In this copy of the Journal , the article “Validation of the International Labour Office Digitized Standard Images for Recognition and Classification of Radiographs of Pneumoconiosis,” by Halldin and colleagues is the latest in a series of articles published by this Journal regarding diagnosis and grading of this occupational disorder. The publication of this article is a significant event in that it will likely be the last article in the radiology literature describing any comparison of film screen radiography and computed or digital radiography.
This article confirms the adequacy of a new digital reference standard for grading of pneumoconiosis with digital as well as film-screen radiography. Evaluation of subtle interstitial changes (and pneumothorax) was the major challenge in the acceptance of computed and direct digital radiography for the chest. Similar challenges existed in musculoskeletal radiography for trabecular pattern and subtle fractures, and in mammography, where digital technology underwent a thorough federally sponsored assessment .
When originally introduced, computed and digital radiography suffered from deficient modulation transfer function compared with film-screen technology for small detail. Over the past two decades, that deficiency has essentially disappeared, and digital technologies have the added advantage of “window/level” contrast adjustments, magnification, and other more sophisticated image-processing tools at the workstation and preprocessor. Early digital radiology also suffered from the lack of high-resolution displays. Financial barriers such as the cost of detectors and displays were (and remain) relative obstacles to adoption. The cost of storage is no longer a significant financial issue. (Our department spends more annually on picture archiving and communication system [PACS] support employee salaries than on the capital acquisition of short- and long-term storage systems.)
Three important factors drove the transition from conventional to digital radiography.
1. Although relatively low spatial resolution and fundamentally digital computed tomography and magnetic resonance were both the initial impetus and the “low-hanging fruit” for PACS development, it became clear that it is not practical to operate hybrid digital/conventional film departments.
2. Despite comparisons of total operating costs favoring digital medical imaging, the security advantages of digital storage and the unique ability of digital images to be available “anytime, anywhere” across a health care enterprise, the widespread adoption of PACS was triggered by the broad deployment of multidetector computed tomography scans that produced study image counts that became impossible to handle with film.
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References
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