Gray-scale inversion radiographic display for the detection of pulmonary nodules on chest radiographs

The purpose of this study was to investigate gray-scale inversion in nodule detection on chest radiography. Simulated nodules were superimposed randomly onto normal chest radiographs. Six radiologists interpreted 144 chest radiographs during three reading sessions: traditional presentation, inverted gray-scale, and a choice session allowing use of traditional and gray-scale inverted views. Sensitivity and specificity were used to assess accuracy based on presence or absence of a nodule. Gray-scale inversion and choice display sessions resulted in significantly higher nodule detection specificity and decreased sensitivity compared to traditional display. Gray-scale inversion may decrease false-positive nodule findings during chest X-ray interpretation.