Evaluation of lumbar spine images with added pathology

Optimisation of radiographic procedures require solid tools for evaluation of the image quality in order to ensure that it is sufficient to answer the clinical question at the lowest possible absorbed dose to the patient. Lumbar spine radiography is an examination giving a relatively high dose and good methods for evaluation of image quality as well as dose are needed. We have developed and used a method for the addition of artificial pathological structures into clinical images. The new images were evaluated in a study of detectability (free-response forced error experiment). The results from the study showed that the methodology can be used to detect differences in the screen-film systems used to produce the images, indicating that the method can be used in a study of image quality. The results of the study of detectability were compared with the outcome of a visual grading analysis based on the structures mentioned in the European Quality Criteria. The comparison indicated that a linear correlation exists between the two methods. This means that the simpler VGA can be used in the evaluation of clinical image quality