonstrated, even after a 50% reduction in radiation dose.
authors.affiliation: Department of Diagnostic Radiology and Institute of Medical Statistics and Epidemiology, Technische Universität München, Ismaninger Str 22, 81675 Munich, Germany. smetz@roe.med.tu-muenchen.de
authors.forename: Stephan
authors.initials: S
authors.lastname: Metz
authors.forename: Petra
authors.initials: P
authors.lastname: Damoser
authors.forename: Regina
authors.initials: R
authors.lastname: Hollweck
authors.forename: Rudolf
authors.initials: R
authors.lastname: Roggel
authors.forename: Christoph
authors.initials: C
authors.lastname: Engelke
authors.forename: Klaus
authors.initials: K
authors.lastname: Woertler
authors.forename: Bernhard
authors.initials: B
authors.lastname: Renger
authors.forename: Ernst J
authors.initials: EJ
authors.lastname: Rummeny
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Link
mesh_terms: D015588:Observer Variation; D019047:Phantoms, Imaging; D012372:ROC Curve; D011829:Radiation Dosage; D011856:Radiographic Image Enhancement / Q000295:instrumentation; D013902:Radiography, Thoracic / Q000295:instrumentation*; D012825:Silicon; D014963:X-Ray Intensifying Screens
chemical_list: D012825:Silicon