Solving the PACS Display Dilemma

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Bruce Leavitt, MD, of Fletcher Allen Health Care, with a Sharp PN-445 monitorThere’s no quick or ‘right’ answer when it comes to PACS displays. Multiple solutions will work, but finding the right option takes time, homework and communication.

PACS, and PACS displays, are ubiquitous in hospitals and imaging centers across the country. While digital image management has become the norm, displays are a different story. There is no standard solution across or even within sites.

Radiologists are the primary PACS users, but even in radiology departments, it’s tough to find a standard display system. That’s because digital modalities — such as CT, MRI, CR and digital mammography — have specific display requirements. The conventional solution for interpreting radiology’s bread-and-butter studies is the high-resolution grayscale display system. But color modalities such as ultrasound and nuclear medicine studies require a color monitor. Similarly, advanced visualization software requires color.

Clinicians’ needs differ from radiologists. They are not the primary interpreters of images. Some, such as general practitioners, require a simple view that can be served by 1.3 or 2 megapixel monitors, but other specialists such as orthopedic surgeons depend heavily on images and need high-resolution solutions.

Size matters in the display world, too. The standard 21-inch system may suffice for the radiologist reading studies at his desk, but a standard system may not work for surgeons in the OR. The surgeon may not want to walk away from the table, and cart-mounted systems can be clumsy. Mega-displays can provide a solution.

Most sites employ a flexible, physician-centric approach to meet their PACS display needs. This month Health Imaging & IT tours several sites to see how they have tackled and solved the display dilemma across the enterprise.

The color world

Spectrum Health — Butterworth Campus in Grand Rapids, Mich., is a typical PACS site. The Grand Rapids hospital is a regional leader in healthcare; it’s designated as a Level 1 Trauma Center, houses a heart center and plans to open a new cancer care pavilion. The hospital has relied on PACS for digital image management for more than five years.

Last year, the radiology department decided to revisit display options as a group of its medical grade grayscale flat-panel display systems reached the end of their three year life cycle, says George Vallillee, manager of radiology medical informatics.

As in most hospitals, real estate, including office space, is at a premium at Spectrum Health. The radiology department decided to pilot a group of Barco Coronis 3 megapixel (MP) color luminance display systems. Physicians use the new systems in a dual-monitor configuration for traditional imaging studies and color modalities such as ultrasound. “Radiologists are infatuated with the new monitors,” says Vallillee.

The high-resolution color approach delivers several key benefits. For starters, the hospital has freed up valuable real estate and saved money as it was able to eliminate or redeploy a number of workstations dedicated to color interpretation. “This approach is more convenient, too,” says Vallillee. Radiologists no longer need to walk to a color station to read ultrasound studies, which translates into productivity improvements.

The color systems fit nicely with the hospital’s new thin-client 3D reconstruction software. 3D reconstruction requires a color system, and the thin-client model delivers 3D capabilities to all PACS workstations. “We’ve seen a productivity bump with the color displays and the thin-client system because radiologists can use the same workstation for all of their interpretations,” sums Vallillee.

The ability to eliminate or redeploy workstations and improve productivity is an economic plus, but the decision to deploy high-resolution color display systems is fiscally sound in other ways as well. “These monitors are a value proposition. From a pricing perspective, they are competitive with traditional grayscale monitors,” states Vallillee.

Thinking big

Deploying PACS and eliminating film in the radiology department is the first, and possibly easiest, step in the filmless process. Eliminating film across the enterprise, particularly in tricky areas such as the OR, represents an entirely different proposition.

Replacing the lightbox with a high-resolution grayscale monitor can eliminate film but does not necessarily meet surgeons’ needs as they still need to leave the table to review images. Cart-mounted displays can travel from room to