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Reducing the Radiation Dose During Excretory Urography: Flat-Panel Silicon X-Ray Detector Versus Computed Radiography

¹ Department of Radiology, University of Cologne, Medical School, Joseph-Stelzmann-Str. 9, 50924 Cologne, Germany.
² Philips Medical Systems, Röntgenstraße 24, Hamburg 22335, Germany.
³ Department of Medical Statistics, Informatics and Epidemiology, University of Cologne, Medical School, 50924 Cologne, Germany.
⁴ Department of Urology, University of Cologne, Medical School, 50924 Cologne, Germany.

View larger version (128K): [in a new window]   Fig. 1A. —Excretory urographs obtained in 56-year-old man with prostate cancer. Image obtained with computed radiography shows normal findings.

View larger version (124K): [in a new window]   Fig. 1B. —Excretory urographs obtained in 56-year-old man with prostate cancer. Image obtained with silicon flat-panel detector radiography depicts both kidneys and renal pelvis with better image quality than urograph acquired with computed radiography (A).

View larger version (16K): [in a new window]   Fig. 2A. —Scores for image quality were derived from four reviewers using scale of 1–5 (1, an anatomic structure was well visualized in all sections; 2, structure was well visualized in some sections; 3, satisfactory visualization; 4, insufficient visualization; and 5, structure could not be detected on image) to rate detectability of various anatomic structures. Two to six typical organ features were described, depending on structure being reviewed. Because of this procedure, these scores were not in original score range of 1–5. Point clouds on graphs depicting scores for image quality can be interpreted as follows: Medians of sum scores for image quality produced by flat-panel detector radiography appear on x-axis. Y-axis represents medians of sum scores for image quality produced by computed radiography. Points on bisector of angle indicate that image quality of two methods was rated as equivalent. Graphs on which points appear above angle bisector indicate that image quality of digital flat-panel detector radiography was rated better than that of computed radiography. Conversely, graphs on which points appear beneath angle bisector indicate that image quality of digital flat-panel detector radiography was judged to be poorer than that of computed radiography. In scores for depiction of liver and spleen, symmetric distribution of points above and beneath bisector of angle indicates that similar image quality was produced with computed radiography and digital flat-panel detector radiography.

View larger version (17K): [in a new window]   Fig. 2B. —Scores for image quality were derived from four reviewers using scale of 1–5 (1, an anatomic structure was well visualized in all sections; 2, structure was well visualized in some sections; 3, satisfactory visualization; 4, insufficient visualization; and 5, structure could not be detected on image) to rate detectability of various anatomic structures. Two to six typical organ features were described, depending on structure being reviewed. Because of this procedure, these scores were not in original score range of 1–5. Point clouds on graphs depicting scores for image quality can be interpreted as follows: Medians of sum scores for image quality produced by flat-panel detector radiography appear on x-axis. Y-axis represents medians of sum scores for image quality produced by computed radiography. Points on bisector of angle indicate that image quality of two methods was rated as equivalent. Graphs on which points appear above angle bisector indicate that image quality of digital flat-panel detector radiography was rated better than that of computed radiography. Conversely, graphs on which points appear beneath angle bisector indicate that image quality of digital flat-panel detector radiography was judged to be poorer than that of computed radiography. In scores for depiction of kidneys, more points above bisector of angle indicates that better image quality was produced with digital flat-panel detector radiography than with computed radiography.

View larger version (17K): [in a new window]   Fig. 2C. —Scores for image quality were derived from four reviewers using scale of 1–5 (1, an anatomic structure was well visualized in all sections; 2, structure was well visualized in some sections; 3, satisfactory visualization; 4, insufficient visualization; and 5, structure could not be detected on image) to rate detectability of various anatomic structures. Two to six typical organ features were described, depending on structure being reviewed. Because of this procedure, these scores were not in original score range of 1–5. Point clouds on graphs depicting scores for image quality can be interpreted as follows: Medians of sum scores for image quality produced by flat-panel detector radiography appear on x-axis. Y-axis represents medians of sum scores for image quality produced by computed radiography. Points on bisector of angle indicate that image quality of two methods was rated as equivalent. Graphs on which points appear above angle bisector indicate that image quality of digital flat-panel detector radiography was rated better than that of computed radiography. Conversely, graphs on which points appear beneath angle bisector indicate that image quality of digital flat-panel detector radiography was judged to be poorer than that of computed radiography. In scores for hollow cavities of upper efferent urinary tract and urinary bladder, more points above bisector of angle indicate superiority of image quality produced with digital flat-panel detector radiography (vs computed radiography).

View larger version (15K): [in a new window]   Fig. 2D. —Scores for image quality were derived from four reviewers using scale of 1–5 (1, an anatomic structure was well visualized in all sections; 2, structure was well visualized in some sections; 3, satisfactory visualization; 4, insufficient visualization; and 5, structure could not be detected on image) to rate detectability of various anatomic structures. Two to six typical organ features were described, depending on structure being reviewed. Because of this procedure, these scores were not in original score range of 1–5. Point clouds on graphs depicting scores for image quality can be interpreted as follows: Medians of sum scores for image quality produced by flat-panel detector radiography appear on x-axis. Y-axis represents medians of sum scores for image quality produced by computed radiography. Points on bisector of angle indicate that image quality of two methods was rated as equivalent. Graphs on which points appear above angle bisector indicate that image quality of digital flat-panel detector radiography was rated better than that of computed radiography. Conversely, graphs on which points appear beneath angle bisector indicate that image quality of digital flat-panel detector radiography was judged to be poorer than that of computed radiography. For lumbar vertebra 2 depiction, symmetric distribution of points above and beneath bisector of angle shows similar image quality was produced with computed radiography and digital flat-panel detector radiography.

