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Assessment of flat panel LCD primary class display performance based on AAPM TG 18 acceptance protocol.

The image display is an important component of the Picture Archiving and Communication System (PACS) and of digital imaging in general. In this paper, we assess the display performance of 32 different flat panel LCD devices, in terms of their reflection, luminance response, luminance uniformity, resolution, noise, veiling glare and color uniformity included in the tentative guidelines of the AAPM TG18 document version 8.1. We also report on the angular dependencies of luminance and contrast, which constitute one of the miscellaneous tests. The tools used included a telescopic photometer, which was also used as a colorimeter, an illuminance meter, light sources for the reflection assessment, light-blocking devices, and digital TG18 test patterns. The luminance ratio (LR), maximum luminance difference (ALmax) and deviation of contrast response with respect to that of DICOM GSDF were 379.2+/-61.0, 1.6+/-1.1%, and 4.84+/-0.58%, respectively. The maximum luminance nonuniformity was 9.2+/-3.9% for the 10% luminance of the TG18-UNL10 test pattern. In the luminance-based resolution test, the percent luminance difference (deltaL) at the center was 0.78+/-0.42%. In all cases of noise testing, the rectangular target in each square in the three quadrants was visible, as were all 15 targets, except for the smallest one, in each corner pattern and the center pattern. The glare ratio (GR) was 2350+/-1460. The average color uniformity parameter, delta(u',v'), across the display area of each display device was 0.002+/-0.001. Nevertheless, not all of the color uniformity parameters of the display devices associated with a workstation met the acceptance criteria. For 7 selected flat panel displays, the mean specular and diffuse reflection coefficients were 0.0061+/-0.0010 and 0.0017+/-0.0005 cd/m2 per lux, respectively. All of the test results conformed to the criteria recommended by AAPM TG18, indicating that the displays were fully acceptable for diagnostic image interpretation. The maximum viewing angle conforming to the DICOM 3.14 standard luminance responses with a 10% tolerance was found to be approximately 50 degrees in both directions along the vertical axis, 10 degrees in the upper direction and 20 degrees in the lower direction along the horizontal axis, and 20 degrees in the upper direction and 10 degrees in the lower direction along the diagonal axis. Therefore, a radiologist should interpret a displayed image by considering the physical characteristics of the narrow viewing angle of the AMLCD displays. The acceptance testing protocol described herein demonstrates the successful clinical implementation of the guidelines for the viewing conditions of medical displays, and if implemented with a QC program, can be used to determine when LCD devices used for diagnostic interpretation need to be upgraded.

Computer Graphics↗

Assessment of display performance for medical imaging systems: executive summary of AAPM TG18 report.

