title: Reporting requirements for skeletal digital radiography: comparison of soft-copy and hard-copy presentation.
abstract: OBJECTIVE
  To assess diagnostic performance and reader preference when reporting results from digital hard-copy and two soft-copy formats of skeletal digital radiography.
  
  
  METHODS
  The data comprised hand radiographs of patients undergoing renal dialysis. Normal hand radiographs obtained in trauma patients were assessed as control images. One hundred fifteen images acquired with a photostimulable-phosphor computed radiography system were analyzed. Image selection and initial assessment were by consensus of two experienced radiologists, who graded the radiographic changes of hyperparathyroidism with the Ritz scoring system. The images were then presented to four readers in three formats: hard-copy output and soft-copy presentations at 2K2 and 1K2 resolutions. These readers scored pathologic change and image preference. The results were analyzed with the receiver operating characteristic technique.
  
  
  RESULTS
  There was a significant improvement in diagnostic performance for both soft-copy formats relative to the hard-copy format (P < .001). No significant difference in diagnostic performance was found between the two soft-copy formats. There was a significant preference for both soft-copy formats relative to the hard-copy format (P < .01), with the 2K2 soft-copy images preferred to the 1K2 images (P < .01).
  
  
  CONCLUSIONS
  Soft-copy reporting can provide superior diagnostic performance even for images viewed at a modest (1K2) resolution. The lack of difference between the two soft-copy formats has important economic implications with respect to departmental hardware requirements.
authors.affiliation: Department of Clinical Radiology, General Infirmary at Leeds, England.
authors.forename: P J
authors.initials: PJ
authors.lastname: O'Connor
authors.forename: A G
authors.initials: AG
authors.lastname: Davies
authors.forename: R C
authors.initials: RC
authors.lastname: Fowler
authors.forename: D J
authors.initials: DJ
authors.lastname: Lintott
authors.forename: R F
authors.initials: RF
authors.lastname: Bury
authors.forename: G J
authors.initials: GJ
authors.lastname: Parkin
authors.forename: D
authors.initials: D
authors.lastname: Martinez
authors.forename: A
authors.initials: A
authors.lastname: Saifuddin
authors.forename: A R
authors.initials: AR
authors.lastname: Cowen
mesh_terms: D001842:Bone and Bones / Q000000981:diagnostic imaging*; D006225:Hand / Q000000981:diagnostic imaging; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging; D007091:Image Processing, Computer-Assisted; D012372:ROC Curve; D011856:Radiographic Image Enhancement; D014963:X-Ray Intensifying Screens