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Do Your Diagnostic LCD Monitors Meet the Guidelines?


Three suggestions for radiology practices to consider when adopting the new Technical Standard for Electronic Practice of Medical Imaging.

The phrase, “Never do today what you can put off till tomorrow. Delay may give clearer light as to what is best to be done,” supposedly originated with American politician Aaron Burr. That may be true when you're stuck trying to untangle a complicated problem or negotiate politics in a young, post-revolutionary country. But when you're running a business, procrastination is your worst enemy, especially when it comes to installing mission-critical technologies.

Unfortunately, many hospitals and radiology centers have taken the Burr approach to adopting the 2012 ACR (American College of Radiology), AAPM (American Association of Physicists in Medicine), and SIIM (Society for Imaging Informatics in Medicine) guidelines that apply to diagnostic LCD monitors. But the truth is, delay will not make the decision any clearer – delay will only leave your organization stuck in yesterday.

The guidelines that were originally introduced by the AAPM Task Group 18 (also known as TG-18) in 2005 were widely accepted and adopted at radiology departments across the country. The updated Technical Standard was produced in 2012. There are several changes in this update that apply to more than just displays, and every practice should thoroughly study all of the details in the document. As it applies to displays, though, some of the most notable changes include:

1. LCD panel technology: An LCD technology with wide viewing angles is recommended. TN (twisted nematic)-type LCD panels should not be used.

2. Connectivity: Digital connectivity, such as DisplayPort, HDMI, or DVI-D is recommended instead of VGA.

3. Brightness: In the new standard, monitors used for diagnosis must meet a minimum brightness of 350 cd/m2 (candelas per meter squared), while monitors used for interpreting mammograms must be at least 420 cd/m2. For other types of displays (typically referred to as clinical or review displays), the minimum calibrated brightness starts at 250 cd/m2.

When the updated guidelines were introduced in 2012, there were no requirements for when they needed to be implemented. As a result, the new guidelines didn't have any teeth. Today, three years after they were introduced, only a few organizations have upgraded their procedures and equipment to meet the new standards.[[{"type":"media","view_mode":"media_crop","fid":"43517","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_5837612558905","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4759","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 255px; width: 170px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"Art Marshall, Senior Product Manager for medical and professional desktop displays, NEC Display Solutions ","typeof":"foaf:Image"}}]]

Because so few organizations have made the leap, LCD displays meeting only the requirements of the 2005 standards are still dominating the market, which makes it all the more difficult to make the needed transition with confidence.

Things are changing, however, and it is in an organization’s best interest to make the shift to the 2012 guidelines sooner rather than later. This is because monitors that adhere to the new standards are all designed around the way humans can best see images on them. The new monitors have more capabilities, and make it easier for radiologists and physicians to read and interpret the results with confidence, thereby reinforcing the quality of the practice.

A few years ago, practices also needed to purchase monitors for dedicated modalities – X-ray, MRI, or mammogram stations, for example. Many of the recently introduced displays can now be used for interpreting multiple modalities on a single screen, making them an efficient way to lower capital while responding to varied radiology department needs. The guidelines were included in the ACR’s Practice Parameters and Technical Standards in 2014, which makes adhering to these standards even more important.

Here are three things to consider as your organization prepares to make the switch.

1. Do your existing monitors support the new standards?

The first and most obvious step is to review the specifications of your current displays to see if they already meet the 2012 guidelines. Depending on when you bought your displays and which manufacturer made them, they may already have the proper capabilities. With a careful inventory, you can find out whether your displays are already capable of compliance – and all it takes is comparing the specs of your current monitors with what is in the guidelines.

One of the most important differences between the 2005 and 2012 standards to evaluate existing monitors involves brightness. The new standard’s higher brightness requirement is much more demanding than the previous standard of 170 cd/m2 for diagnosis. While this higher brightness is expected of modern medical-grade displays, standard desktop displays will be unable to meet the requirements.

2. Are you using quality assurance (QA) software that supports the new standard?

Installing automated QA software takes the guesswork out of knowing whether your monitors are properly calibrated and delivering consistent image quality. It will run real-time checks on your models to ensure that they’re performing at their peak. If your monitors aren't performing at the level of the 2012 standards, some vendor systems will alert you to the problem and recalibrate the displays so they're back on track. This type of QA software can ensure that your displays meet the specs, helping you to know that you have products that you can trust.

3. Are you working with a vendor that is adhering to the changes of the guidelines?

The whole process of upgrading to meet the 2012 guidelines will be that much smoother and simpler if you work with a vendor who is knowledgeable about the specifications. There are plenty of vendors who can sell to a medical clinic but may not understand the requirements for radiology. Relying on a company with a proven track record of providing high quality diagnostic displays is critical to ensuring success.

Don’t get stuck in the past! Purchasing new monitors today that cannot meet the most recent guidelines will only prolong the inevitable change to a better technology. Understanding these few key points will help you make a good investment decision and ensure that your practice is ready when compliance is required.

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