Parameters of image quality, comprising spacial resolution and contrast, have been determined in the form of a contrast/detail diagram for a digital system (Topogram) and a film-screen system. The digital system was particularly examined concerning its contrast sensitivity in relation to quantum noise. The clinical implications of the comparison of the systems, where evaluated on chest X-rays of 250 patients. Despite lower image sharpness, the digital method is already able to produce equivalent or better diagnostic results in certain circumstances. The advantages and disadvantages of both systems are discussed in detail.