Hard-Copy Versus Soft-Copy with and Without Simple Image Manipulation for Detection of Pulmonary Nodules and Masses

PURPOSE: To compare interpretation performance on soft-copy presentations, with and without simple image manipulation, and on unmodified hard-copy presentations with regard to detection of pulmonary nodules and masses. MATERIAL AND METHODS: Fifty chest digital radiograph combinations of patients with a total of 60 nodules, 32 of which were 2.0 cm in diameter, were selected for the study. Three readers evaluated three separate image formats: unmodified hard- and soft-copies, and soft-copies with simple image manipulation of lung and mediastinum window settings, and zooming. The screen display was 1600 x 1200 pixels with 8 bits/pixel. RESULTS: The sensitivity, accuracy, detectability, and Az value of the soft-copy systems were clearly inferior to hard-copy evaluation. The mean Az values were 0.921 for unmodified hard-copy, 0.820 for image-manipulated soft-copy, and 0.781 for unmodified soft-copy. CONCLUSION: Soft-copy interpretations were not as sensitive in detecting pulmonary nodules and masses as hard-copy evaluation.