title: A comparison of conventional film, CR hard copy and PACS soft copy images of the chest: analyses of ROC curves and inter-observer agreement.
abstract: OBJECTIVE
  The aim of this study was to determine whether the accuracy of diagnosis of a spectrum of chest pathology was affected by the imaging technique used, and to compare conventional film/screen, hard copy computed (phosphor plate) radiography (CR) and soft copy CR (PACS) images.
  
  
  METHODS
  For each of 44 patients who had a CT examination of the thorax, PA and lateral chest radiographs were produced using conventional film, hard copy CR and soft copy PACS images. Five radiologists independently scored all images for the presence of abnormalities. The data were analysed in two stages using the result of the CT scan as the reference standard diagnosis: firstly, to investigate differences in abnormality scores between image modalities and observers using ROC analysis; secondly, to investigate the agreement of the diagnoses with the reference standard by the analysis of kappa scores.
  
  
  RESULTS
  The ROC analyses and comparison of kappa scores showed no differences between image modalities (P=0.72, P=0.87), but highly significant differences between observers (P<0.001, P=0.003).
  
  
  CONCLUSIONS
  The detection of chest lesions did not vary between conventional film, CR hard copy and PACS soft copy images. For all three image types, there were statistically significant differences between observers.
authors.affiliation: Health Economics Research Group, Brunel University, Uxbridge, UK. gwyn.weatherburn@bcuc.ac.uk
authors.forename: Gwyneth C
authors.initials: GC
authors.lastname: Weatherburn
authors.forename: Deborah
authors.initials: D
authors.lastname: Ridout
authors.forename: Nicola H
authors.initials: NH
authors.lastname: Strickland
authors.forename: Peter
authors.initials: P
authors.lastname: Robins
authors.forename: Christine M
authors.initials: CM
authors.lastname: Glastonbury
authors.forename: Walter
authors.initials: W
authors.lastname: Curati
authors.forename: Chris
authors.initials: C
authors.lastname: Harvey
authors.forename: Clair
authors.initials: C
authors.lastname: Shadbolt
mesh_terms: D000704:Analysis of Variance; D006801:Humans; D015588:Observer Variation; D012372:ROC Curve; D013902:Radiography, Thoracic / Q000295:instrumentation* / Q000706:statistics & numerical data*; D011873:Radiology Information Systems / Q000295:instrumentation* / Q000706:statistics & numerical data*; D013909:Thorax; D006113:United Kingdom; D014962:X-Ray Film