Radiol Phys Technol (2011) 4:128–133
DOI 10.1007/s12194-011-0111-8
Visual evaluation and usefulness of medical high-resolution
liquid-crystal displays with use of independent sub-pixel
driving technology
Seigo Yamada • Yoshiharu Hirata •
Rie Ishii • Toshihide Ogawa
Received: 8 September 2010 / Revised: 31 January 2011 / Accepted: 1 February 2011 / Published online: 17 February 2011
Ó Japanese Society of Radiological Technology and Japan Society of Medical Physics 2011
Abstract Liquid-crystal displays (LCDs) used for medi-
cal imaging, such as luminance characteristics and panel
surface processing, have been developed as a medium
substituting for film. There are various models of and
specifications for display, but those compatible with high-
resolution radiographic diagnostic images have been
required with the recent progression of high-resolution
modalities. Displays are necessary for faithful presentation
of radiographic diagnostic images acquired by X-ray sys-
tems. In independent sub-pixel driving (ISD) technology,
aiming at high-resolution display, three sub-pixels con-
tained in one pixel of the LCD independently display
images, which increases the threefold resolutions in
direction of the sub-pixels, facilitating faithful image dis-
play with less curtailed pixels. This is a new display
technology which may improve the diagnostic performance
with regard to reading of medical images. We evaluated the
characteristics of ISD technology and performed a visual
evaluation of phantom images to investigate its usefulness.
After confirming the physical properties of LCDs, we
performed a visual evaluation of CDMAM phantom ima-
ges employing the calculated image quality figure (IQF).
S. Yamada (&)  Y. Hirata  R. Ishii
Division of Clinical Radiology, Tottori University Hospital,
36-1 Nishi-Machi, Yonago, Tottori 683-8504, Japan
e-mail: yamadachs-ttr@umin.ac.jp
Y. Hirata
e-mail: ysiauhira-ttr@umin.ac.jp
R. Ishii
e-mail: m-r-ishii@mx1.tiki.ne.jp
T. Ogawa
Department of Radiology, Tottori University Hospital,
36-1 Nishi-Machi, Yonago, Tottori 683-8504, Japan
e-mail: ogawa@grape.med.tottori-u.ac.jp
The detectability of 15 mega-sub-pixel (15 MsP) signifi-
cantly improved despite the specification being 5 mega-
pixel (5 MP), and that of 9 MsP was higher than that of
5 MP despite the specification being 3 MP. The usefulness
of ISD for 6 MsP was also confirmed. Therefore, ISD
technology was useful for all LCDs. ISD technology
markedly advanced the LCD display performance for
medical use.
Keywords Liquid-crystal display (LCD) 
Independent sub-pixel driving (ISD)  Sub-pixel
1 Introduction
With recent advancements in high-resolution digital radio-
graphic imaging diagnosis, a high-resolution, high-defini-
tion medical image display is needed. Displays are reading of
radiographic diagnostic images substituting for film, and
there are various models and specifications for LCDs, such as
those with different resolutions, luminance characteristics,
panel structures, and surface processing, for which one needs
prevention of the curtailing of image data sent from moda-
lities due to the display performance, and the addition of
noise components based on the characteristics of individual
monitors is necessary.
In independent sub-pixel driving (ISD) technology, aim-
ing at high-resolution displays, three sub-pixels contained in
one pixel of the LCD-independent display images, which
increase the threefold resolution in the direction of the sub-
pixels, facilitates a faithful image display with less curtailed
pixels [1, 2]. We investigated the characteristics of ISD
technology by applying 15 mega-sub-pixel (15 MsP), 9
mega-sub-pixel (9 MsP), and 6 mega-sub-pixel (6 MsP)
LCDs and the visual perception of these by observers to
Visual evaluation and usefulness of medical high-resolution LCDs
evaluate their usefulness as a method of mammographic
image display.
2 Materials and methods
2.1 Devices
ISD technology-compatible 15, 9, and 6 MsP monochrome
LCDs (MS51i2, MS31i2, and MS21i2 monochrome LCDs,
respectively) were used as medical image displays (all
were from TOTOKU, Tokyo, Japan). The grayscale stan-
dard display function (GSDF) (DICOM Part 14) [3] was
applied to the gray-level characteristics of the displays. The
monochrome LCDs were calibrated with a calibration
system (Medivisor Grayscale for i2 Series, TOTOKU,
Tokyo, Japan). The luminance range established was from
