Bringing Images into the OR

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Successfully integrating digital images into the operating room is a task many facilities are facing but few have successfully tackled. Here's a review of what to consider in displays, carts and computers on wheels (COWs), PACS and networking to create a filmless, image-friendly OR.

For many hospitals, the operating room (OR) is the last stand for film with OR film accounting for up to 20 to 25 percent of residual film in PACS sites. Bringing images into the OR is a multi-faceted process with several key ingredients for hospitals to evaluate and understand as they move forward in the process. This month Health Imaging & IT examines four components of image viewing in the OR: displays, carts and computers on wheels (COWs), PACS and networking. Considerations for each component often intersect and overlap, so an understanding of the big picture is equally important.

DISPLAYS

Monitors or displays are the medium on which OR images are viewed. Key considerations include size, placement and performance. Kaiser Permanente Medical Centers in Northern California rely on Planar dual display 21-inch color monitors for OR viewing. Skip Kennedy, assistant director for radiology informatics for Kaiser Permanente Northern California, discusses the essentials. "Dual displays are really critical for the OR because the standard views are AP and lateral chest, and surgeons need a large enough display to see images from a distance of 10 to 12 feet."

Another consideration is glare. Glare from OR lights can affect viewing, so brighter monitors tend to be better OR solutions. Other adjustments to minimize glare include moving the lights away from the monitor or adding a hood around the top of the display.

Fairview Health Services (Minneapolis) uses NEC 40-inch, flat-panel LCD monitors permanently mounted on the wall in its busiest ORs. Patricia Berger, IMS system director, says the larger size translates into better visualization. The 40-inch monitors also are deployed in orthopedic ORs where better visualization is a necessity. Springhill Medical Center (Mobile, Ala.) considered 40-inch, flat-screen monitors for its OR project. After a thorough analysis, the hospital wasn't able to find a strategic location on OR walls for maximum functionality and workflow and instead deployed wireless cart-mounted displays.

In lesser-used ORs and smaller hospitals, Fairview relies on 20-inch, cart-mounted displays. This option can be more cost-effective than wall-mounted displays because displays and carts can be shared among ORs, says Berger.

University of Chicago Hospital uses a mix of wall and cart-mounted displays. Every OR has dual-mounted Totuku 20-inch grayscale monitors that replicate the functionality of the film box. Cart-mounted color monitors also are available for additional views or to enable surgeons to view echo studies, cardiac ultrasound or fusion images. These displays also serve as a redundant solution if a wall-mounted display goes down. Milton Griffin, assistant director of radiology at the University of Chicago Hospital, says the layout of some ORs can make it difficult to wall-mount displays, so sometimes carts serve as a de facto solution.

Surgeons at The Ottawa Hospital (Ottawa, Canada) opted for wall-mounted displays after a one month pilot of both wall and cart-mounted displays. Michelle LeFlour, manager of the electronic health record and imaging systems, says surgeons felt carts were too cumbersome and could get in the way during surgical procedures. In addition, she says, surgeons were used to viewing images on the wall with lightboxes, so wall-mounted displays seemed to provide the most practical solution.

St. Mary's Hospital in Athens, Ga., deployed 18-inch ViewSonic monitors in its ORs. CT Supervisor and Assistant PACS Administrator Brian Duncan says one benefit of these monitors is their ability to rotate to allow portrait viewing. All OR rooms at St. Mary's use monitors on COWs with the exception of one neurosurgery room, which has a Stryker system that consists of 18-inch displays mounted on booms. This setup allows nurses to transmit images from one screen to another.

A final display consideration is consistency. When Memorial Hospital in Colorado Springs, Colo., completed a side-by-side image quality comparison of its first selection, the radiology director realized that the color was not uniform. The hospital went back to the drawing board and found 19-inch medical grade Wide monitors from Double Black Imaging fit