How Does the Display Luminance Level Affect Detectability of Breast Microcalcifications and Spiculated Lesions in Digital Breast Tomosynthesis (DBT) Images?

Abstract

Rationale and objectives: This study evaluates the influence of the calibrated luminance level of medical displays in the detectability of microcalcifications and spiculated lesions in digital breast tomosynthesis images.

Materials and methods: Four models of medical displays with calibrated maximum and minimum luminance, respectively, ranging from 500 to 1000 cd/m² and from 0.5 to 1.0 cd/m², were investigated. Forty-eight studies were selected by a senior radiologist: 16 with microcalcifications, 16 with spiculated lesions, and 16 without lesions. All images were anonymized and blindly evaluated by one senior and two junior radiologists. For each study, lesion presence or absence and localization statements, interpretative difficulty level, and overall quality were reported. Cohen's kappa statistic was computed between monitors and within or between radiologists to estimate the reproducibility in correctly identifying lesions; for multireader-multicase analysis, the weighted jackknife alternative free-response receiver operating characteristic statistical tool was applied.

Results: Intraradiologist reproducibility ranged from 0.75 to 1.00. Interreader as well as reader-truth agreement values were >0.80 and higher with the two 1000 cd/m² luminance displays than with the lower luminance displays for each radiologist. Performances in the detectability of breast lesions were significantly greater with the 1000 cd/m² luminance displays when compared to the display with the lowest luminance value (P value <0.001).

Conclusions: Our findings highlight the role of display luminance level on the accuracy of detecting breast lesions.

Keywords: Digital breast tomosynthesis; ROC curve; breast neoplasm; display device; liquid crystal display; luminance; radiographic image interpretation.