the minimum luminance, 0.8 cd/m2, to a maximum of
500 cd/m2. The highest luminance output of the 15 MsP
display was 750 cd/m2, and those of the 9 and 6 MsP
displays were 1,000 cd/m2 or higher. The highest lumi-
nance for the X-ray radiographic diagnostic images rec-
ommended by the manufacturer is 400 cd/m2, but our
evaluation was performed at the highest luminance used for
actual clinical mammography image displays. The room
styles were made uniform, and sunlight from the outside
was intercepted. The illuminance of the room was set to
about 50 lx. In this situation, it was confirmed that there
was no reflection on the LCD panels.
For the evaluation image, a contrast-detail mammogra-
phy (CDMAM) phantom (Artinis, Zetten, The Nether-
lands) was used. This phantom was imaged with use of a
clinically employed digital mammography device
(MAMMOMAT Novation DR, SIEMENS, Munich, Ger-
many), and the images were subjected to evaluation of the
visual characteristics. The phantom images were observed
with use of an ISD technology-compatible viewer (Medica
Viewer, PSP, Tokyo, Japan). For evaluation of the standard
ISD-incompatible (non-ISD) 5, 3, and 2 MP monochrome
displays, to avoid influences of the differences in perfor-
mance other than resolution, such as panel surface pro-
cessing, the same displays of 15, 9, and 6 MsP ISD were
used by switching of the display setting of the viewer
software.
2.2 Evaluation methods
2.2.1 Evaluation of physical characteristics
To evaluate the physical characteristics, we performed
resolution measurements by employing the bar-pattern
method [modulation transfer function (MTF)] designed by
Ichikawa et al. of Kanazawa University and granularity
129
measurement by using pattern images exclusive for ana-
lytical systems [Wiener spectrum (WS)]. On resolution
measurement, test pattern images for the bar-pattern
method were displayed on the monitor and photographed
with a single-lens reflex digital camera (D70, Nikon,
Tokyo, Japan) [4]. The MTF was calculated from the raw
data from the charge-coupled device (CCD) by use of an
analytical system (NS-2002, S.S. Techno, Nagoya, Japan).
The test patterns for the bar-pattern method were 5-cycle
bar patterns with 1–6 pixel widths and a homogenous
background signal-level area containing bars at the top and
bottom. On granularity measurement, an estimation pattern
image was displayed on the monitor and photographed
with a single-lens reflex digital camera, and the WS in a
100 9 100 pixel homogenous area displayed at a specific
brightness was calculated from the raw CCD data. These
measurement methods were adopted as simple, accurate
methods for the physical evaluation of LCD panels [5, 6].
2.2.2 Evaluation of visual characteristics
Digital images of the CDMAM phantom acquired by use of
a clinically applied digital mammography system were
employed for evaluation of the visual characteristics. The
pixel size of this system was 70 lm. The CDMAM phan-
tom was imaged under X-ray radiography conditions
(30 kV, 56 mA, and Mo target/Mo filter), which adjust the
mean dose for the mammary gland at about 2 mGy with
use of four 1 cm acrylic plates (4 cm). The CDMAM
phantom was composed of gold disks with logarithmically
varied diameters and thicknesses.
Observers noted the contrast of images acquired at sig-
nal sizes 0.03–2.00 lm in thickness and 0.06–2.00 mm in
diameter in the phantom, and they specified the identifiable
diameter (detectable minimum diameter) that was detect-
able with 50% certainty. Based on this evaluation, the
minimum threshold thickness of each signal diameter was
determined and presented as a contrast-detail (C-D) curve.
In addition, the image quality figure (IQF) was calculated
from the C-D curve (Eq. 1). A high IQF value was regar-
ded as indicating high-level detectability [7]:
n
IQF ¼ Pn ; ð1Þ
i¼1 ðCi  Di ; minÞ
where Ci is the thickness (lm) of column i, and Di,min is the
threshold diameter (mm) in diameter column i. Error bars
shown in graphs represent standard errors.
Regarding the test image window, the window width
and level were fixed by a default setting for standardization
of the gray-level characteristics. The display magnification
of the phantom images was set at life-size and actual pixel
(pixel-by-pixel) size, the standards for all displays. In the
life-size display, the display size was identical among
130 S. Yamada et al.

