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Objective: The aim of this study was to compare the diagnostic quality of paper prints with film copies in a sample of observers who were trying to detect small coin lesions on radiographs of a phantom., Materials and Methods: The phantom consisted of 60 high-contrast and 60 low-contrast test objects, half of which had holes in them. Diameter and depth of the holes varied from 0.5 mm to 2 mm. Fifteen radiographs were obtained from different areas of the test objects. Film copies and paper prints were made using high-quality printers. Five observers independently evaluated 1,800 high-contrast and 1,800 low-contrast images. Data were evaluated using the well-established receiver operating characteristic methodology., Results: The mean area under the curve rated 0.863 for paper prints (0.859 for high contrast and 0.860 for low contrast) and 0.926 for laser films (0.937 for high contrast and 0.913 for low contrast). The difference between the two imaging techniques was statistically significant for both high- and low-contrast lesions (p < 0.05)., Conclusion: Detection of small coin lesions on radiographs of a phantom was significantly less sensitive on paper prints than on film. We found paper prints less acceptable for the diagnosis of small-sized lesions.