Objective: To compare the detectability of simulated interstitial pneumonia on chest radiographs between an irradiation side sampling indirect flat-panel detector (ISS-FPD) and computed radiography (CR). Methods: Simulated interstitial pneumonia findings (ground-glass opacity, reticular opacity and honeycomb lung) were superimposed on an anthropomorphic chest phantom. Chest radiographs were acquired under three exposure levels (4.0, 3.2 and 2.0 mAs) with an ISS-FPD and with CR. 5 thoracic radiologists evaluated 72 images for the presence or absence of a lesion over each of 6 areas. A total of 1296 observations were analysed in a receiver-operating characteristic analysis. A jackknife method was used for the statistical analysis.Results: The areas under the curves (AUCs) for the detection of simulated honeycomb lung obtained with the ISS-FPD were significantly larger than those obtained with CR at all exposure conditions. For the detection of simulated ground-glass opacity and reticular opacity, there were no significant differences between the two systems. In addition, the AUCs for the detectability of simulated honeycomb lung obtained with the ISS-FPD at all exposure levels were significantly larger than those obtained with CR at 4 mAs.
Conclusion:The ISS-FPD was superior to CR for the detection of simulated honeycomb lung. Provided that the chosen model is representative of interstitial pneumonia, the use of an ISS-FPD might reduce a patient's exposure dose during the detection of interstitial pneumonia. Advances in knowledge: The ISS-FPD has shown its advantage compared with CR in the detection of honeycombing, one sign of interstitial pneumonia.Computed radiography (CR) and flat-panel detector (FPD) systems have been widely used as digital chest radiography systems. FPDs provide excellent inherent physical image quality; their modulation transfer function (MTF) and detective quantum efficiency (DQE) were found to be superior to those of a CR system. 1 For chest radiographs, the detectability of abnormalities by general FPDs has been compared with that obtained by CR systems and screen-film systems; some studies showed that the FPD was superior for the detectability of some nodules, but other studies showed the detectability of chest abnormalities, including nodules and interstitial pneumonia, to be equal. [2][3][4][5][6] To further improve image quality, irradiation side sampling (ISS) technology was developed and was made commercially available in 2010. 7 In the original indirect FPD, the luminescence converted from the X-rays was attenuated and diffused by the scintillator before photodiodes read it. This caused a significant degradation of resolution and efficiency in using the X-rays. An ISS-FPD can reduce the diffusion and the attenuation of the light converted from the X-rays because the photodiodes are placed on the X-ray incident side of the scintillation layer; in the original FPD, the photodiodes are located on the X-ray penetration side.8 This change improved the physical imaging properties, 7-10 ...