The potential for improved pulmonary nodule detection with scanning equalization radiography (SER) was evaluated by means of observer performance testing during the interpretation of posteroanterior conventional radiographs and SER images of an anthropomorphic chest phantom with simulated nodules. A test set of 200 conventional and 200 SER radiographs of phantoms containing either one nodule or none was interpreted by four radiologists attempting to detect a nodule and indicate a confidence value. Their ability to detect nodules positioned over the lung was slightly improved with SER compared with conventional radiography (sensitivity, .56 vs .70); for nodules over the mediastinum or diaphragmatic areas, it was much improved (sensitivity, .29 vs .64). The results were also analyzed with receiver-operating characteristic methods, which revealed a significant improvement in lesion detect-ability over the thicker body parts with SER images. The capability of equalized chest radiographs to provide improved lesion detectability suggests that SER may set a new standard for film-based chest radiography and have a large clinical application.
The results of a numerical simulation indicate that scanning equalization radiography (SER) provides the opportunity to use film/screen combinations of significantly higher contrast than currently practical in conventional chest radiography. These calculations which attempt to maximize overall image contrast while minimizing areas of over and under exposure demonstrate that optimum film gradient varies inversely with scanning beam area. Furthermore, we show that in an SER system which we have optimized for chest imaging that the peak film gamma gradient can be increased from that typical of conventional films (3.0-3.5) to approximately 7 with advantage.
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