Purpose: To evaluate the effect of reducing image size on observers' ability to detect lung nodules on computed tomographic (CT) scans.
Materials and methods: Stimuli were 80 single sections from 13 normal chest CT studies. On half of the images, 3-5-mm-diameter nodules were superimposed electronically at random locations. Four observers viewed images in six formats and sizes that ranged from 6 on 1 (133 x 133 mm) to 80 on 1 (40 x 40 mm). The images were viewed at a fixed distance of 55 cm and at an unrestricted, variable distance.
Results: With the fixed viewing distance, nodule detection decreased with smaller image sizes. The area under the receiver operating characteristic curve (Az) decreased from 0.857 for the 6-on-1 format to 0.671 for the 80-on-1 format (P = .0001). With a variable viewing distance, Az decreased from 0.884 to 0.834 across all formats (difference not statistically significant). However, there was a significant drop in performance with the smallest images (P < .05). Overall, Az for the fixed and variable viewing distances was significantly different (P < .001).
Conclusion: Reducing image size leads to decreased lung nodule detection on CT scans viewed at a fixed distance; however, the observer can compensate for the smaller image by adjusting the viewing distance.