To demonstrate conformance with the Grayscale Standard Display Function is a much more complex task than, for example, validating the responses of a totally digital system to DICOM messages.

Display systems ultimately produce analog output, either directly as Luminances or indirectly as optical densities. For some Display Systems, this analog output can be affected by various imperfections in addition to whatever imperfections exist in the Display System's Display Function which is to be validated. For example, there may be spatial non-uniformities in the final presented image (e.g., arising from film, printing, or processing non-uniformities in the case of a hardcopy printer) which are measurable but are at low spatial frequencies which do not ordinarily pose an image quality problem in diagnostic radiology.

It is worth noting that CRTs and light-boxes also introduce their own spatial non-uniformities. These non-uniformities are outside the scope of the Grayscale Standard Display Function and the measurement procedures described here. But because of them, even a test image which is perfectly presented in terms of the Grayscale Standard Display Function will be less than perfectly perceived on a real CRT or a real light-box.

Furthermore, the question "How close (to the Grayscale Standard Display Function) is close enough?" is currently unanswered, since the answer depends on psychophysical studies not yet done to determine what difference in Display Function is "just noticeable" when two nearly identical image presentations (e.g., two nearly identical films placed on equivalent side-by-side light-boxes) are presented to an observer.

Furthermore, the evaluation of a given Display System could be based either on visual tests (e.g., assessing the perceived contrast of many low-contrast targets in one or more test images) or by quantitative analysis based on measured data obtained from instruments (e.g., photometers or densitometers).

Even the quantitative approach could be addressed in different ways. One could, for example, simply superimpose plots of measured and theoretical analog output (i.e., Luminance or optical density) vs. P-Value, perhaps along with "error bars" indicating the expected uncertainty (non-repeatable variations) in the measured output. As a mathematically more elegant alternative, all the measured data points could be used as input to a statistical mathematical analysis which could attempt to determine the underlying Display Function of the Display System, yielding one or more quantitative values (metrics) which define how well the Display System conforms with the Grayscale Standard Display Function.

In what follows in this and the following annexes, an example of the latter type of metric analysis is used, in which measured data is analyzed using a "FIT" test which is intended to validate the shape of the Characteristic Curve and a "LUM" test which is intended to show the degree of scatter from the ideal Grayscale Standard Display Function. This approach has been applied, for example, to quantitatively demonstrate how improvements were successfully made to the Display Function of certain Display Systems.

Before proceeding with the description of the methodology of this specific metric approach, it should be noted that it is offered as one possible approach, not necessarily as the most appropriate approach for evaluating all Display Systems. In particular, the following notes should be considered before selecting or interpreting results from any particular metric approach.

1) There may be practical issues which limit the number of P-Values which can be meaningfully used in the analysis. For example, it may be practical to measure all 256 possible Luminances from a fixed position on the screen of an 8-bit video monitor, but it may be impractical to meaningfully measure all 4096 densities theoretically printable by a 12-bit film printer. One reason for the impracticality is the limited accuracy of densitometers (or even film digitizers). A second reason is that the film density measurements, unlike the CRT photometer measurements, are obtained from different locations on the display area, so any spatial non-uniformity which is present in the film affects the hardcopy measurement. Current hardcopy printers and densitometers both have absolute optical density accuracy limitations which are significantly worse than the change which would be caused by a change in just the least significant bit of a 12-bit P-Value. In general, selecting a larger number of P-Values allows, in principle, more localized aberrations from the Grayscale Standard Display Function to be "caught", but the signal-to-noise ratio (or significance) of each of these will be decreased.

2) If the measurement data for a particular Display System has significant "noise" (as indicated by limited repeatability in the data when multiple sets of measurements are taken), it may be desirable to apply a statistical analysis technique which goes beyond the "FIT” and “LUM" metric by explicitly utilizing the known standard deviations in the input data set, along with the data itself, to prevent the fitting technique from over-reacting to noise. See, for example, the section "General Linear Least Squares" in Reference C1 and the chapter "Least-Squares Fit to a Polynomial" in Reference C2. If measurement noise is not explicitly taken into account in the analysis, the metric's returned root-mean-square error of the data points relative to the fit could be misleadingly high, since it would include the combined effect of errors due to incorrectness in the Display Function and errors due to measurement noise.

3) If possible, the sensitivity and specificity of the metric being considered should be checked against visual tests. For example, a digital test pattern with many low-contrast steps at many ambient Luminances could be printed on a "laboratory standard" Grayscale Standard Display Function printer and also printed on a printer being evaluated. The resultant films could then be placed side-by-side on light-boxes for comparison by a human observer. A good metric technique should detect as sensitively and repeatably as the human observer the existence of deviations (of any shape) from the Grayscale Standard Display Function. For example, if a Display System has a Characteristic Curve which, for even a very short interval of DDL values, is too contrasty, too flat, or (worse yet) non-monotonic, the metric should be able to detect and respond to that anomaly as strongly as the human observer does.

4) Finally, in addition to the experimentally encountered non-repeatabilities in the data from a Display System, there may be reason to consider additional possible causes of variations. For example, varying the ordering of P-Values in a test pattern (temporally for CRTs, spatially for printers) might affect the results. For printers, switching to different media might affect the results. A higher confidence can be placed in the results obtained from any metric if the results are stable in the presence of any or all such changes.

