The influence of the characteristic curve on the clinical image quality and patient absorbed dose in lumbar spine radiography

The 'European Guidelines on Quality Criteria for Diagnostic Radiographic Images' do not address the choice of film characteristic (H/D) curve, which is an important parameter for the description of a radiographic screen-film system. Since it is not possible to investigate this influence by taking repeated exposures of the same patients on films with systematically varied H/D curves, patient images of lumbar spine were digitised in the current study. The image contrast was altered by digital image processing techniques, simulating images with H/D curves varying from flat over standard latitude to a film type steeper than a mammography film. The manipulated images were printed on film for evaluation. Seven European radiologists evaluated the clinical image quality of in total 224 images by analysing the fulfilment of the European Image Criteria and by visual grading analysis of the images. The results show that the local quality can be significantly improved by the application of films with a steeper film H/D curve compared to the standard latitude film. For images with an average optical density of about 1.25, the application of the steeper film results in a reduction of patient absorbed dose by about 10-15% without a loss of diagnostically relevant image information. The results also show that the patient absorbed dose reduction obtained by altering the tube voltage from 70 kV to 90 kV coincides with a loss of image information that cannot be compensated for by simply changing the shape of the H/D curve.