Comparison of the perceived image quality between two digital imaging systems for neonatal bedside radiography – A case study

• DR system provides better image quality than the CR system for all technical factors evaluated.
• The average values obtained from the VAS showed that the DR system still needs to be optimised.
• There is need for improved feedback in terms of exposure index and the training of radiographers.
• There were significant differences between the two imaging systems for all the questions on Day zero.
• Perceived approaches have a lack of reproducibility and hence there is need to train the observers.

BackgroundChest X-rays are performed daily in the neonatal intensive care and high care units. The skill of the radiographer is critical for obtaining the best image quality and limiting the patient's radiation exposure. The literature states that indirect flat panel detectors produce images of superior quality in comparison to computed radiography systems. At Steve Biko Academic Hospital a decision was made to revert from the direct digital radiography (DR) system to the computed radiography (CR) system, due to poor image quality experienced.MethodThe case study objective was to conduct a comparative analysis describing key technical factors contributing to image quality. The analysis entailed retrospectively comparing the images obtained during 2010 and 2011. An image analysis form was utilised in evaluating the technical aspects of the image. A total of 160 images were viewed by 16 participants sampled from the radiography, radiology and paediatric departments. The participants were asked to re-evaluate two of their allotted images after five days to determine their reliability.ResultsFindings were that the DR system provides significantly better image quality than the CR system (p < 0.05) for all the technical factors evaluated. However technical improvements are recommended. A wide variance in intra-observer reliability was also found.ConclusionThis case study demonstrated that DR images were considered to be superior to CR images. Recommendations include: a standardised technique for imaging the neonates; optimisation of the imaging software for the digital detectors, improved feedback systems in terms of exposure index values, and the training of radiographers and referring physicians in technical image analysis.