New Vistas
By Beth W. Orenstein
Radiology Today
Vol. 25 No. 3 P. 20

Advanced monitor technology helps reduce demands on radiologists’ time.

The demand for imaging studies is on the rise, while the number of radiologists available to read them is on the decline worldwide. It’s no wonder workload and productivity are huge topics in radiology these days. Solutions are complex and hotly debated. Inge Haesaerts, vice president of product and solutions for diagnostic imaging at Barco, believes a big part of the answer is to “leverage technology to make the radiologists’ work as efficient and flexible as possible.” And doing that, she says, begins with the technology used to display images. The following is a look at the latest in medical displays from several leading manufacturers—some on the market and some coming soon—designed to address these pressing issues.

Dialed in on Density
Barco’s biggest new feature is DL Precise, a one-click software visualization tool for breast radiologists. It uses an AI algorithm to recognize structures in dense breast tissue on medical images that are not always visible to the human eye. Dense breast tissue is problematic because it can disguise small or incipient cancers, making it difficult to delineate a tumor and estimate whether it is benign or not. DL Precise highlights different levels of density in the image and helps radiologists measure and visualize structures more clearly with colored patterns and automated measurements.

“DL Precise is a real-time tool that you can turn on whenever you choose to,” Haesaerts says. “As a radiologist, you can choose the area of an image where you focus the tool—it has a circular shape that you can move around on your screen.”

The tool helps with perception and provides initial measures and illustrations, which help with risk assessment. “But it’s the radiologist who chooses whether and how they use this information,” Haesaerts says. Radiologists appreciate that this tool is not intrusive and that they can stay in charge of their workflow decisions, Haesaerts adds.

It also enables rapid and accurate lesion segmentation, measurement, and visualization, which helps address workflow issues. DL Precise is currently available only in the United States and the United Kingdom, but registrations in other countries are on their way, Haesaerts says.

Another new tool Barco recently introduced is its Multi-Display Confer. This tool allows radiologists to share their multiple monitor setup, or a part of it, with a remote colleague or peer through any video conferencing tool such as Microsoft Teams or Zoom. “In the past,” Haesaerts says, “this used to be a complex matter, especially with multiplehead setups. Now you can really choose which content you do or don’t share via a conference call, at he click of a button.”

Barco soon plans to introduce two new displays that have built-in speakers, a microphone, and a camera, as well as the Multi-Display Confer tool. “These displays make it very easy to have video calls with peers from anywhere and share your screen with them without needing a complex setup with external webcams and other equipment attached to your desktop,” Haesaerts says. Radiologists who work remotely say that having to buy and install an external camera, microphone, and speakers to have virtual calls is a significant inconvenience, Haesaerts says. “This is an example of how something new is appreciated because it actually helps the radiologist.”

In addition, with 3D visualization in health care becoming more prominent, Haeserts says Barco has an autostereoscopic 3D display that can be used for presurgical planning, patient engagement, and education in the pipeline. “Autostereoscopic means that you don’t need glasses to see the 3D effect, which, of course, is much more comfortable,” she notes.

Barco is also working on efficiency improvements for health care organizations that want to facilitate remote reading for their radiologists, Haesaerts says. “Radiologists must be able to work with the same image quality and display performance as in the hospital, but this also must happen in a secure way. And this can be a challenge for PACS managers and IT teams. So, we are doing a lot of research on how to make remote reading easier to organize and manage.”

Flexible Configurations
LG’s expanded family of medical monitors and devices, including diagnostic 2-megapixel (MP), 3MP, 5MP, 8MP, and 12MP resolutions, offer hospitals and medical professionals more options to outfit their spaces with the type and size of monitor they need to review medical images and make diagnoses, says Yoosoo Choi, director of product management for medical monitors at LG Business Solutions USA. Most recently, the company debuted a 31.5-inch 8MP in-plane switching (IPS) Black Diagnostic Monitor, a 55-inch IPS 4K Surgical Monitor, and an upcoming 21.5-inch 5MP Diagnostic Monitor. It will soon introduce a 24-inch 2MP Diagnostic IPS monitor.

LG’s flagship 31.5-inch Black Diagnostic Monitor includes an 8MP IPS display with 1,000 nits of brightness and a 2,000:1 contrast ratio. The IPS panel delivers deep black levels for sharp expression, and the high contrast ratio of 2,000:1 helps deliver clear image definition with detailed low gray expression, Choi says. The monitor includes an integrated front sensor for automatic self-calibration and a luminance sensor, which sets screen brightness properly for ambient lighting. This model also features multiresolution mode (8/6/4MP), a focus view mode, an antiglare screen, three-way tilt/height/swivel adjustments for viewing comfort, a presence sensor for power management, and six hot keys for easier changes to mode, screen resolution, and lighting settings.

The new 55-inch surgical monitor offers 4K resolution, a wide viewing angle, resilience to damage, and the ability to display multiple images at once in a 2 X 2 on-screen grid. The display is ideal for surgical centers, general operating rooms, and hybrid operating rooms and is designed to withstand the daily rigors of such environments, Choi says. “One of the special features of the 680-nit display is a Failover Input Switch that automatically switches to a secondary feed if the main feed is unavailable or disconnected. Additionally, users can choose from multiple viewing modes, including picture-in-picture, a 2 X 2 grid with up to four feeds (4PBP), or a three-way split screen with one main portrait-oriented feed and two smaller landscape-oriented feeds (3PBP).”

