Effects of Image Postprocessing in Digital Radiography to Detect Wooden, Soft Tissue Foreign Bodies

Purpose To investigate the effects of image postprocessing functions (ie, edge enhancement, noise reduction, and sharpening) that are available on digital radiography systems, including computed radiography (CR) and direct digital radiography (DDR), for detection of wooden, soft tissue foreign bodies. Methods Dorsoplantar and lateral porcine foot radiographs with 4 lengths of wooden foreign bodies (no foreign bodies, 2 mm, 5 mm, and 10 mm) placed 1 mm (superficial) and 1 cm (deep) below the skin were acquired by CR and DDR systems using 10 exposure factors. Images were postprocessed to produce 960 images, including original CR, original DDR, sharpened CR, sharpened DDR, edge-enhanced DDR, and noised-reduced DDR images. Contrast-to-noise ratios (CNR) were used for objective assessments of foreign body visibility on the images. Six Australian radiologic technologists were recruited to review selected images. Australia allows radiologic technologists to provide initial comments on plain radiographs with the supervision of a radiologist. Technologists rated the visibility of foreign bodies using a 4-point scale to determine diagnostic performances of different image receptor and postprocessing types. Means, standard deviations, analyses of variance, and intraclass correlation coefficients were calculated for statistical analyses. Results Among the CR and DDR images with and without postprocessing, the edge-enhanced DDR images had the highest overall mean CNR value (3.39, P = .003) and sensitivity (35.13%). The sensitivity of the edge-enhanced DDR images for detecting the 10 mm foreign body was 43.33%. Discussion Edge-enhanced DDR can be considered an additional tool for suspected wooden, soft tissue foreign body diagnoses in rural areas where digital radiography is the only available imaging modality. This would allow some patients in rural areas to avoid long-distance travel to access sonography or computed tomography to detect foreign bodies, which could minimize emotional, financial, and social costs. Conclusion This study shows that the image postprocessing function of the DDR system can detect wooden, soft tissue foreign bodies. Edge enhancement, specifically, can improve wooden, soft tissue foreign body detection, especially for large foreign bodies >= 10 mm).