The effects of ambient lighting in chest radiology reading rooms.

Under typical dark chest radiography reading room conditions, a radiologist's pupils contract and dilate as their visual focus intermittently shifts between the high luminance monitor and the darker background wall, resulting in increased visual fatigue and degradation of diagnostic performance. A controlled increase of ambient lighting may minimize these visual adjustments and potentially improve comfort and accuracy. This study was designed to determine the effect of a controlled increase of ambient lighting on chest radiologist nodule detection performance. Four chest radiologists read 100 radiographs (50 normal and 50 containing a subtle nodule) under low (E=1 lx) and elevated (E=50 lx) ambient lighting levels on a DICOM-calibrated, medical-grade liquid crystal display. Radiologists were asked to identify nodule locations and rate their detection confidence. A receiver operating characteristic (ROC) analysis of radiologist results was performed and area under ROC curve (AUC) values calculated for each ambient lighting level. Additionally, radiologist selection times under both illuminance conditions were determined. Average AUC values did not significantly differ (p>0.05) between ambient lighting levels (estimated mean difference=-0.03; 95% CI, (-0.08, 0.03)). Average selection times decreased or remained constant with increased illuminance. The most considerable decreases occurred for false positive identification times (35.4±18.8 to 26.2±14.9 s) and true positive identification times (29.7±18.3 to 24.5±15.5 s). No performance differences were statistically significant. Study findings suggest that a controlled increase of ambient lighting within darkly lit chest radiology reading rooms, to a level more suitable for performance of common radiological tasks, does not appear to have a statistically significant effect on nodule detection performance.

The influence of increased ambient lighting on mass detection in mammograms.

RATIONALE AND OBJECTIVES: Recent research has provided evidence that in reading rooms equipped with liquid crystal displays (LCDs), a measured increase of ambient lighting may improve clinicians' detection performance. In agreement with this research, the American College of Radiology (ACR) has recommended a moderate increase of ambient lighting in mammography reading rooms. This study was designed to examine the effect of a controlled increase of ambient lighting in mammography reading rooms on the diagnostic performance of breast imaging radiologists. MATERIALS AND METHODS: Four breast imaging radiologists read 86 mammograms (43 containing subtle cancerous masses and 43 normal) under low (E = 1 lux) and elevated (E = 50 lux) ambient lighting levels on a Digital Imaging and Communications in Medicine-calibrated, medical-grade LCD. Radiologists were asked to identify cancerous masses and to rate their detection confidence. Observer areas under the curve (AUCs) were calculated using a receiver-operating characteristic analysis of fully paired results. Additionally, average observer selection times under both ambient lighting levels were determined. RESULTS: Average radiologist AUCs decreased with elevated ambient lighting (0.78 +/- 0.03 to 0.72 +/- 0.04). Observer performance differences, however, were of the same order of magnitude as interobserver variability and were not statistically significant. Average selection times under increased ambient lighting remained constant or decreased, with the greatest decrease occurring for false-positive (20.4 +/- 18.9 to 14.4 +/- 9.6 seconds) and true-positive (18.0 +/- 13.8 to 12.9 +/- 9.4 seconds) selections. CONCLUSION: The results agree with those of previous studies in that observer performance differences under a controlled increase of ambient lighting are not statistically significant. On the basis of these findings and ACR guidelines, a moderate increase of ambient lighting in mammography reading rooms is still suggested, but further research with additional cases and observers should be considered.

Object detectability at increased ambient lighting conditions.

Under typical dark conditions encountered in diagnostic reading rooms, a reader's pupils will contract and dilate as the visual focus intermittently shifts between the high luminance display and the darker background wall, resulting in increased visual fatigue and the degradation of diagnostic performance. A controlled increase of ambient lighting may, however, reduce the severity of these pupillary adjustments by minimizing the difference between the luminance level to which the eyes adapt while viewing an image (L(adp)) and the luminance level of diffusely reflected light from the area surrounding the display (L(s)). Although ambient lighting in reading rooms has conventionally been kept at a minimum to maintain the perceived contrast of film images, proper Digital Imaging and Communications in Medicine (DICOM) calibration of modern medical-grade liquid crystal displays can compensate for minor lighting increases with very little loss of image contrast. This paper describes two psychophysical studies developed to evaluate and refine optimum reading room ambient lighting conditions through the use of observational tasks intended to simulate real clinical practices. The first study utilized the biologic contrast response of the human visual system to determine a range of representative L(adp) values for typical medical images. Readers identified low contrast horizontal objects in circular foregrounds of uniform luminance (5, 12, 20, and 30 cd/m2) embedded within digitized mammograms. The second study examined the effect of increased ambient lighting on the detection of subtle objects embedded in circular foregrounds of uniform luminance (5, 12, and 35 cd/m2) centered within a constant background of 12 cd/m2 luminance. The images were displayed under a dark room condition (1 lux) and an increased ambient lighting level (50 lux) such that the luminance level of the diffusely reflected light from the background wall was approximately equal to the image L(adp) value of 12 cd/m2. Results from the first study demonstrated that observer true positive and false positive detection rates and true positive detection times were considerably better while viewing foregrounds at 12 and 20 cd/m2 than at the other foreground luminance levels. Results from the second study revealed that under increased room illuminance, the average true positive detection rate improved a statistically significant amount from 39.3% to 55.6% at 5 cd/m2 foreground luminance. Additionally, the true positive rate increased from 46.4% to 56.6% at 35 cd/m2 foreground luminance, and decreased slightly from 90.2% to 87.5% at 12 cd/m2 foreground luminance. False positive rates at all foreground luminance levels remained approximately constant with increased ambient lighting. Furthermore, under increased room illuminance, true positive detection times declined at every foreground luminance level, with the most considerable decrease (approximately 500 ms) at the 5 cd/m2 foreground luminance. The first study suggests that L(adp) of typical mammograms lies between 12 and 20 cd/m2, leading to an optimum reading room illuminance of approximately 50-80 lux. Findings from the second study provide psychophysical evidence that ambient lighting may be increased to a level within this range, potentially improving radiologist comfort, without deleterious effects on diagnostic performance.