title: Using receiver operating characteristic methodology to evaluate the diagnostic quality of radiography on paper prints versus film.
abstract: OBJECTIVE
  The aim of this study was to compare the diagnostic quality of paper prints with film copies in a sample of observers who were trying to detect small coin lesions on radiographs of a phantom.
  
  
  METHODS
  The phantom consisted of 60 high-contrast and 60 low-contrast test objects, half of which had holes in them. Diameter and depth of the holes varied from 0.5 mm to 2 mm. Fifteen radiographs were obtained from different areas of the test objects. Film copies and paper prints were made using high-quality printers. Five observers independently evaluated 1,800 high-contrast and 1,800 low-contrast images. Data were evaluated using the well-established receiver operating characteristic methodology.
  
  
  RESULTS
  The mean area under the curve rated 0.863 for paper prints (0.859 for high contrast and 0.860 for low contrast) and 0.926 for laser films (0.937 for high contrast and 0.913 for low contrast). The difference between the two imaging techniques was statistically significant for both high- and low-contrast lesions (p < 0.05).
  
  
  CONCLUSIONS
  Detection of small coin lesions on radiographs of a phantom was significantly less sensitive on paper prints than on film. We found paper prints less acceptable for the diagnosis of small-sized lesions.
authors: Department of Diagnostic Radiology, University Hospital Freiburg, Hugstetter Stra. 55, Freiburg 79106, Germany. bley@mrs1.ukl.uni-freiburg.de
authors: T A
authors: TA
authors: Bley
authors: E
authors: E
authors: Kotter
authors: U
authors: U
authors: Saueressig
authors: O S
authors: OS
authors: Springer
authors: D
authors: D
authors: Fisch
authors: N A
authors: NA
authors: Ghanem
authors: M
authors: M
authors: Langer
mesh_terms: D003951:Diagnostic Errors; D006801:Humans; D010209:Paper; D019047:Phantoms, Imaging; D012372:ROC Curve; D011859:Radiography / Q000295:instrumentation*; D015203:Reproducibility of Results; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging*; D014962:X-Ray Film