sensors

Article
Development of Portable Digital Radiography
System with a Device for Monitoring X-ray
Source-Detector Angle and Its Application in
Chest Imaging
Tae-Hoon Kim 1 , Dong-Woon Heo 1 , Chang-Won Jeong 1 , Jong-Hyun Ryu 1 , Hong Young Jun 1 ,
Seung-Jun Han 1 , Taeuk Ha 1 and Kwon-Ha Yoon 1,2, *
1 Imaging Science Research Center, Wonkwang University, 460 Iksandeaero, Iksan, Jeonbuk 54538, Korea;
tae_hoonkim@hanmail.net (T.-H.K.); dongwoon7069@naver.com (D.-W.H.); mediblue@wku.ac.kr (C.-W.J.);
jhryu@wku.ac.kr (J.-H.R.); zip80@wku.ac.kr (H.Y.J.); mari153@nate.com (S.-J.H.); 10mari@hanmail.net (T.H.)
2 Department of Radiology, Wonkwang University School of Medicine, 460 Iksandeaero, Iksan,
Jeonbuk 54538, Korea
* Correspondence: khy1646@wku.ac.kr; Tel.: +82-63-859-1921

Academic Editors: Ioannis Kompatsiaris, Thanos G. Stavropoulos and Antonis Bikakis

Received: 15 December 2016; Accepted: 2 March 2017; Published: 7 March 2017

Abstract: This study developed a device measuring the X-ray source-detector angle (SDA) and
evaluated the imaging performance for diagnosing chest images. The SDA device consisted of
Arduino, an accelerometer and gyro sensor, and a Bluetooth module. The SDA values were compared
with the values of a digital angle meter. The performance of the portable digital radiography (PDR)
was evaluated using the signal-to-noise (SNR), contrast-to-noise ratio (CNR), spatial resolution,
distortion and entrance surface dose (ESD). According to different angle degrees, five anatomical
landmarks were assessed using a five-point scale. The mean SNR and CNR were 182.47 and 141.43.
The spatial resolution and ESD were 3.17 lp/mm (157 µm) and 0.266 mGy. The angle values of the
SDA device were not significantly difference as compared to those of the digital angle meter. In chest
imaging, the SNR and CNR values were not significantly different according to the different angle
degrees. The visibility scores of the border of the heart, the fifth rib and the scapula showed significant
differences according to different angles (p < 0.05), whereas the scores of the clavicle and first rib were
not significant. It is noticeable that the increase in the SDA degree was consistent with the increases
of the distortion and visibility score. The proposed PDR with a SDA device would be useful for
application in the clinical radiography setting according to the standard radiography guidelines.

Keywords: portable digital radiography (PDR) system; X-ray source-detector angle (SDA);
radiography setting

1. Introduction
Digital radiography (DR) systems are frequently used in medical and industrial applications
such as dental X-ray imaging, the aerospace industry, and in security and nondestructive
testing [1]. Advancements in DR technologies have allowed more opportunities in the medical
field because of a number of useful capabilities such as real-time acquisition, real-time post-processing,
wireless techniques, and electronic data archiving and retrieval [2,3]. Such advantages of the DR
system enhanced portability, mobility and smart environments due to the decreased size, light weight
and better image quality depending on the improvement of the detector performance, as well as the
implementation of multi-functional software. Among these advantages, mobility is an increasingly
important topic in radiographic image acquisition [4]. Portable DR (PDR) detectors are suitable for

Sensors 2017, 17, 531; doi:10.3390/s17030531 www.mdpi.com/journal/sensors

Sensors 2017, 17, 531 2 of 12

important topic in radiographic image acquisition [4]. Portable DR (PDR) detectors are suitable for
Sensors 2017, 17, 531 2 of 12
intensive care units, emergency departments, outpatient clinics and so on [5]. Recent DR systems
have increased the use of flat-panel detectors (FPDs) because they offer a lower radiation dose while
preserving
intensive care imaging
units,quality
emergencyas contrasted
departments,with thin-film
outpatient transistor (TFT)
clinics and sodetectors [6–8]. Therefore,
on [5]. Recent DR systems it
is important
have increasedthat newer
the use DR systems
of flat-panel are designed
detectors to solve
(FPDs) because theythe unmet
offer a lower needs of radiologists,
radiation dose while
technologists,
preserving imaging administrators and private
quality as contrasted withpractices
thin-filmin conjunction
transistor (TFT) with the [6–8].
detectors advantages in DR
Therefore, it is
technologies.
important that newer DR systems are designed to solve the unmet needs of radiologists, technologists,
In clinical radiography,
administrators the X-ray
and private practices in source–to-detector
conjunction with the distance (SDD)inand
advantages DR X-ray source-detector
technologies.
angleIn(SDA) are important factors for acquiring appropriate image quality.
clinical radiography, the X-ray source–to-detector distance (SDD) and X-ray source-detector According to standard
clinical radiography
angle (SDA) guidelines
are important [9,10],
factors foritacquiring
is recommended
appropriatefor such
imageimaging positions
quality. Accordingas follows: SDD
to standard
of
clinical radiography guidelines [9,10], it is recommended for such imaging positions as follows: SDDPA
180 cm, and SDA of 0° (around 5°, vertical incidence) for chest AP (anterior to posterior) and of
(posterior
180 cm, and to SDA of 0◦imaging;
anterior) (around100 5◦ , vertical
cm SDDincidence)
and 15°–20° forSDAchest(head side direction
AP (anterior incidence)
to posterior) and for
PA
cervical
(posteriorspine AP imaging;
to anterior) and 100
imaging; 100cm cmSDDSDD and and 15◦SDA
5°–7° –20◦ (head side direction
SDA (head incidence)
side direction for lateral
incidence) for
knee imaging. Currently, most commercial PDR ◦ ◦
systems are well equipped
cervical spine AP imaging; and 100 cm SDD and 5 –7 SDA (head side direction incidence) for lateral as a tape measure for
SDD, whereas Currently,
knee imaging. they are relatively less equipped
most commercial a specific
PDR systems device
are well for SDA
equipped as acompared
tape measure to the
for
equipment
SDD, whereas for they
SDDare [11]. In clinical
relatively lesssituations,
equippedunexpected
a specific deviceconditions
for SDA or compared
extreme medical situations
to the equipment
such
for SDDas imaging
[11]. Inexperiments for immobilized
clinical situations, unexpected bedridden
conditions patients,
or extremepost-stroke
medicalhemiplegic
situations patients
such as
and severely
imaging injured for
experiments patients are often
immobilized encountered
bedridden [12].
patients, From these
post-stroke viewpoints,
hemiplegic a radiographic
patients and severely
imaging systemare
injured patients automatically
often encountered determining
[12]. From thethese
SDDviewpoints,
and SDAa radiographic
can be helpful for clinical
imaging system
radiographic
automatically settings.
determiningHowever,
the SDDthere and SDAare few
can bestudies
helpful focusing on radiographic
for clinical SDA measurement settings.inHowever,
clinical
radiography.
there are few studies focusing on SDA measurement in clinical radiography.
Therefore,
Therefore, the thepurpose
purposeofof thisthis
studystudy
waswas to develop
to develop a PDRasystemPDR system
including including
a device afordevice for
obtaining
obtaining
the SDA and the to
SDA andthe
assess to assess
imaging theperformance
imaging performance for the diagnosis
for the diagnosis of chest imaging.
of chest imaging.

