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2 손기경 외: 판독용 모니터 정도 관리를 위한 AAPM TG18 측정 도구의 제작과 그 유용성 보고 리용 휘도계(VeriLUM Color Dual Mode, Fluke Biomedical, U.S.A.)를 1) 책상 위 평평한 곳에 측정 도구를 놓은 다음 휘 도계를 대고 휘도를 측정하거나, 일반적으로 휘도계(Minolta 설계하였다. 이러한 규격은, 대표적인 판독용 모니터들에서 AAPM TG18 QC 패턴 또는 SMPTE(Society of Motion Picture and Television Engineers) 테스트패턴을 이용한 기하 학적 왜곡의 정량 평가 시 측정범위가 24 cm에서 27 cm 범 위에 포함되는 것을 고려한 것이다 (Table 1). 개발한 측정 도 구의 한쪽 면에는 폭 5 mm, 길이 30 cm 크기의 얇고 길쭉한 직사각형 천공 측정자(punched ruler)를 만들어 측정자 천공 부 후면의 평면 계측부분을 mm 단위로 측정할 수 있게 하였 고, 가운데에는 지름 8 mm의 천공된 원형 측정자를 포함함으 로써 측정자 후면부에 대한 제한적인 관찰에 활용할 수 있게 하였다. 또한 측정 도구 내의 표기 단위는 mm와 inch 단위로 좌우 양쪽에 각기 표기함으로써 계측 값 변환 표현이 쉽도록 하였다. 측정 도구의 명칭과 용도, 제작 주체 등을 한쪽 면에 표기하였다(Fig. 1). 측정 도구를 이용하여 AAPM TG18 기하학적 왜곡 항목의 정량적 평가, AAPM TG18 veiling glare 항목의 시각적 평가, 그리고 판독용 모니터 정도관리에 사용하는 휘도계에 대해 0(zero)% 휘도 조정에 사용하였다. 정확한 0% 휘도 조정 조건을 얻고자, 판독용 모니터 정도관 A Fig. 1. AAPM TG18 evaluation tool. B Fig. 2. Luminance meter 0(zero)% calibration on the variable conditions, black evaluation tool (A), thigh (B), and folded white gown (C). C 632

3 Table 1. Size of Evaluable Lesion and Test Pattern (horizontal vertical) BARCO CRT MGD521, BARCO LCD MFGD5421, TOTOKU ME552i2 and WIDE PN21IQS model from left Test Patterns Size (cm) BARCO BARCO CRT LCD TOTOKU WIDE AAPM TG18-QC pattern Full size of test pattern Evaluable lesion SMPTE test pattern Evaluable lesion Table 2. Results of Luminance Meter 0(zero)% Calibration under Variable Conditions Conditions (cd/m 2 ) 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th On the black evaluation tool On the black suit (thigh) On the folded white gown A B Fig. 3. Evaluation of distance and distortion using punched ruler (A, B). 633

4 Table 3. Available Items about Diagnostic Monitor using Evaluation Tool Available Item Method Required Instrument or Test Pattern Geometrical distortions Measure the upper and lower grid line of the AAPM TG18-QC pattern (Quantitative evaluation) central region using evaluation instrument, SMPTE test pattern and record the value Measure the left and right grid line of the central region using evaluation instrument, and record the value Veiling glare Evaluate the number of targets visible in AAPM TG18-GV pattern (Visual evaluation) TG18-GV and GVN Patterns using AAPM TG18-GVN pattern evaluation instrument 0(zero)% luminance Luminance resetting process on luminance luminance meter calibration meter using evaluation instrument A B C Fig. 4. Veiling glare evaluation with TG18-GV pattern. Evaluation tool on the monitor (A), AAPM TG18-GV test pattern (B), and 5 inner circles within large circle (C). 634

