Selenium-based digital radiography of the chest: radiologists' preference compared with film-screen radiographs

A new digital thoracic radiography system (Thoravision; Philips Medical Systems, Hamburg, Germany), which uses selenium as a detector material, was evaluated for observer preference. The system has been shown to have higher detection efficiency than conventional film-screen systems and thus could provide an image with reduced noise. The hypothesis tested in this study was that the selenium-based digital system would provide an image appearance for conventional thoracic imaging that would be equal or superior to that provided by a conventional film-screen system. Fifty-three patient volunteers were imaged at 120 kV with both the selenium-based system and a thoracic film-screen combination system (InSight HC; Kodak, Rochester, NY). Posteroanterior and lateral images were acquired with both systems, for a total of 212 images. Both imaging systems included a stationary 12:1 antiscatter grid. Exposures were the same for both imaging systems, and the digital images were printed to film. Images for the same patient were compared by six observers--three specialized chest radiologists and three general radiologists. Images included both normal chest radiographs and radiographs with abnormal findings. Each pair of images was ranked on a scale from 1 to 5 for preference of technique, with a score of 3 indicating no preference. Eleven anatomic features were evaluated in the posteroanterior views, and six features were evaluated in the lateral views. Statistical significance of preference was evaluated with Student's t test. The chest radiologists had a statistically significant preference for the selenium-based system for all 17 features (p < .001). The general radiologists had a statistically significant preference for the selenium-based system for visualization of 10 of the 17 features (p < .05). Neither group had a statistically significant preference for the conventional images in any category. The selenium-based system provided an image appearance that was significantly preferred by all radiologists, more strongly by those specializing in chest radiography. This study demonstrates that a digital thoracic imaging system can routinely produce images that are perceived as equal or superior to conventional images.