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Primary diagnosis of chest images in a PACS environment

In this study, we used a high-resolution workstation (1536x2048) with window width (contrast) and level (brightness) manipulations available to test diagnostic accuracy rates of seven experienced radiologists on 300 posteroanterior chest images in a clinically simulated environment. Observer performance was assessed by receiver operating characteristic analysis, and the results were compared to performance when the same cases were interpreted by the same radiologists using conventional film. Efficiency on the workstation was comparable to, if not better than, that with the conventional film, but accuracy indices (Az) for the detection of interstitial disease and pneumothoraces were lower for the workstation than for conventional film. Since window width and level did not compensate for the lack of resolution, we then examined in a following study the effects of different processing options (reverse mode, unsharp masking) on diagnostic accuracy. These image processing options did not significantly improve readers' performance.