View larger version (15K): [in a new window]   Fig. 2E. —Scores for image quality were derived from four reviewers using scale of 1–5 (1, an anatomic structure was well visualized in all sections; 2, structure was well visualized in some sections; 3, satisfactory visualization; 4, insufficient visualization; and 5, structure could not be detected on image) to rate detectability of various anatomic structures. Two to six typical organ features were described, depending on structure being reviewed. Because of this procedure, these scores were not in original score range of 1–5. Point clouds on graphs depicting scores for image quality can be interpreted as follows: Medians of sum scores for image quality produced by flat-panel detector radiography appear on x-axis. Y-axis represents medians of sum scores for image quality produced by computed radiography. Points on bisector of angle indicate that image quality of two methods was rated as equivalent. Graphs on which points appear above angle bisector indicate that image quality of digital flat-panel detector radiography was rated better than that of computed radiography. Conversely, graphs on which points appear beneath angle bisector indicate that image quality of digital flat-panel detector radiography was judged to be poorer than that of computed radiography. For lumbar vertebra 5 depiction, symmetric distribution of points above and beneath bisector of angle shows that image quality produced with computed radiography and digital flat-panel detector radiography is similar.

View larger version (16K): [in a new window]   Fig. 2F. —Scores for image quality were derived from four reviewers using scale of 1–5 (1, an anatomic structure was well visualized in all sections; 2, structure was well visualized in some sections; 3, satisfactory visualization; 4, insufficient visualization; and 5, structure could not be detected on image) to rate detectability of various anatomic structures. Two to six typical organ features were described, depending on structure being reviewed. Because of this procedure, these scores were not in original score range of 1–5. Point clouds on graphs depicting scores for image quality can be interpreted as follows: Medians of sum scores for image quality produced by flat-panel detector radiography appear on x-axis. Y-axis represents medians of sum scores for image quality produced by computed radiography. Points on bisector of angle indicate that image quality of two methods was rated as equivalent. Graphs on which points appear above angle bisector indicate that image quality of digital flat-panel detector radiography was rated better than that of computed radiography. Conversely, graphs on which points appear beneath angle bisector indicate that image quality of digital flat-panel detector radiography was judged to be poorer than that of computed radiography. Bland-Altman plot for lumbar vertebra 5 shows difference (digital flat-panel detector radiography – computed radiography) versus average of values measured by two imaging techniques. Narrow limit of agreement (mean ± 2 SDs) shows comparable image quality of computed radiography and flat-panel detector radiography.

View larger version (17K): [in a new window]   Fig. 2G. —Scores for image quality were derived from four reviewers using scale of 1–5 (1, an anatomic structure was well visualized in all sections; 2, structure was well visualized in some sections; 3, satisfactory visualization; 4, insufficient visualization; and 5, structure could not be detected on image) to rate detectability of various anatomic structures. Two to six typical organ features were described, depending on structure being reviewed. Because of this procedure, these scores were not in original score range of 1–5. Point clouds on graphs depicting scores for image quality can be interpreted as follows: Medians of sum scores for image quality produced by flat-panel detector radiography appear on x-axis. Y-axis represents medians of sum scores for image quality produced by computed radiography. Points on bisector of angle indicate that image quality of two methods was rated as equivalent. Graphs on which points appear above angle bisector indicate that image quality of digital flat-panel detector radiography was rated better than that of computed radiography. Conversely, graphs on which points appear beneath angle bisector indicate that image quality of digital flat-panel detector radiography was judged to be poorer than that of computed radiography. For depiction of psoas margin, symmetric distribution of points above and beneath bisector of angle indicates no significant difference between computed radiography and digital flat-panel detector radiography.

View larger version (16K): [in a new window]   Fig. 2H. —Scores for image quality were derived from four reviewers using scale of 1–5 (1, an anatomic structure was well visualized in all sections; 2, structure was well visualized in some sections; 3, satisfactory visualization; 4, insufficient visualization; and 5, structure could not be detected on image) to rate detectability of various anatomic structures. Two to six typical organ features were described, depending on structure being reviewed. Because of this procedure, these scores were not in original score range of 1–5. Point clouds on graphs depicting scores for image quality can be interpreted as follows: Medians of sum scores for image quality produced by flat-panel detector radiography appear on x-axis. Y-axis represents medians of sum scores for image quality produced by computed radiography. Points on bisector of angle indicate that image quality of two methods was rated as equivalent. Graphs on which points appear above angle bisector indicate that image quality of digital flat-panel detector radiography was rated better than that of computed radiography. Conversely, graphs on which points appear beneath angle bisector indicate that image quality of digital flat-panel detector radiography was judged to be poorer than that of computed radiography. For depiction of pelvis, sacroiliac joint, and head of femur, symmetric distribution of points above and beneath bisector of angle indicates no significant difference between image quality of computed radiography and digital flat-panel detector radiography.

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