Forced-choice just noticeable difference (JND) studies are extremely sensitive to image quality variations that are below the threshold at which the differences are apparent to or definable by the observer. Paired comparisons of 4K and 2K laser-printed posteroanterior chest images consistently demonstrated that although images are viewed as comparable by radiologists, when forced to choose the better ("sharper") image, they actually select the higher-resolution images in 83% of the paired observations. We conclude that small differences in image quality may be detectable even in image sets which are considered to be comparable by subjective assessments.