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Step (1)
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The Characteristic Curve of the test Display System should be determined with as many measurements as practical (see Sections D.1, D.2, and D.3). Using the Grayscale Standard Display Function, the fractional number of JNDs are calculated for each Luminance interval between equally spaced P-Value steps. The JNDs/Luminance interval may be calculated directly, or iteratively. For example, if only a few JNDs belong to every Luminance interval, a linear interpolation may be performed. After transformation of the grayscale response of the Display System, the Luminance Levels for every P-Value are Li and the corresponding Standard Luminance Levels are Lj; dj specifies the JNDs /Luminance-Interval on the Grayscale Standard Display Function for the given number of P-Values. Then, the JNDs/Luminance interval for the transformed Display Function are

*
r = d
*
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j
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(L
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i+1
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- L
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i
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)(L
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j+1
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+ L
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j
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) / ((L
*
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i+1
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+ L
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i
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)(L
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j+1
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*

Additionally, an iterative method can be used to calculate the number of JNDs per Luminance interval, requiring only the Grayscale Standard Display Function that defines a JND step in Luminance given a Luminance value. This is done by simply counting the number of complete JND steps in the Luminance interval, and then the remaining fractional step. Start at the Luminance low end of the interval, and calculate from the Grayscale Standard Display Function the Luminance step required for one JND step. Then continue stepping from the low Luminance value to the high Luminance value in single JND steps, until the Luminance value of the upper end of the Luminance Range is passed. Calculate the fraction portion of one JND that this last step represents. the total number of completed integer JND steps plus the fractional portion of the last uncompleted step is the fractional number of JND steps in the Luminance interval.

Plot the number of JNDs per Luminance interval (vertical axis) versus the index of the Luminance interval (horizontal axis). This curve is referred to as the
*
Luminance intervals vs JNDs
*
curve. An example of a plot of Luminance intervals vs JNDs is shown in figure C-1. The plot is matched very well by a horizontal line when a linear regression is applied.

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[pic]
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Figure C-1. Illustration for the LUM and FIT conformance measures
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The JNDs/Luminance interval data are evaluated by two statistical measures [C4]. The first assesses the global match of the test Display Function with the Grayscale Standard Display Function. The second measure locally analyses the approximation of the Grayscale Standard Display Function to the test Display Function.
*

*
Step (2)
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Two related measures of a regression analysis are applied after normal multiple linear regression assumptions are verified for the data [C3].The first measure, named the
*
FIT
*
test, attempts to match the Luminance-Intervals-vs-JNDs curve of the test Luminance distribution with different order polynomial fits. The Grayscale Standard Display Function is characterized by exactly one JND per Luminance interval over the entire Luminance Range. Therefore, ideally, the data of JNDs/Luminance intervals vs index of the Luminance interval are best fit by a horizontal line of a constant number of JNDs/Luminance interval, indicating that both the local and global means of JNDs/Luminance interval are constant over the given Luminance Range. If the curve is better matched by a higher-order curve, the distribution is not closely approximating the Grayscale Standard Display Function. The regression analysis should test comparisons through third-order curves.

The second measure, the Luminance uniformity metric (LUM) , analyzes whether the size of Luminance steps are uniform in perceptual size (i.e. JNDs) across the Luminance Range. This is measured by the Root Mean Square Error (RMSE) of the curve fit by a horizontal line of the JNDs/Luminance interval. The smaller the RMSE of the JNDs/Luminance interval, the more closely the test Display Function approximates the Grayscale Standard Display Function on a microscopic scale.

Both the FIT and LUM measures can be conveniently calculated on standard statistical packages.

Assuming the test Luminance distribution passes the FIT test, then the measure of quality of the distribution is determined by the single quantitative measurement (LUM) of the standard deviation of the JNDs/Luminance interval from their mean. Clinical practice is expected to determine the tolerances for the FIT and LUM values.

An important factor in reaching a close approximation of a test Display Function to the Grayscale Standard Display Function is the number of discrete output levels of the Display System. For instance, the LUM measure can be improved by using only a subset of the available DDLs while maintaining the full available output digitization resolution at the cost of decreasing contrast resolution.

While the LUM is influenced by the choice of the number of discrete output gray levels in the Grayscale Standard Display Function, the appropriate number of output levels is determined by the clinical application, including possible gray scale image processing that may occur independently of the Grayscale Standard Display Function standardization. Thus, PS 3.14 does not prescribe a certain number of gray levels of output. However, in general, the larger the number of distinguishable gray levels available, the higher the possible image quality because the contrast resolution is increased. It is recommended that the number of necessary output driving levels for the transformed Display Function be determined prior to standardization of the Display System (based on clinical applications of the Display System), so that this information can be used when calculating the transformation in order to avoid using gray scale distributions with fewer output levels than needed.

[C1] Press, William H, et al., Numerical Recipes in C, Cambridge University Press, 1988, Section "General Linear Least Squares"

[C2] Bevington, Phillip R., Data Reduction and Error Analysis for the Physical Sciences, McGraw-Hill, 1969, the chapter "Least-Squares Fit to a Polynomial" .

[C3] Kleinbaum DG, Kupper LL, Muller KE, Applied Regression Analysis and Other Multivariable Methods, Duxbury Press, 2nd Edition, pp 45-49, 1987.

[C4] Hemminger, B., Muller, K., "Performance Metric for evaluating conformance of medical image displays with the ACR/NEMA display function standard", SPIE Medical Imaging 1997, editor Yongmin Kim, vol 3031-25, 1997.