The effect of compression on confidence during the detection of skull fractures in CT

As part of a study to establish whether detection of cranial vault fractures is affected by JPEG 2000 30:1 and 60:1 lossy compression when compared to JPEG 2000 lossless compression we looked at the effects on confidence ratings 55 CT images, with three levels of JPEG 2000 compression (lossless, 30:1 & 60:1) were presented to 14 senior radiologists, 12 from the American Board of Radiology and 2 form Australia, 7 of whom were MSK specialists and 7 were neuroradiologists. 32 Images contained a single skull fracture while 23 were normal. Images were displayed on one calibrated, secondary LCD, in an ambient lighting of 32.2 lux. Observers were asked to identify the presence or absence of a fracture and where a fracture was present to locate and rate their confidence in its presence. A jack-knifed alternate free-response receiver operating characteristic (JAFROC) and a ROC methodology was employed and the DBM MRMC and ANOVA were used to explore differences between the lossless and lossy compressed images. A significant trend of increased confidence in true and false positive scores was seen with JPEG2000 Lossy 60:1 compression. An ANOVA on the mean confidence rating obtained for correct (TP) and incorrect (FP) localization skull fractions demonstrated that this was a significant difference between lossless and 60:1 [FP, p<0.001; TP, p<0.014] and 30:1 and 60:1 [FP, p<0.014; TP, p<0.037].