Influence of monitor display resolution and displayed image size on the spatial resolution of ultra-high-resolution CT images: a phantom study.

To determine the optimal display conditions for ultra-high-resolution computed tomography (UHRCT) images in clinical practice, this study investigated the effects of liquid-crystal display (LCD) resolution and displayed image size on the spatial resolution of phantom images acquired using a UHRCT system. A phantom designed to evaluate the high-contrast resolution was scanned. The scan data were reconstructed into four types of UHRCT image series consisting of the following possible combinations: two types of reconstruction kernels on the filtered back-projection method (for the lung and mediastinum) and two types of matrix sizes (10242 and 20482). These images were displayed under eight types of display conditions: three image sizes displayed on a 2-megapixel (MP) and 3-MP color LCD and two image sizes on an 8-MP color LCD. A total of 32 samples (four image series × eight display conditions) were evaluated by eight observers for high-contrast resolution. The high-contrast resolution of the displayed UHRCT images was significantly affected by the displayed image size, although the largest (full-screen) displayed image size did not necessarily show the maximum high-contrast resolution. When the images were displayed in the full-screen size, LCD resolution affected the high-contrast resolution of only the 20482-matrix-size images reconstructed using the lung kernel. In conclusion, the spatial resolution of UHRCT images may be affected by LCD resolution and displayed image size. To optimize the clinical display conditions for UHRCT images, it is necessary to adopt an LCD with an adequate resolution for each viewing situation.

Bilateral Stress Fractures of the Femoral Neck after Total Knee Arthroplasty: Importance of Early Diagnosis.

Unilateral stress fracture of the femoral neck following total knee arthroplasty (TKA) is a rare complication; only 21 cases are described in English literature so far. Bilateral stress fractures of the femoral neck occurring simultaneously following a bilateral TKA have been seen in only 2 cases till now. We report a patient suffering from rheumatoid arthritis of both knees, who was treated with bilateral TKA. She developed spontaneous fractures of the femoral neck on both sides 12 months following the TKA. She was treated with bilateral total hip arthroplasty (THA). Stress fracture of the femoral neck should be suspected in patients complaining of hip pain who have undergone TKA.

[Assessment Tool of Image Quality for Medical Liquid-crystal Displays Using Commercially Available Digital Cameras].

We developed a simplified tool for measuring image quality of medical liquid-crystal displays (LCDs) using a commercially available color digital camera. This tool implemented as a plug-in software for ImageJ (open-source image processing program) was designed to compute modulation transfer functions (MTFs) and Wiener spectra (WS) of monochrome and color LCDs from LCD photographed images captured by a camera. The intensities of the red (R), green (G), and blue (B) signals of the unprocessed image data depend on the spectral sensitivity of the image sensor used in the camera. In order to evaluate image quality based on LCD luminance, the plug-in software calibrates the RGB signals from the camera using measured luminance of the LCD and converts them into grayscale signals that correspond to the luminance of the LCD. The MTFs and WS are determined based on the line response from a one-pixel line image and the one-dimensional noise profiles acquired by scanning the uniform image using numerically synthesized slit, respectively. With this plug-in software for ImageJ, we are able to readily compute MTFs and WS of both monochrome and color LCDs from unprocessed image data of cameras. Our simplified tool is helpful to evaluate and understand the physical performance of LCDs for a large number of display users in hospitals and medical centers.

Is the alignment guide technique in total hip arthroplasty sufficient for accurate cup positioning with a modified Watson Jones approach?

PURPOSE:: Cup setting with only an alignment guide has been reported to be inaccurate in the lateral decubitus position in total hip arthroplasty (THA). We assessed the accuracy of cup positioning using only the alignment guide technique via a modified Watson Jones approach in the lateral decubitus position. METHODS:: Two hundred hips of 189 patients underwent THA from October 2014 to September 2016 via a modified Watson Jones approach. In the final sample, 181 hips of 171 patients (35 males, 136 females) were included in this investigation. The alignment of the cup was evaluated by an anteroposterior radiograph of the pelvis 1 week after surgery. Measurements were divided into safe zone determined by Callanan and Lewinnek. RESULTS:: There were 168 (92.8%) acetabular cups that were placed within the safe zone for both inclination and anteversion based on the safe zones defined by Lewinnek, and 134 (74%) acetabular cups that were placed within the safe zone defined by Callanan. Multiple logistic analysis showed that the laterality and the addition of the confirmation method were indicators for malpositioning of combined inclination and anteversion. CONCLUSION:: Our data suggested that even if special tools were not used in the lateral decubitus position, using only the alignment guide enabled cup positioning to be achieved with 92.8% accuracy in the Lewinnek safe zone and 74% accuracy in the Callanan safe zone. Multiple logistic analysis showed that the laterality and the addition of a confirmation alignment guide influenced the accuracy of cup positioning.

