Dual-energy subtraction imaging allows tissue and bone structures to be separated from each other and attenuating thicknesses measured. Potential applications include chest imaging, bone mineral measurement, angiography, and mammography. However, intrinsic to most x-ray detectors is the acceptance of scattered radiation as part of the image signal. Added to that is the veiling glare component when an image intensifier is used. Together, they result in erroneous transmission measurement and degrade the accuracy of energy subtraction processing. In this paper, the effects of scattered radiation and veiling glare on energy subtraction images are examined theoretically. A model is derived and used to compute the effects on the thickness signals, image contrast, and image noise as a function of the scatter glare to primary ratios. The ratios were measured on a point-by-point basis for a Rando chest phantom. For 96% of the image field studied, the thickness signals may be subject to an error ranging from 0 to -22.5 cm for tissue and 0 to 5.2 cm for bone. The image contrast in the tissue image may be reduced by a factor ranging from 1 to 59. The percentage of the uncanceled bone signals ranges from -52% to 52%. The contrast-to-noise ratio may be reduced by a factor ranging from 1 to 18.
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