Efficacy of a new detector automatic exposure control in portable anteroposterior chest radiography: a retrospective examination of radiation dose optimization and image quality

Background: Automatic exposure control (AEC) devices are necessary to reduce the radiation dose and enhance image quality in radiography. However, AEC devices are not being used in portable X-ray systems due to technical issues. Purpose: To evaluate the radiation dose and image quality of a new AEC for a wireless portable X-ray system compared to the standard fixed radiation dose of manual controls in chest radiography. Material and Methods: This retrospective analysis evaluated the performance of a portable X-ray system equipped with software-based AEC on anteroposterior chest radiographs. A quantitative evaluation comparing the manual and AEC groups was conducted to ascertain the exposure index (EI) and dose-area product (DAP). We performed observer-based analysis of image quality for lowest exposure and average exposure images in the manual and AEC groups. Results: Overall, 2093 examinations were conducted in 467 patients. AEC yielded a statistically significant reduction in the DAP (AEC: 1.64 dGycm²; manual: 1.99 dGycm²) and EI (AEC: 266; manual: 393) compared to manual control (P <0.001). Evaluation of the average and low exposure images revealed that the DAP and EI were consistently lower in the AEC group (P <0.01). Observer-based analysis of the lowest exposure images revealed that AEC yielded a statistically significant higher score compared to manual control (12.5 manual, 13.4 AEC; P <0.001). Conclusion: AEC within a wireless portable X-ray system improves subjective image quality while reducing radiation exposure, as substantiated by quantitative and qualitative metrics.