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(Radiology. 2000;216:220-224.)
© RSNA, 2000

Experimental Studies

Selenium-based Digital Radiography in the Detection of Bone Lesions: Preliminary Experience with Experimentally Created Defects1

Karl Ludwig, MD, Thomas M. Link, MD, Martin Fiebich, PhD, Bernhard Renger, MS, Stefan Diederich, MD, Michael Oelerich, MD, Horst Lenzen, MS and Walter Heindel, MD

1 From the Department of Clinical Radiology, University of Muenster, Albert Schweitzer Strasse 33, D-48129 Muenster, Germany. Received July 8, 1999; revision requested August 25; revision received October 12; accepted November 22. Address correspondence to K.L. (e-mail: lud@uni-muenster.de).


   ABSTRACT
TOP
 ABSTRACT
INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
PURPOSE: To compare the diagnostic performance of selenium-based digital radiography with that of conventional screen-film radiography and storage phosphor radiography for the detection of bone lesions simulating osteolyses.

MATERIALS AND METHODS: Artificial osseous lesions 1.0–3.0 mm in diameter were created in 80 of 160 predefined regions in 16 porcine femoral specimens. Specimens were enclosed in containers filled with paraffin to ensure accurate repositioning and to obtain an absorption condition comparable to that of a human extremity. Imaging was performed with a selenium-based digital radiography system, a conventional screen-film system, and a storage phosphor radiography system with an exposure identical to that used during clinical imaging. The presence of a lesion was assessed with a five-point confidence scale. Receiver operating characteristic (ROC) analysis was performed for a total of 1,440 observations (480 per modality), and diagnostic performance was estimated with the area under the ROC curve (Az). Differences in diagnostic performance were assessed with the paired Student t test.

RESULTS: ROC analysis results showed Az values of 0.656 for selenium-based digital radiography, 0.679 for storage phosphor radiography, and 0.680 for conventional screen-film radiography. Differences between the three modalities were not significant (P = .60–.93).

CONCLUSION: Image quality with selenium-based digital radiography was comparable to that with conventional screen-film radiography and storage phosphor radiography.

Index terms: Animals • Bones, radiography, 451.11, 451.1215, 451.1219 • Femur, abnormalities, 451.1869 • Radiography, comparative studies, 451.11, 451.1215, 451.1219 • Radiography, digital, 451.1215 • Radiography, selenium detector, 451.1219 • Radiography, storage phosphor, 451.1219 • Selenium


   INTRODUCTION
TOP
 ABSTRACT
 INTRODUCTION
MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 
Selenium-based digital radiography provides excellent image quality in chest imaging and has been used clinically in this field for a number of years (1–10). The detector quantum efficiency of selenium-based digital radiography is superior to that of storage phosphor systems (11,12). In comparison with conventional screen-film systems, selenium-based digital systems offer a wider dynamic range and can be used with specific postprocessing algorithms, which helps improve lesion visibility (13–15). Furthermore, selenium-based digital radiography may be implemented into a digital picture archiving and communication system (PACS) (11,12).

There is little experience with the use of selenium-based digital radiography for skeletal imaging. Winterer et al (16) compared the performance of a selenium-based system with that of a conventional screen-film system in the assessment of the visibility of trabecular and cortical structures in different anatomic regions of the pelvis. In some of the regions assessed, the selenium-based system was superior to the conventional screen-film system. In skeletal imaging, a number of pathologic processes (eg, osteolyses or rheumatoid lesions) can be either small or visible only due to a distortion of fine trabecular structures. Therefore, spatial resolution is a major determinant of image quality. Spatial resolution, however, is a parameter in which digital imaging systems are inferior to conventional screen-film systems.

The purpose of this study was to analyze the diagnostic performance of a selenium-based digital radiography system for bone lesions that can usually be seen only with high spatial resolution. The experimental model used was similar to those implemented by Prokop et al (17) and Link et al (18). In our model, artificial spongy bone lesions were created to mimic small osteolytic lesions. We compared the diagnostic performance of selenium-based digital radiography with that of a conventional screen-film system and a storage phosphor system.


