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Nebraska Medical Center, in Omaha, exemplifies the state-of-the-art academic medical center. The 700-bed organization completes approximately 300,000 imaging studies annually. Two years ago, the center upgraded to McKesson Horizon Medical Imaging PACS.
The upgrade provided an opportunity for the medical information systems department to revisit its imaging display portfolio. At the time of the upgrade, the center operated a mixed, multi-vendor platform with some CRT and LCD display systems, including Dome monitors ranging from 2 to 5 MP and in a variety of configurations.
"With the move to McKesson PACS, we wanted to standardize the monitor configuration across the facility," explains Michael Battreall, director of medical information systems.
Battreall spearheaded a rigorous evaluation process, developing an RFP and inviting multiple vendors to a display "bake-off," in which radiologists compared the same imaging datasets on a variety of vendors' display systems.
"Dome came out on top," shares Battreall. During the evaluation process, he had asked radiologists and medical physicists to consider a number of different factors, including resolution. However, Battreall points out that resolution is fairly standard across various vendors' systems.
In fact, radiologists and physicists bypassed a series of 6 MP display systems, as the configuration boils down to two 3MP bolted together, says Battreall. Instead, Nebraska Medical Center standardized on Dome GX2MP (3D viewing), Dome E3cHB (a high-bright color system) and Dome E5 (grayscale) for CR and DR image review. Additionally, the multiple monitor setup allows radiologists to choose by subspecialty if they want the monitors in a portrait or landscape mode, shares Battreall. This is not an option with large displays such as a 6 MP or greater model.
Other considerations beyond resolution and real estate factored into the decision-making process. "The differences between various vendors became more apparent as we looked at how displays are serviced and maintained," explains Battreall.
Calibration emerged as a major differentiator in NMC's decision. All diagnostic displays require frequent monitoring of white levels and DICOM calibration; however, vendors approach the task differently. For example, one vendor has developed hardware that measures DICOM calibration in a ¼- by ¼ inch square. The hitch is that the monitor might fall out of calibration in an area outside of the target space, says Battreall.
Dome display systems are DICOM calibrated in the factory from the front center of the screen using a high precision light meter. The white level is monitored and maintained using a light sensor in the back of the display. There is no need to calibrate on site.
The medical information systems department, along with medical physicists and radiologists, are looking forward to additional improvements in calibration technology when NMC implements Dome Dashboard, remote calibration software that automatically checks displays to determine whether or not the monitors are at the correct white levels and calibration. The software also alerts support staff if the monitor is out of calibration or the white level is not at the correct level.
In the interim, the transition to a standardized configuration has benefited both radiologists and IT staff. "Radiologists love the standardized systems because they don't have to change how they work when they move from one area to the next," explains Battreall.
Standardization also benefits NMC from an IT management perspective. With any maintenance, such as calibration and cloning workstations, it's the same process from monitor to monitor, explains Battreall. In the event a workstation fails, IT staff members don't have to determine what the monitor type was on the workstation. All video cards and drivers are standard across the department, which simplifies the repair and maintenance process, continues Battreall.
Battreall urges his colleagues in IT to ensure that radiologists and medical physicists are engaged and involved in the decision-making process. At NMC, the evaluation did yield a few surprises. For example, some stakeholders had assumed more expensive display technology would produce better images. "We assumed higher price tags would be associated with detectable