title: Digital Paper Prints as Replacement for LASER Films: A Study of Intra-Observer Agreement for Wrist Radiographic Findings in Rickets.
abstract: BACKGROUND
  Replacement of conventional LASER films with digital paper prints as supplement to radiology reports may serve as an economical and environment friendly method. However, it is essential that such a change does not compromise patient's intended diagnostic outcome.
  
  
  OBJECTIVE
  The aim of this study was to assess the reliability and acceptability of digital paper prints for the radiographic images by the treating physicians and radiologists.
  
  
  METHODS
  This observational analytical study was done at a tertiary care hospital of New Delhi, India. A total of 58 consecutively ordered wrist radiographs of paediatric patients (6 months to 12 years of age) for ruling out rickets were retrieved from the PACS (Picture Archiving and Communication System). These 58 radiographs, out of which 21 (36.2%) had radiological evidence of rickets over PACS were printed on two different media i.e., LASER films and glossy photographic paper. An objective scoring for the severity of rickets was done on both LASER films and paper prints by six observers independently. Overall comfort level with paper prints was rated on a 1-5 point Likert scale. Data was analysed using STATA 14.0 (Stata Corp, College Station, TX).
  
  
  RESULTS
  Intra-observer percentage agreement and value of Cohen's kappa for PACS vs. LASER films and PACS vs. paper prints was equal i.e., 98.3% and 0.97, respectively. Intra-observer agreement between LASER films and paper prints for all six observers was excellent, ranging from 0.92 to 1.00; percentage agreement ranging from 94.8% to 100%. Fracture of ulna/radius present in 4 sets of the X-rays was well demonstrated in both LASER films and paper prints. Comfort level with paper prints was rated as 5 out of 5 by all due to no requirement of any special illuminated view box and dark room.
  
  
  CONCLUSIONS
  This study concludes that the use of paper prints may serve as a reliable alternative to LASER films to communicate the report of wrist radiographs for the treating physicians without any compromise over diagnostic information in cases of rickets.
authors.affiliation: Assistant Professor, Department of Radiodiagnosis, Hamdard Institute of Medical Sciences and Research and Hakeem Abdul Hameed Centenary Hospital , New Delhi, India .
authors.forename: Abhinav
authors.initials: A
authors.lastname: Jain
authors.affiliation: Associate Professor, Department of Paediatrics, Hamdard Institute of Medical Sciences and Research and Hakeem Abdul Hameed Centenary Hospital , New Delhi, India .
authors.forename: Priyanka
authors.initials: P
authors.lastname: Gupta
authors.affiliation: Professor, Department of Radiodiagnosis, Hamdard Institute of Medical Sciences and Research and Hakeem Abdul Hameed Centenary Hospital , New Delhi, India .
authors.forename: Surinder Pal Singh
authors.initials: SP
authors.lastname: Anand
authors.affiliation: Ph.D. Scholar, Delhi School of Economics, University of Delhi , India .
authors.forename: Archana
authors.initials: A
authors.lastname: Dang
keywords: Clinical utility; Conventional LASER films; X-rays