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Medical displays for primary diagnosis are calibrated to the DICOM GSDF1 but there is no accepted standard today that describes how display systems for medical modalities involving color should be calibrated. Recently the Color Standard Display Function3,4 (CSDF), a calibration using the CIEDE2000 color difference metric to make a display as perceptually linear as possible has been proposed. In this work we present the results of a first observer study set up to investigate the interpretation accuracy of a rainbow color scale when a medical display is calibrated to CSDF versus DICOM GSDF and a second observer study set up to investigate the detectability of color differences when a medical display is calibrated to CSDF, DICOM GSDF and sRGB. The results of the first study indicate that the error when interpreting a rainbow color scale is lower for CSDF than for DICOM GSDF with statistically significant difference (Mann-Whitney U test) for eight out of twelve observers. The results correspond to what is expected based on CIEDE2000 color differences between consecutive colors along the rainbow color scale for both calibrations. The results of the second study indicate a statistical significant improvement in detecting color differences when a display is calibrated to CSDF compared to DICOM GSDF and a (non-significant) trend indicating improved detection for CSDF compared to sRGB. To our knowledge this is the first work that shows the added value of a perceptual color calibration method (CSDF) in interpreting medical color images using the rainbow color scale. Improved interpretation of the rainbow color scale may be beneficial in the area of quantitative medical imaging (e.g. PET SUV, quantitative MRI and CT and doppler US), where a medical specialist needs to interpret quantitative medical data based on a color scale and/or detect subtle color differences and where improved interpretation accuracy and improved detection of color differences may contribute to a better diagnosis. Our results indicate that for diagnostic applications involving both grayscale and color images, CSDF should be chosen over DICOM GSDF and sRGB as it assures excellent detection for color images and at the same time maintains DICOM GSDF for grayscale images.
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