Prospective study of digital radiographs versus conventional screen films in Small Bowel Follow-Through examination

PURPOSE To prospectively compare subjective radiological quality, radiation dose and effect on workflow using digital radiography (DR) vs. conventional screen film (SF) radiography in the Small Bowel Follow-Through (SBFT) examination. METHODS Five attending and four resident radiologists compared hard-copy images from 11 SBFT examinations, for which every patient had a defined pair of SF and DR images taken 20-30 min apart. SF and DR were performed with equivalent exposure data. Overall image quality, intestinal mucosa definition and bone visualization were graded on a 5-point scale, with 5 being the highest value. Thus, 11 patients had three criteria judged by nine observers in two modalities for a total of 594 observations of image quality. The radiation doses and effect on workflow were also compared. Statistical analysis was performed with the Mann-Whitney U test. RESULTS The mean scores on DR and SF for overall image quality, intestinal mucosa definition and bone visualization were 4.49 vs. 3.17, 4.38 vs. 3.4, and 4.5 vs. 2.4, respectively (p<0.001 in all cases). The average radiation dose with DR was 0.93+/-0.54 cGy, and -1.58+/-0.63 cGy with SF (p=0.016), reflecting a 41% dose reduction. Production of a DR image by technicians took 3.5+/-1.3 min vs. 5.5+/-1.5 min for SF (p=0.002). CONCLUSION Subjective image quality of hard-copy digital radiographs of the small bowel through examination is superior to images obtained with conventional radiographs, with an associated reduction of 41% in radiation dose and increased efficiency.