Purpose: To compare a large-area direct-readout flat-panel detector system with a conventional screen-film system and a storage-phosphor system in detecting small artificial osseous lesions simulating osteolytic disease and to assess diagnostic performance with decreasing exposure dose.
Materials and methods: Artificial lesions (0.5-3.0 mm) were created in 100 of 200 predefined regions in 20 porcine femoral specimens. Specimens were enclosed in containers filled with water to create absorption and scatter radiation conditions comparable with those in a human extremity. Imaging was performed with a flat-panel detector system, a conventional screen-film system, and a storage-phosphor system. Levels of exposure equivalent to speed classes 400, 800, 1600, and 3200 were used. In all images, the presence or absence of a lesion was assessed by three radiologists using a five-point confidence scale. Receiver operating characteristic (ROC) analysis was performed for 4,800 observations (600 for each imaging modality and exposure level) and diagnostic performance estimated with the area under the ROC curve (A(z)). The significance of differences in diagnostic performance was tested with analysis of variance.
Results: ROC analysis showed A(z) values of 0.820 (speed class 400), 0.780 (class 800), 0.758 (class 1600), and 0.676 (class 3200) for the flat-panel detector; 0.761 (class 400), 0.725 (class 800), and 0.662 (class 1600) for the storage-phosphor system; and 0.788 (class 400) for the conventional screen-film system. The A(z) value for the flat-panel detector at speed class 400 was significantly higher than that for all other systems (P <.05). A(z) values for the speed class 400 screen-film system and flat-panel detector system at speed class 800 were not significantly different.
Conclusion: The flat-panel detector has diagnostic performance superior to that of conventional screen-film and storage-phosphor radiography for detecting small artificial osseous lesions at clinical exposure settings. With the flat-panel detector, exposure dose can be reduced by 50% to obtain diagnostic performance comparable with that of a conventional speed class 400 screen-film system.