Comparison of digital direct readout radiography with conventional film-screen radiography for the recognition of pneumoconiosis in dust-exposed Chinese workers.

OBJECTIVES Pneumoconiosis in China remains a disease with substantial public health significance. Diagnostic standards for the pneumoconioses are based on traditional film-screen radiography (FSR). However, FSR is increasingly being replaced with digital radiographic imaging, which has become the predominant technology available in Chinese clinical practice. To evaluate the applicability of digital direct readout radiography (DR) images in the recognition of pneumoconioses, we compared the profusion of small opacities and large opacities between FSR and DR radiographs. METHODS We enrolled 161 pneumoconioses patients and 31 dust-exposed workers during the course of the study, with FSR and DR images obtained from all participants. Each chest film was interpreted by five readers using the Chinese Diagnostic Criteria classification of radiographs of pneumoconiosis, as were DR images displayed on medical-grade computer monitors. RESULTS No statistically significant differences were observed when the data were analyzed by small opacity profusion subcategory except for 1/1. The overall intermodality agreement of small opacities was good, with a weighted kappa (κ) of 0.77. CONCLUSIONS DR images with soft copy display are equivalent with respect to image quality and the recognition and classification of small parenchymal lung opacities. Additionally, we observed likeness between modalities with respect to the classification of large opacities. Overall, our study findings demonstrate that in a population of Chinese workers with pneumoconiosis, direct readout digital systems are equivalent to traditional film-screen radiography in the recognition and classification of small pneumoconiotic opacities.