SIIM: Size matters. Rads discuss resolution preferences with large OR monitors

Research presented as a Scientific Poster at the Society for Imaging Informatics in Medicine (SIIM) annual meeting in Orlando, Fla., concluded that careful analysis of physician radiographic image viewing preferences and appropriate display monitor selection will help enhance patient care in the operating room, particularly when medical-grade monitors are unavailable.

Ajay D. Wadgaonkar, MD, from Johns Hopkins Hospital in Baltimore, and colleagues set up an environment for physicians that frequent the operating room (OR) to evaluate multiple large-screen computer monitors side-by-side. “Reviewing a patient’s radiographic images in the operating room is truly an essential aspect of modern surgery,” said Wadgaonkar in an interview. “In many larger medical institutions, digital radiology imaging viewing is the standard of care in the operating room, typically employing flat-screen, commercially available monitors.”

He added there is little research available on how to best choose and evaluate these monitors for the OR.

For the project, an environment was created for board-certified radiologists and surgeons to evaluate multiple large-screen monitors, both 42” and 52”, side-by-side.

According to the researchers, a clinical workstation of the same configuration used in the operating rooms drove a video management system that connected different monitors using DVI connections. The workstation had a resolution of 1920x1080 pixels with a 512MB video card. Using the diagnostic PACS client, physicians were asked to open cases from their own patient portfolios to review. Monitor evaluation was carried out from a distance of approximately 10-12 feet and with the lights on, to simulate operating room conditions.

The cohorts were not asked to make value-based decisions and were unaware of monitor pricing. No DICOM calibration was performed on the monitors and default monitor configurations were used; monitors were kept with factory default settings as they would not be used as actual diagnostic workstations and were unlikely to fall under the umbrella of a diagnostic monitor quality control program.

Participants also were asked to give their preferences regarding non-glare or regular translucent protective cover. A medical grade monitor was provided as a control.

“All of the physicians indicated all the commercial monitors were suitable for intraoperative viewing,” Wadgaonker noted. In the 52” monitor analysis, 73 percent preferred the 1920x1080/16:9/70,000:1 (resolution/aspect ratio/dynamic contrast ratio respectively). In the 42” analysis, 43 percent indicated the 1920x1080/16:9/3,000:1 monitor was the top choice, with another 43 percent indicating an equal preference for this monitor and another 42" 1920x1080/16:9/40,000:1 monitor.

Additionally, he noted that the cohort mostly preferred the non-glare protective covers as opposed to the regular, translucent kind. “I think this highlights the need to select covers that don’t distort the image under operating room lighting.”

Looking toward the future, Wadgaonker stated that this project is a good start for more discussion and research. “Too often, administrators end up selecting monitoring equipment without radiologists’ or surgeons’ input which can end up being suboptimal for the physicians’ needs,” he said. “The broader context of this project is making people aware that analyzing radiology viewing preferences and including those preferences in the equipment selection process is going to lead to an optimal experience for patients, providers and administrators.”

Going forward, he highlighted that physicians preferred monitors that were providing sharper lines and richer, deeper blacks. He noted an analysis of 10 to 12 foot viewing distance showed larger monitors are preferable to smaller monitors that have higher resolution. “That’s because the limitation at that 10 to 12 foot viewing range is a resulting capacity of the human eye.”

He stated there are future research applications that can stem from the project. “Future research could include a greater selection of monitors or could assess whether different monitors impacted diagnostic accuracy in a simulated OR environment,” he said.