To evaluate the reliability of storage phosphor radiography (SR) in diagnosis of subtle interstitial lung abnormalities, the differences among radiologists in interpreting conventional screen-film radiographs and full-size and minified SR images obtained in 80 patients were studied. Forty patients had subtle interstitial lung abnormalities and 40 had no lung abnormalities. Seven chest radiologists and seven residents evaluated the images by using a five-point presence of abnormality scale. Results were evaluated with receiver operating characteristic technique. For all observers, no significant differences were observed among the three image types. For the chest radiologists, significant differences were observed between conventional radiographs and the two SR formats (P < .01). Furthermore, perceptual accuracy was best with conventional radiographs evaluated by chest radiologists. Overall performance with SR and conventional radiography was identical for diagnosis of abnormalities, but detection performance was significantly dependent on observer experience (P < .01 for chest radiologists and P > .01 for residents). For chest radiologists, critically important information may be lost with commercially available SR.