Diagnostic usefulness of chest computed radiography--film versus cathode-ray tube images

Seventy-one plain chest images obtained by computed radiography (CR) with an imaging plate were interpreted on film and two kinds of cathode-ray tube (CRT) monitors installed separately at two facilities (1,024 x 1,536 pixels, 8 bits, and 1,024 x 1,280 pixels, 10 bits) by 20 radiologists and four chest internists. The clinical categories of these 71 cases included pulmonary nodules and interstitial abnormalities. Image reading sessions were held over a total of 4 days, ie, 2 days and then another 2 days, 3 weeks later. Twenty-four observers formed four groups with six members each. Two groups read either films or CRT images at one of the two facilities. In the second experiment, 26 of 71 images were compressed at 10:1, 19 of 71 were compressed at 20:1, and 26 were not compressed. Analyses of the areas under the receiver-operating characteristic curves showed no significant differences in detection of pulmonary abnormalities between film and CRT. In detecting interstitial pulmonary abnormalities, film was more sensitive than CRT monitor. There were no significant differences in observers' performances between the two different kinds of CRT workstation. Subjective evaluation of image quality showed that images irreversibly compressed to the ratios of 10:1 and 20:1 were inferior to original images. Although further considerations are needed with regard to spatial resolution requirements, image processing, and image compression, the utilization of CR CRT image as a substitute for CR film image will be possible.