Effect of image processing on diagnostic decisions in chest radiography

The goal of this study was to determine what the influence of image processing functions was on decisions and decision changes made while reading chest radiographs displayed on a monitor. Six radiologists read 168 computed radiography chest images first without then with the use of six image processing functions. Diagnostic performance was measured using Receiver Operating Characteristic analysis, and decision changes made without and with processing use were analyzed. Diagnostic performance did not differ statistically for readings without and with image processing. The decision change analysis showed that readers were just as likely to change decisions from tree-positive to false-negative as they were from false-negative to true-positive. With image processing, there were significantly more changes from true-negative to false-positive than from false-positive to true-negative. 93% of all decisions did not change with the use of image processing. No significant correlations were found between the type of lesions present on the radiograph and the type of image processing function used. Positive decision changes made with the use of image processing are offset by equivalent numbers of negative decision changes. The use of image processing does not affect significantly diagnostic performance in chest radiography.