Effect of the display medium of a mammogram on microcalcification—diagnostic performance and the subjective preference of radiologists according to differing professional experience

This study was nvestigate the effect of different display media of mammographic images (visual display terminals [VDT] and a view-box) on the display-media diagnostic performance and subjective prefereness of radiologists according to differing professional experience. This study included 30 patients and 120 images (four images per patient) who underwent digital mammography at Changhua Christian Hospital in central Taiwan, using the General Electric digital mammography system. Biopsies indicated that 15 patients had microcalcifications, while the other 15 patients were normal. In this experiment, the interpreting physicians included of five males and one female. The physicians were divided into three groups (attending physicians, radiology residents and interns) according to varying levels of experience and expertise in digital mammography. Three different display media were used, including a medical monitor (BARCO V9601100), a general monitor (SAMSUNG 191T), and an unmasked view-box. A signal-blind test based on these three different display media was used to evaluate the six radiologists' microcalcifications-diagnosis performance and to obtain the area-under-curve (AUC) values from the receiver-operating-characteristic (ROC) curves, sensitivity, and specificity. A five-point Likert-type rating scale was used to evaluate the radiologists' subjective preference. The results of the analyses of variances showed that different professional experience settings had a significant effect on all AUC, sensitivity, and specificity. Attending and resident physicians performed significantly better on AUC, sensitivity, and specificity than interns. Different display-type settings had a significant effect on AUC and sensitivity; however, they had no significant effect on specificity. The physicians performed significantly better on AUC when the display types were a BARCO medical LCD and a SAMSUNG general LCD rather than a conventional unmasked view-box. The physicians performed significantly better on sensitivity when the display type was a BARCO medical LCD rather than a SAMSUNG general LCD or a conventional unmasked view-box. Different professional experience provided significantly different preference evaluating (F(2, 16)=6.50, p<0.05), and different display type settings had a significant effect on physicians' diagnosis performance (F(2, 16)=138.5, p<0.05). The results of a Duncan test demonstrated that the physicians' most preferred display media was a BARCO medical LCD. The findings of this research indicate that physicians' better diagnosis performance depends on both their professional experience and a high-resolution medical-level display media to interpret digital mammographic microcalcifications.