title: Changing from analog to digital images: does it affect the accuracy of alignment measurements of the lower extremity?
abstract: OBJECTIVE
  Medical imaging has changed from analog films to digital media. We examined and compared the accuracy of orthopedic measurements using different media.
  
  
  METHODS
  Before knee arthroplasty, full-length standing radiographs of 52 legs were obtained. The mechanical axis (MA), tibio-femoral angle (TFA), and femur angle (FA) were measured and analyzed twice, by 2 radiologists, using (1) true-size films, (2) short films, (3) a digital high-resolution workstation, and (4) a web-based personal computer. The agreement between the 4 media was evaluated using the Bland-Altman method (limits of agreement) using the true-size films as a reference standard.
  
  
  RESULTS
  The mean differences in measurements between the traditional true-size films and the 3 other methods were small: for MA -0.20 to 0.07 degrees, and for TFA -0.02 to 0.18 degrees. Also, the limits of agreement between the traditional true-size films and the three other methods were small.
  
  
  CONCLUSIONS
  The agreement of the alignment measurements across the 4 different media was good. Orthopedic angles can be measured as accurately from analog films as from digital screens, regardless of film or monitor size.
authors: Helsinki University Central Hospital, Helsinki, Finland. martina.lohman@hus.fi
authors: Martina
authors: M
authors: Lohman
authors: Kaj
authors: K
authors: Tallroth
authors: Jyrki A
authors: JA
authors: Kettunen
authors: Ville
authors: V
authors: Remes
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