title: Intramodality and intermodality comparisons of storage phosphor computed radiography and conventional film-screen radiography in the recognition of small pneumoconiotic opacities.
abstract: BACKGROUND
  Digital radiography systems are replacing traditional film for chest radiographic monitoring in the recognition of pneumoconiosis.
  
  
  METHODS
  To further investigate previous findings regarding the equivalence of film-screen radiographs (FSRs) and storage phosphor computed radiographs (CRs), FSRs and CRs from 172 underground coal miners were classified independently by seven National Institute for Occupational Safety and Health-approved B readers, using the International Labor Office (ILO) classification of radiographs of pneumoconiosis.
  
  
  RESULTS
  More CRs were classified as "good" quality compared with FSRs (prevalence ratio [PR], 1.5; 95% CI, 1.4-1.6; P , .001). B readers showed good overall agreement on scoring small opacity profusion using CRs vs FSRs (weighted κ, 0.58; 95% CI, 0.54-0.62). Significantly more irregular opacities (compared with rounded) were classified using CR images compared with FSR (PR, 1.3; 95% CI, 1.1-1.6; P = .01). Similarly, the smallest sized opacities (width < 1.5 mm, p and s type) were reported more frequently using CR vs FSR images (PR, 1.3; 95% CI, 1.1-1.5; P < .001). Interreader and intrareader agreement was lower with respect to the classification of shape and size than for small opacity profusion. Overall, interreader and intrareader variability did not differ significantly using CR vs FSR.
  
  
  CONCLUSIONS
  Under optimal conditions, using standardized methods and equipment, reader visualization of small pneumoconiotic opacities does not appear to differ meaningfully, whether using CR or FSR. Variability in ILO classifications between imaging modalities appears to be considerably lower than variability among readers. The well-documented challenge of reader variability does not appear to be resolved through the use of digital imaging alone, and additional approaches must be evaluated.
authors.affiliation: Surveillance Branch, Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV. Electronic address: alaney@cdc.gov.
authors.forename: A Scott
authors.initials: AS
authors.lastname: Laney
authors.affiliation: Surveillance Branch, Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV.
authors.forename: Edward L
authors.initials: EL
authors.lastname: Petsonk
authors.affiliation: Surveillance Branch, Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Attfield
mesh_terms: D000328:Adult; D003032:Coal Mining; D015331:Cohort Studies; D016001:Confidence Intervals; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D016272:Occupational Health; D016017:Odds Ratio; D010758:Phosphorus; D011009:Pneumoconiosis / Q000000981:diagnostic imaging* / Q000473:pathology; D011856:Radiographic Image Enhancement / Q000379:methods*; D013902:Radiography, Thoracic / Q000379:methods; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D010758:Phosphorus