Effects of ambient light and view box luminance on the detection of calcifications in mammography

Viewing conditions can affect diagnostic performance differently depending on background optical densities. We quantified detection accuracy when viewing calcifications in glandular tissue under recommended viewing conditions versus accuracy with lower view box luminance and higher ambient lighting.

A phantom with adipose, 50% adipose and 50% glandular, and glandular-simulating material was imaged, and images were interpreted by five medical imaging physicists using two lighting conditions: the recommended one, high view box luminance (4365 nits) with low ambient light (25 lx), and a suboptimal one, low view box luminance (1763 nits) with moderate ambient lighting (290 lx). Then, a dense (Breast Imaging Reporting and Data System breast composition pattern type 4) unfixed cadaveric breast with numerous native calcifications was imaged 28 times. Nineteen of the films had added clusters of simulated calcifications. Three radiology fellows, each with 11 months of training in mammography, identified the added calcification clusters in the images under the two lighting conditions. Changes in phantom analysis and accuracy of the clinical diagnosis were compared for each lighting condition.

On mammograms of the phantom, both speck and fibril identification were degraded by an average of 1.4 objects for the adipose-simulating section (with its darker optical density). For medium optical densities, found in the section with the simulation of 50% glandular and 50% adipose tissue, suboptimal lighting conditions had little or no effect on speck and fibril identification. For sections of the phantom that simulated glandular tissue, an average of 0.6 specks or fibers were not seen when lighting was suboptimal. With the dense cadaveric breast, the fraction of added calcification clusters detected by the three observers improved by an average of 17% when low luminance viewers and high ambient light were replaced with recommended viewing conditions; individual scores of the observers improved significantly: p values ranged from .02 to .05.

Luminance of the view box and ambient lighting significantly affect detection of calcifications in dense breasts when images are interpreted by radiologists with about 1 year of training in mammography. Detection of calcifications in phantoms is primarily degraded for adipose tissue with its darker optical density. However, when lighting conditions are suboptimal, some observers also have trouble detecting calcifications in glandular tissue with its low optical density.