study [15].

In the same study, it was found that the four-point lung ul- trasound had worse sensitivity and specificity (sensitivity 66.7%,
speci- ficity 97.9%) for any pneumothorax [15]. However, these results were better than supine position of the X-ray (sensitivity 32.6%,
specificity 100%) to diagnosis of any pneumothorax [15]. Ultimately the diagnostic power of the ultrasound in small pneumothorax is
inadequate. Despite these disadvantages of lung ultrasound, in line with available evidence, it should not be forgotten that it may be the only
test before chest CT. However, emergency medicine specialists are still searching for new al- ternative, highly sensitive diagnostic imaging
modalities which do not cause radiation exposure and additional cost, Just in line with this re- search process in the website of Free Open
Access Medical Education (FOAMed) as an expert opinion of higher level of evidence, assessment of inverted gray-scale chest X-ray has
been indicated as an helpful ad- junct in the diagnosis of pneumothorax [9].

In our literature scanning the articled related to keywords of “gray- scale”, “gray-scale”, “inverted”, “negative”, “chest X-ray”,
“radiography”, “pneumothorax” were searched in databases of PubMed, Embase, Medline, Cochrane Library, Evidence Based Medicine
Reviews ve Google Scholar and we didn't encounter any article on inverted gray-scale find- ings/signs of pneumothorax. However in the
literature it has been indi- cated that dark-coloured images on a bright background is more easily discernible relative to bright images on a
dark background [16]. Some studies have reported contribution of inverted gray-scale radiograms to the diagnosis in the detection of rib
fractures and pulmonary nodules [8,17,18]. However some other authors advocated that inverted gray- scale radiograms had not provided
additional contribution to the detec- tion of pulmonary nodules [19]. In a study performed by dentists where peridental bone losses were
evaluated, the effectiveness of inverted gray-scale radiograms in the detection of these bone losses was empha- sized, but without any
superiority over digital-conventional radiograms [20]. In another study where mandibular foramen and mandibular canal was tried to be
localized, inverted gray-scale and digital-conventional images were indicated to have similar diagnositic accuracies [21]. In summary, it has
been stated in the literature that in the detection of pa- thologies apart from pneumothorax, inverted gray-scale images were not superior
over conventional images, while they can be used in com- bination during diagnostic processes.