Digital imaging provides an effective means to electronically acquire, archive, distribute, and view medical images. Medical imaging display stations are an integral part of these operations. Therefore, it is vitally important to assure that electronic display devices do not compromise image quality and ultimately patient care. The AAPM Task Group 18 (TG18) recently published guidelines and acceptance criteria for acceptance testing and quality control of medical display devices. This paper is an executive summary of the TG18 report. TG18 guidelines include visual, quantitative, and advanced testing methodologies for primary and secondary class display devices. The characteristics, tested in conjunction with specially designed test patterns (i.e., TG18 patterns), include reflection, geometric distortion, luminance, the spatial and angular dependencies of luminance, resolution, noise, glare, chromaticity, and display artifacts. Geometric distortions are evaluated by linear measurements of the TG18-QC test pattern, which should render distortion coefficients less than 2%/5% for primary/secondary displays, respectively. Reflection measurements include specular and diffuse reflection coefficients from which the maximum allowable ambient lighting is determined such that contrast degradation due to display reflection remains below a 20% limit and the level of ambient luminance (Lamb) does not unduly compromise luminance ratio (LR) and contrast at low luminance levels. Luminance evaluation relies on visual assessment of low contrast features in the TG18-CT and TG18-MP test patterns, or quantitative measurements at 18 distinct luminance levels of the TG18-LN test patterns. The major acceptable criteria for primary/ secondary displays are maximum luminance of greater than 170/100 cd/m2, LR of greater than 250/100, and contrast conformance to that of the grayscale standard display function (GSDF) of better than 10%/20%, respectively. The angular response is tested to ascertain the viewing cone within which contrast conformance to the GSDF is better than 30%/60% and LR is greater than 175/70 for primary/secondary displays, or alternatively, within which the on-axis contrast thresholds of the TG18-CT test pattern remain discernible. The evaluation of luminance spatial uniformity at two distinct luminance levels across the display faceplate using TG18-UNL test patterns should yield nonuniformity coefficients smaller than 30%. The resolution evaluation includes the visual scoring of the CX test target in the TG18-QC or TG18-CX test patterns, which should yield scores greater than 4/6 for primary/secondary displays. Noise evaluation includes visual evaluation of the contrast threshold in the TG18-AFC test pattern, which should yield a minimum of 3/2 targets visible for primary/secondary displays. The guidelines also include methodologies for more quantitative resolution and noise measurements based on MTF and NPS analyses. The display glare test, based on the visibility of the low-contrast targets of the TG18-GV test pattern or the measurement of the glare ratio (GR), is expected to yield scores greater than 3/1 and GRs greater than 400/150 for primary/secondary displays. Chromaticity, measured across a display faceplate or between two display devices, is expected to render a u',v' color separation of less than 0.01 for primary displays. The report offers further descriptions of prior standardization efforts, current display technologies, testing prerequisites, streamlined procedures and timelines, and TG18 test patterns.

Computer Graphics↗

[Monocrystalline aluminum dental implants in animals: a study of the peri-implant tissue].

After the extraction of two molars in a dog's jaw, a single crystal alumina screw was implanted. Monthly radiographs were taken and analyzed by means of a video display computer (VDC) to obtain densitometric informations about the interface. After one year implantation, the bone segment containing the prosthesis was fixed in 4% paraformaldehyde, embedded in methacrylate and sectioned by a microtome saw. The results in light microscopy with ordinary and polarized light, in SEM and X-ray microanalysis, show the presence of a thick connective tissue layer interposed between the screw and the bone. The histological findings confirm the results obtained through the VDC analysis of the radiographic images.

Absorptiometry, Photon↗

Comparison of computer display monitors for computed radiography diagnostic application in a radiology PACS.

A study to compare the performance of the following display monitors for application as PACS CR diagnostic workstations is described. 1. Diagnostic quality, 3 megapixel, 21 inch monochrome LCD monitors. 2. Commercial grade, 2 megapixel, 20 inch colour LCD monitors. Two sets of fifty radiological studies each were presented separately to five radiologists on two occasions, using different displays on each occasion. The two sets of radiological studies were CR of the chest, querying the presence of pneumothorax, and CR of the wrist, querying the presence of a scaphoid fracture. Receiver Operating Characteristic (ROC) curves were constructed for diagnostic performance for each presentation. Areas under the ROC curves (AUC) for diagnosis using different monitors were compared for each image set and the following results obtained: Set 1: Monochrome AUC = 0.873 +/- 0.026; Colour AUC = 0.831 +/- 0.032; Set 2: Monochrome AUC = 0.945 +/- 0.014; Colour AUC = 0.931 +/- 0.019; Differences in AUC were attributed to the different monitors. While not significant at a 95% confidence level, the results have supported a cautious approach to consideration of the use of commercial grade LCD colour monitors for diagnostic application.

Computer Terminals↗

Teleradiology in Turku University Hospital--diagnostic evaluation and clinical applications.

Teleradiology installation between the Radiology Departments of the Main Hospital Compound and the Paimio Hospital, both belonging to the Turku University Central Hospital has been in clinical use since August 1991. It is based on Unix workstations with 1280 x 1024 pixel display with 216 shades of gray. It has been used to receive previous chest images from Paimio to be compared with recent films taken at TUCH Emergency Department. Scanning resolution of 1024 x 1024 pixels seems to be enough for reference images and probably sufficient for most other purposes.

