Quantifying the quality of medical x-ray images. An evaluation based on normal anatomy for lumbar spine and chest radiography.

Optimisation in diagnostic radiology requires accurate methods for determination of patient absorbed dose and clinical image quality. Simple methods for evaluation of clinical image quality are at present scarce and this project aims at developing such methods. Two methods are used and further developed; fulfilment of image criteria (IC) and visual grading analysis (VGA). Clinical image quality descriptors are defined based on these two methods: image criteria score (ICS) and visual grading analysis score (VGAS), respectively. For both methods the basis is the Image Criteria of the “European Guidelines on Quality Criteria for Diagnostic Radiographic Images”. Both methods have proved to be useful for evaluation of clinical image quality. The two methods complement each other: IC is an absolute method, which means that the quality of images of different patients and produced with different radiographic tech-niques can be compared with each other. The separating power of IC is, however, weaker than that of VGA. VGA is the best method for comparing images produced with different radiographic techniques and has strong separating power, but the re-sults are relative, since the quality of an image is compared to the quality of a refer-ence image. The usefulness of the two methods has been verified by comparing the results from both of them with results from a generally accepted method for evaluation of clinical image quality, receiver operating characteristics (ROC). The results of the comparison between the two methods based on visibility of anatomical structures and the method based on detection of pathological structures (free-response forced error) indicate that the former two methods can be used for evaluation of clinical image quality as efficiently as the method based on ROC. More studies are, however, needed for us to be able to draw a general conclusion, including studies of other organs, using other radiographic techniques, etc. The results of the experimental evaluation of clinical image quality are compared with physical quantities calculated with a theoretical model based on a voxel phantom, and correlations are found. The results demonstrate that the computer model can be a useful tool in planning further experimental studies.