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In total, 300 anteroposterior and 420 lateral images were included. Image quality was evaluated by three experienced pediatric radiologists. Gradings were analyzed with visual grading characteristics (VGC) resulting in area under the VGC curve (AUC<jats:sub>VGC<\/jats:sub>) values and associated confidence intervals (CI).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Image quality of different anatomical structures and overall clinical image quality were statistically significantly better in the anteroposterior INR images than in the corresponding standard noise reduced images at each dose level. Compared with reference anteroposterior images at a dose level of 100% with standard noise reduction, the image quality of the anteroposterior INR images was graded as significantly better at dose levels of\u2009\u2265\u200980%. Statistical significance was also achieved at lower dose levels for some structures. The assessments of the lateral images showed similar trends but with fewer significant results.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>The results of the present study indicate that the AI-based INR may potentially be used to improve image quality at a specific dose level or to reduce dose and maintain the image quality in pediatric chest radiography.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Graphical abstract<\/jats:title>\n          <\/jats:sec>","DOI":"10.1007\/s00247-025-06251-0","type":"journal-article","created":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T05:20:27Z","timestamp":1747113627000},"page":"1475-1486","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Evaluation of an artificial intelligence noise reduction tool for conventional X-ray imaging \u2013 a visual grading study of pediatric chest examinations at different radiation dose levels using anthropomorphic phantoms"],"prefix":"10.1007","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1616-0394","authenticated-orcid":false,"given":"Maria","family":"Hultenmo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna","family":"Pernbro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenny","family":"Ahlin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Bonnier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4004-2603","authenticated-orcid":false,"given":"Magnus","family":"B\u00e5th","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,5,13]]},"reference":[{"key":"6251_CR1","unstructured":"Health AI Register. http:\/\/www.healthairegister.com\/. 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