The display’s antifingerprint and antireflection protection glass achieves IP 45 protection, while the body cabinet also offers IP 32 protection from liquid intrusion and contact with solid objects. “The LG IPS LCD panel provides a 178-degree viewing angle both horizontally and vertically, so clarity is maintained for all viewers as they move around the room,” Choi says. HDR10 compatibility and a DCI-P3 color gamut of 86% ensure all images are presented as intended.

LG’s upcoming 21.5-inch 5MP Diagnostic Monitor (model 21HQ613D) offers a 2048 X 2560 IPS display, 1,800:1 contrast ratio, and special features such as an autoluminance sensor and Light Box Mode with external lighting that increases readability in darkened environments. It also offers daisy chain capability to connect two monitors to a single PC and includes five hotkeys for rapid switching between screen modes.

Today’s monitors are much more flexible, cost-effective, light, and simple for any radiologist to set up at home, Choi says. “By providing diagnostic monitors that are lightweight, easy to connect, bundled with cloud-based calibration software, outfitted with high picture quality, flexible, and cost-conscious, LG’s new technologies allow radiologists to read images with a high degree of accuracy from home,” he adds. “As manufacturing costs have fluctuated over time, trending downward, these savings can fortunately be applied to customer buying costs, as well, making high quality medical monitors much more accessible.”

Eye on Graphics
JVC has medical displays for general radiology and mammography/tomosynthesis, as well as modality displays for cath labs, fluoroscopy, and operating rooms with features that are designed to improve workflow and ease strain on readers. For example, says Manoj Tyagi, general manager of sales and marketing for North and South America at JVC Kenwood, JVC’s CL-S1200 30.9-inch color monitor has a resolution of 12 million pixels. The high pixel resolution reduces eye movement load, Tyagi says.

Users can also arrange the layout of windows on the monitors. For example, when reading mammograms, radiologists can open two windows and display images side-by-side. The same capability is available for reading CT, MRI, and ultrasound, Tyagi says.

JVC’s CL-S1200 also has a visual point mode that allows users to focus on the details they want to see. A Turbo Luminance function can boost screen brightness and contrast to maximum for 30 seconds to magnify identifiable grayscale gradations. This function makes it easier to find low contrast lesions on mammograms, Tyagi says.

Medical monitors typically come with high luminance, which is not comfortable for text reading, Tyagi says. The CL-2100 has an autotext mode that automatically adjusts brightness on patient lists and reporting applications to help reduce eye strain.

JVC monitors do not require expansive or special graphics cards, Tyagi says. “Radiologists are not stuck with one vendor just for the graphics card.” Tyagi also says any of JVC’s i3 models perfectly colormatch one another with pixel-to-pixel patented technology.

JVC has its own calibration and remote calibration software and doesn’t rely on third-party calibration tools. All of JVC’s displays are self-calibrating and come with a free calibration CD. This self-calibrating software allows for performance calibration checks to be performed remotely. “We keep 10Bit LUT DICOM Lookup Table in the LCD that makes their calibration steadfast,” Tyagi says. He adds that the built-in self-calibrating sensor ensures that the monitors are constantly performing at their best.

Speed and Portability
James Lupino, senior vice president of Lumin Innovations, says his company is entering the medical display business after a voluntary five-year withdrawal. Having attended RSNA every year, Lupino says he hasn’t seen much change in medical displays over the last 10 years. “They are getting higher resolution, maybe better brightness,” he says, “but I don’t see a big change in requirements for medical displays.”

However, Lupino expects one area to greatly affect medical displays in the near future: AI. “I expect that folks will be able to use AI locally at the workstation, rather than sending information up to the cloud and waiting for it to come back,” he says. He thinks AI applications at the workstation will increase speed, reduce cost, and improve security.

Lumin Innovations is developing medical workstations that enable readers to do AI inferencing on their desktops. A couple of years ago, Lupino says, another manufacturer developed a workstation that had enough CPU power to use AI apps locally, but it was bulky. “We developed a component for that product, but it never went to market,” he adds. Lupino is optimistic that all-in-one displays that demonstrate the capability to do AI inferencing locally will be showing up at RSNA soon.

When radiologists have to send information to the cloud, it can take several minutes for a response. “If you’re doing it locally, you know it’s still going to take 10 to 20 seconds or more,” Lupino says, but even half a minute is far less time than it takes in the cloud. Also, Lupino says using the AI app on the cloud is “pretty expensive. If you can do it locally, you’re not paying.” The upfront cost of a workstation with local AI inference capability may be higher, but the return on investment can be significant, and radiologists can feel comfortable keeping their studies locally rather than sending them to the cloud, Lupino says.

Lupino also foresees heads-up display headsets becoming available for radiologists who desire increased portability. “They won’t replace but rather augment the market,” Lupino says. He anticipates radiologists donning goggles equipped with virtual reality to read images. These systems would be highly portable and make it possible for radiologists to read images while traveling. “It seems to me if you are a radiologist and could buy something for $5,000 to $7,000 that you could put in your briefcase or suitcase when you travel and still be able to work and diagnose images, it would be something that you’re very interested in,” Lupino says.

— Beth W. Orenstein, a freelance medical writer of Northampton, Pennsylvania, is a regular contributor to Radiology Today.