Detection of CT-proved pulmonary nodules: Comparison of selenium-based digital and conventional screen-film chest radiographs

PURPOSE: To compare hard-copy digital chest radiographs obtained with a selenium-based system with wide-latitude asymmetric screen-film radiographs for detection of pulmonary nodules. MATERIALS AND METHODS: Fifty patients undergoing thoracic computed tomography (CT) for suspected pulmonary nodules were recruited to undergo both digital I and screen-film posteroanterior (PA) and lateral chest radiography. Three chest radiologists blinded to the CT results independently reviewed each digital and screen-film radiograph, identified each nodule, and graded their confidence for its presence. RESULTS: Seventy-eight pulmonary nodules (mean diameter, 1.5 cm; range, 0.5-3.5 cm; 62 soft tissue, 16 calcified) were identified with CT in 34 patients, while 16 patients had clear lungs. the mean sensitivity for the detection of all nodules by all readers (PA and lateral) was 66% (95% CI, 54%, 76%) for digital radiographs and 64% (95% CI, 52%, 74%) for screen-film radiographs. Differences between the two techniques were not statistically significant (P > .05, Student t test). There was no difference in mean false-positive-true-positive ratios (PA, 0.35; lateral, 0.53) or positive predictive values(PA, 74%; lateral, 65%), and no significant difference (P > .05)was seen in mean reader confidence rating. CONCLUSION: In detecting pulmonary nodules, radiologists perform comparably with selenium-based digital and wide-latitude asymmetric screen-film radiographs.