Study of X-ray filter and peak kilovoltage in film-screen chest radiographs in regard to detection of simulated pulmonary nodules: comparison between film-screen combination and FCR]

We compared the ability of standard film-screen chest radiographs to detect simulated pulmonary nodules. The radiographs were taken with different X-ray filters and tube voltages. Detection capability was analyzed utilizing receiver operating characteristic (ROC) curves formed from the interpretation of six readers. Nodule detection was slightly better in images obtained with a tube voltage of 135 kVp than with one of 100 kVp (not statistically significant). Approximately equal detection performance was shown by a conventional film-screen system and FCR with three X-ray filter sets: a copper filter backed by aluminium, a tungsten filter backed by yttrium and aluminium, and a lead filter backed by yttrium and aluminium. Results showed less X-ray exposure with the two latter filter sets. Unenhanced FCR images taken with approximately the same X-ray exposure as conventional radiographs showed nearly equal ability to detect the simulated nodules.