Image-intensifier photofluorography and conventional chest radiography: comparison of diagnostic efficacy

Photofluorography with a large image intensifier, which provides an image field of 40 x 40 cm, reduces both the radiation dose and the imaging costs in chest radiography as compared with the film-screen technique. The two techniques were evaluated in a clinical study of 135 patients with suspected chest abnormalities. Photofluorographs and film-screen chest radiographs were interpreted independently by three radiologists. The diagnoses were confirmed by CT, follow-up radiographs, and clinical records. Among the 135 patients, 75 had primary lung cancer, 39 had pulmonary nodules, 52 had hilar or mediastinal abnormalities, 17 had pleural fluid, and 45 had pneumonic or atelectatic changes. Twenty-three normal subjects were included. Differences in diagnostic accuracy, measured by sensitivity and specificity, were not statistically significant. A larger number of true-positive cases (65%) with peripheral lung nodules were found by photofluorography than by film-screen radiography (54%) (p less than .05). The results suggest that the diagnostic accuracy of chest images made by photofluorography is sufficient to warrant using it instead of the film-screen technique in routine chest radiography, especially to detect lung tumors and metastases.