2. Materials
2. Materials and
and Methods
Methods

2.1. Portable
2.1. Portable Digital
Digital Radiography
Radiography System
System
The PDR
The PDR main
main body
body consisted
consisted of of an
an X-ray
X-ray source,
source, aa FPD,
FPD, and
and anan integral
integral PC
PC (Figure
(Figure 1A)
1A) and
and its
its
detailed structure of PDR is shown in Figure 1B. The X-ray source generated 40–110
detailed structure of PDR is shown in Figure 1B. The X-ray source generated 40–110 kVp and 20–100 kVp and 20–100 mA
withwith
mA a focal spot size
a focal spotofsize
1.8 of
mm1.8and
mmweight of 20.4 of
and weight kg20.4
(PXP-100CA, Poskom,Poskom,
kg (PXP-100CA, Goyang,Goyang,
Korea). We used
Korea).
a high
We resolution
used amorphousamorphous
a high resolution silicon (a-Si)/CsI
siliconthin-film
(a-Si)/CsItransistor
thin-film(TFT) with PIN
transistor diode
(TFT) withsensor-based
PIN diode
with 3072 × 3072 pixels (pixel pitch 140 × 140 µm), image size of 43 cm ×
sensor-based FPD with 3072 × 3072 pixels (pixel pitch 140 × 140 μm), image size of 43 cm × weight
FPD 43 cm, and 43 cm,
of 11weight
and kg (FXRD-1717SA, Vieworks, Seoul,
of 11 kg (FXRD-1717SA, Korea).
Vieworks, Image
Seoul, acquisition
Korea). time of thetime
Image acquisition FPDofwasthe below
FPD was1 s.
The integrated
below PC for internal
1 s. The integrated PC for processing weighed 7.95
internal processing kg and
weighed used
7.95 kg Windows
and used 7Windows
OS, an Intel Core
7 OS, an
i5 4300U with a 1.9 GHz CPU (POC-W242, Advantech, Taiwan). In order
Intel Core i5 4300U with a 1.9 GHz CPU (POC-W242, Advantech, Taiwan). In order to increase to increase flexibility and
mobility ofand
flexibility PDR system,of
mobility X-ray
PDRsource
system, implemented
X-ray source twoimplemented
gas springs totwo smoothly move under
gas springs a zero
to smoothly
gravity state and PDR main body installed two main wheels and an auxiliary
move under a zero gravity state and PDR main body installed two main wheels and an auxiliarywheel. The main body of
the PDR system attached on a slot for safekeeping an independent detector.
wheel. The main body of the PDR system attached on a slot for safekeeping an independent detector.

Figure 1. A simple diagram of portable digital radiography (PDR) (A), the detailed drawing of PDR
Figure 1. A simple diagram of portable digital radiography (PDR) (A), the detailed drawing of PDR
structure (B) and developed PDR system (C).
structure (B) and developed PDR system (C).
Sensors 2017, 17, 531 3 of 12

2.2. Internal Processing of Portable Digital Radiography

The integrated
Sensors 2017, 17, 531PC is detachable type and received image data from the FPD. In order to process
3 of 12

