title: Scanning technology selection impacts acceptability and usefulness of image-rich content.
abstract: OBJECTIVE
  Clinical and research usefulness of articles can depend on image quality. This study addressed whether scans of figures in black and white (B&W), grayscale, or color, or portable document format (PDF) to tagged image file format (TIFF) conversions as provided by interlibrary loan or document delivery were viewed as acceptable or useful by radiologists or pathologists.
  
  
  METHODS
  Residency coordinators selected eighteen figures from studies from radiology, clinical pathology, and anatomic pathology journals. With original PDF controls, each figure was prepared in three or four experimental conditions: PDF conversion to TIFF, and scans from print in B&W, grayscale, and color. Twelve independent observers indicated whether they could identify the features and whether the image quality was acceptable. They also ranked all the experimental conditions of each figure in terms of usefulness.
  
  
  RESULTS
  Of 982 assessments of 87 anatomic pathology, 83 clinical pathology, and 77 radiology images, 471 (48%) were unidentifiable. Unidentifiability of originals (4%) and conversions (10%) was low. For scans, unidentifiability ranged from 53% for color, to 74% for grayscale, to 97% for B&W. Of 987 responses about acceptability (n=405), 41% were said to be unacceptable, 97% of B&W, 66% of grayscale, 41% of color, and 1% of conversions. Hypothesized order (original, conversion, color, grayscale, B&W) matched 67% of rankings (n=215).
  
  
  CONCLUSIONS
  PDF to TIFF conversion provided acceptable content. Color images are rarely useful in grayscale (12%) or B&W (less than 1%). Acceptability of grayscale scans of noncolor originals was 52%. Digital originals are needed for most images. Print images in color or grayscale should be scanned using those modalities.
authors.forename: Kristine M
authors.initials: KM
authors.lastname: Alpi
authors.forename: James C
authors.initials: JC
authors.lastname: Brown
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Neel
authors.forename: Carol B
authors.initials: CB
authors.lastname: Grindem
authors.forename: Keith E
authors.initials: KE
authors.lastname: Linder
authors.forename: James B
authors.initials: JB
authors.lastname: Harper
mesh_terms: D003952:Diagnostic Imaging / Q000592:standards*; D004282:Documentation / Q000592:standards*; D057286:Electronic Health Records / Q000592:standards*; D006801:Humans; D007379:Interlibrary Loans / Q000592:standards*; D007993:Libraries, Medical / Q000592:standards*; D008855:Microscopy, Electron, Scanning / Q000592:standards*; D010781:Photography / Q000592:standards*; D014481:United States
keywords: Image Compression; Image Enhancement; Interlibrary Loans; Pathology; Photographs; Radiology