[Effect of Color Temperature on Color Scale Test Patterns in Medical Liquid-crystal Display Monitor].

In Japan, medical liquid-crystal display (LCD) and general LCD monitors have color temperatures of 7500 and 6500 K, respectively. The differences in color temperature make it difficult for radiologists to judge whether the same color is being displayed on the monitor. Therefore, the radiologist may overlook lesions. We examined chromaticity on a color scale test pattern to determine the relationships between color temperature (6500-12,500 K) of the medical color LCD monitors, there are three types of fluorescent light and three types of illuminance LCD monitors. As the color temperature of the monitor increased, the variation in chromaticity for grayscale test patterns increased and those variations for the blue scale test patterns decreased in a dark room and at 600 lux. In addition, even if the color temperature of the monitor was changed, the variation in chromaticity showed no change under fluorescent lighting with light bulb color and daylight color. The results of this study will be useful for quality control and quality assurance of medical LCD monitors in terms of illuminance and color temperature of the monitor.

[Diagnostic detection performance of a simulated nodule in chest computed tomography images and gray and color nuclear medicine images: comparison between a medical liquid crystal display monitor and an ordinary liquid crystal display monitor].

The purpose of this study was to evaluate the detection performance of simulated nodules in chest computed tomography (CT) images and nuclear medicine images with an ordinary liquid crystal display (LCD) and a medical LCD (grayscale standard display function: GSDF) and gamma 2.2. We collected 72 chest CT image slices obtained from an LSCT phantom with simulated signals composed of various sizes and CT values and 78 slices of monochrome and color nuclear medicine images obtained from a digital phantom with a simulated signal composed of various sizes and radiation levels. Six observers performed receiver operating characteristic (ROC) analysis using a continuous scale. The area under the ROC curve (AUC) was calculated for each monitor. The average AUC values for detection of chest CT images on a medical LCD (GSDF), medical LCD (gamma 2.2), and ordinary LCD were 0.71, 0.67, and 0.73, respectively. The average AUC values for detection of monochrome nuclear medicine images using a medical LCD (GSDF), medical LCD (gamma 2.2), and ordinary LCD were 0.81, 0.75, and 0.72, respectively. The average AUC values for detection of color nuclear medicine images on a medical LCD (GSDF), medical LCD (gamma 2.2), and ordinary LCD were 0.88, 0.86, and 0.90, respectively. Observer performance for detection of simulated nodules in chest CT images and nuclear medicine images was not significantly different between the three LCD monitors. We therefore conclude that an ordinary LCD monitor can be used to detect simulated nodules in chest CT images and nuclear medicine images.

Effect of fluorescent lighting on the color of liquid-crystal displays.

Liquid-crystal displays (LCDs) are used for displaying medical images under various illuminance conditions and with ambient-lighting colors. Our purpose in this study was to understand the variations of the chromaticity in LCDs under different fluorescent lighting conditions. The variation of chromaticity of LCDs at a white point consisting of equivalent pixel value in Red, Green, and Blue was examined under different types of fluorescent lighting. The direction of changes in the chromaticity diagram shifted to the color of each fluorescent lighting. When the differences in chromaticity (∆u'v') increased, the observers' confidence levels in distinguishing color differences also increased. When the luminance of the LCD increased, observers' sensitivities for recognizing differences in chromaticity also increased as compared to observers' sensitivities at lower luminances. Our results indicate that observers recognized slightly yellowish colors even if ∆u'v' was less than 0.01; thus, observers could perceive differences in chromaticity. These results could provide important and relevant information with regard to better ambient lighting conditions in an image-reading room.

Difficulty in locking head screw removal.