received image data, the PDR system used a two-step correction algorithm as follows. In the first step,
2.2. Internal Processing of Portable Digital Radiography
bad pixels on image data were detected with a 3 × 3 differentiation operator. When the differentiation
The integrated
at a given pixel was greaterPC is detachable
than type and
a threshold received
value, image
the pixel wasdata from theasFPD.
classified In pixel.
a bad order to
Inprocess
the second
received
step, the image
intensity data,ofthe
value thePDR
badsystem usedreplaced
pixel was a two-step
by correction
a bi-linearalgorithm as follows.
interpolating In the
function first
of adjacent
step, bad pixels on image data were detected with a 3 × 3 differentiation operator.
pixel values [13]. Then, the final image data were generated to Digital Imaging and Communications When the
differentiation at a given pixel was greater than a threshold value, the pixel was classified as a bad
in Medicine (DICOM) file format. The DICOM files were stored in a specific directory on the PC hard
pixel. In the second step, the intensity value of the bad pixel was replaced by a bi-linear interpolating
disk storage.
function of adjacent pixel values [13]. Then, the final image data were generated to Digital Imaging
and Communications in Medicine (DICOM) file format. The DICOM files were stored in a specific
2.3. Development and Performance Test of X-ray SDA Device
directory on the PC hard disk storage.
To determine the flip angle degree between an X-ray source and a detector, we developed
2.3. Development
an X-ray SDA device andthat
Performance
consisted Testofof aX-ray
main SDA Device
board (Arduino Uno R3 board; ARDUINO, Ivrea,
Italy), a 6To degrees
determine of freedom (DOF)
the flip angle degree inertial
between measurement
an X-ray source unitand (IMU) shieldwe
a detector, (embedded
developed an in the
ADXL345X-rayaccelerometer
SDA device thatand consisted of a main board
the ITG-3200 gyro; (Arduino
Sparkfun Uno R3 board; ARDUINO,
Electronics, Boulder, CO, Ivrea, Italy),and
USA), a a
6 degrees of freedom (DOF) inertial measurement unit (IMU) shield
Bluetooth module (HC-05 master, HC-06 slave; Shenzhen Rainbowsemi Electronics Co., Guangdong, (embedded in the ADXL345
China)accelerometer
[14]. This deviceand thewasITG-3200
attachedgyro;to theSparkfun Electronics,
X-ray source (deviceBoulder, CO, USA),
1) and detector and a2),Bluetooth
(device respectively.
module (HC-05 master, HC-06 slave; Shenzhen Rainbowsemi Electronics Co., Guangdong, China)
The Arduino main board was the core processing component coded by the Sketch software tool. The 6
[14]. This device was attached to the X-ray source (device 1) and detector (device 2), respectively.
DOF IMU shield included an accelerometer and gyro sensor, and transmitted the angle data to the
The Arduino main board was the core processing component coded by the Sketch software tool. The
Arduino6 DOFthrough I2C communication
IMU shield after sensing
included an accelerometer the angle
and gyro sensor, data
andfrom the X-ray
transmitted the source andtodetector.
angle data the
The 6 Arduino
DOF is achieved
through I2C by using a microelectromechanical
communication after sensing thesystem to sense
angle data fromtranslational movement
the X-ray source and in
three detector.
perpendicularThe 6 DOFaxes is(surge,
achievedheave, sway)
by using and rotational movement
a microelectromechanical about
system threetranslational
to sense perpendicular
axes (roll, pitch, in
movement yaw).
threeThe 6 DOF IMUaxes
perpendicular designed
(surge,toheave,
provide
sway) motion, position,movement
and rotational and navigational
about threesensing
perpendicular axes (roll, pitch, yaw). The 6 DOF IMU designed to provide
from a durable single device over 6 DOF (six-dimensional motion variants) [14]. The Bluetooth module motion, position, and
navigational
was connected sensing
to the from core
Arduino a durable single device over 6 DOF (six-dimensional motion variants)
processor.
[14]. The Bluetooth module was connected
Figure 2 shows the system block for processing to the Arduino core processor.
procedures by the SDA device. The SDA value
Figure 2 shows the system block for processing procedures by the SDA device. The SDA value
was measured as following steps. The Arduinos of devices 1 and 2 received angle data through I2C
was measured as following steps. The Arduinos of devices 1 and 2 received angle data through I2C
communication from the 6 DOF IMU Shield. Then, the Arduinos calculated the angle values for device
communication from the 6 DOF IMU Shield. Then, the Arduinos calculated the angle values for
1 (XS and
deviceYS 1) and device
(XS and 2 (XD
YS) and and Y
device 2 D(X) Dby applying
and an algorithm
YD) by applying to the angle
an algorithm to thedata
angle[15].
dataThe Bluetooth
[15]. The
module (HC-06) on device 2 received the angle values (X and Y
Bluetooth module (HC-06) on device 2 received the angle values (XD and YD) via serial
D D ) via serial communication from the
Arduino, and transmitted
communication from the theArduino,
angle values (XD and Ythe
and transmitted D ) to thevalues
angle Bluetooth module
(XD and YD) to(HC-05) of device
the Bluetooth
1 in real-time. The Bluetooth
module (HC-05) of devicemodule (HC-05)
1 in real-time. TheofBluetooth
device 1 module
transmitted(HC-05) theofangle
device values (XD andthe
1 transmitted YD ) to
angle values
the Arduino (XD and
via serial YD) to the Arduino
communication. via serial
Finally, communication.
the Arduino of device Finally, the Arduino
1 calculated of device
the SDA 1
difference
(XSDAcalculated
and YSDAthe ) asSDA difference
follows: XSDA(X=SDA XSand −X YSDA
D , )Yas follows:
SDA = Y S −XSDA
YD
=. XS − XD, YSDA = YS − YD.

Figure 2. System
Figure block
2. System of the
block device
of the devicefor
forobtaining
obtaining the X-raysource-detector
the X-ray source-detector angle
angle (SDA).
(SDA).
Sensors 2017, 17, 531 4 of 12

Sensors 2017, 17, 531 4 of 12

In order to test the performance of SDA device, we used a digital angle meter (DL-155V, STS,
Tokyo, In orderwith
Japan) to test the performance
accuracies of SDA device,
of 0.1%/degree (0◦ –10we used
◦ /80 a ◦digital
◦ –90 ), andangle meter (DL-155V,
0.2%/degree (10◦ –80◦STS,
) as a
Tokyo, Japan) with accuracies of 0.1%/degree (0°–10°/80°–90°), and 0.2%/degree
standard reference device. Figure 3 showed the developed SDA device attaching on the PDR system (10°–80°) as a
standard reference device. Figure 3 showed the developed SDA device attaching on the
and the initial setting for achieving the angle degrees using both the SDA device and digital angle PDR system
and the initial setting for achieving the angle degrees using both the SDA device and digital angle
meter. First, the ‘0.0◦ ’ value on the SDA device was accordant with a ‘0.0◦ ’ reference value on the
meter. First, the ‘0.0°’ value on the SDA device was accordant with a ‘0.0°’ reference value on the
digital angle meter (Figure 3C). Next, the angle value of the digital angle meter changed from 0 to
digital angle meter (Figure 3C). Next, the angle value of the digital angle meter changed from 0 to 60
60 degrees in units of five degrees, and then, the angle value on the SDA device measured three times.
degrees in units of five degrees, and then, the angle value on the SDA device measured three times.
The measured angle degree using PDR with SDA device displayed on a LCD monitor (Figure 3D).
The measured angle degree using PDR with SDA device displayed on a LCD monitor (Figure 3D).
Finally, thethe
Finally, angle difference
angle differencebetween
betweendigital
digital angle
angle meter and SDA
meter and SDAdevice
deviceinineach
eachangle
angle degree
degree waswas
calculated as mean difference of both angle values.
calculated as mean difference of both angle values.

Figure 3. Details of the device for obtaining the SDA, which was attached on an X-ray source (A) and
Figure 3. Details of the device for obtaining the SDA, which was attached on an X-ray source (A) and
a detector (B). Photography showed the initial setting for obtaining the angle degree using the SDA
a detector (B). Photography showed the initial setting for obtaining the angle degree using the SDA
device and digital angle meter (C). The ‘0.0°’ value on the SDA device was accordant with a ‘0.0°’
device and digital angle meter (C). The ‘0.0◦ ’ value on the SDA device was accordant with a ‘0.0◦ ’
reference value on the digital angle meter. The measured angle degree using PDR with SDA device
reference value on the digital angle meter. The measured angle degree using PDR with SDA device
displayed on a LCD monitor (D).
displayed on a LCD monitor (D).
2.4. Measurements of Image Quality and Radiation Dose
2.4. Measurements of Image Quality and Radiation Dose
The image quality of the PDR system was evaluated as signal-to-noise ratio (SNR),
The image quality
contrast-to-noise of the
ratio (CNR), and PDR
spatialsystem was
resolution evaluated
using as signal-to-noise
a bar phantom ratio
(X-ray test pattern type(SNR),
18;
FUNK, Berlin, Germany).
contrast-to-noise The
ratio (CNR), andSNR and CNR
spatial were calculated
resolution using a barasphantom
the ratio (X-ray
of the lead bar (0.05type
test pattern mm18;
thick)Berlin,
FUNK, value to noise and The
Germany). the ratio
SNRofandtheCNR
lead bar-air contrast toas
were calculated noise, respectively
the ratio [16].bar
of the lead Mean SNR
(0.05 mm
and CNR values were obtained from six image sets using the developed PDR system.
thick) value to noise and the ratio of the lead bar-air contrast to noise, respectively [16]. Mean SNR The
Sensors 2017, 17, 531 5 of 12
Sensors 2017, 17, 531 5 of 12

