Skip to main content

Advertisement

SpringerLink
Log in

Effect of display type and room illuminance in chest radiographs

  • Chest
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To compare diagnostic accuracy in the detection of subtle chest lesions on digital chest radiographs using medical-grade displays, consumer-grade displays, and tablet devices under bright and dim ambient light.

Methods

Five experienced radiologists independently assessed 50 chest radiographs (32 with subtle pulmonary findings and 18 without apparent findings) under bright (510 lx) and dim (16 lx) ambient lighting. Computed tomography was used as the reference standard for interstitial and nodular lesions and follow-up chest radiograph for pneumothorax. Diagnostic accuracy and sensitivity were calculated for assessments carried out in all displays and compared using the McNemar test. The level of significance was set to p < 0.05.

Results

Significant differences in sensitivity between the assessments under bright and dim lighting were found among consumer-grade displays in interstitial opacities with, and in pneumothorax without, Digital Imaging and Communication in Medicine-Grayscale Standard Display Function (DICOM-GSDF) calibration. Compared to 6 megapixel (MP) display under bright lighting, sensitivity in pneumothorax was lower in the tablet device and the consumer-grade display. Sensitivity in interstitial opacities was lower in the DICOM-GSDF calibrated consumer-grade display.

Conclusions

A consumer-grade display with or without DICOM-GSDF calibration or a tablet device is not suitable for reading digital chest radiographs in bright lighting. No significant differences were observed between five displays in dim light.

Key Points

• Ambient lighting affects performance of consumer-grade displays (with or without DICOM-GSDF calibration).

• Bright light decreases detection of pneumothorax on non-medical displays.

• Bright light decreases detection of interstitial opacities on DICOM-GSDF-calibrated, consumer-grade displays.

• Dim light is sufficient to detect subtle chest lesions from all displays.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Abbreviations

LCD:

Liquid Crystal Display

Lx:

Lux

MP:

Megapixels

CT:

Computed Tomography

DICOM:

Digital Imaging and Communications in Medicine

GSDF:

Grayscale Standard Display Function

PACS:

Picture Archiving and Communication Systems

AAPM:

American Association of Physicists in Medicine

CR:

Computed Radiography

DR:

Direct Radiography

References

  1. Samei E, Badano A, Chakraborty D et al (2005) Assessment of display performance for medical imaging systems: executive summary of AAPM TG18 report. Med Phys 32:1205–1225

    Article  PubMed  Google Scholar 

  2. Norweck JT, Seibert JA, Andriole KP et al (2013) ACR-AAPM-SIIM technical standard for electronic practice of medical imaging. J Digit Imaging 26:38–52

    Article  PubMed  Google Scholar 

  3. Hemminger B, Muller K (1997) A performance metric for evaluating conformance of medical image displays with the proposed ACR/NEMA display function standard. SPIE, Bellingham

    Book  Google Scholar 

  4. Blume H, Steven P, Ho A et al (2003) Characterization of liquid-crystal displays for medical images - part 2. In: Galloway R (ed) Proceedings of SPIE: medical imaging 2003, vol 5029. International Society for Optical Engineering Edn, Bellingham, pp 449–473

    Google Scholar 

  5. Abboud S, Weiss F, Siegel E, Jeudy J (2013) TB or not TB: interreader and intrareader variability in screening diagnosis on an iPad versus a traditional display. J Am Coll Radiol 10:42–44

    Article  PubMed  Google Scholar 

  6. McEntee MF, Lowe J, Butler ML et al (2012) iPads and LCDs show similar performance in the detection of pulmonary nodules. In: Abbey CK, Mello- Thomas CR (ed) Proceedings of SPIE

  7. Salazar AJ, Romero J, Bernal O, Moreno A, Velasco S, Diaz X (2013) Effects of the DICOM grayscale standard display function on the accuracy of medical-grade grayscale and consumer-grade color displays for telemammography screening. In: Brieva Je B (ed) Proceedings of SPIE, p 89220r

  8. Yin J, Guo Q, Zhang W et al (2012) Effect of greyscale liquid crystal displays of different resolutions on observer performance during detection of small solitary pulmonary nodules. Br J Radiol 85:E549–E555

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Yoshimura K, Nihashi T, Ikeda M et al (2013) Comparison of liquid crystal display monitors calibrated with gray-scale standard display function and with gamma 2.2 and iPad: observer performance in detection of cerebral infarction on brain CT. Am J Roentgenol 200:1304–1309

    Article  Google Scholar 

  10. Park JB, Choi HJ, Lee JH, Kang BS (2013) An assessment of the iPad 2 as a CT teleradiology tool using brain CT with subtle intracranial hemorrhage under conventional illumination. J Digit Imaging 26:683–690

    Article  PubMed  PubMed Central  Google Scholar 

  11. Tewes S, Rodt T, Marquardt S, Evangelidou E, Wacker FK, Von Falck C (2013) Evaluation of the use of a tablet computer with a high-resolution display for interpreting emergency CT scans. Rofo 185:1066–1072

    Google Scholar 

  12. Hammon M, Schlechtweg PM, Schulz-Wendtland R, Uder M, Schwab SA (2014) iPads in breast imaging - a phantom study. Geburtshilfe Frauenheilkd 74:152–156

    Article  PubMed  PubMed Central  Google Scholar 

  13. Barten PGJ (1999) Contrast sensitivity of the human eye and its effects on image quality. SPIE-The International Society For Optical Engineering, Washington, USA

  14. Pollard BJ, Samei E, Chawla AS et al (2012) The effects of ambient lighting in chest radiology reading rooms. J Digit Imaging 25:520–526