   MATERIALS AND METHODS
TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
RESULTS
 DISCUSSION
 REFERENCES
 
Animal Model
Sixteen porcine femora were used as specimens because their radiographic appearance resembles that of the human femur. All specimens were obtained from a slaughterhouse. Creation of artificial lesions and imaging of all specimens were performed within 6 hours after the animals were killed. Ten regions of approximately equal size were defined in each bone by using a grid. Cylindric lesions with different diameters were created in 80 of the 160 predefined regions by using a standard drilling device (Fig 1). To prevent bias due to patterns of lesion distribution, a computerized random mechanism was used to determine whether each region included a lesion.



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  		Figure 1. Schematic of the experimental setting. A porcine femoral bone was placed into a cylindric polypropylene container filled with paraffin. Horizontal defects were created in five of the predefined areas marked with the grid. Markings were applied to ensure accurate repositioning and identical collimation settings.

 
Optimum lesion sizes were determined in a preliminary study. To obtain good discrimination with the different imaging techniques, lesion diameter ranged from 1.0 to 3.0 mm in 0.5-mm increments to achieve lesions of various degrees of detectability. When a lesion was created, a computerized random mechanism was used to determine its size. To ensure accurate repositioning during the different imaging procedures and to simulate surrounding soft tissue, each femur was enclosed in a paraffin-filled, cylindric, polypropylene container (diameter, 12 cm). The location of the central beam and the collimation settings were marked on the outside of each container.

Imaging Technique
Selenium-based digital imaging was performed with a Thoravision system (Philips Medical Systems, Eindhoven, the Netherlands). This system uses an aluminum drum coated with a thin layer of amorphous selenium. Before each x-ray exposure, a homogeneous positive charge was applied to the outer surface of the selenium layer, which resulted in an electric field in the selenium. Exposure leads to a local generation of charge carriers in the selenium, which causes a local discharge at the selenium surface. The strength of discharge corresponds to the energy of the x-ray exposure, resulting in a latent charge image. This image is detected by an array of microelectrometer probes by means of capacitive coupling. The readout data are processed in several steps, including a correction of detector inhomogeneities and correction for geometric distortion caused by the curved detector surface, as well as unsharp-mask and noise filters.

Storage phosphor radiography was performed with a Digiscan 2H system (Siemens Medical Systems, Erlangen, Germany). Film size was 24 x 30 cm, for a pixel size of 150 µm (matrix size, 1,600 x 2,000). For conventional screen-film imaging, an Insight Skeletal Regular screen-film combination (Eastman Kodak, Rochester, NY) was used. An Optimus 100 system (Philips Medical Systems) served as the corresponding x-ray source. Standard exposure parameters were used for all imaging modalities: 70 kVp and an automatic exposure system calibrated to be equivalent to a screen-film system with a sensitivity, or speed, of 400, which corresponded to exposure settings used for human femurs.

Image Evaluation
All images were assessed independently by three board-certified radiologists (T.M.L., S.D., M.O.), who recorded the presence of a bone lesion. This resulted in a total of 1,440 observations (480 observations per imaging modality). To avoid learning bias, all images were shown in random order. No time constraints were used. Conventional images were viewed with a view box, and digital images were viewed at a workstation equipped with a monochrome monitor (Siemomed, Siemens Medical Systems) with a matrix size of 1,280 x 1,024 and diagonal display size of 20 inches (50.8 cm). Readers were allowed to optimize the window parameters and the degree of an optional edge-enhancement filter (20-pixel kernel size) for each observation separately. In all images, cortical bone was covered with an individual mask such that the readers could see only the trabecular bone. Thus, only the intratrabecular extent of the lesion was assessed.

Readers were asked to grade the presence of a lesion according to a five-point confidence scale: 1 for definitely positive, 2 for probably positive, 3 for uncertain, 4 for probably negative, and 5 for definitely negative. Data were analyzed by using receiver operating characteristic (ROC) analysis (19). ROC curves were created with a maximum-likelihood, curve-fitting algorithm. Lesion detectability was estimated on the basis of the area under the ROC curve (Az). Lesion size was not taken into account.

The statistical significance of differences in diagnostic performance was evaluated with the paired Student t test for individual Az values and scores (20). In addition, sensitivities and specificities in the detection of the artificial lesions were calculated for the different imaging systems. Lesions with a score of 1–3 were assessed as positive, and those with scores of 4 or 5 were assessed as negative. Sensitivities and specificities were compared by using the {chi}2 test (20). Software packages (ROCFIT, C. E. Metz, Chicago, Ill; and SAS, SAS Institute, Cary, NC) were used for statistical analysis.


