• Karim S Karim and Steven Tilley Ii.
• Electrical and Computer Engineering, University of Waterloo, Waterloo, ON N2L 3G1, Canada.
• Mil Med. 2023 Nov 8; 188 (Suppl 6): 849184-91.

IntroductionDual-energy subtraction (DES) imaging is well known to reduce anatomical noise and enable material classification. The current approaches to DES imaging have trade-offs, such as motion artifacts, low sensitivity because of losses in a mid-filter, and lack of portability. Recently, a portable triple-layer flat-panel detector (FPD) was proposed for use in single-shot DES imaging that can provide improved sensitivity and removal of motion artifacts in a point-of-care setting. The purpose of this study is to evaluate the feasibility of such a detector. Various image quality metrics and clinical images are provided.Materials And MethodsAn FDA-cleared single-exposure DES FPD consisting of three stacked sensors was used for all measurements. This detector generates three images per exposure: A digital radiography (DR) image, i.e., as would be produced with a conventional detector, and two DES images, bone and soft tissue. To evaluate DR image quality, detective quantum efficiency (DQE) and modulation transfer function were measured for multiple radiation quality beams. Digital radiography and DES images obtained from this FPD were evaluated in previously reported fixed and portable clinical studies. Digital radiography and DES images from case studies are presented for qualitative assessment.ResultsModulation transfer function and DQE were measured across multiple radiation quality beams for the DR image. The DES images showed good tissue separation and uniformity with no visible motion or alignment artifacts. The DES images, when read in conjunction with the DR image, resulted in increased reader confidence and revealed abnormalities or details that were sometimes overlooked in the DR image.ConclusionsThe proposed panel produces high-quality DR images as indicated by the DQE and modulation transfer function. The DES images have been shown to improve sensitivity in clinical applications and increase reader confidence. This detector can enable DES in portable or otherwise difficult applications, opening new doors for improved patient care.© The Association of Military Surgeons of the United States 2023. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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