Radiology Turns to Color
Eizo provides high-brightness color LCD solutions in their 2MP and 3MP medical imaging monitors, RadiForce.

High-resolution color display systems are one of the newest—and hottest—items in the imaging informatics market. Interest is a function of economics and efficiency. Radiology desktop real estate is tight with more applications shoehorned onto displays. And as new color applications such as 3D modeling and CT perfusion enter the mainstream, healthcare facilities are starting to clamor for a new approach to the conventional PACS workstation display configuration. Color displays offer a new and improved paradigm.

One of the primary reasons for going with the latest generation of color display systems is versatility. Color monitors can fill multiple roles, serving as a home for administrative applications and providing a space for reviewing color images. Adopting color frees up precious desktop space, allowing sites to trim the conventional three-monitor PACS workstation to a two-display station. Efficiency wins, too. Radiologists no longer need to trudge from one station to another to read color images; and IT staffers have fewer displays to manage, which can reduce their burden.

Color displays are an up-and-coming topic at many sites. A few pioneers explain the rationale behind the approach as well as its advantages and pre-deployment considerations.

The overcrowded desktop

Sunnybrooke Health Sciences Centre is a typical, busy teaching hospital in Toronto, Ontario. Its imaging team, complete with 30 radiologists, performs 300,000 exams annually. The hospital deployed PACS nine years ago, and until recently, relied on a three-monitor configuration with the third color monitor housing RIS, administrative software and color imaging applications. “Three years ago, we realized we needed a new solution. Radiologists were performing more color imaging, and when we added voice dictation, the third monitor became really busy,” explains PACS Administrator Andrew Volkening.

The hospital decided to replace its 2 and 3 megapixel (MP) displays with Eizo Nanao Technologies’ Eizo RadiForce R22, 2 MP color medical LCD monitors. The new approach addresses the real estate challenge head-on and creates a more streamlined environment for radiologists. “Voice dictation isn’t covered by another application. It also simplifies workflow. Radiologists don’t need to move data from one display to another to open specific applications. There’s a lot more flexibility with the screens,” sums Volkening.

Spectrum Health hospitals in Grand Rapids, Mich., found itself in a similar situation last year. “We were deploying more applications that required color displays, and although clinical applications like 3D rendering can be performed on non-medical grade monitors used in a typical three-monitor configuration, it is better to use medical grade displays,” says George Vallillee, manager, radiology medical informatics. The health system realized that a medical-grade color display system would facilitate consolidation and allow the radiology department to reduce its desktop footprint.

The introduction of the Barco Coronis 3MP DL changed the playing field. “Barco met the bar with a system that addresses the dual needs of color and grayscale imaging,” Vallillee says. The new system meets the hospital’s technical brightness specification of at least 500 lumens, which provides a path to workstation consolidation.

Spectrum Health is nearly midway through its color monitor deployment. The system plans to phase out the conventional three-monitor configuration with RIS and third-party applications on an independent display, replacing each three-monitor setup with a pair of color displays. “Radiologists have realized an efficiency gain,” reports Vallillee, “as they can shift from various applications without moving workstations.” For example, prior to the color deployment, radiologists would need to move from the PACS review station to a dedicated ultrasound workstation to read color Doppler studies. Some radiologists needed to shift stations dozens of times a day, creating a significant workflow burden. Now, the high-resolution color model brings an efficiency gain.

While some early PACS adopters shift to color after deploying grayscale, a few later PACS adopters are turning to color with the initial move to digital image management. Take for example Baptist Health, a nine-site organization in Montgomery, Ala. The original PACS plan called for grayscale display systems, says PACS Administrator Scott Edwards; however, during the on-site monitor evaluation, the Double Black Imaging representative also presented a Wide 3 MP color display system.

Radiologists and administrators realized that the color system could bring cost and workflow benefits. The health system’s radiologists read a lot of echo and ultrasound studies. The traditional grayscale dual-head configuration forces radiologists to take the extra step of dragging images to a color monitor to read color studies. Deploying color instead of grayscale eliminates this step. What’s more, says Edwards, the cost of the color systems is comparable to similar grayscale monitors. After weighing all factors, the health system equipped its reading rooms with 23 dual-head Wide color display systems and a separate navigation monitor. “Radiologists, even the few who had hesitated about color, have been very pleased,” confirms Edwards.

Radiologists gain an immediate benefit with the shift to color, but the impact on the ever-busy IT department is another consideration. Eventually, the imaging informatics department will share in the efficiency gain, says Vallillee, because the color configuration reduces the number of monitors, which, in turn, decreases the preventative maintenance burden for IT staffers. Edwards offers another way to ease the IT burden. “Invest in remote QC and calibration software. It saves time and helps keep displays functioning optimally.”

