Can we see enough? A comparative study of film-screen vs digital radiographs in small lesions in rheumatoid arthritis

The aim of this study was to evaluate the performance of digital radiograph y in the detection of early very small erosions and joint space narrowing; in the hands and feet in rheumatoid arthritis. Fifty-three sets of film-scr een and digital radiographs of the same hands and feet with very small and some-times questionable lesions (possible erosions and cysts) were scored i ndependently two times by four investigators. The percentage of lesions fou nd in exactly the same position for each investigator was calculated. Intra -observer agreement between first and reading in film-screen radiography wa s (mean 67%), and in digital radiographs 60-71% (mean 64%), Agreement betwe en film-screen and digital radiographs ranged fi om 54 to 64% (mean 58%) in the first reading and from 56 to, 66% (mean 62%) in the second reading. Ov erall agreement between both techniques between first and second reading ra nged between 62 and 73% (mean 65%). Digital radiography of the hands and fe et can be used in patients suspected of rheumatoid arthritis and in follow- up of those patients, because small and early erosions call be seen equally well with the digital technique as compared with the conventional film-scr een technique.