modulation transfer function (MTF) has been used to evaluate spatial resolution of imaging systems
and CNR values were obtained from six image sets using the developed PDR system. The modulation
[17]. This study was used a bar phantom to generate the MTF curve and was measured image
transfer function (MTF) has been used to evaluate spatial resolution of imaging systems [17]. This study
resolution at 10% on MTF curve.
was used a bar phantom to generate the MTF curve and was measured image resolution at 10% on
The radiation dose was calculated using the method described by the International Commission
MTF curve.
on Radiological Protection [18]. Entrance surface dose (ESD) is the absorbed dose including the
The radiation dose was calculated using the method described by the International Commission
contribution from backscatter [1]. The ESD measurement was performed using a dosimeter (Piranha,
on Radiological Protection [18]. Entrance surface dose (ESD) is the absorbed dose including
RTI Electronics, Mölndal, Sweden). This study was measured the ESD under the conditions of 80
the contribution from backscatter [1]. The ESD measurement was performed using a dosimeter
kVp tube voltage, 4 mAs current, 100 ms and 1 m SDD.
(Piranha, RTI Electronics, Mölndal, Sweden). This study was measured the ESD under the conditions
of 80 kVp tube voltage, 4 mAs current, 100 ms and 1 m SDD.
2.5. Chest Radiography According to Different Angle Degrees
2.5. Chest
ChestRadiography
radiographs According to Different
were performed sixAngle
timesDegrees
under the conditions of different angles using the
developed
Chest PDR system with
radiographs were SDA device.six
performed Totimes
assessunder
the image quality according
the conditions of differentto the angulation
angles using theof
the detector in the mediolateral plane of the patient, the angle value of
developed PDR system with SDA device. To assess the image quality according to the angulation the SDA changed from 0°
(medial line) to in
of the detector 30°thein units of 10 degrees
mediolateral plane (Figure 4). For the
of the patient, theanalysis of chest
angle value images,
of the SDA SNR and CNR
changed from
according
◦ to different ◦ angle degrees were measured from 15 different points
0 (medial line) to 30 in units of 10 degrees (Figure 4). For the analysis of chest images, SNR and using the Alderson
Radiation Therapy
CNR according (ART) angle
to different male degrees
phantom were(ART-200A).
measured from The 15 image distortion
different according
points using to the
the Alderson
changes
RadiationofTherapy
angulation
(ART)was malemeasured the deformity
phantom (ART-200A). Theasimage
percent changes
distortion in the to
according sizes
the of cardiac
changes of
transverse diameter (CTD), thoracic transverse diameter (TTD), and thoracic
angulation was measured the deformity as percent changes in the sizes of cardiac transverse diameter longitudinal diameter
(TLD). Also, two
(CTD), thoracic expert radiologists
transverse (moreand
diameter (TTD), thanthoracic
10 years of experience)
longitudinal blindly
diameter evaluated
(TLD). eachexpert
Also, two chest
image, and (more
radiologists reached than a 10
consensus regarding the
years of experience) anatomic
blindly landmarks
evaluated each chest[19].image,
The five anatomica
and reached
landmarks were the border of the heart, clavicle, first rib, fifth rib
consensus regarding the anatomic landmarks [19]. The five anatomic landmarks were the borderand scapula. Each anatomic
of the
landmark on chest image data was analyzed according to the radiological diagnosis
heart, clavicle, first rib, fifth rib and scapula. Each anatomic landmark on chest image data was analyzed on a five-point
scale: 1, definitely
according seen; 2, probably
to the radiological diagnosisseen;on3,a equivocal;
five-point 4, probably
scale: not seen;
1, definitely and2,5,probably
seen; definitelyseen;
not
seen.
3, equivocal; 4, probably not seen; and 5, definitely not seen.

Figure 4.
Figure The angulation
4. The angulation plane
plane (A)
(A) and
and reference
reference line
line setting
setting (B)
(B) for
for the
the measurement
measurement of of distortion
distortion
on chest phantom: (a) cardiac transverse diameter (CTD); (b) thoracic transverse diameter
on chest phantom: (a) cardiac transverse diameter (CTD); (b) thoracic transverse diameter (TTD); (TTD);
and (c)
and (c) thoracic
thoracic longitudinal
longitudinal diameter
diameter (TLD).
(TLD). L
L and
and RR indicated
indicated left
left side
side and
and right
right side.
side.

Statistical Analysis
2.6. Statistical
analyses were performed
All statistical analyses performed using the Statistical Package for the Social Sciences
Coefficient of
(SPSS version 20.0, Chicago, IL, USA) software. Coefficient of variance
variance (CV)
(CV) of SNR and CNR was
calculated for the variability of measurements in the PDR system [20]. [20]. The angle difference between
both angle
anglemeters
meters(SDA
(SDAdevice
deviceand digital
and angle
digital meter)
angle was analyzed
meter) with the
was analyzed independent
with two sample
the independent two
t-test. According
sample to the different
t-test. According to the angle degrees,
different anglethe variation
degrees, theinvariation
image qualities,
in imagedistortion anddistortion
qualities, visibility
scores
and were analyzed
visibility with the
scores were repeated-measures
analyzed analysis of variance
with the repeated-measures (rmANOVA)
analysis of varianceand(rmANOVA)
Tukey’s post
hoc tests.
and Tukey’s post hocp-values
Two-sided less than 0.05
tests. Two-sided wereless
p-values considered
than 0.05towere
indicate statistical
considered to significance.
indicate statistical
significance.
Sensors 2017, 17, 531 6 of 12
Sensors 2017, 17, 531 6 of 12