Computer Terminals↗

Digital imaging for dentists.

This review of digital imaging and the technical aspects of radiographic equipment manufactured for dentists is designed to provide practical information to assist in the decision making process and purchase of radiographic digital imaging for clinical use.

Computer Terminals↗

Using a computerized patient record to reengineer an outpatient clinic.

By employing process flow analysis and work redesign techniques during the design and implementation of a computerized patient record in the pediatric outpatient clinics at the University of Virginia Health Sciences Center, we have developed a database of clinical observations while simultaneously shortening the time that patients spend waiting in the pediatric clinics and decreasing the number of support staff employed within the clinics.

Ambulatory Care Information Systems↗

An algorithm for planning stereotactic brain implants.

A computer software package was developed for the planning and execution of brain biopsy and radioactive implant procedures with the BRW Stereotaxic System. With the application of computer graphics and a zero-one integer variable programming algorithm, an implant plan with accompanying isodose distributions and stereotactic coordinates can be easily accomplished at the time of the operation when the computer imaging terminal and a printer/plotter is placed in the operating room.

Algorithms↗

Accommodation to simulations of defocus and chromatic aberration in the presence of chromatic misalignment.

Previous studies have demonstrated that accommodation will respond to sine gratings in which the relative modulations of red, green and blue image components have been altered to simulate the effects of defocus and longitudinal chromatic aberration. The present study aimed to determine the tolerance of the accommodative system to relative phase shifts in those components induced by chromatic misalignment. It was found that accommodation can tolerate moderate amounts of chromatic misalignment (6'), but responds adversely when misalignments are large. Applications to visual display terminals and spectacle lens and instrument design are discussed.

Accommodation, Ocular↗

Nurse-computer performance. Considerations for the nurse administrator.

Regulatory reporting requirements and economic pressures to create a unified healthcare database are leading to the development of a fully computerized patient record. Nursing staff members will be responsible increasingly for using this technology, yet little is known about the interaction effect of staff characteristics and computer screen design on on-line accuracy and speed. In examining these issues, new considerations are raised for nurse administrators interested in facilitating staff use of clinical information systems.

Adult↗

Entrainment to video displays in primary visual cortex of macaque and humans.

Cathode ray tubes (CRTs) display images refreshed at high frequency, and the temporal waveform of each pixel is a luminance impulse only a few milliseconds long. Although humans are perceptually oblivious to this flicker, we show in V1 in macaque monkeys and in humans that extracellularly recorded action potentials (spikes) and visual-evoked potentials (VEPs) align with the video impulses, particularly when high-contrast stimuli are viewed. Of 91 single units analyzed in macaque with a 60 Hz video refresh, 29 cells (32%) significantly locked their firing to a uniform luminance display, but their number increased to 75 (82%) when high-contrast stimuli were shown. Of 92 cells exposed to a 100 Hz refresh, 21 (23%) significantly phase locked to high-contrast stimuli. Phase locking occurred in both input and output layers of V1 for simple and complex cells, regardless of preferred temporal frequency. VEPs recorded in humans showed significant phase locking to the video refresh in all seven observers. Like the monkey neurons, human VEPs more typically phase locked to stimuli containing spatial contrast than to spatially uniform stimuli. Phase locking decreased when the refresh rate was increased. Thus in humans and macaques phase locking to the high strobe frequency of a CRT is enhanced by a salient spatial pattern, although the perceptual impact is uncertain. We note that a billion people worldwide manage to watch TV without obvious distortion of their visual perception despite extraordinary phase locking of their V1s to a 50 or 60 Hz signal.

Action Potentials↗

Design for user efficiency in a dedicated ICU viewing station.

