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This study evaluated the potential clinical utility of a high-performance (3 Mega-pixel) color display compared with two monochrome displays--one of comparable luminance (250 cd/m2) and one of higher luminance (450 cd/m2). Six radiologists viewed 50 DR chest images, half with nodules and half without, once on each display. Eye position was recorded on a subset of images. There was no statistically significant difference in ROC Az performance as a function of monitor (F = 1.176, p = 0.3127), although there was a clear trend towards the monochrome 450 cd/m2 monitor being better than the monochrome 250 cd/m2 monitor, which was better than the color monitor. In terms of total viewing time, there were no statistically significant differences between the three monitors (F = 1.478, p = 0.2298). The dwell times associated with true and false positive decisions were shortest for the high luminance monochrome display, longer for the low luminance monochrome, and longest for the low luminance color display. Dwells for the false negative decisions were longest for the high luminance monochrome display, shorter for the low luminance monochrome, and shortest for the low luminance color display. The true negative dwells were not significantly different. The study suggest high luminance displays may have an advantage in terms of diagnostic accuracy and visual search efficiency for detecting nodules in chest images compared to both monochrome and color lower luminance displays, although these differences may have little clinical impact because they are relatively small.
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