Effects of tube potential and scatter rejection on image quality and effective dose in digital chest X-ray examination: An anthropomorphic phantom study

Objectives: The purpose of this study was to investigate the effects of tube potential and scatter rejection techniques on image quality of digital posteroanterior (PA) chest radiographs. Methods: An anthropomorphic phantom was imaged using a range of tube potentials (81-125 kV(p)) without scatter rejection, with an anti-scatter grid, and using a 10 cm air gap. Images were anonymised and randomised before being evaluated using a visual graded analysis (VGA) method. Results: The effects of tube potential on image quality were found to be negligible (p > 0.63) for the flat panel detector (FPD). Decreased image quality (p = 0.031) was noted for 125 kV(p) relative to 109 kV(p), though no difference was noted for any of the other potentials (p > 0.398) for computed radiography (CR). Both scatter rejection techniques improved image quality (p < 0.01). For FPD imaging the anti-scatter grid offered slightly improved image quality relative to the air gap (p = 0.038) but this was not seen for CR (p = 0.404). Conclusions: For FPD chest imaging of the anthropomorphic phantom there was no dependence of image quality on tube potential. Scatter rejection improved image quality, with the anti-scatter grid giving greater improvements than an air-gap, but at the expense of increased effective dose. CR imaging of the chest phantom demonstrated negligible dependence on tube potential except at 125 kVp. Scatter rejection improved image quality, but with no difference found between techniques. The air-gap resulted in a smaller increase in effective dose than the anti-scatter grid and would be the preferred scatter rejection technique. (C) 2013 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.