LAUSR

Abstract Purpose Medical displays are fundamental in today's healthcare since they provide the link between digitally stored data and the human clinician, and it is thus important that the transfer of information is as effective and reliable as possible. Contrast perception in viewed images is complex due to the nature of the human visual system, and the luminance distribution in the viewed scene plays a major role. Standards and guidelines concerning medical displays are important as they set a baseline image quality. However, as the number of imaging applications as well as display technology has evolved rapidly during the past decades, there may be possible uses not foreseen in the current guidelines. Bright screens may perform as good in bright rooms as less bright displays do in dark rooms, but current guidelines are likely to favor dark rooms due to historical reasons. The purpose of this study was to determine the limits of contrast perception in three very different lighting conditions and relate the outcome to guideline recommendations. Methods Three different display luminance settings were studied, 1–250, 6–500, and 12–750 cd/m2 with luminance ratios of 250, 85, and 62, respectively. Although the luminance ratios, black levels, and white levels were different, they all covered the same number of just noticeable differences (JNDs). By using a two‐alternative forced‐choice method, contrast thresholds were determined at dark, mid‐gray, and bright pixel values for all luminance settings using bar patterns with two different spatial frequencies. In total, 18 contrast thresholds were determined by each of the 10 observers. Results The contrast thresholds for the low‐frequency patterns were close to 0.5 JNDs and there were no systematic differences between the three luminance conditions at any of the pixel values. The high‐frequency patterns required almost 10 times higher contrast where the highest contrast threshold (worst visibility) was obtained for the luminance setting 1–250 cd/m2 at the dark pixel value. Conclusions The differences between the three luminance conditions were mostly minor, which indicate that display settings with low luminance ratios and high minimum luminance levels can be used without compromising displayed image contrast. The number of JNDs enclosed by the luminance range of a display is a reliable metric for global perceived contrast. Luminance ratios are limited regarding the ability to detect low contrast objects when there are large differences in luminance, although they can still be used within a relatively small range of luminance levels. Low luminance levels may cause a loss of visibility, especially for fine details, and should be avoided.