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Five radiologists independently assessed the visibility of anatomical structures, the level of motion artifacts, and the overall image quality of all attenuation images on a five-point scale, with 5 points being the highest rating. The average scores were compared between the two image types. The differences were evaluated using an area under the curve (AUC) based z-test with a significance level of\n                      <jats:italic>p<\/jats:italic>\n                      \u2009\u2264\u20090.05. To assess the variability among the images, the distributions of the average scores per image were compared between the systems.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The overall image quality was rated high for both devices, 4.2 for the prototype and 4.6 for the commercial system. The rating scores varied only slightly between both image types, especially for structures relevant to lung assessment, where the images from the commercial system were graded slightly higher. The differences were statistically significant for all criteria except for the bronchial structures, the cardiophrenic recess, and the carina.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The attenuation images acquired with the prototype were assigned a high diagnostic quality despite a lower resolution and the presence of motion artifacts. Thus, the attenuation-based radiographs from the prototype can be used for diagnosis, eliminating the need for an additional conventional radiograph.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Points<\/jats:title>\n                    <jats:p>\n                      \u2022\n                      <jats:italic>Despite a low tube voltage (70\u00a0kVp) and comparably long acquisition time, the attenuation images from the dark-field chest radiography system achieved diagnostic quality for lung assessment.<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      \u2022\n                      <jats:italic>Commercial chest radiographs obtained a mean rating score regarding their diagnostic quality of 4.6 out of 5, and the grating-based images had a slightly lower mean rating score of 4.2 out of 5.<\/jats:italic>\n                    <\/jats:p>\n                    <jats:p>\n                      \u2022\n                      <jats:italic>The difference in rating scores for anatomical structures relevant to lung assessment is below 5%.<\/jats:italic>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00330-023-09477-4","type":"journal-article","created":{"date-parts":[[2023,2,19]],"date-time":"2023-02-19T13:17:04Z","timestamp":1676812624000},"page":"5549-5556","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["X-ray dark-field chest radiography: a reader study to evaluate the diagnostic quality of attenuation chest X-rays from a dual-contrast scanning prototype"],"prefix":"10.1007","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1092-8262","authenticated-orcid":false,"given":"Margarete","family":"Kattau","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantin","family":"Willer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfgang","family":"Noichl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theresa","family":"Urban","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuela","family":"Frank","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"De Marco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael","family":"Schick","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Koehler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanns-Ingo","family":"Maack","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard","family":"Renger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Renz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Sauter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yannik","family":"Leonhardt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Fingerle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus","family":"Makowski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Pfeiffer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franz","family":"Pfeiffer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,2,18]]},"reference":[{"key":"9477_CR1","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1038\/nmat2096","volume":"7","author":"F Pfeiffer","year":"2008","unstructured":"Pfeiffer F, Bech M, Bunk O et al (2008) Hard-X-ray dark-field imaging using a grating interferometer. 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Radiology, 2021), Urban & Gassert et al (Qualitative and Quantitative Assessment of Emphysema Using Dark-Field Chest Radiography. Radiology, 2022), Willer & Fingerle et al (X-ray dark-field chest imaging for detection and quantification of emphysema in patients with chronic obstructive pulmonary disease: a diagnostic accuracy study. The Lancet Digital Health, 2021), Urban & Sauter et al (submitted).","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Study subjects or cohorts overlap"}},{"value":"\u2022 retrospective\u2022 observational\u2022 performed at one institution","order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}