Objectives We evaluated the different Virtual Grid software ratios (Fujifilm, Tokyo, Japan) on gridless clinical chest radiographs with visual grading analysis (VGA). In addition, we investigated the 2 image quality assessment algorithms (IQAAs). Materials and Methods Gridless chest radiographs of 50 different intensive care unit patients were collected and afterward processed with Virtual Grid software. Different software (SW) grid ratios—6:1, 10:1, 13:1, 17:1, and 20:1—were applied to investigate the image quality (IQ) improvement. Image quality improvement was assessed by 4 radiologists in a relative VGA study where the reference image was processed with SW grid ratio of 10:1. One of the IQAAs used to analyze the radiographs was implemented in our department but was originally developed by the research group of the Duke University Medical Center. A general IQ score (IQS) was calculated based on contrast, detail, and noise. Another IQAA—NIQE (naturalness image quality evaluator)—available in Matlab (MATLAB Research R2019b; the MathWorks, Inc) was evaluated. Both methods were compared with VGA. Results Visual grading analysis scores of gridless radiographs are significantly lower (P
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