PURPOSE: Grids are often not used in mobile chest radiography, and when used, they have a low ratio and are often inaccurately aligned. Recently, a mobile radiography automatic grid alignment system (MRAGA) was developed that accurately and automatically aligns the focal spot with the grid. The objective of this study is to investigate high-ratio grid tradeoffs in mobile chest radiography at fixed patient dose when the focal spot lies on the focal axis of the grid. METHODS: The chest phantoms (medium and large) used in this study were modifications of the ANSI (American National Standards Institute) chest phantom and consisted of layers of Lucite™, aluminum, and air. For the large chest phantom, the amount of Lucite and aluminum was increased by 50% over the medium phantom. Further modifications included a mediastinum insert and the addition of contrast targets in the lung and mediastinum regions. Five high-ratio grids were evaluated and compared to the nongrid results at x-ray tube potentials of 80, 90, 100, and 110 kVp for both phantoms. The grids investigated were from two manufacturers: 12:1 and 15:1 aluminum interspace grids from one and 10:1, 13:1, and 15:1 fiber interspace grids from another. MRAGA was employed to align the focal spot with the grid. All exposures for a given kVp and phantom size were made using the same current-time product (CTP). The phantom images were acquired using computed radiography, and contrast-to-noise ratios (CNR) and CNR improvement factors (k(CNR)) were determined from the resultant images. The noise in the targets and the contrast between the targets and their backgrounds were calculated using a local detrending correction, and the CNR was calculated as the ratio of the target contrast to the background noise. k(CNR) was defined as the ratio of the CNR imaged with the grid divided by the CNR imaged without a grid. RESULTS: The CNR values obtained with a high-ratio grid were 4%-65% higher than those obtained without a grid at the same phantom dose. The improvement was greater for the large chest phantom than the medium chest phantom and greater for the mediastinum targets than for the lung targets. In general, the fiber interspace grids performed better than the aluminum interspace grids. In the lung, k(CNR) for both types of grids exhibited little dependence on kVp or grid ratio. In the mediastinum, k(CNR) decreased 4%-10% with increasing kVp, and varied up to 5.3% with grid ratio. CONCLUSIONS: When the focal spot is accurately aligned with the grid, the use of a high-ratio grid in mobile chest radiography improves image quality with no increase in dose to the phantom. For the grids studied, the performance of the fiber interspace grids was superior to the performance of the aluminum interspace grids, with the fiber interspace 13:1 grid producing the best overall results for the medium chest phantom and the fiber interspace 15:1 producing the best overall results for the large chest phantom.