Effect of dose on image quality in a detector-based dual-exposure, dual-energy system for chest radiography.

To assess the image quality of subtracted soft tissue and bone images of a CsI-detector-based dual-energy system for chest radiography at varying dose levels.We evaluated a CsI-detector-based, dual-exposure, dual-energy prototype system; 126 patients were categorized into groups of small, medium, and large. Fixed values were applied for mAs and mA. The patients were randomized into two groups with intended higher and lower speed pairs of approximately 400/1000 (high and low energy shot) and 200/500, respectively. True speed equivalents were calculated retrospectively using the detector dose. Image quality was evaluated by two highly experienced radiologists in consensus applying a rating scale of 1 to 5 for quality indicators such as image noise, residual bone structures, motion artifacts, and others.Significantly decreased noise and a significant improvement for display of bone details in the bone image were noted with the higher dose, whereas a significant increase in motion artifacts reduced image quality at the higher dose.Radiation dose did not significantly influence the perception of dual-energy image quality. Dual-energy subtraction, as described, has the potential to become a future routine application in chest radiography.