Evaluation of an Enhanced Digital Film-Duplication System by Receiver Operating Characteristic Analysis

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Abstract
Over- or underexposure often results in poor quality radiographs. Using receiver operating characteristic analysis, the authors investigated the potential utility of a system that corrects densities in such images to improve the accuracy of lung nodule detection. Chest radiographs were digitized by a laser film digitizer. Simulated nodules were superimposed on 36 improperly exposed chest radiographs. All images, with and without nodules, were then processed by a nonlinear density-correction technique. Hard-copy images were produced by a laser film printer. Eight radiologists evaluated the corrected and uncorrected images for the presence or absence of lung nodules using a continuous (0-100) confidence-rating scale. The detectability of lung nodules improved significantly in the retrocardiac/retrodiaphragmatic regions of underexposed images and in the peripheral lung region of overexposed images. This system may increase diagnostic accuracy in detection of lung nodules in improperly exposed images.

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