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Influence of the characteristic curve on the clinical image quality of lumbar spine and chest radiographs

¹ Department of Radiation Physics, Malmö University Hospital, SE-205 02 Malmö, Sweden, ² GSF-National Research Centre for Environment and Health, D-857 64 Neuherberg, Germany, ³ Department of Radiation Physics, Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden, ⁴ Department of Radiation Physics, Faculty of Health Sciences, Linköping University, SE-581 85 Linköping, Sweden, ⁵ Joint Department of Physics, The Royal Marsden NHS Trust, Fulham Road, London SW3 6JJ, UK, ⁶ Department of Diagnostic Radiology, Malmö University Hospital, SE-205 02 Malmö, Sweden and ⁷ Department of Diagnostic Radiology, Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden

The "European Guidelines on Quality Criteria for Diagnostic Radiographic Images" do not address the choice of the film characteristic (H&D) curve, which is an important parameter for the description of a radiographic screen–film system. The image contrast of clinical lumbar spine and chest radiographs was altered by digital image processing techniques, simulating images with different H&D curves, both steeper and flatter than the original. The manipulated images were printed on film for evaluation. Seven experienced radiologists evaluated the clinical image quality by analysing the fulfilment of the European Image Criteria (ICS) and by visual grading analysis (VGA) of in total 224 lumbar spine and 360 chest images. A parallel study of the effect of the H&D curve has also been made using a theoretical model. The contrast (OD) of relevant anatomical details was calculated, using a Monte Carlo simulation-model of the complete imaging system including a 3D voxel phantom of a patient. Correlations between the calculated contrast and the radiologists' assessment by VGA were sought. The results of the radiologists' assessment show that the quality in selected regions of lumbar spine and chest images can be significantly improved by the use of films with a steeper H&D curve compared with the standard latitude film. Significant (p<0.05) correlations were found between the VGA results and the calculations of the contrast of transverse processes and trabecular details in the lumbar spine vertebrae, and with the contrast of blood vessels in the retrocardiac area of the chest.

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