To evaluate the sensitivity of a non-receiver-operating characteristic (ROC) study in assessing small differences of perceived image quality of hand images acquired by computed radiography (CR) and conventional screen-film systems, hand images were acquired on 12 patients with both conventional screen-film and CR. Each CR image was then processed with three different edge-enhancement algorithms. One conventional film and four CR images were then viewed side by side by five radiologists. Observers rated perceived image quality of each radiograph using a 10-category discrete scale. The study was repeated after 6 weeks using a different block randomization scheme. Despite the small sample size, significant differences (P < .05) in assigned image quality were detected among CR images acquired at low, medium, and high resolutions. Image processing routines did not fully compensate for differences in quality between conventional film and CR-acquired images. The quality rating of the reference conventional image was found to be dependent on the quality of images with which it was compared. Small, highly sensitive study designs can be used to identify radiologists' perceived differences in image quality. "Reference" or "gold standard" quality are important in such studies. Edge-enhancement schemes cannot fully compensate for perceived image quality degradations because of reduced image resolution.