Natural display mode for digital DICOM-conformant diagnostic imaging.

Rationale and Objectives: The authors performed this study to investigate the verification of the contrast display properties defined by the digital imaging and communication in medicine (DICOM) PS (picture archiving and communication system [PACS] standard) 3.14-2001 gray-scale display function standard and their dependency on display luminance range and video signal bandwidth.
Materials and Methods: Contrast sensitivity and contrast linearity of DICOM-conformant displays were measured in just-noticeable differences (JNDs) on special perceptual contrast test patterns. Measurements were obtained six times at various display settings under dark room conditions.
Results: Display luminance range and video bandwidth had a significant effect on contrast perception. The perceptual promises of the standard could be established only with displays that were calibrated to a unity contrast resolution, at which the number of displayed intensity steps was equal to the number of perceivable contrast steps (JNDs). Such display conditions provide for visual perception information at the level of single-step contrast sensitivity and full-range contrast linearity. These "natural display" conditions also help minimize the Mach banding effects that otherwise reduce contrast sensitivity and contrast linearity.
Conclusion: Most, if not all, conventionally used digital display modalities are driven with a contrast resolution larger than 1. Such conditions reduce contrast perception when compared with natural imaging conditions. The DICOM-conformant display conditions at unity contrast resolution were characterized as the "natural display" mode, and, thus, the authors a priori recommend them as being useful for making a primary diagnosis with PACS and teleradiology and as a standard for psychophysical research and performance measurements.