Soft-copy versus hard-copy cranial sonography: intraobserver agreement and workstation efficiency

Area of Science:

• Medical imaging
• Radiology
• Neonatal care

Background:

• Cranial sonography is crucial for evaluating premature infants.
• Digital imaging (soft-copy) is increasingly replacing traditional film (hard-copy) in radiology.
• Assessing the impact of display modality on diagnostic performance is essential.

Purpose of the Study:

• To compare intraobserver agreement, confidence, and interpretation efficiency of cranial sonograms displayed on soft-copy versus hard-copy.
• To evaluate the impact of display modality on radiologist performance in diagnosing intracranial hemorrhage in neonates.

Main Methods:

• Three observers reviewed cranial sonograms of 100 premature infants twice.
• Images were presented in both soft-copy (workstation) and hard-copy (laser-printed film) formats.
• Intraobserver agreement (kappa statistic), confidence scores, and viewing times were recorded and analyzed.

Main Results:

• Intraobserver agreement and confidence scores were similar for both soft-copy and hard-copy interpretations (mean kappa .73 vs .71, confidence 5.3 vs 5.3).
• Soft-copy interpretation required significantly more viewing time (24 minutes longer per 100 studies) primarily due to case selection.
• While soft-copy image handling (opening/closing) was faster, case selection added 8-15 minutes per 100 cases.

Conclusions:

• Soft-copy and hard-copy display of cranial sonograms yield comparable radiologist agreement and confidence for hemorrhage detection.
• Current soft-copy workflows are less efficient due to time spent on case selection.
• Optimizing soft-copy case selection interfaces could improve interpretation efficiency without compromising diagnostic accuracy.