Picking the Perfect PACS Displays

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Advances in color viewing for certain modalities, such as MR and color Doppler ultrasound, are forcing hospitals and imaging centers to reconsider their PACS displays. On the monitor front, technology allows for greater longevity and less drift. The result is a wider selection, with the best options depending on an organization’s needs.

Displaying color

Radnet inc., a group of outpatient imaging centers in Maryland, New York, Florida, Delaware, and California, uses a wide assortment of image displays, says Mike Backof, director of clinical applications. They include about 35 sets of 5 megapixel (MP) greyscale monitors, about 30 sets of 3MP greyscale monitors, and about 60 sets of 2MP color monitors. Models include Planar PX212s, Planar Domes C3i and Barco 3MP Coronis, Barco MFGD5621 HD, and Totoku ME551i2. Recently, Radnet began purchasing monitors from U.S. Electronics (USEI).

Radnet started installing PACS in 2003, which required additional displays and diagnostic workstations. Some specialized workstations already existed, but “we certainly bought quite a few displays during the initial PACS installs.”

USEI helped Radnet set up five sets of 5MP monitors in just four days for a mammography workstation project. “We saw some discrepancies in the image quality of the mammography display on the IReadMammo software that we were testing while using the Totoku 5MP displays when comparing the images to [another] workstation,” Backof says. He hooked up the Barco monitors to the IReadMammo workstation so that both were running the same software and was able to verify that there was a difference in the image quality between the Barco and Totoku displays.

“It turns out that the Barco and Totoku 5MP are truly the same monitor glass and panel, but Barco uses a blue bulb to light the display of their mammography 5MP displays where Totoku uses a white bulb,” he explains. The blue bulb tends to mute the bright white in certain areas of the breast image and allows users to see more soft tissue information. “That makes general x-ray exams and mammography look really nice, but it makes ultrasound, MRI, and CT studies look less attractive than the white-bulbed monitor,” Backof says. Totoku also manufactures a 5MP display with a blue bulb, but it’s only sold overseas. USEI helped Radnet acquire those monitors from Japan. When we had a radiologist compare images on the blue-bulbed Totoku monitor to the blue-bulbed Barco monitor, the image quality was identical.”

Meanwhile, Radnet uses the 2MP color monitors for breast MR, ultrasound Doppler and other color-based studies. General x-ray is displayed on the 3 and 5MP monitors. “We build workstations that have two 2MP greyscale monitors and one color monitor for worklists.”

Three levels for displays

Allina Hospitals & Clinics is a not-for-profit system of hospitals, clinics and other care services throughout Minnesota and western Wisconsin. Before upgrading PACS in 2003, the system had several locally managed PACS. Now, those are centralized with 11 hospitals on one PACS and expansion to clinics underway.

According to Bruce Facile, systems administrator, Allina chose NEC Display Solutions’ 21-inch MultiSync LCD2190UXi 2 MP color systems in 2006, when the system made the transition from greyscale to color with diagnostic displays. Facile says the decision in switching to color displays came down to “mostly the requirements by the different modalities to display color.”

In the transition to PACS, Allina considered three levels for displays—diagnostic workstations, critical-care displays and those for reviewing images in physician offices. “Typically, diagnostic workstations get the most attention and highest end displays,” he says. But, “we try to use standardized workstations and displays. That makes it easier for us to support and manage.”

Ultrasound, MRI and even some of the workstations that do 3D reconstructions have been adding more and more color, he says. “You’ll see, in the near future, more and more consumer-level manufacturers producing high-bright color displays of excellent quality.”

Allina’s operating rooms use a combination of displays. “Some surgeons prefer large, 40-inch displays. But most use a combination of 21-inch color monitors. Those using interoperable MRIs use the NEC 2190, a 2MP color display.”

Allina uses 3MP grayscale monitors for CR and DR images. “We made the move from grayscale to color for the added information and flexibility for cardiac imaging,” Facile says.