In Living Color: Displays expand to cover the full spectrum

With high-resolution, medical-grade color monitors growing in prominence, you’ll feel like you’ve been carried off to the radiology Land of Oz. When it comes to displays, you’re not stuck in grayscale Kansas anymore.

For most of the history of color displays, they have not offered the resolution or brightness for reading diagnostic images. But that’s all changed with high-quality color medical-grade displays now available — and quickly growing in popularity. A type of ideal is possible: A radiology department can install grayscale and color monitors so that, case by case, the best monitor for the image can be used. Some facilities are taking their investment in color displays even further, investing solely in color.

This is especially true for organizations looking for a single-monitor — grayscale or color — solution. “It makes much more sense to just go with a medical-grade color monitor rather than a grayscale monitor because now you can read literally everything off those color displays,” says Jim Busch, MD, radiologist, director of Specialty Networks, Diagnostic Radiology Consultants, a private practice radiology group in Chattanooga, Tenn., that services Tennessee and Georgia. “That way you can maximize your efficiency and flexibility across your practice by reading anything from anywhere,” says Busch.

Although 2 megapixel (MP) monitors generally suffice, some images must be read on 3 MP monitors — for example, bone radiography. Moreover, the attraction of state-of-the-art 3 MP color monitors is clearly strong for some facilities, especially those that have not made huge investments in grayscale.


One monitor fits all

The Radiology Department at Georgetown University Hospital (GUH) in Washington, D.C., has opted to use both top-of-the-line grayscale and color displays at dedicated PACS workstations. Although the department has drawn clear lines between the two types of workstations in some ways, the advances in color monitors have significantly blurred them.

A prime example of increased flexibility in image viewing is how radiologists use the Barco Coronis Color 3MP displays to interpret studies from a variety of modalities such as conventional radiography, CT, MR, ultrasound and PET/CT. Another example is reading myelograms. The 3 MP color displays allow the radiologists to read the radiographic portion of the myelogram — a combined static image-fluoroscopy exam looking at the spinal cord and nerve roots — on the same workstation used to read the accompanying CT portion of the exam.

“A radiologist can read the CT portion of the myelogram and on the same monitor read the fluoroscopic portion. That’s very convenient,” says Carlos Jamis-Dow, director of imaging technology at GUH.

A similar situation arises when reading renal ultrasounds and abdominal x-rays of patients with renal calculi. “We can read the ultrasound images in color and are able to interpret the radiographic examinations of the abdomen because of the 3 MP resolution and brightness of the color displays,” says Jamis-Dow.

The same advantage exists when viewing a patient’s prior images. “I can read studies from any modality on any PACS workstation throughout the department. In nuclear medicine we can review the full-color fused PET/CT images and in the same workstation review at full resolution the patient’s abnormal chest x-ray that prompted the PET/CT,” says Jamis-Dow.

“We purposefully chose this next generation of Barco monitors because they were the first medical displays on the market to offer 3 MP resolution and brightness equal to that of diagnostic grayscale displays.”

All of this flexibility also has improved their workflow. Any of their subspecialist radiologists using several diagnostic modalities can dictate any type of study in any of the department’s reading rooms, Jamis-Dow says.


All color, all the time

Radiology departments planning to standardize on 3 MP color displays should prepare to be patient because the technology is so new that not all PACS work with every model — yet. But with some determination, it’s possible. Norton Healthcare, which services Kentucky and Southern Indiana with a network of five hospitals in Kentucky, proved its diligence in marrying its new McKesson Horizon Medical Imaging PACS with Planar 3MP color displays, one of the first to do so. They also had to tie in to IBM workstations throughout the Norton facilities. The department went digital this past summer in a big way. Over a 90-day period ending in June, the organization installed the PACS and added Planar Dome E3c 3MP color monitors at 36 radiology workstations, says Brian Cox, PC support manager, Information Services.

“We worked it out with Planar to get McKesson to begin certifying the Planar monitors for use with their application,” says Cox.

In fact, Planar actually guaranteed Norton that if McKesson couldn’t certify the color displays in time then they would provide them with enough grayscale monitors to meet their workstation needs. But McKesson delivered, and since then, they have had no problems with the application running within the color monitors. “It’s been pretty much a breeze,” says Cox.


Mixed-monitor magic

If a facility has invested heavily into PACS workstations built around grayscale monitor technology, the priority is to maintain what they have and add medical-grade color monitors to the existing systems. Specialty Networks has taken such an approach, with workstations that are built around two central Siemens Medical Displays SMD 21300 3 MP grayscale monitors and two Siemens SHD 21205 2 MP color monitors on the left and right.

“We use a mixed-monitor configuration, so the primary PACS application runs on two Siemens 3 MP monitors, and we use those for primary image interpretation,” says Busch. “Just to my left is our clinical monitor, which is a Siemens 2 MP monitor that right now we use for clinical applications such as RIS, voice recognition, digital libraries or web access. This is all included in one location run in Siemens’ syngo suite. Then we have another color monitor on the right-hand side which runs the postprocessing applications that are integrated into the system as well,” he adds.

A postprocessing application called 3D runs on the color monitors, which is fusion capable for PET interpretation. They also are able to view ultrasound images on the color monitor by reviewing it via the 3D application. And the color monitors are good for color-enhanced volume renderings, he says.

Busch emphasizes that the radiologists within the practice like the cockpit-like feel of the workstation configuration, which ties in one mouse across all the displays so the cursor glides from one monitor to the next. This sensation is likely to grow with coming software upgrades.

“What we’re going to do in the future is use the next iteration of [Siemens] syngo Imaging that will support mixed monitor configurations so that I can use that 2 MP monitor as part of the traditional PACS application. In the future, if I open an ultrasound exam or a nuclear medicine exam, it will launch those images on the color monitor rather than the two 3 MPs in the middle,” says Busch. Siemens has designed this new capability to make it easier to introduce color into an existing PACS workstation.


Conclusion

Color medical displays have become more sophisticated, but that also means that the choice could be easier if you lack the resources or desire to install both top-shelf grayscale and color displays. Choosing color displays could be the answer. But first, the key is to determine which type of display fits best with your current technology and radiologists’ needs.