For decades, radiology has existed in a black and white world. It isn’t necessary to look any farther than the ubiquitous radiograph that defines radiology to understand why radiologists have existed in a monochromatic world. But that is changing thanks to the more recent transition to digital imaging in radiology and the introduction of monochromatic or grayscale medical display systems with the resolution necessary to view fine anatomic details and make accurate diagnosis. For the most part, the lack of color has served the specialty fairly well.
But as you look around, you’re noticing radiology is evolving — a lot. Plain film radiography is now just one of many digital-based medical imaging modalities. Grayscale no longer fits the bill for all modalities. In fact, modalities and techniques that depend on color such as 3D reconstruction, Doppler ultrasound, CAD and PET-CT fusion have become essential to the business of radiology. The department that cannot efficiently and effectively deploy these new technologies will struggle to operate and compete. The advent of fusion imaging and increasing use of color overlays to highlight key information make color displays appealing and even essential. Low-resolution color systems simply failed to fit the bill — until now. More recently, color medical display technology has improved tremendously; vendors have overcome the brightness and luminance drawbacks that prevented the use of color monitors in the early days.
The upshot? Radiology is on the verge of a new paradigm; color displays are ready for prime time. In fact, color monitors like Barco’s Coronis Color Diagnostic Luminance displays offer numerous benefits over their monochromatic peers. Color brings advantages on a number of fronts: clinical, financial, technical and physical.
“I highly recommend color monitors for everyone,” opines Eliot Siegel, MD, chief of imaging service with Veterans Affairs (VA) Maryland Health Care System in Baltimore. “In the next five years, we will see an increasing tendency to incorporate medical grade color displays systems in radiology,” continues Siegel.
The reasons for Siegel’s prediction are simple. Radiologists need color from the clinical and workflow perspectives; however, it makes little sense to adopt a technology before its time. But the time for color has arrived. Barco has refined and perfected color display technology, making it possible and practical for healthcare to embrace color displays systems for diagnostic interpretation in radiology and across the enterprise to other departments.
Color applications at a glance
Ghent University Hospital in Ghent, Belgium, operates a fairly typical radiology department. The radiology reading room is configured with a triple monitor set-up, two grayscale monitors for viewing monochrome images and a single, low-resolution color display that conveys administrative information patient data. Radiologists rely on the two high-resolution, monochromatic medical display systems for the bulk of diagnostic work. “The high resolution of the monochromatic display is required, so radiologists don’t miss small lesions,” explains Staff Radiologist Peter Smeets, MD.
The arrangement is nearly universal in the radiology world. “The current model uses two monochromatic, 3 megapixel (MP) monitors for PACS display and diagnosis and a third color monitor for the worklist,” says Siegel. The reason for the model is simple. “Until now, manufacturers did not offer high-resolution color monitors that could perform at the same level as black-and-white display systems,” notes Smeets.
But some medical imaging applications depend on color, says Smeets. “The advent of functional imaging in MR and PET-CT requires color,” he notes. PET-CT data associated with FDG is presented as a color overlay, which means that a radiologist can not interpret the studies on a conventional, high-resolution monochromatic monitor. Other color-dependent applications include Doppler ultrasound and nuclear medicine.
In the conventional department, the radiologist exits the PACS workstation and treks to yet another modality workstation such as the PET-CT workstation when he or she needs to interpret PET-CT images. “Moving to the acquisition station to review color images like 3D reconstructions is a significant drawback,” states Morly Ball, PACS administrator at Scripps Medical Center in San Diego. “This model has [negative] workflow and financial implications,” adds Siegel. In addition, the hospital is forced to purchase additional modality workstations and software. It’s hardly an ideal model.
But Barco has reinvented and refined color display systems. In the past, brightness and luminance levels on color monitors were too low to allow diagnostic review of medical images. “Brightness is no longer a limiting factor,” asserts Siegel. The luminance, brightness and resolution of Barco’s Coronis Color Diagnostic Luminance displays are on par with those of monochromatic monitors. “There’s no significant advantage to going with monochromatic display systems for spatial resolution. In fact, the distinction between color and monochromatic monitors is relatively small,” says Siegel.
This means radiology departments can deploy color monitors across the board. Siegel, for example, relies on color monitors for everything from internet access to EMR viewing to diagnostic review and interpretation.
The current generation color displays systems like Barco’s Coronis Color Diagnostic Luminance display systems provide a luminance level that exceeds 500 cd/m2. These levels enable the use of the color display for diagnostic interpretation.
Deploying color displays will bring multiple benefits to the healthcare enterprise. Take for example Scripps Medical Center, which plans to install four Barco Coronis Color Diagnostic Luminance displays to view PACS images. “Deploying the newest high-resolution, 3 megapixel color monitors will allow the center to more completely take advantage of technologies like 3D reconstruction and PET-CT imaging,” says Ball.
