Examining practitioners' assessments of perceived aesthetic and diagnostic quality of high kVp-Low mAs pelvis, chest, skull, and hand phantom radiographs

This study investigated the usefulness of the dose optimization strategy of increased tube voltage (kVp) and decreased tube current-exposure time product (mAs) (or high kVp-low mAs) by examining practitioners' assessments of perceived aesthetic and diagnostic quality of direct digital radiographs acquired using this strategy. Ninety-one practitioners (radiologists, radiology residents, radiographers, and radiography students) from eight clinical sites in Ontario examined three types of radiographs ("standard" image, +20 kVp image, and +30 kVp image) for anthropomorphic pelvis, chest, skull, and hand phantoms and rated (on a five-point scale) each image in regard to its perceived aesthetic quality, perceived diagnostic quality, and visualization of anatomic structures. Our primary findings are that for the pelvis, skull, and hand-although not the chest-images acquired using standard technical factors were rated significantly higher in diagnostic and aesthetic quality than those acquired using the high kVp-low mAs strategy. Despite this, both standard and dose-optimized images of the pelvis, skull, and hand were rated to be of acceptable diagnostic quality for clinical use. In conclusion, for the pelvis, skull, and hand, an increase of 20 kVp was an effective strategy to reduce dose while still acquiring images of diagnostic quality.