The intensive care unit (ICU) is one application where significant benefit is expected from the use of digital technology in the acquisition, management and presentation of images. However, the potential benefits should not be outweighed by disadvantages of current digital technology. One of the bottlenecks is the efficiency of image viewing using a workstation, especially if this viewing station is implemented using affordable commonly available hardware. In this paper we describe the design concepts of a relatively low-cost but efficient viewing station for chest images, and discuss clinical experience with this system at an ICU ward. The user interface has been optimized towards the specific patterns of ICU image viewing. By anticipating user requests and preparing images during idle times of the computer, the mean image access time could be reduced by a factor of 4, while most images could be presented instantaneously. Information from the hospital information system (HIS) is exploited in the user interface, and a simplified PAC-HIS coupling has been implemented for the simultaneous presentation of images and reports.

Belgium↗

Complexity of terminal airspace geometry assessed by computed tomography in asthma.

Low attenuation areas in computed tomography images from patients with chronic obstructive pulmonary disease have been reported to represent macroscopic and/or microscopic emphysema. The cumulative size distribution of the clusters has been shown to follow a power law characterized by the exponent D, a measure of the complexity of the terminal airspace geometry. We have previously found increased low attenuation areas in nonsmoking subjects with asthma. We examined the size distribution of the clusters in nonsmoking subjects with asthma compared with both nonsmoking control subjects and subjects with asthma with a smoking history. The percentage of lung field occupied by low attenuation areas (LAA%) and D in subjects with asthma with a smoking history differed significantly from nonsmoking subjects with asthma and control subjects. In nonsmoking subjects with asthma, both parameters differed significantly between severe asthma and mild or moderate asthma. The LAA% differed significantly between moderate and mild asthma, but D did not. In mild and moderate asthma, a highly significant correlation between LAA% and D was observed in patients with a smoking history, but not in nonsmoking subjects with asthma. Our results suggest that decreased D is mostly related to emphysematous change, and both measurements of LAA% and D may provide useful information to characterize low attenuation areas in subjects with asthma.

Aged↗

Preferred viewing distance and screen angle of electronic paper displays.

This study explored the viewing distance and screen angle for electronic paper (E-Paper) displays under various light sources, ambient illuminations, and character sizes. Data analysis showed that the mean viewing distance and screen angle were 495 mm and 123.7 degrees. The mean viewing distances for Kolin Chlorestic Liquid Crystal display was 500 mm, significantly longer than Sony electronic ink display, 491 mm. Screen angle for Kolin was 127.4 degrees, significantly greater than that of Sony, 120.0 degrees. Various light sources revealed no significant effect on viewing distances; nevertheless, they showed significant effect on screen angles. The screen angle for sunlight lamp (D65) was similar to that of fluorescent lamp (TL84), but greater than that of tungsten lamp (F). Ambient illumination and E-paper type had significant effects on viewing distance and screen angle. The higher the ambient illumination was, the longer the viewing distance and the lesser the screen angle. Character size had significant effect on viewing distances: the larger the character size, the longer the viewing distance. The results of this study indicated that the viewing distance for E-Paper was similar to that of visual display terminal (VDT) at around 500 mm, but greater than normal paper at about 360 mm. The mean screen angle was around 123.7 degrees, which in terms of viewing angle is 29.5 degrees below horizontal eye level. This result is similar to the general suggested viewing angle between 20 degrees and 50 degrees below the horizontal line of sight.

Adolescent↗

Reproducibility and validity of workers' self-reports of physical work demands.

The objective of this paper is to provide a systematic review of the reproducibility and validity of self-report questions concerning physical work demands. After a bibliographic search of Medline and Ergonomic Abstracts for 1980-2003, 15 articles meeting the eligibility criteria were reviewed for methodological quality; 82 formulations of questions on physical work demands were evaluated for reproducibility and 83 for validity. Questions evaluated for both reproducibility and validity that performed well in both sets of studies included those on duration or presence of sitting and standing posture, the presence of walking, kneeling or squatting postures, duration or frequency of hands above shoulders, manual handling of more than or less than 10 kg, general level of physical effort, presence and duration of whole-body vibration, and duration of the use of visual display terminals. Suggestions for improving the design of reproducibility and validity studies and directions for future research in physical workload measurement are proposed.

