Digital chest radiography: effect on diagnostic accuracy of hard copy, conventional video, and reversed gray scale video display formats.

Observer performance tests were conducted to compare the effects on diagnostic accuracy of hard copy (film) versus video display and to determine the diagnostic merits of conventional negative ("white bone") versus positive ("black bone") video displays. Subjective preferences were elicited from each observer for each display modality, and diagnostic accuracy was determined with receiver operating characteristic analysis. Digitized chest radiographs were used, including normal and abnormal cases with a variety of subtle abnormalities. The hard copy was printed with a 1,024 X 1,024-matrix by a high-quality drum scanner in conventional white bone format only. The video images were displayed on a 1,023-line monitor (30 Hz, interlaced) in both white bone and black bone formats with fixed window and brightness settings. Most observers preferred hard copy to video, but preferences were sharply divided between white bone and black bone video. Diagnostic accuracy was significantly greater with hard copy than with video display, and the conventional white bone format was significantly superior in accuracy to the black bone display.