3.
3. Results
Results

3.1.
3.1. Development
Development and
and Performances
Performances of
of PDR
PDR
The
The size
size and
and weight
weight of the PDR
of the PDR system
system were
were 723
723 mm
mm (width)
(width) ×× 650 mm (depth)
650 mm (depth) × × 1376
1376 mm
mm
(height)
(height) and approximately 60 kg, respectively (Figure 1). The PDR has a smooth flexibility of
and approximately 60 kg, respectively (Figure 1). The PDR has a smooth flexibility of the
the
X-ray
X-ray source
sourceand
andcan
canbebemoved
movedeasily
easilybybyanan
adult. TheThe
adult. meanmeanSNR andand
SNR CNR werewere
CNR 182.47 ± 6.75
182.47 ±(CV:
6.75
3.7%) and 141.43
(CV: 3.7%) ± 6.08 (4.3%),
and 141.43 ± 6.08 respectively. The overall
(4.3%), respectively. TheCV values
overall CVinvalues
the system
in thewere less were
system than 5%.
less
The
thanspatial
5%. Theresolution at 10% MTF
spatial resolution at was
10%3.17
MTFlp/mm (157lp/mm
was 3.17 μm) (Figure 5) and
(157 µm) the ESD
(Figure 5) andwasthe
0.266
ESD mGy.
was
Therefore,
0.266 mGy.our PDR system
Therefore, our PDRis easily
systemapplicable for imaging
is easily applicable forbedside
imagingpatients
bedsideor inpatients
patients such as
or inpatients
immobilized bedridden patients and post-stroke hemiplegic patients.
such as immobilized bedridden patients and post-stroke hemiplegic patients.

Figure 5. Bar phantom image obtained from the PDR to calculate the signal-to-noise ratio (SNR),
Figure 5. Bar phantom image obtained from the PDR to calculate the signal-to-noise ratio (SNR),
contrast-to-noise ratio (CNR) and spatial resolution (A). Line-squares on the phantom images
contrast-to-noise ratio (CNR) and spatial resolution (A). Line-squares on the phantom images indicated
indicated
the regionstheofregions
interestof
forinterest
SNR and forCNR
SNRmeasurements.
and CNR measurements. A modulation
A modulation transfer
transfer function function
(MTF, 10%)
(MTF, 10%) curve was used for resolution evaluation (B). The 10% MTF value is 3.17 lp/mm (157μm)
curve was used for resolution evaluation (B). The 10% MTF value is 3.17 lp/mm (157µm) on the image
on the image
obtained fromobtained
the PDR.from the PDR.

3.2. Performance of the SDA Device

3.2. Performance of the SDA Device
Figure 3 shows the features of the SDA device on the PDR system. The device was attached to
Figure 3 shows the features of the SDA device on the PDR system. The device was attached
the X-ray source and detector, respectively, and its size was 55 mm (width) × 80 mm (depth) × 35 mm
to the X-ray source and detector, respectively, and its size was 55 mm (width) × 80 mm (depth) ×
(height). The angle values obtained from the SDA device were displayed in real time on the LCD
35 mm (height). The angle values obtained from the SDA device were displayed in real time on the
monitor (1 times/s). The averaged angle values of the SDA device and digital angle meter are
LCD monitor (1 times/s). The averaged angle values of the SDA device and digital angle meter are
summarized in Table 1, and the mean difference in both angle values was 0.71° ± 0.15°. There was no
summarized in Table 1, and the mean difference in both angle values was 0.71◦ ± 0.15◦ . There was no
significant angle difference between the digital angle meter and our SDA device (p > 0.05).
significant angle difference between the digital angle meter and our SDA device (p > 0.05).
3.3.
3.3. Chest
Chest Radiographic
Radiographic Study
Study According
According to
to Different
Different Angles
Angles for
for Clinical
Clinical Application
Application
Figure
Figure 66 shows
shows thethe representative
representative chest
chest AP
AP images
images obtained
obtained from
from the
the developed
developed PDR PDR according
according
to different angles. Imaging quality, distortion and visibility scores are summarized
to different angles. Imaging quality, distortion and visibility scores are summarized in Table in Table 2. SNR2.
and CNR values were not significantly different from different the angle degrees
SNR and CNR values were not significantly different from different the angle degrees (rmANOVA, (rmANOVA, p>
0.05). TheThe
p > 0.05). objective image
objective qualities
image were
qualities notnot
were significantly
significantlydifferent
differentininthis
thisstudy;
study;thus,
thus,ititcould
could be
be
considered to be applicable for appropriate angle degrees in clinical experiments. However,
considered to be applicable for appropriate angle degrees in clinical experiments. However, the sizes the sizes
and
and deformity
deformity (%)(%) in
in the
the CTD,
CTD, TTD
TTD and
and TLD
TLD increased
increased according
according to to the
the increment
increment of of angulation
angulation
(rmANOVA,
(rmANOVA, pp << 0.001).
0.001). The
Theimage
imagedistortion
distortionappeared
appearedmore moresevere
severe according
according to to the
the increment
increment of of
angulation. Figure 7 shows the mean visibility scores on anatomic landmarks according
angulation. Figure 7 shows the mean visibility scores on anatomic landmarks according to different to different
angle degrees. The visibility scores of the border of the heart, the fifth rib and the scapula were
Sensors 2017, 17, 531 7 of 12
Sensors 2017, 17, 531 7 of 12

