The hidden variable in radiological accuracy: The impact of monitor quality under real-life emergency department conditions

Abstract

Background/Objectives: Radiological assessment has become indispensable for modern clinical decision-making. Image quality plays a critical role in the reliability of radiological interpretation. Unlike most previous studies, this study investigated the effect of monitor type on diagnostic accuracy and ease of diagnosis under physical conditions outside the radiology unit. Methods: Three image sets were prepared for the study, consisting of emergency radiological images, each containing 50 computed tomography, magnetic resonance imaging, and digital radiography images. The image sets were examined by five emergency specialists, who were blinded to each other’s work, under emergency service conditions on a standard monitor (SM), medical monitor (MM), and advanced monitor (AM). The accuracy and ease of diagnosis were analyzed statistically according to the type of monitor used. Results: Overall diagnostic accuracy rates were 98.7% for SM, 100% for AM, and 100% for MM. Cochran’s Q test demonstrated a statistically significant difference between monitor types (p = 0.002), with significant pairwise differences for SM–AM and SM–MM comparisons. The absolute risk difference between SM and AM/MM was 1.3%, corresponding to a relative risk of 1.013 and a number needed to benefit (NNB) of 77. Ease of diagnosis scores increased progressively across monitor types (SM: 7.6 [IQR 7–8], AM: 9.4 [IQR 9–9.8], MM: 9.8 [IQR 9.6–10]; p < 0.001), with a large overall effect size (Kendall’s W = 0.81). Multilevel modeling confirmed that these associations persisted after adjustment for clustering effects. Conclusions: In situations where medical monitors cannot be used due to cost and operational constraints, opting for advanced monitors instead of standard monitors may modestly improve diagnostic accuracy while substantially enhancing perceived ease of diagnosis.