title: Comparison of fixed and adjustable window width and level settings in the CT evaluation of diffuse lung disease.
abstract: OBJECTIVE
  The purpose of this investigation was to assess the utility of allowing free adjustment of window width and level in comparison with the use of a fixed lung window in the CT evaluation of diffuse lung disease.
  
  
  METHODS
  Six radiologists each judged 36 cases (28 diffuse lung disease and 8 normal) using a standardized form. In half of the sessions, images were viewed in a fixed lung window (level = -500 HU; width = 2,000 HU). In the other sessions, the observer was able to adjust the window and level freely while viewing the images. Each case was seen twice in separate sessions: once in a fixed lung window and once with window width and level adjusted by the reader. A variety of diagnostic features were evaluated using a 5 point scale. These included visibility of fine lung structures, abnormalities of the lung parenchyma, and overall evaluation of the lung.
  
  
  RESULTS
  The visibility of lung structures was not improved with adjustable window settings. Receiver operating characteristic (ROC) analysis showed fixed windows to be superior to adjustable windows for overall evaluation of the cases [fixed A(z) = 0.90, adjustable A(z) = 0.84, p < 0.05, jackknife method]. Time to rate each case was increased by 15% with window width and level adjustment.
  
  
  CONCLUSIONS
  Free adjustment of window width and level produced no improvement in reader performance over that achieved with fixed window width and level.
authors.affiliation: Department of Radiology, Long Island Jewish Medical Center, Albert Einstein College of Medicine, New Hyde Park, NY 11042.
authors.forename: W M
authors.initials: WM
authors.lastname: Maguire
authors.forename: P G
authors.initials: PG
authors.lastname: Herman
authors.forename: A
authors.initials: A
authors.lastname: Khan
authors.forename: R H
authors.initials: RH
authors.lastname: Smith
authors.forename: S
authors.initials: S
authors.lastname: Noma
authors.forename: T M
authors.initials: TM
authors.lastname: Eacobacci
authors.forename: D M
authors.initials: DM
authors.lastname: Barlev
authors.forename: N
authors.initials: N
authors.lastname: Mandell
authors.forename: A
authors.initials: A
authors.lastname: Sunshine
authors.forename: M
authors.initials: M
authors.lastname: Carlin
mesh_terms: D006801:Humans; D007091:Image Processing, Computer-Assisted; D008171:Lung Diseases / Q000000981:diagnostic imaging*; D012372:ROC Curve; D014057:Tomography, X-Ray Computed / Q000379:methods*