High luminance monochrome vs color displays: Impact on performance and search

To determine if diagnostic accuracy and visual search efficiency with a high luminance medical-grade color display are equivalent to a high luminance medical-grade monochrome display. Six radiologists viewed DR chest images, half with a solitary pulmonary nodule and half without. Observers reported whether or not a nodule was present and their confidence in that decision. Total viewing time per image was recorded. On a subset of 15 cases eye-position was recorded. Confidence data were analyzed using MRMC ROC techniques. There was no statistically significant difference (F = 0.0136, p = 0.9078) between color (mean Az = 0.8981, se = 0.0065) and monochrome (mean Az = 0.8945, se = 0.0148) diagnostic performance. Total viewing time per image did not differ significantly (F = 0.392, p = 0.5315) as a function of color (mean = 27.36 sec, sd = 12.95) vs monochrome (mean = 28.04, sd = 14.36) display. There were no significant differences in decision dwell times (true and false, positive and negative) overall for color vs monochrome displays (F = 0.133, p = 0.7154). The true positive (TP) and false positive (FP) decisions were associated with the longest dwell times, the false negatives (FN) with slightly shorter dwell times, and the true negative decisions (TN) with the shortest (F = 50.552, p < 0.0001) and these trends were consistent for both color and monochrome displays. Current color medical-grade displays are suitable for primary diagnostic interpretation in clinical radiology.