{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T15:14:19Z","timestamp":1774883659533,"version":"3.50.1"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2022,1,18]],"date-time":"2022-01-18T00:00:00Z","timestamp":1642464000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,1,18]],"date-time":"2022-01-18T00:00:00Z","timestamp":1642464000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Radiol med"],"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>We investigated whether the additional use of grey-scale inversion technique improves the interpretation of eight chest abnormalities, in terms of diagnostic performance and interobserver variability.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Material and methods<\/jats:title>\n                <jats:p>A total of 507 patients who underwent a chest computed tomography (CT) examination and a chest radiography (CXR) within 24\u00a0h were enrolled. CT was the standard of reference. Images were retrospectively reviewed for the presence of atelectasis, consolidation, interstitial abnormality, nodule, mass, pleural effusion, pneumothorax and rib fractures. Four CXR reading settings, involving 3 readers were organized: only standard; only inverted; standard followed by inverted; and inverted followed by standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy, assessed with the area under the curve (AUC), and their 95% confidence interval were calculated for each reader and setting. Interobserver agreement was tested by Cohen\u2019s K test with quadratic weights (<jats:italic>K<\/jats:italic><jats:sub><jats:italic>w<\/jats:italic><\/jats:sub>) and its 95%CI.\n<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>CXR sensitivity % for any finding was 35.1 (95% CI: 33 to 37) for setting 1, 35.9 (95% CI: 33 to 37), for setting 2, 32.59 (95% CI: 30 to 34) for setting 3, and 35.56 (95% CI: 33 to 37) for setting 4; specificity % 93.78 (95% CI: 91 to 95), 93.92 (95% CI: 91 to 95), 94.43 (95% CI: 92 to 96), 93.86 (95% CI: 91 to 95); PPV % 56.22 (95% CI: 54.2 to 58.2), 56.49 (95% CI: 54.5 to 58.5), 57.15 (95% CI: 55 to 59), 56.75 (95% CI: 54 to 58); NPV % 85.66 (95% CI: 83 to 87), 85.74 (95% CI: 83 to 87), 85.29 (95% CI: 83 to 87), 85.73 (95% CI: 83 to 87); AUC values 0.64 (95% CI: 0.62 to 0.66), 0.65 (95% CI: 0.63 to 0.67), 0.64 (95% CI: 0.62 to 0.66), 0.65 (95% CI: 0.63 to 0.67); <jats:italic>K<\/jats:italic><jats:sub><jats:italic>w<\/jats:italic><\/jats:sub> values 0.42 (95% CI: 0.4 to 0.44), 0.40 (95% CI: 0.38 to 0.42), 0.42 (95% CI: 0.4 to 0.44), 0.41 (95% CI: 0.39 to 0.43) for settings 1, 2, 3 and 4, respectively.\n<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>No significant advantages were observed in the use of grey-scale inversion technique neither over standard display mode nor in combination at the detection of eight chest abnormalities.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s11547-022-01453-0","type":"journal-article","created":{"date-parts":[[2022,1,18]],"date-time":"2022-01-18T09:17:50Z","timestamp":1642497470000},"page":"294-304","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["The diagnostic value of grey-scale inversion technique in chest radiography"],"prefix":"10.1007","volume":"127","author":[{"given":"Roberta Eufrasia","family":"Ledda","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mario","family":"Silva","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole","family":"McMichael","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlotta","family":"Sartorio","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristina","family":"Branchi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gianluca","family":"Milanese","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sundeep M.","family":"Nayak","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicola","family":"Sverzellati","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2022,1,18]]},"reference":[{"issue":"3","key":"1453_CR1","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1016\/j.jacr.2016.08.025","volume":"14","author":"DC Levin","year":"2017","unstructured":"Levin DC, Parker L, Rao VM (2017) Recent trends in imaging use in hospital settings: implications for future planning. J Am Coll Radiol 