Effectiveness of high-luminance display monitors in digital mammography

Receiver operating characteristic (ROC) examination was performed to investigate the effectiveness of high-luminance monitors in digital X-ray mammography. For this purpose, an original breast phantom consisting of adipose and fibroglandular equivalent tissues with an identical X-ray absorption characteristic over the entire mammographic photon energy range was developed. Furthermore, the phantom’s fibroglandular density and distribution could be changed arbitrarily. Three types of lesions, microcalcification, mass, and spiculated, were inserted into the breast phantom, and the ROC examination was performed by five radiological technologists certified in screening mammography, to obtain the area under the curve. A liquid crystal display (LCD) monitor with 5 megapixels in a 21-inch display size calibrated to a grayscale standard display function curve was used for the observation. The monitor was set to 600, 900, and 1200 cd/m2 in maximum luminance. The experimental details were fibroglandular density of 25%, respective 50 positive and negative images, and free observation time and distance. As a result, the dependence on monitor luminance differed according to the lesion type. The detectability of microcalcification increased with the increase in the luminance of the monitor. Spiculated lesions were similar for all luminance changes. The detectability of mass lesions was significantly higher at 900 cd/m2 than at 600 cd/m2 . There was no significant difference between those at 900 cd/m2 and 1200 cd/m2 . In conclusion, the maximum luminance of the diagnostic LCD monitor for mammography should be at least 900 cd/m2 to guarantee stable detectability.