15MsP (V) 5MP (V) 15MsP (H) 5MP (H) 15MsP-V 5MP-V
1.E-01

Wiener Spectral Value (mm2)

1
1.E-02

1E-03

1.E-04
MTF

0.5 1.E-05

1.E-06

1.E-07

1.E-08
0 5 10 15 20 25 30
0 Spatial Frequency (cycles/mm)
0 2 4 6 8 10
Spatial Frequency (cycles/mm) Fig. 2 WS measurement results of sub-pixels of 15 MsP and 5 MP
Fig. 1 MTF measurement results of 15 MsP and 5 MP employing
the bar-pattern method
15MsP-H 5MP-H
1.E-01

Wiener Spectral Value (mm2)

LCDs with different resolutions. In the pixel-by-pixel-size
1.E-02
display, one pixel of the phantom image was displayed as
one pixel. The display image of a medical image was 1.E-03
considered about this display magnification. 1.E-04
The observers conducting visual evaluation were 12 1.E-05
radiologic technologists (1–30 years of experience) 1.E-06
engaged in X-ray radiography: 6 were in charge of 1.E-07
acquiring breast images, and 4 were certified by the Central 1.E-08
Committee on Quality Control of Mammographic Screen- 0 5 10 15 20 25 30
ing of a Non-Profit Organization. The evaluation and its Spatial Frequency (cycles/mm)
difficulty were fully explained to the observers beforehand.
Fig. 3 WS measurement results of non-sub-pixels of 15 MsP and
The observers’ results of their evaluation were based on 5 MP
evaluations they made, their experience, and on their being
engaged in breast imaging or not, and the absence of sig-
nificant differences was confirmed. 14
12
IQF Value

10
8
6
3 Results 4
2
The results of the physical and visual characteristic eva- 0

luations were analyzed by comparison with those of

15 MsP as the standard, which has already been employed
clinically at our hospital.

3.1 Evaluation of physical characteristics LCDs (15MsP vs 5MP)

Regarding the sub-pixel and non-sub-pixel directions
expressed by ISD technology, the MTF of 15 MsP and
5 MP is shown in Fig. 1. These represent the vertical
(V) and horizontal (H) in an LCD placed in the portrait
orientation. The resolution characteristic in the sub-pixel
and the non-sub-pixel was similar on the 5 MP monitor,
but that in the sub-pixel was improved relative to that in the
non-sub-pixel on the 15 MsP monitor.
The WS of 15 MsP and 5 MP in the sub-pixel are shown
in Fig. 2, and those in the non-sub-pixel in Fig. 3. The
granularity of 15 MsP and 5 MP was similar in both the
sub-pixel and non-sub-pixel.
Fig. 4 Comparison of the mean IQF calculated from the C-D curve
between 15 MsP and 5 MP
3.2 Evaluation of visual characteristics
The IQF values of 15 MsP and 5 MP calculated from the
C-D curves for comparison of life-size and pixel-by-pixel-
size displays on the monochrome LCDs are shown in
Fig. 4, and those calculated from the C-D curves for
comparison of the other ISD and non-ISD displays are
shown in Figs. 5 and 6. The significance of differences in
evaluations made by the observers was analyzed by use of
Visual evaluation and usefulness of medical high-resolution LCDs 131

14 a 14
12
IQF Value

10 12
8
10
6

IQF Value
4 8
2
0 6

0
15MsP 5MP 9MsP 3MP 6MsP 2MP
LCDs (9MsP vs 3MP)
LCDs
Fig. 5 Comparison of the mean IQF calculated from the C-D curve
between 9 MsP and 3 MP b 15MsP 5MP 9MsP
3MP 6MsP 2MP
10

14
12
10
IQF Value

8
1

Diameter (mm)
6
4
2
0

0.1

LCDs (6MsP vs 2MP) 0.01

Fig. 6 Comparison of the mean IQF calculated from the C-D curve
between 6 MsP and 2 MP
the one-sided t test (a = 0.05). The detectability on life-
size ISD was improved significantly compared to that
on non-ISD in all displays (p \ 0.05): the detectability on
15 MsP was significantly increased compared to that on
5 MP, that on 9 MsP compared to 3 MP, and 6 MsP
compared to 2 MP. The detectability at the pixel-by-pixel
size was similar between ISD and non-ISD in all displays:
the detectability of 15 MsP and 5 MP was comparable, as
well as between 9 MsP and 3 MP, and between 6 MsP and
2 MP.
Resolution-associated differences in detectability among
the displays were investigated. The IQF values of the dis-
plays with different resolutions were calculated from the
C-D curves of visual evaluations made by the observers.
The values are summarized based on life-size and pixel-by-
pixel-size displays in Figs. 7 and 8. At a life-size magni-
fication, the highest detectability was noted on 15 MsP,
followed by 9 MsP, 6 MsP, and 5 MP with a similar
detectability, and next 3 MP and 2 MP. At a pixel-by-
pixel-size magnification, the highest detectability was
noted on 5 MP, followed by 3 MP and 2 MP, showing
higher-level detectability on monitors with a higher
resolution.
0.01 0.1 1 10
Thickness (µm)
Fig. 7 Comparison of the mean IQF calculated from the C-D curves
at life-size magnification. a Comparison of the mean IQF. b C-D
curves at life-size magnification
4 Discussion
The results of resolution measurement (MTF) employing
the bar-pattern method suggested that improvement of the
resolution characteristic in the sub-pixel was due to
the independent display of sub-pixels of ISD technology.
The resolution characteristic was exceeded on a monitor with
a small pixel size specification, suggesting that the resolution
characteristics change depending on the pixel size.
On WS with use of the analysis system, to avoid the
influences of differences in the characteristics of individual
display models and to investigate true ISD technology-
associated differences, ISD and non-ISD were compared
by switching the ISD on viewer software. Accordingly, the
same monitor (panel) was used for evaluating identical test
patterns, which may have resulted in the same granularity.
This granularity was evaluated within a specified pixel
area. Even if an independent sub-pixel display is adopted
employing ISD technology, the ISD and non-ISD displays
are the same; accordingly, the granularity is also the same.
132 S. Yamada et al.