14(3):331\u2013336","journal-title":"J Am Coll Radiol"},{"issue":"3","key":"1453_CR2","doi-asserted-by":"publisher","first-page":"663","DOI":"10.1148\/radiol.2413051535","volume":"241","author":"HP McAdams","year":"2006","unstructured":"McAdams HP, Samei E, Dobbins J 3rd, Tourassi GD, Ravin CE (2006) Recent advances in chest radiography. Radiology 241(3):663\u2013683","journal-title":"Radiology"},{"issue":"1","key":"1453_CR3","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1148\/rg.271065073","volume":"27","author":"JM Gibbs","year":"2007","unstructured":"Gibbs JM, Chandrasekhar CA, Ferguson EC, Oldham SA (2007) Lines and stripes: where did they go?\u2013from conventional radiography to CT. Radiographics 27(1):33\u201348","journal-title":"Radiographics"},{"issue":"9","key":"1453_CR4","doi-asserted-by":"publisher","first-page":"1818","DOI":"10.1007\/s00330-008-0948-3","volume":"18","author":"C Schaefer-Prokop","year":"2008","unstructured":"Schaefer-Prokop C, Neitzel U, Venema HW, Uffmann M, Prokop M (2008) Digital chest radiography: an update on modern technology, dose containment and control of image quality. Eur Radiol 18(9):1818\u20131830","journal-title":"Eur Radiol"},{"issue":"2","key":"1453_CR5","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1007\/s12194-016-0361-6","volume":"9","author":"R Tanaka","year":"2016","unstructured":"Tanaka R (2016) Dynamic chest radiography: flat-panel detector (FPD) based functional X-ray imaging. Radiol Phys Technol 9(2):139\u2013153","journal-title":"Radiol Phys Technol"},{"issue":"2","key":"1453_CR6","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1148\/rg.342135057","volume":"34","author":"SH Chou","year":"2014","unstructured":"Chou SH, Kicska GA, Pipavath SN, Reddy GP (2014) Digital tomosynthesis of the chest: current and emerging applications. Radiographics 34(2):359\u2013372","journal-title":"Radiographics"},{"key":"1453_CR7","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1016\/j.ejrad.2018.08.006","volume":"107","author":"Y Nagatani","year":"2018","unstructured":"Nagatani Y, Takahashi M, Ikeda M, Nitta N, Miyata K, Hanaoka J et al (2018) Sub-solid nodule detectability in seven observers of seventy-nine clinical cases: comparison between ultra-low-dose chest digital tomosynthesis with iterative reconstruction and chest radiography by receiver-operating characteristics analysis. Eur J Radiol 107:166\u2013174","journal-title":"Eur J Radiol"},{"issue":"1\u20134","key":"1453_CR8","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1093\/rpd\/ncw040","volume":"169","author":"C Petersson","year":"2016","unstructured":"Petersson C, Bath M, Vikgren J, Johnsson AA (2016) An analysis of the potential role of chest tomosynthesis in optimising imaging resources in thoracic radiology. Radiat Prot Dosimetry 169(1\u20134):165\u2013170","journal-title":"Radiat Prot Dosimetry"},{"issue":"7","key":"1453_CR9","doi-asserted-by":"publisher","first-page":"1383","DOI":"10.1016\/j.ejrad.2015.03.020","volume":"84","author":"SG Kumar","year":"2015","unstructured":"Kumar SG, Garg MK, Khandelwal N, Gupta P, Gupta D, Aggarwal AN et al (2015) Role of digital tomosynthesis and dual energy subtraction digital radiography in detecting pulmonary nodules. Eur J Radiol 84(7):1383\u20131391","journal-title":"Eur J Radiol"},{"issue":"1","key":"1453_CR10","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1148\/rg.261055034","volume":"26","author":"JE Kuhlman","year":"2006","unstructured":"Kuhlman JE, Collins J, Brooks GN, Yandow DR, Broderick LS (2006) Dual-energy subtraction chest radiography: what to look for beyond calcified nodules. Radiographics 26(1):79\u201392","journal-title":"Radiographics"},{"issue":"2","key":"1453_CR11","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1097\/RTI.0b013e318173dd38","volume":"23","author":"H MacMahon","year":"2008","unstructured":"MacMahon H, Li F, Engelmann R, Roberts R, Armato S (2008) Dual energy subtraction and temporal subtraction chest radiography. J Thorac Imaging 23(2):77\u201385","journal-title":"J Thorac Imaging"},{"issue":"2","key":"1453_CR12","doi-asserted-by":"publisher","first-page":"226","DOI":"10.1016\/j.ejrad.2009.05.061","volume":"72","author":"B van Ginneken","year":"2009","unstructured":"van Ginneken B, Hogeweg