Display colour scale effects on diagnostic performance and reader agreement in cardiac CT and prostate apparent diffusion coefficient assessment. Issue 1 (January 2019) - Zabala-Travers, S.
Abstract : Aim: To investigate the effect of colour scale choice on diagnostic performance in the interpretation of medical images. Materials and methods: Twelve clinicians interpreted 210 myocardial computed tomography (CT) perfusion (CTP) examinations, and nine clinicians interpreted 165 magnetic resonance imaging (MRI) apparent diffusion coefficient (ADC) prostate images. In three separate sessions, each participant read the same image set using greyscale, hot-iron, and rainbow scales, respectively. Participants scored their level of confidence for tumour presence in the ADC study, and for ischaemia in the CTP study, from 0 to 100. The area under the receiver operating characteristic (ROC) curve (AUC) was used as the performance metric. For cases that scored >50, CTP readers' agreement on the ischaemic transmural extent was analysed, and ADC map readers' selected values and coordinates for the lowest ADC within the detected tumour were compared across different colour scales. Results: For CTP detection, the AUC was up to 0.10 higher with greyscale, 0.67±0.02 (standard error), compared to rainbow, 0.56±0.02, and detection with hot-iron was in between (0.61±0.03). For ischaemic transmural lesion categorisation, observed inter-reader agreement was highest with greyscale for category 25–50%. There is a small tendency for rainbow and greyscale to outperform hot-iron in the detection of prostate tumours. The selected lowest ADC value and pixel localisation was similar with all colour scales. Conclusions: The present findings suggest that colour visualisation has a measurable effect on CTP and ADC performance. Further investigation is necessary to determine the magnitude of the effect in diagnostic tasks. Highlights: Choice of visualization colour scale significantly affects lesion detection performance and diagnostic decision consistency. Myocardial perfusion CT readers have higher lesion detection performance and are more consistent when using greyscale. The inverted rainbow and grey scales tend to outperform the hot-iron scale in prostate cancer detection. We show that the choice of display colour scale for image visualization contributes to variability in reader performance.