BACKGROUND: Locking plates are an internal fixation material useful in the treatment of bone fractures, which provides effective stabilization between the plate and locking head screws (LHSs) via the locking mechanism. However, difficulty in removing LHSs is relatively common, and such cases can require long surgical procedures or use of special removal equipment. The purpose of this study was to report the incidence and risk factors for difficult removal of LHSs. METHODS: During the 5-year-6-month period from April 2006 to September 2011, 83 locking plates containing a total of 482 LHSs were removed in 80 patients at our institution. Out of 482 LHSs, there were 118 LHSs with a 2.4-2.7 mm diameter, 308 LHSs with a 3.5 mm diameter and 56 LHSs with a 5.0 mm diameter. The incidence of removal difficulty was examined on the basis of screw diameter. In addition, the risk factors were assessed in only LHSs with a 3.5 mm diameter. LHSs with a 3.5 mm diameter were divided into 2 groups, the difficult removal group and the easy removal group, and the data were examined based on age, sex, time between insertion and removal, and screw position. The incidence of removal difficulty in LHSs with a 3.5 mm diameter was examined every 6 months between insertion and removal. RESULTS: Difficulty in removal was encountered in none (0 %) of 118 LHSs with a 2.4-2.7 mm diameter, 15 (4.9 %) of 308 LHSs with a 3.5 mm diameter, and none (0 %) of 56 LHSs with a 5.0 mm diameter. In only LHSs with a 3.5 mm diameter, the mean ages of the patients in the difficult removal group and the easy removal group were 32.1 and 45.6 years, respectively. The average time between insertion and removal in the difficult removal group and the easy removal group was 529.2 and 389.2 days, respectively. There was a statistically significant difference in age and time between insertion and removal. Removal was difficult in 15 (9.1 %) of 165 LHSs with a 3.5 mm diameter in those with >1 year between insertion and removal. CONCLUSION: This study suggests that (1) the use of LHSs with a 3.5 mm diameter is a necessary condition for difficulty in screw removal, and that (2) longer time from internal fixation to removal, and (3) younger age, are risk factors for it. When removing LHSs with a 3.5 mm diameter, appropriate instruments and sufficient training are necessary.

A preliminary study for exploring the luminance ratio of liquid-crystal displays required for display of radiographs.

Medical-grade liquid-crystal displays (LCDs) with high contrast ratio (CR) values have recently been developed and become available for soft-copy reading. When the LCD is used under ambient light conditions, the luminance ratio (LR) is a more appropriate indicator than the CR. Our aim was to explore the LR required for LCDs for soft-copy reading by comparing the effective LR values with the LR of the LCD. We defined "the luminance ratio in an image (LRimg)", the ratio of the maximum to minimum luminance in a radiograph displayed on the LCD, as the effective LR values required for the LCD. The maximum LRimg values in chest radiographs and those in mammograms ranged from 109 to 143 and 372 to 431, respectively. The LR of the LCD was higher than the LRimg values of the radiographs. Our results indicate that currently available medical-grade LCDs have enough LR for display of radiographs.

Visual assessment method of angular performance in medical liquid-crystal displays by use of the ANG test pattern: effect of ambient illuminance and effectiveness of modified scoring.

A visual assessment method of the angular performance in medical liquid-crystal displays (LCDs) by use of the "ANG test pattern" was proposed by Badano and the International Electrotechnical Commission. Our goals were to examine the effect of ambient illuminance on the visual assessment, and to investigate whether our modified visual assessment (with the ANG test pattern) can be used instead of the conventional assessment based on luminance measurements. As the ambient illuminance increased, the original scores obtained with the visual assessment decreased. The modified score of the visual assessment was in reasonable agreement with the results of the luminance-based assessment. We conclude that the visual assessment with the ANG test pattern should be performed in a room with constant ambient illuminance, and the modified visual assessment could have the potential to be used instead of the luminance-based assessment for quality assurance of medical LCDs.

Effect of angular performance on the chromaticity of grayscale images displayed on medical liquid-crystal displays.

Although variation of chromaticity in medical liquid-crystal displays (LCDs) has created interest in the quality assurance and quality control of display devices for medical use, it is unknown how chromaticity varies with the viewing angle. Our aims in this study were to investigate the variations of chromaticity in grayscale images displayed on medical LCDs depending on viewing angles, and to examine color discrimination at different viewing angles. Variations in chromaticity, Δu'v', between 0° and each viewing angle (-60° to +60°) were investigated. The chromaticity of each LCD varied as the viewing angle changed. We examined confidence levels of color discrimination at different viewing angles by rotating the LCD for ten observers. When the viewing angle and variation in chromaticity increased, the confidence levels of color discrimination increased. Our results indicated that observers, such as radiologists and radiological technologists, could recognize variation in chromaticity at different viewing angles.

Effect of ambient lighting on liquid-crystal displays with different types of surface treatment.

