Comparison of conventional and computed radiography: assessment of image quality and reader performance in skeletal extremity trauma.

RATIONALE AND OBJECTIVES: Reader performance and image quality wee assessed for standard film, computed film, and computer monitor radiography viewing formats in the evaluation of skeletal extremity trauma.

MATERIALS AND METHODS: Three radiologists and three orthopedic surgeons interpreted 27 skeletal radiographs obtained with equivalent technical parameters. Readers evaluated standard film, computed film, and computer monitor formats randomly for fracture and soft-tissue abnormalities. Sessions were videotaped, and eye motion was recorded.

RESULTS: No statistically significant differences were found between image formats for true-positive or false-positive findings of trauma indicators. Findings were classified as false-negative based on eye position fixation times. Search errors (lesion not fixated) accounted for 21.7%, 20.6% and 17.1% of false-negative errors with the computer monitor, computed film, and standard film formats, respectively. Combined recognition errors and decision errors were 78.3%, 79.4%, and 82.9%, respectively. Viewing times were longest for the computer monitor images (P < .001). Image quality, contrast, and sharpness were rated highest for computed radiographs (P = .001). Radiologists had a higher true-positive decision rate than orthopedic surgeons (P = .03).

CONCLUSION: No statistically significant differences were seen in reader performance among viewing formats. The computed film format received the highest quality rating, and workstation viewing times were longest.