Comparison of Subjective Image Quality of Mobile C-Arms Equipped with a-Si, CMOS or IGZO Flat-Panel Detectors for Intraoperative Fluoroscopy

Different flat-panel detector technologies are available for intraoperative fluoroscopy. This study compared orthopedic and trauma surgeons’ preference and subjective image quality among mobile C-arm systems equipped with amorphous silicon (a-Si), complementary metal oxide semiconductor (CMOS) or indium gallium zinc oxide (IGZO) detectors. Fluoroscopic imaging was performed on four human specimens at four anatomic locations at pulse rates of 1/s and 10/s in low- and high-dose settings using three C-arm systems. Subjective image quality was rated by two observers on 5-point Likert scales. Pairwise forced-choice comparisons of images with identical acquisition parameters were analyzed using a Bradley–Terry model. Across all images, CMOS- and IGZO-based systems were preferred over the a-Si-based system in 91.8% and 90.4% of comparisons, respectively (ORs 9.53 and 11.20; both p < 0.001). No significant overall preference was observed between the IGZO- and CMOS-equipped systems. Subjective image quality ratings were significantly higher for CMOS- and IGZO-based systems compared with the a-Si-based system, particularly for overall image quality and perceived noise, while no consistent differences in image quality were found between CMOS- and IGZO-based systems. Overall, the CMOS- and IGZO-based systems evaluated in this study were preferred over the a-Si-based system and achieved superior subjective image quality ratings.