Detection of pneumothorax: comparison of digital and conventional chest imaging

To investigate radiologists' performance at interpreting digital radiographic images, we compared the detectability of pneumothoraces on computed radiographic chest images with 0.2-mm pixel size (2.5 Ip/mm) with their detectability on matched conventional screen-film images (5 Ip/mm). Eight radiologists reviewed 50 computed and 50 screen-film chest radiographs from 25 patients with pneumothoraces and 25 patients with other (or no) abnormalities. Four of the readers who best detected pneumothoraces on screen-film examinations performed worse when interpreting computed radiographic studies; the other four readers detected pneumothoraces similarly with both techniques. No relationship was found between the size of a pneumothorax and its likelihood of detection by either technique. These results raise concerns about implementing computed radiography for comprehensive chest imaging.