Liquid-crystal displays (LCDs) with different types of surface treatment have been developed for decreasing the effect of ambient lighting on a displayed image. The effect of ambient lighting on LCDs with different surface treatments, namely, glare (G)-type, anti-glare (AG)-type, and anti-reflection (AR)-coating LCDs, was evaluated quantitatively in this study for appropriate selection. The effect of ambient lighting on diffuse reflection and specular reflection was investigated. The coefficient of diffuse reflection of the AR-coating LCD was smaller than the others. The effect of diffuse reflection on the display function of each LCD was evaluated in terms of the deviation of the contrast response at the lowest luminance level when the illuminance changed from the condition that was used for calibration of the grayscale standard display function. The display function of the AR-coating LCD was affected less by diffuse reflection compared to the others. On the other hand, the coefficient of specular reflection of the AG-type LCD was the smallest until the angle of aperture of the light source was 4.6°. The specular-reflected image on the AG-type LCD had a remarkably broad distribution compared to the others. Our results are merely examples for a limited number of LCDs; however, we clarified quantitatively that the AR-coating and the AG-type LCDs were affected less by diffuse and specular reflection than the G-type LCD.

Chromaticity and correlated color temperature of the white point in medical liquid-crystal display.

PURPOSE: The color characteristics of medical liquid-crystal displays (LCDs) have become one of the main interests in quality assurance and quality control of medical display devices. It is necessary to evaluate variations of the color characteristics in medical LCDs in order to provide consistent color characteristics for image reading. In this study, we characterize the color characteristics in grayscale images displayed on medical LCDs. METHODS: Eight medical color LCDs and eight medical monochrome LCDs were used in this study with operating times ranging from 800 to 25 000 h. Default settings of correlated color temperature (CCT) of white points for all color LCDs were set at 7500 K. We measured chromaticity in the Commission Internationale de l'Éclairage (CIE) u'v' color space and CCT of the white point at 18 luminance levels. A colorimeter and grayscale test patterns with various luminance levels were used for the measurements. First, we examined differences in chromaticity and CCT at 18 luminance levels for each LCD. Second, we compared chromaticities of the different LCDs. Then, chromaticity and CCT of LCDs were measured at different ambient light conditions (30 and 560 lux) and compared to those measured in a dark room. Finally, the relationship between operating times and CCT was evaluated. RESULTS: The chromaticities of monochrome LCDs changed toward the blue and CCT increased as luminance decreased. In color LCDs, the chromaticity and CCT of the white point except at the minimum luminance were nearly constant to those measured at the maximum luminance. We observed differences in chromaticity between color and monochrome LCDs because of the nonadjustable white point of monochrome LCDs. When the ambient light increased, chromaticity varied, and CCT decreased on every LCD. Ambient light had a much greater impact on chromaticity and CCT at lower luminance levels. The CCT of LCDs decreased in longer operating times. The grayscale of LCDs with longer operating times was measured to be more yellowish due to the degradation of cold cathode fluorescent lamps. CONCLUSIONS: Our results clearly indicate that the white point in grayscale images displayed on medical LCDs changes depending on luminance levels, color or monochrome LCDs, ambient light conditions, and operating times. These data provide useful information to understand color characteristics of LCD for image reading, especially for quality assurance and quality control of LCDs.

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.

[Investigation of practical method for quality assurance and control of medical displays].

Quality assurance (QA) guidelines for medical display systems in Japan, JESRA X-0093, were published in August 2005 and have been used in many medical fields to maintain image quality on medical displays. This report offers detailed explanations of terms and testing methodologies in the guidelines, taking into account users with little knowledge of display technology. The management grade classifications, luminance meters, test patterns, and evaluation methods for executing the QA are supplementally described based on the technical background of related things. In addition, the validity of the evaluation methods and judgment criteria for uniformity and contrast response tests were examined in some experiments. The experimental results of the contrast response indicated that some cases presented inadequate display contrast even if the contrast responses were set within ± 15% of the standard acceptable range for grade 1. The luminance responses of displays used in two computed tomography systems (CTs) and one magnetic resonance imaging system (MRI) were also measured, and the results indicated that their responses with conventional gamma responses were problematic for comparing images with those of medical displays.

Comparison of detectability of a simple object with low contrast displayed on a high-brightness color LCD and a monochrome LCD.