The enterprise push

At Aspirus Wausau Hospital in Wausau, Wis., two ‘ologies’ initiated the push to add color monitors to the workstation mix. Radiologist workstations are four-monitor behemoths with four grayscale displays and a fifth color monitor for worklist. 3D interpretation occurs at a separate workstation with a color monitor. Cardiologists, however, aimed for a simpler, more streamlined approach.

“They asked for color displays to enable echo and vascular image review,” says Robert Long, IT systems analyst, cardiology and radiology systems. The hospital equipped cardiology PACS review stations with U.S. Electronics Totoku CCL212 21.3-inch 2 MP monitors. The where of the color arrangement is as important as the what, says Long. Cardiologists asked to place the dual color review stations throughout the cardiac floors. “It’s changed their workflow; they don’t need to interrupt rounds to find a workstation to view images.”

The success of the cardiology model encouraged the hospital to try color in other settings. When Aspirus deployed PACS in the OR, it equipped its OR review stations with two grayscale displays and a color monitor. Now, other image-intense specialties, such as neurology, are clamoring for color, too.

Radiology, however, is not quite ready to change to a new paradigm, “We can see the possible benefits [of deploying color in radiology] from the IT perspective,” states Long, “but radiologists are accustomed to a certain configuration.”

At Allina Hospitals & Clinics in Minneapolis, Minn., radiology and cardiology presented a united front during a display upgrade in 2006. Color is the logical solution for cardiology with its heavy use of echocardiography. But the upgrade to NEC 2190 UXi 2MP color systems presented a new paradigm for some radiologists, who use the new 2 MP color NEC systems for all CT, MRI, ultrasound and nuclear medicine image review. “These systems are appropriate for all studies with the exception of x-ray and mammography,” says PACS administrator Bruce Facile, Allina Information Services. The upgrade has streamlined radiologists’ workflow because they don’t need to move to specialized workstations to read various studies, says Facile. The health system further improved radiology workflow by transitioning from single to multi-monitor review stations to allow radiologists to concurrently view multiple series and studies.  

The ins and outs of color

One of the first issues to consider with color display systems is cost. “Color displays [can be] more expensive,” admits Vallillee, “but not substantially so, and the incremental cost is justifiable based on the efficiency and space gains.”

Another item high on the evaluation checklist is technical specifications. The site needs to compare its minimum specifications for grayscale display systems and determine if a color monitor meets the specs. “A color monitor in the appropriate range will deliver the necessary brightness and contrast and bring added efficiency,” notes Volkening.

At this point, Allina balances its cost and technical needs by bypassing color in general x-ray. That’s because its general x-ray luminance requirement of 450 candelas/m3 calls for a higher-priced 3 MP color system.

IT legwork is another key hurdle. It’s important to understand system components and requirements. Sunnybrooke Health Sciences Centre, for example, uses Matrox video cards with PACS workstations. “The video card has nearly as much to do with the experience as the monitor itself. Eizo let us remain with Matrox cards, which increased our comfort level,” says Volkening.

Vallillee adds another major issue. “New color monitors have much more bit density [or data] to write than grayscale systems. This requires a fast interface between the PC and the monitor.” The Barco systems use PCI-SIG’s Express Bus interface, but some of Spectrum Health’s workstations were outfitted with older adaptors that couldn’t support the PCI Express Bus, so the imaging informatics team inspected each workstation and switched workstations to equip systems in the color lineup with the appropriate adaptor.

There is a human element to the color display deployment as well. Long recommends a clinician-centric approach with IT soliciting feedback from clinicians about their workflow and patient care needs. “Find out what would make their job easier and determine the optimal location for new workstations.” This, in turn, should benefit IT. “It’s easier to manage the project if clinicians have what they want,” opines Long. Remote monitoring solutions and automated calibration tools offer IT another helping hand by simplifying display maintenance and management.

The right vendor can provide another IT boost. “Look at a variety of vendors,” recommends Edwards, “and try to schedule back-to-back onsite demonstrations.” Radiologists can complete a more thorough evaluation and compare different solutions if they review options back to back rather than on separate days. Finally, IT should not take a back seat in the vendor evaluation and should compare specs, customer service and warranties. It’s important to ask each vendor about turn-around time if a display goes down. A 24-hour exchange program is valuable—particularly if the site does not maintain a “hot spare” to swap out for downed display.

One last glance

“Color is the wave of the future,” says Facile, who predicts that color will overtake grayscale as the price of high-brightness 3 MP color systems drops. Early adopters are showing that color is a winner, streamlining the radiology desktop and delivering efficiency gains to radiology and IT while allowing radiologists to focus on their primary duty of reading pristine images.