   RESULTS
TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
DISCUSSION
 REFERENCES
 
The Table shows the Az values for the individual observers. The Az values averaged for all imaging modalities ranged from 0.648 (observer 3) to 0.728 (observer 2) (n = 160). Direct comparison of Az values for the three imaging modalities with the data from each individual observer showed no statistically significant differences (P = .09–.89).


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  		Az Values for Imaging Systems and Observers
 
With the mean values from all three observers, the results of the ROC analysis showed Az values of 0.656 for the selenium-based digital radiography system, 0.679 for the storage phosphor system, and 0.680 for the conventional screen-film system (n = 160). Differences were not statistically significant (selenium-based vs storage phosphor system, P = .66; selenium-based vs screen-film system, P = .60; storage phosphor vs screen-film system, P = .93). Figure 2 depicts the corresponding ROC curves for the three imaging modalities.



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  		Figure 2. ROC curves for the detection of artificial lesions with selenium-based digital radiography system ({square}, solid line), a conventional screen-film system ({triangleup}, dotted line), and storage phosphor system ({circ}, dashed line). The curves were not significantly different.

 
With pooled data from all three observers and a level of confidence of 1–3 as equivalent to lesion detection, the sensitivity was 79% (126 of 160) for the selenium-based digital radiography system, 83% (133 of 160) for the storage phosphor system, and 80% (128 of 160) for the conventional screen-film system. Specificity was calculated by using confidence levels of 4 and 5 as equivalent to no lesion detection. Thus, the specificity was 70% (112 of 160) for the selenium-based digital radiography system, 70% (112 of 160) for the storage phosphor system, and 75% (120 of 160) for the conventional screen-film system. Differences in sensitivity and specificity among the three imaging methods were not significant (sensitivity, P = .13; specificity, P = .20).


   DISCUSSION
TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
REFERENCES
 
Selenium-based digital radiography is considered to be a state-of-the-art technology for chest radiography (1–10). It offers a detector quantum efficiency that is superior to that of storage phosphor systems and a dynamic range wider than that of conventional screen-film systems (11,12). Furthermore, selenium-based digital radiography can be used with specific postprocessing algorithms (13–15) and can be directly implemented in a PACS environment.

These characteristics should make selenium-based digital radiography a useful technique for skeletal imaging, as well. However, few data have been published about this technique. In a clinical study in which the visibility of anatomic structures in the pelvis at selenium-based radiography was compared with that at conventional screen-film imaging, Winterer et al (16) showed advantages of the selenium-based system in certain anatomic regions. They did not address pathologic lesions, however, and their study was based on the subjective estimation of structure visibility only. By using a flat-panel system, Vandevenne et al (21), in an experimental study, showed advantages of selenium as a detector material. The authors showed that even with a 56% reduction in the exposure dose, image quality was still comparable to that achieved with conventional screen-film systems. The study of Vandevenne et al, however, was limited because a qualitative descriptive approach was used and only one specimen was analyzed.

Despite all of the advantages outlined earlier, selenium-based digital radiography shares one disadvantage with other digital imaging modalities: With a Nyquist frequency of 2.7 line pairs per millimeter (lp/mm), the spatial resolution of selenium-based digital radiography is inferior to that of storage phosphor systems (Nyquist frequency, 3.3 lp/mm) and conventional screen-film systems (Nyquist frequency, 5 lp/mm) (10,22). In skeletal imaging, however, there are a variety of pathologic processes (eg, small osteolytic lesions or rheumatoid lesions) in which spatial resolution is a major determinant of image quality. The usefulness of selenium-based digital radiography in skeletal imaging, therefore, must be measured according to its ability to demonstrate these lesions.

For that reason, we examined the diagnostic performance of selenium-based digital radiography in an experimental model with small artificial lesions that mimicked osteolytic disease (Figs 3, 4). The experimental design had certain advantages: Because lesions were created artificially, there was a well-defined standard of reference (which is frequently difficult to obtain in clinical studies). The design allowed a large number of observations, and the use of radiation in patients was avoided. The range of lesion sizes and, thus, lesion detectability could be chosen arbitrarily to achieve good discrimination of imaging methods: Lesions perceived too easily would have resulted in an Az value that was too close to 1.0, which would not have been useful in the comparison of imaging systems. Lesions that were too small to detect would have resulted in an Az value that was close to 0.5, which also would be useless for system comparisons. The fact that Az values in our study ranged from 0.65 to 0.73 shows that the chosen lesion sizes were within a reasonable range for all three imaging systems.



