Influence of display quality on radiologists' performance in the detection of lung nodules on radiographs

The purpose of this study was to evaluate the influence of display quality on radiologists' performance in the detection of lung nodules. Display systems with various technical properties were considered based on their general availability in a radiology department. Their quality was assessed by physical tests. Multireader-multicase receiver operating characteristic (ROC) analysis was used to evaluate observer performance. The area under the curve (Az) was used as a metric for detectability of simulated lung nodules with diameters of 5 mm and 10 mm, and peak contrast values ranging from 0.1 (subtle) to 0.4 (evident) that were digitally superimposed on normal chest radiographs. Three experienced radiologists interpreted a batch of 60 radiographs on five different display systems; four monitors (two liquid crystal display (LCD) and two cathode ray tube (CRT) monitors) and one printed hardcopy. The physical tests showed superior performance of the two LCD monitors. ROC analysis resulted in the following Az scores: LCD-5MP Az = 0.78, hardcopy Az = 0.77, LCDc-2MP Az = 0.75, CRT-5MP Az = 0.72 and CRTc-1MP Az = 0.71. Difference in Az scores between the LCD-5MP monitor and both the CRT-5MP (p = 0.04) and CRTc-1MP (p = 0.01) monitors was significant. The primary class CRT-5MP monitor that showed reduced observer performance failed to comply with physical acceptance requirements. Luminance response was particularly observed to be insufficient. The results indicate that a quality assurance program has the potential to detect non-optimised display systems that could otherwise result in reduced observer performance.