European Radiology

, Volume 27, Issue 12, pp 5049–5055 | Cite as

Comparison of medical-grade and calibrated consumer-grade displays for diagnosis of subtle bone fissures

  • Daniel Pinto dos Santos
  • Jonas Welter
  • Tilman Emrich
  • Florian Jungmann
  • Evelyn Dappa
  • Peter Mildenberger
  • Roman Kloeckner
Computer Applications



To compare the diagnostic accuracy of medical-grade and calibrated consumer-grade digital displays for the detection of subtle bone fissures.


Three experienced radiologists assessed 96 digital radiographs, 40 without and 56 with subtle bone fissures, for the presence or absence of fissures in various bones using one consumer-grade and two medical-grade displays calibrated according to the DICOM-Grayscale Standard Display Function. The reference standard was consensus reading. Subjective image quality was also assessed by the three readers. Statistical analysis was performed using receiver operating characteristic analysis and by calculating the sensitivity, specificity, and Youden’s J for each combination of reader and display. Cohen’s unweighted kappa was calculated to assess inter-rater agreement. Subjective image quality was compared using the Wilcoxon signed-rank test.


No significant differences were found for the assessment of subjective image quality. Diagnostic performance was similar across all readers and displays, with Youden’s J ranging from 0.443 to 0.661. The differences were influenced more by the reader than by the display used for the assessment.


No significant differences were found between medical-grade and calibrated consumer-grade displays with regard to their diagnostic performance in assessing subtle bone fissures. Calibrated consumer-grade displays may be sufficient for most radiological examinations.

Key points

Diagnostic performance of calibrated consumer-grade displays is comparable to medical-grade displays.

There is no significant difference with regard to subjective image quality.

Use of calibrated consumer-grade displays could cut display costs by 60-80%.


Quality Assurance, Health Care Radiography Fractures, Bone Diagnostic Imaging Computer Terminals 

Abbreviations and acronyms


computed radiography


Digital Imaging and Communication in Medicine


direct radiography


Grayscale Standard Display Function


liquid crystal displays


picture archiving and communication systems


receiver operating characteristic


light-emitting diode


in-plane switching






area under the curve



The authors thank Ms. Helen Toder and Ms. Franziska Inka Meyer for their support in conducting this study and for their help with data collection. The authors would also like to thank Dr. Veronika Weyer-Elberich for her help in planning the statistical analysis for this study.

Compliance with ethical standards


The scientific guarantor of this publication is Prof. Dr. Peter Mildenberger.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, that have products or services may be related to the subject matter of the article.


The authors state that this work has not received any funding.

Statistics and biometry

Ms. Dr. Veronika Weyer- Elberich kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.



•performed at one institution


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Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  • Daniel Pinto dos Santos
    • 1
    • 2
  • Jonas Welter
    • 1
  • Tilman Emrich
    • 1
  • Florian Jungmann
    • 1
  • Evelyn Dappa
    • 1
  • Peter Mildenberger
    • 1
  • Roman Kloeckner
    • 1
  1. 1.Department of Diagnostic and Interventional RadiologyUniversity Medical Centre of the Johannes Gutenberg-University MainzMainzGermany
  2. 2.Department of RadiologyUniversity Hospital CologneKölnGermany

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