Image quality and dose management in digital radiography: a new paradigm for optimisation.

The advent of digital imaging in radiology, combined with the explosive growth of technology, has dramatically improved imaging techniques. This has led to the expansion of diagnostic capabilities, both in terms of the number of procedures and their scope. Throughout the world, film/screen radiography systems are being rapidly replaced with digital systems. Many progressive medical institutions have acquired, or are considering the purchase of computed radiography systems with storage phosphor plates or direct digital radiography systems with flat panel detectors. However, unknown to some users, these devices offer a new paradigm of opportunity and challenges. Images can be obtained at a lower dose owing to the higher detective quantum efficiency (DQE). These fundamental differences in comparison to conventional film/screens necessitate the development of new strategies for dose and quality optimizations. A set of referral criteria based upon three dose levels is proposed.