The classification of pneumoconiosis on 108 paired radiographs obtained in coal miners was compared by using conventional radiograph film images and digitized images of those conventional film images. Conventional film images and digitized images were each independently read in a random order in two separate sessions by three radiologists certified as "B" readers. Overall, the digitized images were perceived as being of better quality than the conventional film images (radiograph quality grade 1, 48% [617 of 1,292 classifications] vs 37% [482 of 1,296], respectively; P < .001). The mean International Labour Office (ILO) scores for small-opacity profusion were similar between the digitized images and conventional film images (3.14 vs 3.24, respectively; P = .19). The mean absolute differences in small-opacity profusion score between radiograph pairs were also similar (0.74 vs 0.77, respectively; P = .50). No difference in the ILO type of opacity was noted between the display modes. Interpretation of digitized images for pneumoconiotic small opacities was shown to be an acceptable alternative to interpretation of conventional film images; the important problem of reader variability affects both display modes.
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