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  		Figure 3a. Images obtained with (a) a conventional screen-film system, (b) a storage phosphor radiography system, and (c) a selenium-based radiography system show lesions (arrows) in porcine femora. There were no differences in lesion visibility.

 


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  		Figure 3b. Images obtained with (a) a conventional screen-film system, (b) a storage phosphor radiography system, and (c) a selenium-based radiography system show lesions (arrows) in porcine femora. There were no differences in lesion visibility.

 


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  		Figure 3c. Images obtained with (a) a conventional screen-film system, (b) a storage phosphor radiography system, and (c) a selenium-based radiography system show lesions (arrows) in porcine femora. There were no differences in lesion visibility.

 


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  		Figure 4a. Optical magnification of images obtained with (a) conventional screen-film radiography, (b) storage phosphor radiography, and (c) selenium-based radiography. There were no differences in lesion visibility. Arrows = lesions.

 


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  		Figure 4b. Optical magnification of images obtained with (a) conventional screen-film radiography, (b) storage phosphor radiography, and (c) selenium-based radiography. There were no differences in lesion visibility. Arrows = lesions.

 


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  		Figure 4c. Optical magnification of images obtained with (a) conventional screen-film radiography, (b) storage phosphor radiography, and (c) selenium-based radiography. There were no differences in lesion visibility. Arrows = lesions.

 
Exposure settings in our study were comparable to those used in clinical imaging of human extremities. The diameter of the porcine femur is similar to that of the human femur, and the paraffin surrounding the specimens accounted for an absorption similar to that of the soft tissue surrounding a human extremity. Furthermore, long bones have relatively homogeneous absorption, as compared with absorption in the spine or pelvis. Therefore, the wider dynamic range of the digital imaging modalities we examined could not compensate for potentially inferior image quality caused by the low spatial resolution.

Our data show that the performance of selenium-based digital radiography was equivalent to that of conventional screen-film radiography and storage phosphor radiography in artificially produced lesions of porcine femora. Our findings were based on a large number of observations and on a study design that emphasized the theoretic weakness of selenium-based digital radiography—its spatial resolution.

Limitations of this study were due to the fact that we assessed artificial lesions in nonhuman cadavers and that, like most true osteolytic lesions, the artificial lesions had a cylindric, rather than circular, shape. Because digital images were analyzed with a monitor and conventional images were assessed with a view box, potential observer bias could not be eliminated completely, and the spatial resolution of the monitor became an important factor in the imaging chain. The ability to view images directly on a monitor display, however, is one of the major advantages of digital systems. Cortical structures were meticulously covered with individual masks for the conventional and digital images, so our results were not likely to have been influenced by incomplete coverage of cortical structures.

Practical application: On the basis our data, we conclude that the diagnostic performance of selenium-based digital radiography in the detection of small osseous lesions was comparable to those of conventional screen-film radiography and storage phosphor radiography. Thus, the advantages provided by selenium-based digital radiography (ie, dynamic range and PACS compatibility) might be used in skeletal imaging, as well. Clinical studies, however, should follow our experimental study to help confirm the potential use of selenium-based digital radiography in skeletal imaging.


   ACKNOWLEDGMENTS
 
We thank Cristina Sauerland, PhD, for her help in the statistical analysis.


   FOOTNOTES
 
Abbreviations: Az = area under the ROC curve, PACS = picture archiving and communication system, ROC = receiver operating characteristic

Author contributions: Guarantor of integrity of entire study, K.L.; study concepts and design, K.L.; definition of intellectual content, W.H.; literature research, S.D.; experimental studies, K.L.; data acquisition, M.O.; data analysis, B.R.; statistical analysis, M.F.; manuscript preparation, K.L.; manuscript editing, T.M.L.; manuscript review, H.L.


   REFERENCES
TOP
 ABSTRACT
 INTRODUCTION
 MATERIALS AND METHODS
 RESULTS
 DISCUSSION
 REFERENCES
 

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