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In daily clinical practice, using only the large focal spot has many potential advantages: simplifying workflow, but also – indirectly – having a positive impact on image quality and financial aspects.

This study demonstrates that there is no significant difference in clinical image quality between large and small focal spot for several types of X ray extremity radiographs at standard exposure conditions. For on-table exposures of extremities at standard SID using DR detectors with standard pixel pitch, the small focal spot has no added value and hence can be omitted.