# The Hidden Variable in Radiological Accuracy: The Impact of Monitor Quality Under Real-Life Emergency Department Conditions

## TL;DR

This study shows that advanced monitors can be a practical alternative to medical monitors in emergency departments, offering similar diagnostic accuracy and better ease of use.

## Contribution

The study evaluates monitor impact on radiological accuracy and ease of diagnosis in real-life emergency conditions, not just controlled settings.

## Key findings

- Advanced monitors showed diagnostic accuracy comparable to medical monitors.
- Advanced monitors significantly improved perceived ease of diagnosis compared to standard monitors.
- The absolute improvement in diagnostic accuracy from standard to advanced/medical monitors was modest (1.3%).

## Abstract

Radiological images are increasingly interpreted outside radiology reading rooms, particularly in emergency departments, where medical monitors may not always be available. Although medical displays are considered the reference standard, advanced monitors are becoming more accessible. This study evaluated whether monitor type influences diagnostic accuracy and perceived ease of diagnosis under real-life emergency department conditions. Although differences in diagnostic accuracy were statistically significant, the absolute improvement was modest. However, advanced monitors significantly improved perceived ease of diagnosis and demonstrated diagnostic accuracy comparable to medical monitors. These findings suggest that advanced monitors may represent a practical alternative to standard monitors in high-volume emergency care settings.

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.