L, Prokop M (2009) Computer-aided diagnosis in chest radiography: beyond nodules. Eur J Radiol 72(2):226\u2013230","journal-title":"Eur J Radiol"},{"issue":"8","key":"1453_CR13","doi-asserted-by":"publisher","first-page":"1659","DOI":"10.1007\/s00330-012-2412-7","volume":"22","author":"DW De Boo","year":"2012","unstructured":"De Boo DW, van Hoorn F, van Schuppen J, Schijf L, Scheerder MJ, Freling NJ et al (2012) Observer training for computer-aided detection of pulmonary nodules in chest radiography. Eur Radiol 22(8):1659\u20131664","journal-title":"Eur Radiol"},{"issue":"1","key":"1453_CR14","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1186\/s41747-019-0104-7","volume":"3","author":"AA Fingerle","year":"2019","unstructured":"Fingerle AA, De Marco F, Andrejewski J, Willer K, Gromann LB, Noichl W et al (2019) Imaging features in post-mortem x-ray dark-field chest radiographs and correlation with conventional X-ray and CT. Eur Radiol Exp 3(1):25","journal-title":"Eur Radiol Exp"},{"issue":"2","key":"1453_CR15","doi-asserted-by":"publisher","first-page":"396","DOI":"10.1148\/radiol.2021211603","volume":"301","author":"H Hatabu","year":"2021","unstructured":"Hatabu H, Madore B (2021) Dark-field chest X-ray imaging: an evolving technique in the century-old history of chest X-ray imaging. Radiology 301(2):396\u2013397","journal-title":"Radiology"},{"issue":"11","key":"1453_CR16","doi-asserted-by":"publisher","first-page":"624","DOI":"10.1364\/JOSA.36.000624","volume":"36","author":"HR Blackwell","year":"1946","unstructured":"Blackwell HR (1946) Contrast thresholds of the human eye. J Opt Soc Am 36(11):624\u2013643","journal-title":"J Opt Soc Am"},{"issue":"5","key":"1453_CR17","doi-asserted-by":"publisher","first-page":"1096","DOI":"10.2214\/AJR.11.6625","volume":"197","author":"DW De Boo","year":"2011","unstructured":"De Boo DW, Uffmann M, Bipat S, Boorsma EF, Scheerder MJ, Weber M et al (2011) Gray-scale reversal for the detection of pulmonary nodules on a PACS workstation. AJR Am J Roentgenol 197(5):1096\u20131100","journal-title":"AJR Am J Roentgenol"},{"issue":"6","key":"1453_CR18","doi-asserted-by":"publisher","first-page":"442","DOI":"10.1177\/028418519103200602","volume":"32","author":"M Kehler","year":"1991","unstructured":"Kehler M, Albrechtsson U, Andresdottir A, Hochbergs P, Larusdottir H, Lundin A et al (1991) Efficacy of inverted digital luminescence radiography in evaluating chest neoplasms. Acta Radiol 32(6):442\u2013448","journal-title":"Acta Radiol"},{"issue":"3","key":"1453_CR19","doi-asserted-by":"publisher","first-page":"669","DOI":"10.1148\/radiology.168.3.3406396","volume":"168","author":"H MacMahon","year":"1988","unstructured":"MacMahon H, Metz CE, Doi K, Kim T, Giger ML, Chan HP (1988) Digital chest radiography: effect on diagnostic accuracy of hard copy, conventional video, and reversed gray scale video display formats. Radiology 168(3):669\u2013673","journal-title":"Radiology"},{"issue":"9","key":"1453_CR20","doi-asserted-by":"publisher","first-page":"1217","DOI":"10.1016\/j.ajem.2017.03.031","volume":"35","author":"E Musalar","year":"2017","unstructured":"Musalar E, Ekinci S, Unek O, Ars E, Eren HS, Gurses B et al (2017) Conventional vs invert-grayscale X-ray for diagnosis of pneumothorax in the emergency setting. Am J Emerg Med 35(9):1217\u20131221","journal-title":"Am J Emerg Med"},{"issue":"1","key":"1453_CR21","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1563\/1548-1336(2004)030<0002:DAOCAI>2.0.CO;2","volume":"30","author":"CE Sakakura","year":"2004","unstructured":"Sakakura CE, Loffredo Lde C, Scaf G (2004) Diagnostic agreement of conventional and inverted scanned panoramic radiographs in the detection of the mandibular canal and the mental foramen. J Oral Implantol 30(1):2\u20136","journal-title":"J Oral Implantol"},{"issue":"10","key":"1453_CR22","doi-asserted-by":"publisher","first-page":"1799","DOI":"10.1016\/j.ejrad.2013.05.001","volume":"82","author":"J Kirchner","year":"2013","unstructured":"Kirchner J, Gadek D, Goltz JP, Doroch-Gadek A, Stuckradt S, Liermann D et al (2013) Standard versus inverted digital luminescence radiography in detecting pulmonary nodules: a ROC analysis. Eur J Radiol 82(10):1799\u20131803","journal-title":"Eur J