title: Imaging performance with different doses in skeletal radiography: comparison of a needle-structured and a conventional storage phosphor system with a flat-panel detector.
abstract: OBJECTIVE
  To evaluate possible radiation dose reduction in the extremities with use of digital radiography and a needle-structured image plate (NIP) by comparing this technique with digital radiography performed with a powder-structured image plate (PIP) and a flat-panel detector (FPD).
  
  
  METHODS
  This study was approved by the local review board. A total of 72 plain radiographs of the feet of six human cadavers were obtained with four surface entrance doses (65, 43, 20, and 10 micro Gy) by using three systems. The reference image of each specimen was obtained with an 85-micro Gy dose and with use of a PIP. Five independent blinded radiologists evaluated the images. The noise level and the depiction of the cortical bone, trabecular bone, and soft tissue were rated and compared with those of the reference image by using a five-point scale. An overall image score was developed for these four criteria by calculating the unweighted mean. The Wilcoxon test was used to assess differences between overall image scores.
  
  
  RESULTS
  For each dose, NIP images were significantly superior (P < .001), whereas FPD images and PIP images were significantly inferior (P < .01). NIP images obtained with 65-, 43-, and 20-micro Gy doses were significantly superior to reference images and to FPD and PIP images obtained with a 65-micro Gy dose. There were no significant differences between reference images and FPD images obtained with 65- and 43-micro Gy doses.
  
  
  CONCLUSIONS
  Radiation dose can be reduced by 75% in clinical skeletal imaging of peripheral extremities by using NIP, with no significant loss of information. For FPD images, this might be possible with a dose reduction of 50%.
authors.affiliation: Department of Clinical Radiology, Ludwig-Maximilians-University, Nussbaumstr 20, 80336 Munich, Germany. Stefan.Wirth@med.uni-muenchen.de
authors.forename: Stefan
authors.initials: S
authors.lastname: Wirth
authors.forename: Marcus
authors.initials: M
authors.lastname: Treitl
authors.forename: Maximilian F
authors.initials: MF
authors.lastname: Reiser
authors.forename: Markus
authors.initials: M
authors.lastname: Körner
mesh_terms: D016477:Artifacts; D001842:Bone and Bones / Q000000981:diagnostic imaging*; D004867:Equipment Design; D005528:Foot / Q000000981:diagnostic imaging; D006801:Humans; D015588:Observer Variation; D011829:Radiation Dosage; D011856:Radiographic Image Enhancement / Q000295:instrumentation*; D012542:Scattering, Radiation; D012680:Sensitivity and Specificity; D013679:Technology, Radiologic / Q000295:instrumentation*; D014963:X-Ray Intensifying Screens