a 14

12

10
IQF Value

0
15MsP 5MP 9MsP 3MP 6MsP 2MP
LCDs

15MsP 5MP 9MsP

b
3MP 6MsP 2MP
10
Diameter (mm)

0.1

0.01
0.01 0.1 1 10
Thickness (µm)

Fig. 8 Comparison of the mean IQF calculated from the C-D curves
at pixel-by-pixel-size magnification. a Comparison of the mean IQF.
b C-D curves at pixel-by-pixel-size magnification

The ISD technology characteristics were confirmed by

visual evaluation of the life-size and pixel-by-pixel-size
displayed images by the observers. At a life-size magnifi-
cation, the independent sub-pixel display by ISD techno-
logy achieved a smaller pixel size (55 lm in the sub-pixel)
on 15 MsP compared to that (165 lm) on 5 MP, resulting
in faithful images. At the pixel-by-pixel size, because one
pixel of the image was presented as one pixel, 15 MsP and
5 MP were equivalent, showing no ISD technology-asso-
ciated improvement in detectability. Although we did not
perform an evaluation at any magnification higher than the
pixel-by-pixel size, ISD technology may not improve the
detectability at a higher magnification.
Here, mammographic image reading is discussed. In
clinical practice at our hospital, mammographic images are
observed with use of two monitors. Two whole mediolateral
oblique view (MLO) and cranial-caudal view (CC) images
each are presented on the monitors, for observation of late-
rality (Fig. 9a). This corresponds to a life-size display at
Fig. 9 An example of image display on reading of mammography
images. a Life-size level. b Fit-size level. c Pixel-by-pixel-size level
which detectability is significantly improved on 15 MsP.
The image is then displayed at one image per monitor on a
full screen (fit-size level) or at a higher magnification (pixel-
by-pixel-size level) as needed (Fig. 9b, c). Therefore,
15 MsP employing ISD technology may improve detect-
ability on reading images, particularly at life-size or close to
this display level.
On comparison of the visual characteristics among dif-
ferent resolutions evaluated by the observers, the detect-
ability on 9 MsP was the second highest following 15 MsP,
with a similar detectability on 6 MsP and 5 MP, and 3 MP
and 2 MP on the life-size display. These findings corre-
sponded to the resolutions of LCDs shown in Table 1. At a
pixel-by-pixel size, because one pixel of the image was
Visual evaluation and usefulness of medical high-resolution LCDs 133

Table 1 Resolutions of monochrome LCDs decided according to the diagnostic imaging by the per-
LCDs Resolutions Total pixels Pixel type
formance of the LCDs. The usefulness of ISD technology
was confirmed in all LCDs for medical use in our evalu-
15 MsP (ISD) (2,560 9 3) 9 2,048 15,728,640 Sub-pixel ation of visual characteristics, showing that high-resolution
9 MsP (ISD) (2,048 9 3) 9 1,536 9,437,184 Sub-pixel X-ray images can be accurately displayed using ISD
6 MsP (ISD) (1,600 9 3) 9 1,200 5,760,000 Sub-pixel technology.
5 MP (non-ISD) 2,560 9 2,048 5,242,880 Pixel
3 MP (non-ISD) 2,048 9 1,536 3,145,728 Pixel Acknowledgments We thank TOTOKU Electric Co., Tokyo,
Japan, for their instruments and support for this study.
2 MP (non-ISD) 1,600 9 1,200 1,920,000 Pixel

displayed as one pixel, there was no ISD technology-asso- References

ciated difference in detectability between the monitors
which used the same resolution base, and the relationship
among 15, 9, and 6 MsP was the same as that among 5, 3, and
2 MP at a magnification higher than the pixel-by-pixel-size
display. It should be understood that the usefulness of ISD
technology varies depending on the resolution of images and
on the magnification. Although the base of 9 MsP is 3 MP,
the detectability was significantly increased (p \ 0.05)
compared to that on 5 MP, which is generally used for
mammography. Switching to a digital mammography dis-
play may be expected, but the quality and safety of the image
display are not guaranteed when images are presented at a
pixel-by-pixel size or higher magnification because the
performance corresponds to 3 MP.
5 Conclusions
It is to be demanded from the medical LCDs that they
display the image data from the X-ray device correctly.
Especially, the resolution will be important, and will be
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