Improving Image Quality of Chest Radiography with Artificial Intelligence-Supported Dual-Energy X-Ray Imaging System: An Observer Preference Study in Healthy Volunteers

<b>Background/Objectives:</b> To compare the image quality of chest radiography with a dual-energy X-ray imaging system using AI technology (DE-AI) to that of conventional chest radiography with a standard protocol. <b>Methods:</b> In this prospective study, 52 healthy volunteers underwent dual-energy chest radiography. Images were obtained using two exposures at 60 kVp and 120 kVp, separated by a 150 ms interval. Four images were generated for each participant: a conventional image, an enhanced standard image, a soft-tissue-selective image, and a bone-selective image. A machine learning model optimized the cancellation parameters for generating soft-tissue and bone-selective images. To enhance image quality, motion artifacts were minimized using Laplacian pyramid diffeomorphic registration, while a wavelet directional cycle-consistent adversarial network (WavCycleGAN) reduced image noise. Four radiologists independently evaluated the visibility of thirteen anatomical regions (eight soft-tissue regions and five bone regions) and the overall image with a five-point scale of preference. Pooled mean values were calculated for each anatomic region through meta-analysis using a random-effects model. <b>Results:</b> Radiologists preferred DE-AI images to conventional chest radiographs in various anatomic regions. The enhanced standard image showed superior quality in 9 of 13 anatomic regions. Preference for the soft-tissue-selective image was statistically significant for three of eight anatomic regions. Preference for the bone-selective image was statistically significant for four of five anatomic regions. <b>Conclusions:</b> Images produced by DE-AI provide better visualization of thoracic structures.