significantly
angle degrees. different according
The visibility to different
scores angles of
of the border (rmANOVA, p < fifth
the heart, the 0.05),rib
whereas thescapula
and the claviclewere
and
first rib were not significant. It was noticeable that the increase in SDA degree was consistent
significantly different according to different angles (rmANOVA, p < 0.05), whereas the clavicle and with
the
firstincreases of the
rib were not distortionItand
significant. wasvisibility score.
noticeable that the increase in SDA degree was consistent with the
increases of the distortion and visibility score.
Table 1. Angle values and angle difference of digital angle meter and developed X-ray
source-detector
Table angle and
1. Angle values (SDA) device.
angle difference of digital angle meter and developed X-ray source-detector
angle (SDA) device.Digital Angle Meter
Degree Developed SDA Device Angle Difference
(°) (A, Mean ± SD) (B, Mean ± SD) (B-A)
0Degree Digital Angle
0.00 ± 0.00 Meter Developed SDA
0.00 ± 0.00 Device Angle Difference
0.00
◦
5 ( ) (A,
5.00 ± 0.00± SD)
Mean (B, 5.30
Mean ± SD)
± 0.08 (B-A)0.30
10 0 0.00± ±
10.00 0.00
0.00 0.00 ±± 0.00
10.70 0.08 0.000.70
15 5 5.00 ±
15.00 ± 0.000.00 5.30 ± 0.08
15.50 ± 0.08 0.300.50
20 10 10.00 ±
20.00 ± 0.00 0.00 10.70 ± 0.08
20.87 ± 0.04 0.700.87
25 15 15.00 ±
25.00 ± 0.00 0.00 15.50 ± 0.08
25.80 ± 0.08 0.500.80
20 20.00 ± 0.00 20.87 ± 0.04 0.87
30 30.00 ± 0.00 30.70 ± 0.08 0.70
25 25.00 ± 0.00 25.80 ± 0.08 0.80
35 35.00 ± 0.00 35.77 ± 0.04 0.77
30 30.00 ± 0.00 30.70 ± 0.08 0.70
40 35 40.00 ± 0.00
35.00 ± 0.00 40.77 ± 0.12
35.77 ± 0.04 0.770.77
45 40 45.00 ± 0.00
40.00 ± 0.00 45.77 ±
40.77 ± 0.04
0.12 0.770.77
50 45 50.00 ± 0.00
45.00 ± 0.00 50.80 ±
45.77 ± 0.08
0.04 0.770.80
55 50 55.00
50.00 ± 0.00
± 0.00 55.77 ±
50.80 ± 0.04
0.08 0.800.77
60 55 55.00
60.00 ± 0.00
± 0.00 60.73 ±
55.77 0.04
± 0.04 0.770.73
p-value60 * 60.00 ± 0.00 0.865 60.73 ± 0.04 0.73
0.71 ± 0.15
p-value * 0.865 0.71 ± 0.15
Abbreviation: SD, standard deviation; SDA, source-detector angle. Data are presented as mean ± SD
Abbreviation:
after SD, standard deviation;
three measurements. SDA, source-detector
Angle difference angle. Data
between digital anglearemeter
presented
(A) as
andmean ± SD after
developed three
device
measurements. Angle difference between digital angle meter (A) and developed device (B) in each degree was
(B) in each
calculated as degree was* calculated
mean (B-A). as between
The difference mean (B-A).
angle *values
The difference between
of digital angle angle
meter (A) andvalues of digital
developed device
(B) wasmeter
angle analyzed
(A)with
and the independent
developed (B) wast-test.
two-sample
device analyzed with the independent two-sample t-test.

Figure 6. Representative
Figure 6. Representative chest
chest AP
AP images
images obtained
obtained from
from the developed PDR
the developed PDR according
according to different
to different
angles: (A) 0°◦(=perpendicular); (B) 10°; ◦(C) 20° and
◦ (D) 30° angle
◦ degree. The squares
angles: (A) 0 (=perpendicular); (B) 10 ; (C) 20 and (D) 30 angle degree. The squares of red of red lineline
(30
× 30×pixels)
(30 on AP
30 pixels) onimage indicated
AP image 15 points
indicated for SNR
15 points and and
for SNR CNRCNR measurements.
measurements.
 Table 2. SNR, CNR, distortion and visibility values on chest AP images according to different angles.

Angle Degree
0° 10° 20° 30° p-Value *
Value
Sensors 2017, 17, 531 8 of 12
SNR 408.7 ± 160.0 408.8 ± 157.8 428.0 ± 176.3 463.4 ± 155.9 0.082
CNR 82.3 ± 23.0 100.0 ± 30.9 102.8 ± 33.1 98.2 ± 28.8 0.114
Table 2.Distortion
†
SNR, CNR, distortion and visibility values on chest AP images according to different angles.
CTD (size, mm) 101.9 ± 0.3 104.4 ± 0.3 106.6 ± 0.4 107.5 ± 0.3
<0.001 a,b,c,d,e,f
(deformity,Angle%) Degree (100.0%) (102.5%) (104.6%) (105.5%) ◦
0◦ 10◦ 20◦ 30 p-Value *
Value TTD (mm) 278.0 ± 0.3 278.5 ± 0.1 278.7 ± 0.1 279.4 ± 0.3
SNR 408.7 ± 160.0 408.8 ± 157.8 (100.3%)428.0 ± 176.3 (100.5%)
463.4 ± 155.9
<0.001 0.082
a,b,c,d,e,f
(%) (100.0%) (100.2%)
CNR 82.3 ± 23.0 100.0 ± 30.9 102.8 ± 33.1 98.2 ± 28.8 0.114
TLD (mm) 250.2 ± 1.0 260.7 ± 1.3 266.3 ± 1.3 273.7 ± 1.4
Distortion † <0.001 a,b,c,d,e,f
(%) (100.0%) (104.2%) (106.4%) (109.4%)
CTD (size, mm)‡ 101.9 ± 0.3 104.4 ± 0.3 106.6 ± 0.4 107.5 ± 0.3
Visibility
(deformity, %) (100.0%) (102.5%) (104.6%) (105.5%) <0.001 abcdef
Border of Heart 1.67 ± 0.52 2.17 ± 0.75 2.50 ± 0.55 3.00 ± 0.00 0.044 bce
TTD (mm) 278.0 ± 0.3 278.5 ± 0.1 278.7 ± 0.1 279.4 ± 0.3
Clavicle
(%) 1.00 ± 0.00
(100.0%) 1.33(100.2%)
± 0.52 1.50 ±(100.3%)
0.55 1.83 ± 0.41
(100.5%) <0.001 abcdef
0.110
1st Rib (Rt-side)
TLD (mm)
1.00 ± 0.00
250.2 ± 1.0
1.33 ± 0.52
260.7 ± 1.3
1.50 266.3
± 0.55± 1.3 1.67 ±273.7
0.52 ± 1.4 0.292
5th Rib bcdef abcdef
<0.001
(%)(Rt-side) 1.33 ± 0.52
(100.0%) 1.67(104.2%)
± 0.52 2.33 ±(106.4%)
0.52 3.00 ± 0.00
(109.4%) <0.001
Scapula
Visibility ‡
1.17 ± 0.41 1.50 ± 0.55 1.67 ± 0.52 2.33 ± 0.52 0.032 cef
Abbreviation:
Border of Heart CNR, contrast-to-noise1.67 ± 0.52ratio; CTD,2.17 ± cardiac
0.75 transverse diameter;3.00
2.50 ± 0.55 SNR, signal-to-noise
± 0.00 0.044 bce
Clavicle 1.00 ± 0.00 1.33 ± 0.52 1.50 ±
ratio; TTD, thoracic transverse diameter; TLD thoracic longitudinal diameter. Data are presented0.55 1.83 ± 0.41 0.110as
1st Rib (Rt-side) 1.00 ± 0.00 1.33 ± 0.52 1.50 ± 0.55 1.67 ± 0.52 0.292
mean ± SD after
5th Rib (Rt-side)
six measurements at
1.33 ± 0.52
each point. * The
1.67 ± 0.52
significant difference
2.33 ± 0.52
between different
3.00 ± 0.00
angle
<0.001 bcdef
degreesScapula
was analyzed with repeated-measures
1.17 ± 0.41 ANOVA
1.50 ± 0.55 with Tukey’s
1.67 ± 0.52post hoc2.33
test: 0 vs. 10; b0.032
± a0.52 0 vs.cef
20; c 0 vs. 30; d 10 vs. 20; e 10 vs. 30; and f 20 vs. 30. † The image distortion according to the changes of
Abbreviation: CNR, contrast-to-noise ratio; CTD, cardiac transverse diameter; SNR, signal-to-noise ratio; TTD,
thoracic
angulation transverse diameter; TLD
was calculated thoracic longitudinal
the deformity diameter.
as the percent Data are
changes in presented
the sizes asof mean ± SD afterThe
the diameter. six
measurements at each point. * The significant difference between different angle degrees was analyzed witha
statistical analysis was used with repeated-measures ANOVA and Tukey’s post hoc test as follows:
repeated-measures ANOVA with Tukey’s post hoc test: a 0 vs. 10; b 0 vs. 20; c 0 vs. 30; d 10 vs. 20; e 10 vs. 30;
and 10;vs.b 030.vs.
0 vs.f 20 20; image
† The c 0 vs. 30; d 10 vs. 20; e 10 vs. 30; and f 20 vs. 30. ‡ The value of each anatomical
distortion according to the changes of angulation was calculated the deformity as the
landmark
percent on the
changes chest
in the sizesimage was analyzed
of the diameter. according
The statistical to the
analysis wasradiological diagnosis on aANOVA
used with repeated-measures five-pointand
Tukey’s post hoc test as follows: a 0 vs. 10; b 0 vs. 20; c 0 vs. 30; d 10 vs. 20; e 10 vs. 30; and f 20 vs. 30. ‡ The value of
scale: 1, definitely seen; 2, probably seen; 3, equivocal; 4, probably not seen; and 5, definitely not
each anatomical landmark on the chest image was analyzed according to the radiological diagnosis on a five-point
seen. 1, definitely seen; 2, probably seen; 3, equivocal; 4, probably not seen; and 5, definitely not seen.
scale:

Figure 7. Cont.
Sensors 17, 531
2017,2017,
Sensors 17, 531 9 of 912of 12

Figure 7. Mean
Figure anatomic
7. Mean landmark
anatomic visibilityvisibility
landmark scores according to differentto
scores according angle degrees.
different The significant
angle degrees. The
difference between different angle degrees was analyzed with repeated-measures
significant difference between different angle degrees was analyzed with repeated-measuresANOVA and Tukey’s
postANOVA a 0 vs. 10; b 0 vs. 20; c 0 vs. 30; d 10 vs. 20; e 10 vs. 30; and f 20 vs. 30. Note that the scores
hoc test: and Tukey’s post hoc test: a 0 vs. 10; b 0 vs. 20; c 0 vs. 30; d 10 vs. 20; e 10 vs. 30; and f 20 vs.
including the that
30. Note border
theofscores
the heart, the fifththe
including rib border
and theof scapula were significantly
the heart, the fifth rib different
and the from angle
scapula were
degrees (p < 0.05). Five-point scale: 1, definitely seen; 2, probably seen; 3, equivocal; 4, probably
significantly different from angle degrees (p < 0.05). Five-point scale: 1, definitely seen; 2, probably not
seen; and3,5,equivocal;
seen; definitely 4,
notprobably
seen. not seen; and 5, definitely not seen.