The goal of this study was to investigate the effect of the different luminance settings of a high-brightness color liquid-crystal display (LCD) on the detectability of a simple grayscale object with low contrast by use of receiver operating characteristic (ROC) analysis. The detectability of a high-brightness color LCD with two maximum-luminance settings (500 and 170 cd/m(2)) was compared with the detectability of a monochrome LCD (500 cd/m(2)). The two LCDs used in this study were calibrated to the grayscale standard display function. The average areas under the ROC curve (AUCs) and the standard deviations for all thirteen observers for the 500 cd/m(2) color LCD, 500 cd/m(2) monochrome LCD, and 170 cd/m(2) color LCD were 0.937 +/- 0.040, 0.924 +/- 0.056, and 0.915 +/- 0.068, respectively. There were no statistically significant differences in the average AUCs among the three LCD monitor conditions. On the other hand, the total observation time for the 170 cd/m(2) color LCD was significantly shorter than that for the 500 cd/m(2) color and monochrome LCDs (p < 0.05). Irrespective of the maximum luminance settings (500 and 170 cd/m(2)), the color LCD provided a performance comparable to the monochrome LCD for detection of a simple grayscale object with low contrast.

Detectability of a lung nodule displayed on a liquid-crystal display monitor with different maximum luminance settings.

Our purpose in this study was to examine the detectability of a lung nodule at different maximum luminance settings of a liquid-crystal display (LCD) monitor by utilizing receiver operating characteristic (ROC) analysis. The LCD monitor used in this study was calibrated to the grayscale standard display function with different maximum luminance settings (670, 450, and 170 cd/m(2)). The average area under the ROC curve (AUC) and the standard deviation for all observers at 670, 450, and 170 cd/m(2) were 0.837 +/- 0.076, 0.832 +/- 0.051, and 0.830 +/- 0.078, respectively. There was no statistically significant difference in AUC as a function of the maximum luminance setting of the LCD monitor. Considering the results, setting the maximum luminance of an LCD monitor at a higher level may not provide a significant advantage in the detectability of a lung nodule.

Activation of the extracellular signal-regulated kinase signal pathway by light emitting diode irradiation.

Irradiation by light emitting diode (LED) promotes fibroblast proliferation and wound healing. However, its mechanism is still unknown. The purpose of this study was to clarify the mechanism of fibroblast proliferation by LED irradiation. Cultured NIH3T3 fibroblasts from normal mice were irradiated by LED with a center wavelength of 627 nm. LED irradiation was performed with an energy density of 4 J/cm(2), at subculture and 24 h later. The expression of several growth factors and their receptors was analyzed by reverse transcriptase-polymerase chain reaction (RT-PCR): platelet-derived growth factor (PDGF)-A, PDGF-B, and PDGF-C, transforming growth factor-beta (TGF-beta), basic fibroblast growth factor (bFGF), PDGF-alpha receptor, and TGF-beta receptor. Then, the activation of the extracellular signal-regulated kinase (ERK) pathway was examined by Western blotting with and without the PDGF receptor inhibitor. LED irradiation induced cell growth of NIH3T3 fibroblasts. The expression of PDGF-C had significantly increased in the irradiated group (P < 0.01). Although strong activation of the ERK pathway was observed in the irradiated group, its activation was completely suppressed by the PDGF receptor inhibitor. We concluded that LED irradiation promotes fibroblast proliferation by increasing autocrine production of PDGF-C and activating the ERK pathway through phosphorylation of the PDGF receptor.

Pyrrolidinium-type fullerene derivative-induced apoptosis by the generation of reactive oxygen species in HL-60 cells.

The biological activities of C(60)-bis(N,N-dimethylpyrrolidinium iodide), a water-soluble cationic fullerene derivative, on human promyeloleukaemia (HL-60) cells were investigated. The pyrrolidinium fullerene derivative showed cytotoxicity in HL-60 cells. The characteristics of apoptosis, such as DNA fragmentation and condensation of chromatin in HL-60 cells, were observed by exposure to the pyrrolidinium fullerene derivative. Caspase-3 and -8 were activated and cytochrome c was also released from mitochondria. The generation of reactive oxygen species (ROS) by the pyrrolidinium fullerene derivative was observed by DCFH-DA, a fluorescence probe for the detection of ROS. Pre-treatment with alpha-tocopherol suppressed cell death and intracellular oxidative stress caused by the pyrrolidinium fullerene derivative. The apoptotic cell death induced by the pyrrolidinium fullerene derivative was suggested to be mediated by ROS generated by the pyrrolidinium fullerene derivative.

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.