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| Medical Grade vs. Commercial Monitors |
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| Contributed by Herman Oosterwijk |
| Published Nov 1, 2007 |
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The discussion on whether to use a medical-grade monitor vs. a commercial off-the-shelf (COTS) monitor for reviewing diagnostic images comes up almost every couple of weeks on one of the PACS discussion groups. I am very glad we found Ken Compton willing to share his expertise and view on the use of appropriate monitors in the fluoroscopy environment in this newsletter.
The same monitor issue exists in the ER, OR, and physician offices. No one challenges the fact that a radiologist needs a medical-grade monitor. These monitors have regularly scheduled quality control (QC) procedures performed on them; either they are auto-calibrated on a regular basis, or someone checks them with some type of manual process every month or so.
 However, as soon as images are distributed outside radiology, there always seem to be people ready to challenge the need for medical-grade monitors in other healthcare environments. This argument is advanced even though ER physicians often have to make their initial, sometimes critical, decision based off information displayed on a COTS monitor.
That is not to say that COTS monitors are not sufficient for many healthcare applications and scenarios.
Unfortunately, it's been my experience that few of these COTS monitors are calibrated according to the DICOM grayscale standard. Furthermore, their display should always be corrected to accommodate for differences in ambient-light conditions; but they rarely are. Last but not least, these devices often lack the availability of a test pattern, such as that defined by the AAPM TG18 workgroup, which would allow a user to easily determine if there are any major grayscale values missing.
The only way to resolve this issue is to keep on educating, training, and publishing about QC for monitors used to display medical images in the healthcare environment. If you ever have a chance to go to a trade show, you should ask for a demonstration from any of the monitor manufacturers. Almost every vendor can show you the impact of incorrect ambient-light correction, and the display the difference between using standard gamma correction vs. the full DICOM curve. You’ll be surprised by the quality of the image when correct medical display QC procedures are used.
That is why we always get a monitor expert such as Ken to come in and do a demonstration for our PACS administrator classes at OTech. These experts are always willing to support you in acquiring the right monitor for your application. In addition, they’ll work with you to ensure that all your medical image displays are maintained at the highest possible quality level. As most PACS manufacturers do not have medical-display expertise in house, I recommend you base your monitor decisions on information provided from the source.
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