Dual-film cassette technique for studying the effect of radiographic image quality on diagnostic accuracy

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Abstract
In order to investigate the relationship between diagnostic accuracy and radiographic image quality, a dual-film cassette was developed which produces 2 radiographs simultaneously with a single exposure. One of these radiographs is of standard quality; the 2nd is of lower quality because of degraded spatial resolution and a significantly lower exposure. The basic physical properties of the standard and low-dose screen-film systems used in the dual-film cassette were studied by comparing their beam hardening, scatter fractions, contrasts, modulation transfer functions (MTF), and Wiener spectra. The X-ray spectrum incident on the low-dose system contained more high-energy photons than that incident on the standard system, and the scatter fractions for the low-dose system were slightly less than or comparable to those for the standard system. While the radiographic contrast produced by the 2 systems was generally comparable, the standard system had a slightly higher contrast than the low-dose system in some cases. The MTF of the low-dose system was considerably lower than that of the standard system, and the low-dose system had a noise level considerably greater than did the standard system. Phantom images and clinical [human] radiographs indicated that, for the low-dose system, the image quality degraded significantly.

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