The purposes of this study were to evaluate the image quality of five types of liquid-crystal display (LCD) monitors by utilizing the normalized-rank approach and to investigate the effect of LCD monitor specifications, such as display colors, luminance, and resolution, on the evaluators' ranking. The LCD monitors used in this study were 2, 3 and 5 mega-pixel monochrome LCD monitors, and 2 and 3 mega-pixel color LCD monitors (Eizo Nanao Corporation). All LCD monitors were calibrated to the grayscale standard display function (GSDF) with different maximum luminance (recommended luminance) settings. Also, four kinds of radiographs were used for observer study based on the normalized-rank approach: three adult chest radiographs, three pediatric chest radiographs, three ankle joint radiographs, and four double-contrasted upper gastrointestinal radiographs. Ten radiological technologists participated in the observer study. Monochrome LCD monitors exhibited superior ranking with statistically significant differences (p<0.05) compared to color LCD monitors in all kinds of radiographs. The major difference between monochrome and color monitors was luminance. Therefore, it is considered that the luminance of LCD monitors affects observers' evaluations based on image quality. Moreover, in the case of radiographs that include high frequency image components, the monitor resolution also affects the evaluation. In clinical practice, it is necessary to optimize the luminance and choose appropriate LCD monitors for diagnostic images.
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