These Barco color display systems will serve as a multipurpose adjunct to existing workstations. The new arrangement will eliminate the time-consuming, workflow-interrupting journey from the PACS workstation to the modality acquisition workstation for interpretation of PET-CT studies, 3D reconstructions and more. Instead, the radiologist remains productive in the reading room, relying on the same high-resolution color display system for several tasks — including interpretation of PET-CT images and creation of 3D reconstructions as well as administrative tasks.
The new paradigm is more than a boon to radiology workflow. It also allows cash-strapped healthcare enterprises to maximize their investments. The need to purchase separate and costly workstations and software for viewing color images is minimized as the same color displays fits multiple purposes.
Scripps Medical Center anticipates to earn a decent return on its investment in with recent changes in reimbursement.
“Previously, reimbursement for 3D reconstructions was very limited. Now, there are new CPT codes for 3D reconstructions at the modality and at remote workstations. This makes it feasible to utilize the color workstations to offset the differential cost of the monitors,” explains Nik Patel, MD, director of technology for department of radiology.
It’s also important for the leading-edge radiology facility that the benefits of color displays extend beyond radiology and across the enterprise, Smeets explains. “With the advent of PACS, more clinicians are viewing native images. Surgeons and clinicians are accustomed to coronal images. They will benefit when radiologists can render 3D reconstructions in color.” In addition, the use of color to sculpt away body parts and accurately depict bone and soft tissue will help pre-operative planning, says Patel. Uses extend around the facility and beyond its walls — to the OR, ICU, ER and surgeon and specialist’s office. Even the patient can benefit from better explanation and education regarding his or her condition.
Inside the color display system
The basics of liquid crystal display (LCD) technology are quite simple. In a grayscale medical display system each pixel of a medical image correlates with an individual cell. The transparency of each cell is controlled by an electrical signal, which assigns each pixel a value ranging from full bright to dark.
Color display systems add a layer of complexity. Each individual cell is split into three parts, and a color filter is applied to each sub pixel to allow the light source to change from red, green and blue to black. The addition of color makes it more difficult to maintain a stable medical image over time as each component is susceptible to changes in outside forces such as temperature, aging circuitry and more.
Barco addresses image stability on its Color Luminance Displays with second-generation I-GUARD technology. I-GUARD continuously measures the light output of the red, green and blue pixels at the front of the display and corrects short and long term changes to ensure stable quality over time. That increases the usability and cuts the complexity for the user and administrator.
Radiology poised for a colorful future
The time for color displays has arrived. A sneak peek into the future reveals the key role that color displays will play. “Radiology will continue to change in the future,” states Siegel. “We’ll see increasing use of decision support and CAD overlays. Suspicious microcalcifications or annotations might be overlaid in red or [another] color,” continues Siegel. At the same time, the CAD paradigm is likely to evolve. Now, the radiologist reconciles CAD images with acquired images after interpreting the original images; however, in the future, CAD could be used at the time of interpretation. New color display technology could facilitate the new CAD paradigm by enabling streamlined viewing of CAD and original images.
Built-in digital dashboards that convey reams of useful information at a glance are on their way to the market, too. Several vendors have unveiled prototype dashboards at recent trade shows such as the Radiological Society of North America (RSNA) and Society for Computer Applications in Radiology (SCAR).
A glance at the digital dashboard reveals the value of color. One prototype dashboard relies of green, red and yellow stoplight icons to display key values like renal function or lab values. “Color can convey a lot of information,” confirms Siegel. The ability to deliver real-time information where it’s needed in a simple matter is a lynchpin of the healthcare enterprise.
Finally, radiology and PACS are slowly merging with other ‘ologies’. As color-essential specialties such as pathology, endoscopy and dermatology are integrated into PACS, it becomes increasingly important to provide a simple solution to view the images.
The new color era in image display promises to deliver big benefits to forward-thinking radiology departments and entire enterprises as well. Barco’s Coronis Color Diagnostic Luminance displays provide the technology and features to make medical grade color display a practical solution for every radiology department.
Radiology departments and enterprises that deploy color display solutions will gain several important advantages. For starters, workflow will be improved as harried radiologists no longer need to exit the PACS workstation and log onto a separate color workstation to read color imaging studies. Color displays also provide radiologists with an effective means to integrate color studies into their workflow and offer leading edge techniques like 3D reconstructions, CT colonography and more. At the same time, costs will drop as radiology deploys universal color monitors, eliminating overlapping investments in separate monochromatic and color displays and software. What’s more, the color display department is well-positioned for the future as well as more color applications like CAD and dashboards become mainstream.