    Article  PubMed  PubMed Central  Google Scholar 

  15. Salazar AJ, Aguirre DA, Ocampo J, Camacho JC, Diaz XA (2014) DICOM gray-scale standard display function: clinical diagnostic accuracy of chest radiography in medical-grade gray-scale and consumer-grade color displays. Am J Roentgenol 202:1272–1280

    Article  Google Scholar 

  16. Fleiss J, Levin B, Paik M (2003) Statistical methods for rates and proportions. John Wiley & Sons, Inc, Hoboken

    Book  Google Scholar 

  17. Landis J, Koch G (1977) Measurement of observer agreement for categorical data. Biometrics 33:159–174

    Article  CAS  PubMed  Google Scholar 

  18. Yoshimura K, Shimamoto K, Ikeda M, Ichikawa K, Naganawa S (2011) A comparative contrast perception phantom image of brain CT study between high-grade and low-grade liquid crystal displays (LCDs) in electronic medical charts rid B-5163-2010. Phys Med 27:109–116

    Article  PubMed  Google Scholar 

  19. Kallio-Pulkkinen S, Haapea M, Liukkonen E, Huumonen S, Tervonen O, Nieminen M (2014) Comparison of consumer grade, tablet and 6MP-displays: observer performance in detection of anatomical and pathological structures in panoramic radiographs. Oral Surg Oral Med Oral Pathol Oral Radiol 118:135–141

    Article  PubMed  Google Scholar 

  20. Pakkala T, Kuusela L, Ekholm M, Wenzel A, Haiter-Neto F, Kortesniemi M (2012) Effect of varying displays and room illuminance on caries diagnostic accuracy in digital dental radiographs. Caries Res 46:568–574

    Article  CAS  PubMed  Google Scholar 

  21. Pollard BJ, Chawla AS, Delong DM, Hashimoto N, Samei E (2008) Object detectability at increased ambient lighting conditions. Med Phys 35:2204–2213

    Article  PubMed  Google Scholar 

  22. Fetterly KA, Blume HR, Flynn MJ, Samei E (2008) Introduction to grayscale calibration and related aspects of medical imaging grade liquid crystal displays. J Digit Imaging 21:193–207

    Article  PubMed  Google Scholar 

  23. Samei E, Ranger N, Delong DM (2008) A comparative contrast-detail study of five medical displays. Med Phys 35:1358–1364

    Article  PubMed  Google Scholar 

  24. Lim H, Chung MJ, Lee G et al (2013) Interpretation of digital chest radiographs: comparison of light emitting diode versus cold cathode fluorescent lamp backlit monitors. Korean J Radiol 14:968–976

    Article  PubMed  PubMed Central  Google Scholar 

  25. Salazar AJ, Aguirre DA, Ocampo J, Camacho JC, Diaz XA (2014) Evaluation of three pneumothorax size quantification methods on digitized chest x-ray films using medical-grade grayscale and consumer-grade color displays. J Digit Imaging 27:280–286

    Article  PubMed  Google Scholar 

  26. Mcnulty JP, Ryan JT, Evanoff MG, Rainford LA (2012) Flexible image evaluation: iPad versus secondary-class monitors for review of MR spinal emergency cases, a comparative study. Acad Radiol 19:1023–1028

    Article  PubMed  Google Scholar 

  27. Bosmans H, De Hauwere A, Lemmens K et al (2013) Technical and clinical breast cancer screening performance indicators for computed radiography versus direct digital radiography. Eur Radiol 23:2891–2898

    Article  PubMed  Google Scholar 

  28. Seradour B, Heid P, Esteve J (2014) Comparison of direct digital mammography, computed radiography, and film-screen in the French national breast cancer screening program. Am J Roentgenol 202:229–236

    Article  Google Scholar 

  29. De Paepe L, De Bock P, Vanovermeire O, Kimpe T (2012) Performance evaluation of a visual display calibration algorithm for ipad. Medical Imaging 2012: Advanced Pacs-Based Imaging Informatics and Therapeutic Applications 8319:831909

Download references

Acknowledgments

The scientific guarantor of this publication is Miika T. Nieminen. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise; Marianne Haapea. Institutional Review Board approval was not required because non-interventional studies based on register data do not need approval from Ethics Committees in Finland as the integrity of a person is not violated. Written informed consent was not required for this study because this is a non-interventional study based on register data. Methodology: prospective study, diagnostic or prognostic study, performed at one institution.

Author information

Authors and Affiliations

  1. Department of Diagnostic Radiology, Oulu University Hospital, P.O. BOX 50, Fin-90029 OYS, Oulu, Finland

    Esa Liukkonen, Airi Jartti, Marianne Haapea, Heljä Oikarinen, Lauri Ahvenjärvi, Seija Mattila, Terhi Nevala, Kari Palosaari, Marja Perhomaa & Miika T. Nieminen

  2. Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland

    Esa Liukkonen, Airi Jartti, Marianne Haapea, Heljä Oikarinen, Lauri Ahvenjärvi, Seija Mattila, Terhi Nevala, Kari Palosaari, Marja Perhomaa & Miika T. Nieminen

  3. Medical Imaging, Physics and Technology consortium, University of Oulu, Oulu, Finland

    Miika T. Nieminen

Authors
  1. Esa Liukkonen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Airi Jartti
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marianne Haapea
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Heljä Oikarinen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lauri Ahvenjärvi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Seija Mattila
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Terhi Nevala
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kari Palosaari
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Marja Perhomaa
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Miika T. Nieminen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Esa Liukkonen.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Liukkonen, E., Jartti, A., Haapea, M. et al. Effect of display type and room illuminance in chest radiographs. Eur Radiol 26, 3171–3179 (2016). https://doi.org/10.1007/s00330-015-4150-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-015-4150-0

Keywords

Search

Navigation