Table 2 - uploaded by Richard L Morin
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The purposes of this study were to determine whether (1) fractures are interpreted differently after digitization and electronic
presentation; (2) there are differences in accuracy between screen radiographs and electronic presentation; (3) differences
in interpretation are a function of monitor resolution; and (4) differences in interpretation bet...
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Citations
... As limb lengthening practices transition to digital acquisition and PACS, differences between manual measurements performed on hard-copy radiographs and digital measurements performed on soft-copy images must be validated. Several studies have compared the reliability, accuracy, and diagnostic performance of digital imaging versus hard-copy radiographs for fracture interpretation [1], interpretation of sonograms [2], hand radiographs [4], chest, brain, and abdominal CT scans [6, 13], MRI for meniscal tears [7], chest radiographs [13] , and comparison of standing full-length radiographs versus scanograms for patients with LLD [9]. These studies found no differences for either system. ...
... They concluded that standing full-length radiographs are as equally reliable as a scanogram for measuring LLD. Other studies report no differences in the reliability, accuracy, and diagnostic performance of digital imaging versus hard-copy radio- graphs [1, 2, 4, 6, 7, 9, 13] . By comparing all the extremity lengths and angular variations, and on valuating the difference in data, the digitally acquired images in PACS permit a smooth transition in clinical reliability. ...
... An added advantage is the reduction in printing of films (in multiple), storing film files, and eventually destroying printed copies. Use of PACS is reliable in a clinical setting [1, 8, 9, 11]. Our observations suggest that regarding the 51-inch standing bilateral leg radiograph, soft-copy deformity and length measurements are as reliable as manual hard-copy measurements. ...
The picture archiving and communication system (PACS) eventually will replace the use of standard hard-copy radiographs. It is unknown whether measurements of limb length discrepancy (LLD) and deformity on PACS compare in accuracy and reproducibility with those from hard-copy radiographs.
We compared the reproducibility and reliability of LLD and deformity measurements for each of these two media.
We retrospectively reviewed 51-inch standing lower extremity images obtained for LLD or deformity analysis from 40 patients to compare the measurements and their reliability on hard-copy film with those performed on soft-copy PACS. Two observers independently performed measurements twice using each system at 1-week intervals to minimize interobserver or intraobserver bias. Intraclass correlation coefficients (ICCs) were determined to test intraobserver and interrater reliability of Rater 1 and Rater 2.
Interrater reliability of measurements made on hard copy ranged from 0.69 to 0.99 and PACS-derived measurements ranged from 0.66 to 0.98. Intraobserver reliability for Rater 1 for measurements made on hard copy ranged from 0.853 to 0.999 and PACS-derived measurements ranged from 0.80 to 0.996. Intraobserver reliability for Rater 2 for measurements made on hard copy ranged from 0.931 to 0.999 and PACS-derived measurements ranged from 0.962 to 0.999.
Each system yielded comparable reliability for measurements, therefore, transition to PACS to perform measurements in patients with LLD or deformity can be made with confidence.
Level III, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.
... PC-based interpretation of radiographs is in comparison to that with a PACS workstation (the standard of reference). There has been very little investigation of this issue in general and almost none related to fractures (3)(4)(5)(6)(7). ...
... Similar considerations apply to another study in which researchers demonstrated differences in accuracy of fracture interpretation on digitized screen-film radiographs, depending on the monitor system used (5). In that study, a PC was used; however, only the lower resolution of two digitizers and a lossy compression system were used. ...
To retrospectively compare the accuracy of observer performance with personal computer (PC) compared with that with dedicated picture archiving and communication system (PACS) workstation display in the detection of wrist fractures on computed radiographs.
This study was conducted according to the principles of the Declaration of Helsinki (2002 version) of the World Medical Association. The institutional clinical board approved the study; informed consent was not required. Seven observers independently assessed randomized anonymous digital radiographs of the wrist from 259 subjects; 146 had fractures, and 113 were healthy control subjects (151 male and 108 female subjects; average age, 33 years). Follow-up radiographs and/or computed tomographic scans were used as the reference standard for patients with fractures, and follow-up radiographs and/or clinical history data were used as the reference standard for controls. The PC was a standard hospital machine with a 17-inch (43-cm) color monitor with which Web browser display software was used. The PACS workstation had two portrait 21-inch (53-cm) monochrome monitors that displayed 2300 lines. The observers assigned scores to the radiographs on a scale of 1 (no fracture) to 5 (definite fracture). Receiver operating characteristic (ROC) curves, sensitivity, specificity, and accuracy were compared.
The areas under the ROC curves were almost identical for the PC and workstation (0.910 vs 0.918, respectively; difference, 0.008; 95% confidence interval: -0.029, 0.013). The average sensitivity with the PC was almost identical to that with the workstation (85% vs 84%, respectively), as was the average specificity (82% vs 81%, respectively). The average accuracy (83%) was the same for both.
The results of this study showed that there was no difference in accuracy of observer performance for detection of wrist fractures with a PC compared with that with a PACS workstation.
We evaluated a telemammography system for reviewing and rating screening mammography in a clinical setting. Three remote sites transmitted 306 exams to a central site. Films were digitized at 50 micron pixel dimensions and compressed at a 50:1 ratio. At the central site images were displayed on a workstation with two high-resolution monitors. Five radiologists reviewed and rated the screens without the availability of prior images or additional information indicating: 1) if additional procedures were needed, 2) which breast was involved, and 3) when appropriate, the recommended additional procedures. During the actual clinical interpretation 13.7% (42 cases) of the patients were recalled for additional procedures. During the retrospective review radiologists 1, 2, 3, 4, and 5 recommended additional procedures for 26.1%, 29.1%, 36.3%, 45.1%, and 54.2% of the cases, respectively. The agreements between the clinical interpretation and radiologists 1, 2, 3, 4, and 5 were 77.8%, 76.1%, 69.0%, 62.7%, and 53.6%, respectively. The exceedingly high percentage of recommended additional procedures using the workstation was attributed to lack of prior images or additional information, the knowledge that case management was not affected, and the observers" expectation for an enriched case mix.
The purpose of this study is to investigate the effects of different bit depths and kilovoltage peak (kVp) values used in intraoral digital radiography on observer performance in detecting subtle radiographic density differences.
Using an intraoral CCD sensor set at 8- or 12-bit depth, kVp set at 60 or 70, and 14 different exposure times, digital radiographs were acquired of a specially designed aluminum step-wedge phantom with small holes of different depths in each step. Ten observers examined all images.
The observers counted more holes with the 12-bit images compared with the 8-bit images, particularly at 60 kVp. Significantly more holes were also counted with images taken at 70 kVp compared with those taken at 60 kVp.
Regarding the detection of subtle radiographic density differences, 12-bit images and 70 kVp were superior to 8-bit images and 60 kVp.
