Color Speaks Volumes

High-resolution color is one of the latest entries in the medical grade display market. While color itself is not new, its role is evolving. The conventional design and function of the PACS workstation is to display grayscale images such as x-ray, CT and MRI using high-resolution grayscale monitors. Color modalities like ultrasound are interpreted on a separate, low-resolution color monitor. A third 1 megapixel color display is used for the worklist in most display configurations. “Color has always been preferable in radiology, but the necessary luminance wasn’t available in the past,” explains Bill Urban, product manager, network systems at FUJIFILM Medical Systems USA

But color technology is improving, and the line dividing color and grayscale is blurring. “One of the biggest drivers is the advances in CT imaging,” explains Rodney Hawkins, vice president of product management at AMICAS. In the past few years, color has become a more important piece of CT data presentation and is essential for viewing 3D data. “Now, we’re beginning to see a need for higher-resolution color monitors for CT and MRI reading,” notes Hawkins. The list of color-dependent applications continues to grow. Currently, it includes CAD as well as 3D. As decision support makes its way into radiology, it will join the list.

At the same time, color display technology has improved; making it possible to develop high-resolution color display systems such as Planar’s Dome E4c. This development, in turn, makes it possible for radiology departments to have the best of both worlds, combining the high-resolution grayscale needed for most medical imaging studies with the color needed for 3D reconstructions. “The goal,” says David Channin, MD, chief of imaging informatics at Northwestern University’s Feinberg School of Medicine in Chicago, “is to provide radiologists with larger and larger surfaces of color to work with.” The Dome E4c brings radiology closer to the ideal of a single glass surface for all imaging needs.

The new color workstation provides the flexibility to handle color modalities like ultrasound and nuclear medicine, complete 3D reconstructions and interpret most grayscale studies. On the other hand, a grayscale monitor with equivalent resolution does provide additional brightness and contrast resolution. That tradeoff appears to be well worth it in cutting-edge sites like Albert Einstein Healthcare Network in Philadelphia, Pa.

The hospital tested a single Dome E4c display system this spring and plans to roll out an additional seven systems this fall. “The Dome E4c system gives us the best of both worlds,” explains David Wild, PACS analyst. “A lot of radiologists aren’t that comfortable with the conventional monitor setup, and they want 3D capabilities. Planar’s advanced color display provides the luminance and additional shades of gray necessary for CT and MR interpretation. Most PACS vendors are getting into thin-client 3D, which means clinicians like orthopedic surgeons and neurosurgeons need color displays. Sites will need high-resolution color displays dispersed throughout the enterprise. Deploying color is a smart long-term strategy.” At 30-inches, the 4 megapixel Dome E4c provides an ideal form factor for radiologists, and it facilitates cross-sectional and 3D review, says Wild.

The 3D explosion could have a significant impact on the types of display systems hospitals invest in. “It may be that as TRIP [Transforming the Radiological Interpretation Process, the Society of Imaging Informatics in Medicine initiative] advances and radiologists are viewing more volume datasets and 3D becomes more integrated that we’ll need color at every workstation,” opines Jeff Shepard, PhD, medical physicist at MD Anderson Cancer Center in Houston.
 
Indeed, AMICAS’ Hawkins hints at the transition. “3D and PACS are evolving and becoming one in the same. The separate PACS and 3D workstation model is inefficient. As color display technology continues to improve, more radiologists are likely to read radiology images using high-end color monitors.” In fact, some AMICAS customers are buying color and reading all images on color displays.

Looking at color

The medical market offers an assortment of decent color display systems, but not every system offers the quality and stability demanded in the radiology environment. “Buyers need to assess how physicians will use color,” begins Wild. Straight color applications do not have the same luminance and resolution requirements as grayscale applications. It’s critical to make sure the resolution is high enough to meet the needs of all intended applications. “To optimize productivity, radiologists need to be able to display full fidelity images without having to pan and zoom,” adds Hawkins. Constant panning and zooming disrupts workflow.

Another key spec is calibration. Albert Einstein Healthcare Network looked for a color solution with easy to use, remote monitoring software to make the installation as maintenance-free as possible.

Speed is important, too, says Hawkins. The video card that drives the monitor should provide the muscle for quick rendering.

The final piece of the puzzle, says Wild, is the vendor. “A strong relationship and immediate service and support go a long way toward ensuring the success of the project.”