Computer Terminals↗

Steady flow of a viscous fluid through a network of tubes with applications to the human arterial system.

The paper presents a finite-element model for the analysis of steady flow of a viscous fluid through a connected system of elastic tubes with the aim of simulating the conditions of blood flow through the human arterial system. The governing equations of the model are non-linear in character and are solved through an iterative computational procedure. This model is capable of incorporating the effects of stenosis on flow and pressure. Typical results are presented and discussed. Quantitative results have been obtained on blood flow through a model of the human arterial system corresponding to the sets of prescribed conditions at the terminations. Also computational results on the effect of stenosis in typical arteries of the system are presented.

Aorta↗

Methodological limitations in the study of video display terminal use and upper extremity musculoskeletal disorders.

Upper extremity musculoskeletal disorders may occur as a result of work with keyboard-equipped video display terminals. Many studies of the associations between keyboard use and upper extremity disorders have appeared in both the human factors and occupational epidemiologic literature. Methodological limitations and inconsistent results have limited conclusions that can be made from these studies, however. Although exposure conditions can be carefully controlled, human factors studies are limited by relatively small sample sizes, short exposure durations, and reliance on outcome measures with unknown relevance to chronic adverse health effects. Epidemiologic studies have been limited by poor ascertainment of both exposure and health outcome. Many have failed to control for any potential confounding. An almost exclusive reliance on cross-sectional study designs has resulted in possible bias from selective survival, exposure-effect reversal, and poor estimates of exposures occurring prior to development of the disorder. Given the inconsistency in the literature and the growing controversy surrounding this issue, prospective study of this question using objective methods for assessment of exposure and health outcome is recommended. This design allows identification of incident cases and minimizes bias from selective survival. In addition, ergonomic and psychosocial variables prior to onset of symptoms can be ascertained periodically. Given estimates for up to 100 million video display terminals to be in use in the United States by the year 2000, clarification of the health effects of their use is critical.

Arm Injuries↗

Perceived muscular tension, emotional stress, psychological demands and physical load during VDU work.

OBJECTIVES: The aim of this study was to investigate whether perceived muscular tension, psychological demands and emotional stress were associated with physical load or working technique during visual display unit (VDU) work. METHODS: Subjects (28 women and 29 men) from two different organisations volunteered to participate in the study. The study design was cross-sectional, and the data were assessed when the subjects performed their usual work tasks at their usual work place. Multivariate linear and logistic regression models were used to investigate possible associations. The different outcome variables were: median muscle activity and muscular rest in the trapezius muscle bilaterally, wrist movements and working technique. The different explanatory variables were: perceived muscular tension (binary), emotional stress (binary), psychological demands (binary), organisation (binary) and gender (binary). Age (continuous) and present musculoskeletal pain (binary) were also controlled for in the multivariate models. Electromyography (EMG) and electrogoniometers were used to assess the physical load, and the data collection time was 15 min. An ergonomic checklist was used to assess working technique, i.e. work with lifted shoulders. RESULTS: Subjects who perceived muscular tension at least a few times per week the month before the measurements were made worked with higher muscle activity [expressed as per cent of a reference voluntary electrical activity (% RVE)] in the trapezius muscle bilaterally (5% RVE, P=0.05). High emotional stress during the measurement was associated with higher muscle activity in the trapezius muscle on the side not operating the computer mouse (8% RVE, P=0.006). Subjects who reported high levels of emotional stress worked more often with lifted shoulders (odds ratio 6.0, 95% CI 1.2-28.9). However, when present musculoskeletal pain was included in the multivariate model the odds ratio for high emotional stress decreased to 4.5 (95% CI 0.9-23.2). CONCLUSIONS: Perceived muscular tension and emotional stress were associated with physical load, in terms of muscle activity in the trapezius muscles, during VDU work in ordinary occupational settings.

Adult↗