[Digital radiography: optimization of chest radiographs using a modified exposure control].

Phototiming over the lung fields frequently compromises the signal-to-noise ratio available in the mediastinal and diaphragmatic regions of the chest. A moderate dose increase would be justified if a significant improvement in diagnostic performance could be achieved. We compared the impact of mediastinal phototiming (150 kVp, 150 cm FFD, 1.0 mm focus, 12:1 grid [higher kVp chosen to minimize dose increase]) to standard lungfield phototiming (125 kVp, 150 cm FFD, 1.0 mm focus, 12:1 grid) on the detectability of simulated pulmonary nodules (wax, 0.5-2.5 cm in diameter) superimposed on human volunteers in storage phosphor radiographs (1744 x 2144 pixels, 10 bit). ROC analysis of 1920 observations by 8 readers showed a significantly higher (p less than 0.03) detectability of simulated pulmonary nodules with mediastinal phototiming (ROC area = 0.89) than standard lungfield phototiming (ROC area = 0.84).