title: Effect of color visualization and display hardware on the visual assessment of pseudocolor medical images.
abstract: OBJECTIVE
  Even though the use of color in the interpretation of medical images has increased significantly in recent years, the ad hoc manner in which color is handled and the lack of standard approaches have been associated with suboptimal and inconsistent diagnostic decisions with a negative impact on patient treatment and prognosis. The purpose of this study is to determine if the choice of color scale and display device hardware affects the visual assessment of patterns that have the characteristics of functional medical images.
  
  
  METHODS
  Perfusion magnetic resonance imaging (MRI) was the basis for designing and performing experiments. Synthetic images resembling brain dynamic-contrast enhanced MRI consisting of scaled mixtures of white, lumpy, and clustered backgrounds were used to assess the performance of a rainbow ("jet"), a heated black-body ("hot"), and a gray ("gray") color scale with display devices of different quality on the detection of small changes in color intensity. The authors used a two-alternative, forced-choice design where readers were presented with 600 pairs of images. Each pair consisted of two images of the same pattern flipped along the vertical axis with a small difference in intensity. Readers were asked to select the image with the highest intensity. Three differences in intensity were tested on four display devices: a medical-grade three-million-pixel display, a consumer-grade monitor, a tablet device, and a phone.
  
  
  RESULTS
  The estimates of percent correct show that jet outperformed hot and gray in the high and low range of the color scales for all devices with a maximum difference in performance of 18% (confidence intervals: 6%, 30%). Performance with hot was different for high and low intensity, comparable to jet for the high range, and worse than gray for lower intensity values. Similar performance was seen between devices using jet and hot, while gray performance was better for handheld devices. Time of performance was shorter with jet.
  
  
  CONCLUSIONS
  Our findings demonstrate that the choice of color scale and display hardware affects the visual comparative analysis of pseudocolor images. Follow-up studies in clinical settings are being considered to confirm the results with patient images.
authors.affiliation: Division of Imaging, Diagnostics, and Software Reliability, OSEL/CDRH/FDA, Silver Spring, Maryland 20993.
authors.forename: Silvina
authors.initials: S
authors.lastname: Zabala-Travers
authors.affiliation: Division of Imaging, Diagnostics, and Software Reliability, OSEL/CDRH/FDA, Silver Spring, Maryland 20993.
authors.forename: Mina
authors.initials: M
authors.lastname: Choi
authors.affiliation: Division of Imaging, Diagnostics, and Software Reliability, OSEL/CDRH/FDA, Silver Spring, Maryland 20993.
authors.forename: Wei-Chung
authors.initials: WC
authors.lastname: Cheng
authors.affiliation: Division of Imaging, Diagnostics, and Software Reliability, OSEL/CDRH/FDA, Silver Spring, Maryland 20993.
authors.forename: Aldo
authors.initials: A
authors.lastname: Badano
mesh_terms: D003116:Color; D003626:Data Display; D007091:Image Processing, Computer-Assisted / Q000295:instrumentation*; D008279:Magnetic Resonance Imaging; D059629:Signal-To-Noise Ratio; D013997:Time Factors