title: Blinded evaluation of the effects of high definition and magnification on perceived image quality in laryngeal imaging.
abstract: OBJECTIVE
  Advances in commercial video technology have improved office-based laryngeal imaging. This study investigates the perceived image quality of a true high-definition (HD) video camera and the effect of magnification on laryngeal videostroboscopy.
  
  
  METHODS
  We performed a prospective, dual-armed, single-blinded analysis of a standard laryngeal videostroboscopic examination comparing 3 separate add-on camera systems: a 1-chip charge-coupled device (CCD) camera, a 3-chip CCD camera, and a true 720p (progressive scan) HD camera. Displayed images were controlled for magnification and image size (20-inch [50-cm] display, red-green-blue, and S-video cable for 1-chip and 3-chip cameras; digital visual interface cable and HD monitor for HD camera). Ten blinded observers were then asked to rate the following 5 items on a 0-to-100 visual analog scale: resolution, color, ability to see vocal fold vibration, sense of depth perception, and clarity of blood vessels. Eight unblinded observers were then asked to rate the difference in perceived resolution and clarity of laryngeal examination images when displayed on a 10-inch (25-cm) monitor versus a 42-inch (105-cm) monitor. A visual analog scale was used. These monitors were controlled for actual resolution capacity.
  
  
  RESULTS
  For each item evaluated, randomized block design analysis demonstrated that the 3-chip camera scored significantly better than the 1-chip camera (p < .05). For the categories of color and blood vessel discrimination, the 3-chip camera scored significantly better than the HD camera (p < .05). For magnification alone, observers rated the 42-inch monitor statistically better than the 10-inch monitor.
  
  
  CONCLUSIONS
  The expense of new medical technology must be judged against its added value. This study suggests that HD laryngeal imaging may not add significant value over currently available video systems, in perceived image quality, when a small monitor is used. Although differences in clarity between standard and HD cameras may not be readily apparent on small displays, a large display size coupled with HD technology may impart improved diagnosis of subtle vocal fold lesions and vibratory anomalies.
authors.affiliation: Department of Otolaryngology, Emory University, Atlanta, GA 30308, USA.
authors.forename: Kristen J
authors.initials: KJ
authors.lastname: Otto
authors.forename: Edie R
authors.initials: ER
authors.lastname: Hapner
authors.forename: Michael
authors.initials: M
authors.lastname: Baker
authors.forename: Michael M
authors.initials: MM
authors.lastname: Johns
mesh_terms: D004867:Equipment Design; D006801:Humans; D007089:Image Enhancement / Q000295:instrumentation*; D007830:Larynx; D011446:Prospective Studies; D011897:Random Allocation; D016037:Single-Blind Method; D049489:Stroboscopy / Q000379:methods* / Q000592:standards; D014741:Video Recording / Q000379:methods* / Q000592:standards; D014827:Vocal Cords