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Liver and Bone Window Settings for Soft-Copy Interpretation of Chest and Abdominal CT

¹ Department of Diagnostic Imaging, University of Maryland Medical System, 22 S. Greene St., Baltimore, MD 21201.
² Department of Diagnostic Imaging, Baltimore Veterans Affairs Medical Center, 10 N. Greene St., Baltimore, MD 21201.
³ Present address: American Radiology Associates, 1838 Green Tree Rd., Baltimore, MD 21208
⁴ Present address: Department of Diagnostic Radiology, South Manchester University Hospitals NHS Trust, Wythenshawe Hospital, S. Moor Rd., Manchester M23 9LT, United Kingdom.

OBJECTIVE. We evaluated whether the use of multiple window and level settings on a soft-copy workstation improves diagnostic accuracy on chest and abdominal CT. We hypothesized that routinely using window and level settings during soft-copy interpretation would beneficially affect the final diagnosis without compromising efficiency.

MATERIALS AND METHODS. Two hundred three randomly selected abdominal and chest CT scans were interpreted by three radiologists using a four-monitor soft-copy workstation (images per screen, nine; resolution, 2K). After the initial interpretations, all scans were reevaluated by the same radiologists using additional liver and bone window and level settings. Differences in conspicuity and characterization of abnormalties were graded on a three-point scale.

RESULTS. Conspicuity and characterization of abnormalities were improved in 67% of abnormal findings (81/121; p = 0.01). Improvement (a finding that substantially affected the final diagnosis) was present in 18% of abnormal findings (22/121; p = 0.04). On average, the evaluation of images at multiple window and level settings required an additional 40 sec per case.

CONCLUSION. The use of multiple window and level settings during soft-copy interpretation resulted in improved lesion detectability and characterization with greater diagnostic efficacy. Using soft-copy workstations, radiologists can evaluate images using multiple settings without compromising efficiency.

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