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Original Research |

Intramodality and Intermodality Comparisons of Storage Phosphor Computed Radiography and Conventional Film-Screen Radiography in the Recognition of Small Pneumoconiotic OpacitiesDigital vs Film Radiographs for Pneumoconiosis

A. Scott Laney, PhD; Edward L. Petsonk, MD, FCCP; Michael D. Attfield, PhD
Author and Funding Information

From the Surveillance Branch, Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV.

Correspondence to: A. Scott Laney, PhD, Surveillance Branch, Division of Respiratory Disease Studies, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, 1095 Willowdale Rd, Mail Stop HG900.2, Morgantown, WV 26505-2888; e-mail: alaney@cdc.gov

Data are presented as No. (%) and are 172 images classified by seven B readers, for a total of 1,204 classifications for FSR and CR each. CR = storage phosphor computed radiograph; FSR = film-screen radiograph.

Data are presented as No. (%) and are 172 images classified by seven B readers, for a total of 1,204 classifications for FSR and CR each. Primary shape and size designations are standard International Labor Office designations. Readers did not record shape and size for images with 0/0 profusion.

κ Values represent six-category agreement level of shape and size classification (p, q, r, s, t, u) between film-screen and digital modalities by reader for each image. ILO = International Labor Office.

Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Funding/Support: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


Chest. 2011;140(6):1574-1580. doi:10.1378/chest.11-0629
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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.

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