Use of a computer simulator to investigate optimized tube voltage for chest imaging of average patients with a digital radiography (DR) imaging system

Abstract

Objective: The aim of this study was to investigate via computer simulation a proposed improvement to clinical practice by deriving an optimized tube voltage (kVp) range for digital radiography (DR) chest imaging. Methods: A digitally reconstructed radiograph algorithm was used which was capable of simulating DR chest radiographs containing clinically relevant anatomy. Five experienced image evaluators graded clinical image criteria, i.e. overall quality, rib, lung, hilar, spine, diaphragm and lung nodule in images of 20 patients at tube voltages across the diagnostic energy range. These criteria were scored against corresponding images of the same patient reconstructed at a specific reference kVp. Evaluators were blinded to kVp. Evaluator score for each criterion was modelled with a linear mixed effects algorithm and compared with the score for the reference image. Results: Score was dependent on tube voltage and image criteria in a statistically significant manner for both. Overall quality, hilar, diaphragm and spine criteria performed poorly at low and high tube voltages, peaking at 80–100 kVp. Lung and lung nodule demonstrated little variation. Rib demonstrated superiority at low kVp. Conclusion: A virtual clinical trial has been performed with simulated chest DR images. Results indicate mid-range tube voltages of 80–100 kVp are optimum for average adults. Advances in knowledge: There are currently no specific recommendations for optimized tube voltage parameters for DR chest imaging. This study, validated with images containing realistic anatomical noise, has investigated and recommended an optimal tube voltage range.