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We are currently in an era of active development of the digital X-ray imaging detectors that will serve the radiological communities in the new millennium. The rigorous comparative physical evaluations of such devices are therefore becoming increasingly important from both the technical and clinical perspectives. The authors have been actively involved in the evaluation of a clinical demonstration version of a flat-panel dynamic digital X-ray image detector (or FDXD). Results of objective physical evaluation of this device have been presented elsewhere at this conference. The imaging performance of FDXD under radiographic exposure conditions have been previously reported, and in this paper a psychophysical evaluation of the FDXD detector operating under continuous fluoroscopic conditions is presented. The evaluation technique employed was the threshold contrast detail detectability (TCDD) technique, which enables image quality to be measured on devices operating in the clinical environment. This approach addresses image quality in the context of both the image acquisition and display processes, and uses human observers to measure performance. The Leeds test objects TO[10] and TO[10+] were used to obtain comparative measurements of performance on the FDXD and two digital spot fluorography (DSF) systems, one utilizing a Plumbicon camera and the other a state of the art CCD camera. Measurements were taken at a range of detector entrance exposure rates, namely 6, 12, 25 and 50 (mu) R/s. In order to facilitate comparisons between the systems, all fluoroscopic image processing such as noise reduction algorithms, were disabled during the experiments. At the highest dose rate FDXD significantly outperformed the DSF comparison systems in the TCDD comparisons. At 25 and 12 (mu) R/s all three-systems performed in an equivalent manner and at the lowest exposure rate FDXD was inferior to the two DSF systems. At standard fluoroscopic exposures, FDXD performed in an equivalent manner to the DSF systems for the TCDD comparisons. This would suggest that FDXD would therefore perform adequately in a clinical fluoroscopic environment and our initial clinical experiences support this. Noise reduction processing of the fluoroscopic data acquired on FDXD was also found to further improve TCDD performance for FDXD. FDXD therefore combines acceptable fluoroscopic performance with excellent radiographic (snap shot) imaging fidelity, allowing the possibility of a universal x-ray detector to be developed, based on FDXD's technology. It is also envisaged that fluoroscopic performance will be improved by the development of digital image enhancement techniques specifically tailored to the characteristics of the FDXD detector.
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