Impact of image size on effectiveness of digital imaging systems

Radiologists detect small diagnostic signals in radiographic film images by altering the distance between the eye and the image, effectively zooming in on a particular detail. Details thus enlarged are more perceptible to the viewer. Considering that conventional film images are nearly life-size, the potential for increasing the detection of small signals in this manner is high. Digital images, however, presented in video format are usually smaller than life-size, sometimes more than 50% smaller. While local enlargements using computer-based imaging systems are extremely useful, the radiologist cannot examine a whole, life-size image. The importance of the latter in the diagnostic process is revealed in detection studies using the same images of a chest phantom with small nodular inclusions, in different size formats. A clear positive correlation exists between overall image size and the detection of signals that are of a diagnostically-relevant size. While it is widely accepted that image fidelity is an important determinant in the clinical acceptability of digital radiography, digital image displays should also be large enough to display life-size images.