5 대한영상의학회지 2008;58: Table 4. Definition of Display Devices Standards Definition of Display Devices AAPM TG-18 Primary display class Diagnostic - Reporting Clinical - Review Secondary display class DIN V Digital radiographic images All other types of images Alphanumeric/graphic or control monitors Category A Category B Category C JESRA X-0093 Lmax(cd/m2) 170, Lmax Lmin 250, Contrast κ δ (%) ±15 Lmax(cd/m2) 100, Lmax Lmin 100, Contrast κ δ (%) ±30 Grade 1 Grade 2 Fig. 5. Luminance meter 0(zero)% calibration using evaluation tool. 독용 모니터나 의료장비 부속모니터 기준에 미달하는 모니터 를 통칭한다. 판독용 모니터에 대한 정도관리를 시행하는 데 있어 대부분 항목은 AAPM TG18 규정 항목에 대한 시각적 평가 및 정량 적 평가를 기본으로 하여 시행하며, 관리자, 제조사 및 사용자 영역으로 나누어 진행하게 된다(4). 관리자는 판독 환경 보장, 시각적 불변성 평가 및 정기 조정 항목 등을 시행하며, 제조사 에서는 유지보수와 정밀 계측기를 이용한 정도관리 항목을 시 행한다. 그리고 판독자는 판독용 모니터 관리자나 제조사에서 제공된 소프트웨어나 테스트 패턴 등을 이용한 시각적 불변성 에 대하여 평가하고 있다(5). 그러나, 판독용 모니터에 대하여 AAPM TG18의 다양한 항 목에 대한 판독자의 정도관리 활동이 편리하고 손쉽게 이루어 지려면 항목 평가에 따르는 도구나 장비의 구비에 큰 영향을 받는다. Jacobs 등(6)은 일상생활에서 매일 시행할 수 있는 모 A B Fig. 6. Evaluable lesion on AAPM TG18-QC pattern, BARCO CRT (A), and TOTOKU LCD (B). 635

6 A B Fig. 7. Evaluable lesion on SMPTE test pattern, BARCO LCD (A), and WIDE LCD (B). 636

7 1. Aldrich JE, Rutledge JD. Assessment of PACS display systems. J Digit Imaging 2005;18: Groth DS, Bernatz SN, Fetterly KA, Hangiandreou NJ. Cathode ray tube quality control and acceptance testing program: initial results for clinical PACS displays. Radiographics 2001;21: Seto E, Ursani A, Cafazzo JA, Rossos PG, Easty AC. Image quality assurance of soft copy display systems. J Digit Imaging 2005;18: Samei E, Badano A, Chakraborty D, Compton K, Cornelius C, Corrigan K, et al. Assessment of display performance for medical imaging systems: executive summary of AAPM TG18 report. Med Phys 2005;32: Crespi A, Bonsignore F, Paruccini N, Macchi I. Grayscale calibration and quality assurance of diagnostic monitors in a PACS sys- tem. Radiol Med 2006;111: Jacobs J, Rogge F, Kotre J, Marchal G, Bosmans H. Preliminary validation of a new variable pattern for daily quality assurance of medical image display devices. Med Phys 2007;34: Andriole KP, Gould RG, Avrin DE, Bazzill TM, Yin L, Arenson RL. Continuiting quality improvement procedures for a clinical PACS. J Digit Imaging 1998;11(3 suppl 1): Parr LF, Anderson AL, Glennon BK, Fetherston P. Quality-control issues on high-resolution diagnostic monitors. J Digit Imaging 2001;14(2 suppl 1): Samei E, Rowberg A, Avraham E, Cornelius C. Toward clinically relevant standardization of image quality. J Digit Imaging 2004;17:

8 A Study on the Usefulness of the AAPM TG18 Evaluation Tool for Diagnostic Monitor QC 1 Gi-Gyeong Son, Dong-Wook Sung, M.D. 2, Jae-Ho Jeong, Hee-Doo Kang, Jeong-Rim Lee 3, Hee Kyo Jung 3 1 PACS Team, Kyung Hee University Medical Center 2 Department of Diagnostic Radiology, Kyung Hee University Hospital 3 Electronic Medical Device Team, Korea FDA Purpose: We created an AAPM TG18 Evaluation Tool and we determined its usefulness for the quality control of a diagnostic monitor. Materials and Methods: We created an evaluation tool (the AAPM TG18) for conducting quality control of a diagnostic monitor, and we evaluated the measurement items of the AAPM TG18 evaluation tool. The measurement items were geometric distortion, fixed quantity assessment and visual assessment of the veiling glare, and we carried out adjustment for the luminance meter 0% calibration, which was used to revise the diagnostic monitor DICOM LUT. Results: With the AAPM TG18 Evaluation Tool, we measured the 2-dimensional length when evaluating the quantitative geometric distortions in the TG18-QC test pattern, and we measured the veiling-glare ring response function, which provided information regarding the spatial extent of the luminance spread, and this measurement of the can be performed using the TG18-GV pattern. Additionally, the AAPM TG18 Evaluation Tool can be used for sensor calibration to standardize the basic rate of 0% luminance when performing periodic calibration. Conclusion: The evaluation tool is a very useful for easily evaluating many of the examination items of the AAPM TG18 for performing quality control of a diagnostic monitor. Index words : Radiology information system Computer terminals Quality control Total quality management Address reprint requests to : Dong-Wook Sung, M.D., Department of Diagnostic Radiology, Kyung Hee University Hospital, 1 Hoeki-dong, Dongdaemun-gu, Seoul , Korea Tel Fax sungdw@khmc.or.kr 638

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