In dual-energy digital radiography (DEDR), the energy subtraction and equivalent thickness methods have been used for detecting thorax lesions. However, the image contrast of the energy subtraction method is low in comparion with that of the equivalent thickness and synthetic methods. Therefore, we applied the equivalent thickness and synthetic methods to material separation to enhance the bone and tissue contrast, and these results were compared with the results of the energy subtraction method in a chest DEDR system. The purpose of this work was to evaluate the image quality of the energy subtraction, equivalent thickness, and synthetic methods. In the energy subtraction method, the optimal weighting factors were selected for bone and tissue visualization, respectively. The equivalent thickness was obtained with a calibration procedure by using combinations of aluminum and polymethyl methacrylate (PMMA) blocks. The synthetic images were acquired with the known equation from the results of the equivalent thickness method. According to these results, the contrast-to-noise-ratio (CNR) values using the equivalent thickness and synthetic methods were improved than those obtained with the energy subtraction method in both aluminum and PMMA enhancement trial. In a cylindrical phantom study, the equivalent thickness and the synthetic method improved the contrast better than energy subtraction method. The synthetic method supplements the air shadows shown in the equivalent thickness method. We compared the enhanced images of bone and tissue with the energy subtraction, equivalent thickness, and synthetic methods. Our results showed that the effects of the synthetic method can improve the image contrast on both bone and tissue and overcome the bone shadows in tissue images in a DEDR system.

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