Radiol"},{"issue":"5","key":"1453_CR23","doi-asserted-by":"publisher","first-page":"515","DOI":"10.1016\/j.clinimag.2012.01.009","volume":"36","author":"MP Lungren","year":"2012","unstructured":"Lungren MP, Samei E, Barnhart H, McAdams HP, Leder RA, Christensen JD et al (2012) Gray-scale inversion radiographic display for the detection of pulmonary nodules on chest radiographs. Clin Imaging 36(5):515\u2013521","journal-title":"Clin Imaging"},{"issue":"1021","key":"1453_CR24","doi-asserted-by":"publisher","first-page":"27961545","DOI":"10.1259\/bjr\/27961545","volume":"86","author":"JW Robinson","year":"2013","unstructured":"Robinson JW, Ryan JT, McEntee MF, Lewis SJ, Evanoff MG, Rainford LA et al (2013) Grey-scale inversion improves detection of lung nodules. Br J Radiol 86(1021):27961545","journal-title":"Br J Radiol"},{"issue":"2","key":"1453_CR25","doi-asserted-by":"publisher","first-page":"261","DOI":"10.2214\/ajr.152.2.261","volume":"152","author":"ME Sheline","year":"1989","unstructured":"Sheline ME, Brikman I, Epstein DM, Mezrich JL, Kundel HL, Arenson RL (1989) The diagnosis of pulmonary nodules: comparison between standard and inverse digitized images and conventional chest radiographs. AJR Am J Roentgenol 152(2):261\u2013263","journal-title":"AJR Am J Roentgenol"},{"issue":"1064","key":"1453_CR26","doi-asserted-by":"publisher","first-page":"20160249","DOI":"10.1259\/bjr.20160249","volume":"89","author":"JD Thompson","year":"2016","unstructured":"Thompson JD, Thomas NB, Manning DJ, Hogg P (2016) The impact of greyscale inversion for nodule detection in an anthropomorphic chest phantom: a free-response observer study. Br J Radiol 89(1064):20160249","journal-title":"Br J Radiol"},{"issue":"4","key":"1453_CR27","doi-asserted-by":"publisher","first-page":"548","DOI":"10.1016\/j.ajem.2015.01.015","volume":"33","author":"JB Park","year":"2015","unstructured":"Park JB, Cho YS, Choi HJ (2015) Diagnostic accuracy of the inverted grayscale rib series for detection of rib fracture in minor chest trauma. Am J Emerg Med 33(4):548\u2013552","journal-title":"Am J Emerg Med"},{"issue":"3","key":"1453_CR28","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1148\/radiol.2462070712","volume":"246","author":"DM Hansell","year":"2008","unstructured":"Hansell DM, Bankier AA, MacMahon H, McLoud TC, Muller NL, Remy J (2008) Fleischner Society: glossary of terms for thoracic imaging. Radiology 246(3):697\u2013722","journal-title":"Radiology"},{"issue":"2","key":"1453_CR29","doi-asserted-by":"publisher","first-page":"590","DOI":"10.1378\/chest.119.2.590","volume":"119","author":"MH Baumann","year":"2001","unstructured":"Baumann MH, Strange C, Heffner JE, Light R, Kirby TJ, Klein J et al (2001) Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi consensus statement. Chest 119(2):590\u2013602","journal-title":"Chest"}],"container-title":["La radiologia medica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11547-022-01453-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11547-022-01453-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11547-022-01453-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,28]],"date-time":"2022-03-28T17:42:51Z","timestamp":1648489371000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11547-022-01453-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,18]]},"references-count":29,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2022,3]]}},"alternative-id":["1453"],"URL":"https:\/\/doi.org\/10.1007\/s11547-022-01453-0","relation":{},"ISSN":["1826-6983"],"issn-type":[{"value":"1826-6983","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,18]]},"assertion":[{"value":"2 August 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 January 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 January 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that they have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"This study was approved by the Institutional Review Board of the University Hospital of Parma (Prot. 51059).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"Given the retrospective nature of the study, informed consent was waived.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Not applicable.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}}]}}