diagnosis of pneumothorax was made based on computed tomographic examinations were also excluded from the study.

As a consequence,
PACXs of 106 patients with diagnosis of pneumothorax and 162 control subjects (total n = 268) were included in the study (Fig. 1).

Eighty-eight percent (n = 236) of the patients were male with a me- dian age of 34 (IQR 27.5–43) years. Characteristic features of the spon-
taneous pneumothorax and the control groups are presented in Table 1.

Within the scope of the study, diagnostic evaluations of pneumotho- rax using digital –conventional and inverted gray-scale images by 10
as- sistant researchers, evaluation results of 28 images randomly selected from all PACXs (digital-conventional and inverted gray-scale)
were found to be in concordance and intraclass correlation coefficient was de- termined to be 0.986 [95 CI %, (0.976–0.993)]. Ten
emergency medicine specialist were divided into 2 groups by lot. Five of them evaluated 268 digital-conventional and the other 5 evaluated
268 inverted gray-scale images. Intragroup compatibility was detected among evaluation re- sults of both groups and their intraclass
coefficients were calculated as 0.957 [%95 CI (0,948–0,965)] and 0.947 [%95 CI (0.936–0.956)], respectively.

Sensitivity, specificity and accuracy rates and also likelihood ratios of making diagnosis of pneumothorax by assistant researchers are shown
in Table 2. Sensitivity of digital-conventional radiograms for the diag- nostic evaluation of pneumothorax were found to be higher relative
to assessments based on inverted gray-scale images [95% CI (2.08–5.04), p b 0,01]. A statistically significant difference was not observed
between the results of the assessments of digital-conventional images made by assistant researchers and gold standard.

[95% CI (0.45–2.17), p = 0,20], diagnostic sensitivities of the inverted gray-scale assessments made by assistant researchers were
statistically significantly lower [95% CI (3.16–5.67) p b 0,01].