[Monitor assessment of digitalized and post-processed portal films compared to conventional films presented on a...

Judgement of image quality and detail recognition of digitized and post-processed portal films presented on a computer monitor compared to the present standard, conventional portal films presented on a light box.

Conventional portal films of 3 different tumor sites (10 pelvis, 10 cranium, 10 vertebral column) were presented to a panel of 8 observers in 3 different matters: conventional film presented on a light box (Conv), digitized post-processed images (Dig-1) and digitized post-processed images (Dig-2) presented on a high resolution computer monitor. Subjective judgement of image quality, detailed recognition and time requirement of conventional films compared to monitor presentation were evaluated using a 5-scaled questionnaire (from 1 = much better to 5 = much worse). Furthermore the observers had to point out predefined anatomical bony structure on the conventional films (Conv) as well as on the digitized post-processed images (Dig-2). Standard deviations of the landmark outlined by 10 different observers were used as a criterion of objective detail recognition (Figure 1).

Image quality of digitized post-processed images presented on the computer monitor was judged statistical significant better than that of conventional films (pelvis 78%, vertebral column 62%, cranium 45% better) (Figure 3). Similar results were found for comparison of detail recognition: digitized post-processed images were scored better for pelvis in 81%, for vertebral column in 57%, for cranium in 40% (Figure 4, Table 1). Most benefit from portal film enhancement was found for pelvic images, where portal films are known to be of poor image quality (Figure 2). In contrast image quality of non-processed digital images compared to conventional films was graded worse (pelvis 69%, vertebral column 53%, cranium 71% worse) (Figure 4). Digital post-processed images were especially for the pelvis judged to require less time (pelvis 68%, vertebral column 26%, cranium 8% less time requirement) (figure 5). For the pelvis a statistical significant decrease of standard deviations was found for Dig-2 compared to conventional films, indicating an objective increase of image quality and detailed recognition (Table 2). In case of vertebral column and cranium no significant differences were evaluated (Table 3).

Digitized enhanced portal films presented on a computer monitor resulted in a quicker assessment and equal to better image quality as well as detail recognition compared to conventional films. Non-processed digitized images were judged to be of less image quality.