Subjective and objective image quality evaluation of a scatter correction algorithm applied to hip radiographs

INTRODUCTION: Hip radiographs are common examinations but are technically challenging because of variable patient body habitus and anatomy. Physical anti-scatter grids improve contrast but increase radiation dose and introduce practical limitations, particularly in trauma and mobile imaging. Software-based scatter correction offers a potential alternative; however, evidence for musculoskeletal applications remains limited. AIM: To evaluate the impact of a software-based scatter correction algorithm on hip radiograph image quality using objective image quality metrics and subjective observer assessment. METHODS: Hip radiographs without a physical grid obtained from a volunteer research study were retrospectively processed with and without IBEX TrueView scatter correction. Objective analysis of 63 images assessed contrast, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) across regions of interest, stratified by body mass index (BMI) and bone density. Seven radiographers of varying experience subjectively assessed 24 images for diagnostic acceptability, overall image quality, anatomical visibility, and windowing behaviour under controlled viewing conditions. RESULTS: Scatter-corrected images showed consistently higher contrast and CNR across BMI and bone density categories than uncorrected images. A reduction in SNR over bone regions was observed following scatter correction, consistent with removal of background scatter signal. Subjectively, scatter-corrected images were more frequently rated as diagnostically acceptable and achieved higher median image quality scores. Anatomical visibility scores favoured scatter-corrected images for all assessed structures. Scatter-corrected images also required less windowing, indicating improved baseline image presentation. CONCLUSION: Software-based scatter correction improves contrast and perceived diagnostic image quality in hip radiographs, despite an associated increase in visible noise. Reduced reliance on windowing suggests potential workflow and reporting efficiency benefits. These findings support further evaluation of scatter correction as an alternative to physical grids in musculoskeletal radiography, particularly in mobile and trauma settings. PLAIN LANGUAGE SUMMARY: Hip X-rays can be hard to perform because unwanted radiation scatter can reduce image quality. This study compared hip X-rays with and without a software tool that removes some of this scatter. This study found that the software improved image contrast, made anatomy easier to see, and increased overall image quality, although images showed slightly more noise. This matters because software-based image improvement may help produce clearer X-rays and could offer an alternative to equipment that can increase radiation dose or be difficult to use in some situations.