4. Discussion andand
4. Discussion Conclusions
Conclusions
In this study,
In this we successfully
study, we successfully developed a PDR asystem
developed with a SDA
PDR system withdevice.
a SDAThe current
device. TheDRcurrent
systemDR
wassystem
combined was various
combined information and communication
various information technologiestechnologies
and communication (ICT) that provide (ICT) that compact,
provide
portable, mobile, and smart environments for the diagnosis of
compact, portable, mobile, and smart environments for the diagnosis of patients [2,3]. patients [2,3]. The advantages of ourThe
PDR system include the increase of flexibility and mobility because
advantages of our PDR system include the increase of flexibility and mobility because the X-ray the X-ray source implemented
twosource
gas springs to smoothly
implemented two gas move under
springs toasmoothly
zero-gravity move state
underandathe PDR mainstate
zero-gravity body and installed
the PDR twomain
main wheels and an auxiliary wheel. Additionally, the slot attached
body installed two main wheels and an auxiliary wheel. Additionally, the slot attached on the PDR on the PDR system is useful
for system
safekeeping an FPD
is useful detector, and
for safekeeping an the
FPDintegrated
detector, andPC is theeasily detachable.
integrated Current
PC is easily PDR systems
detachable. Current
in radiography and radiological fields are necessary to provide images
PDR systems in radiography and radiological fields are necessary to provide images in the standard in the standard DICOM file
format [1]. The proposed PDR system can save the acquired DICOM-formatted
DICOM file format [1]. The proposed PDR system can save the acquired DICOM-formatted images images to hard disk
storage.
to hard Also,
diskourstorage.
SDA device Also,can ourprovide
SDA devicequantitative angulation
can provide information
quantitative in clinicalinformation
angulation settings. in
With regard
clinical settings. to the imaging performance, the mean SNR and CNR values were 182 and 141,
respectively.
WithThe spatial
regard resolution
to the imaging of performance,
10% MTF was the 3.17mean
lp/mm SNR(157andµm). CNRThevalues
proposed were PDR182system
and 141,
hadrespectively.
proper CV values (<5%)resolution
The spatial and imageofquality 10% MTF for clinical
was 3.17 study.
lp/mm In terms
(157 μm).of the The radiation
proposed dose PDR
safety, the reduction of the radiation dose for patients is an important
system had proper CV values (<5%) and image quality for clinical study. In terms of the radiation issue. This emphasizes the
importance
dose safety, of the
theas low as reasonably
reduction achievable
of the radiation dose (ALARA)
for patients concept. At present,
is an important cancer
issue. Thisinduction
emphasizes
is athe
stochastic risk with a linear-no-threshold dose model; therefore,
importance of the as low as reasonably achievable (ALARA) concept. At present, cancer reduced exposure to radiation
decreases
induction theisrisk of the development
a stochastic risk with a of cancer, such as leukemia,
linear-no-threshold dose model; in subjects
therefore,[21]. To resolve
reduced this, to
exposure
theradiation
ESD mustdecreases
be reduced thewhilerisk ofmaintaining
the developmentthe image quality. such
of cancer, According to the recommendation
as leukemia, in subjects [21]. To
of the radiographic guideline [18], the ESD limit for the chest
resolve this, the ESD must be reduced while maintaining the image quality. According is 0.4 mGy. The guidelines of the
to the
European Union (EU) [22] and the American College of Radiologists
recommendation of the radiographic guideline [18], the ESD limit for the chest is 0.4 mGy. (ACR) [23,24] suggest that theThe
mean entranceofsurface
guidelines exposure
the European should
Union (EU)range
[22]from
and the0.05American
to 0.3 mGy per exposure
College scan in (ACR)
of Radiologists newborns, [23,24]
infants and children. In the present study, the ESD of the proposed
suggest that the mean entrance surface exposure should range from 0.05 to 0.3 mGy per exposure PDR was 0.266 mGy under the
conditions at 80 kV, 0.4 mA, 100 ms and 1 m SDD. Therefore, the proposed
scan in newborns, infants and children. In the present study, the ESD of the proposed PDR was PDR system could be likely
to be safemGy
0.266 in clinical
underradiography
the conditions settings.
at 80 kV, 0.4 mA, 100 ms and 1 m SDD. Therefore, the proposed
PDR system could be likely to be safeangle
The accuracy test of the developed device
in clinical is essentialsettings.
radiography to evaluate the performance of the
SDA device. From this
The accuracy testviewpoint, we usedangle
of the developed a digital
deviceangle meter with
is essential an accuracy
to evaluate of 0.1%/degree
the performance of the
(0◦ –10 ◦ /80◦ –90◦ ) and 0.2%/degree (10◦ –80◦ ) as a reference device. In the present study, the angle
SDA device. From this viewpoint, we used a digital angle meter with an accuracy of 0.1%/degree
difference between both
(0°–10°/80°–90°) and the digital angle
0.2%/degree meter as
(10°–80°) anda the SDA device
reference device. wasIn below 1◦ andstudy,
the present there was the no
angle
significant
difference difference.
between Therefore,
both the digitalthe SDAangledevice
meter provided
and the accurate
SDA device SDAwas values
below to the
1° and operator
there wasand no
thesignificant
angle values will be useful
difference. for thethe
Therefore, clinical radiography
SDA device provided setting. Moreover,
accurate SDA valuesdue to to our theSDA deviceand
operator
being attached easily to any other systems, it can be widely used with the
the angle values will be useful for the clinical radiography setting. Moreover, due to our SDA device products requiring accurate
angle values.
being The current
attached easily accuracy
to any otherof oursystems,
SDA device is good
it can enough used
be widely (<0.8◦with
) for chest imaging, requiring
the products but its
accurate angle values. The current accuracy of our SDA device is good enough (<0.8°) for chest
Sensors 2017, 17, 531 10 of 12

accuracy needs improvement for more demanding imaging such as the computed tomography (CT)
imaging. For clinical applications in unexpected conditions or extreme medical situations, it should be
considered that the increment of angulation leads to image distortion of the anatomy.
With regard to the factors for clinical imaging, SDD and SDA are important factors for acquiring
appropriate image quality according to standard clinical radiography guidelines [9,10]. From these
radiographic guidelines, it is recommended the imaging positions as cervical spine AP imaging of
100 cm SDD and 15◦ –20◦ SDA (head side direction incidence), and lateral knee imaging SDD of
100 cm and SDA of 5◦ –7◦ (head side direction incidence), respectively. Especially, for PA and AP
chest radiography (SDD of 180 cm), it is common practice to have a small caudal tube angulation
(SDA around five degrees). We believed to reduce the dose to the radiosensitive thyroid gland. Also,
the proposed PDR system with the SDA device could provide both SDD and SDA values, and thus
it might be considered to be applicable for the measurements at any distance and angle degree of
the imaging positioning under unexpected conditions or in extreme medical situations. In the future,
device development for the real-time tracking of SDD would be helpful for immobilized bedridden
patients, post-stroke patients, severely injured patients, etc.
In conclusion, the proposed PDR system provided a flexible structure, light weight, and high
portability, as well as accurate SDA and SDD values according to the clinical radiography standard
guidelines. This system will be useful for applications in clinical radiography.

Acknowledgments: This study was supported by a grant from the Korean Health Technology R&D Project,
Ministry of Health and Welfare, Republic of Korea (HI12C0110).
Author Contributions: T.H.K., D.W.H. and K.H.Y. conceived the main idea. T.H.K., D.W.H., C.W.J., J.H.Y., H.Y.J.,
S.J.H. and T.H. performed the study and T.H.K., D.W.H., C.W.J., J.H.R. and H.Y.J. interpreted the data. T.H.K.,
D.W.H. and J.H.R. prepared the initial manuscript. T.H.K. and K.H.Y. confirmed and validated the overall
performances from the clinical perspective, and participated in manuscript writing and revision. All authors read
and approved the final manuscript.
Conflicts of Interest: The authors declare no conflicts of interest.

Abbreviations
The following abbreviations are used in this manuscript:

ALARA as low as reasonably achievable

CNR contrast-to noise
CTD cardiac transverse diameter
CV coefficient of variance
DICOM Digital Imaging and Communications in Medicine
DOF degree of freedom
DR digital radiography
ESD entrance surface dose
FPD flat-panel detector ratio
ICT information and communication technologies
IMU inertial measurement unit
MTF modulation transfer function
PDR portable digital radiography
rmANOVA repeated-measures analysis of variance
SDA X-ray source-detector angle
SDD X-ray source-detector distance
SNR signal-to-noise ratio
TFT thin-film transistor
TLD thoracic longitudinal diameter
TTD thoracic transverse diameter
Sensors 2017, 17, 531 11 of 12

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