It isn’t surprising that all medical-imaging displays in the University of California at Los Angeles (UCLA) Medical Center’s new, 1.05-million-sq-ft hospital will be flat-panel LCDs using PACS technology. The institution was a pioneer in PACS, researching the possibilities of digital images for use in radiology as early as 1983.

Osman Ratib, MD, PhD, professor and vice chair of information systems for UCLA’s department of radiological sciences?who was part of this pioneering research?says the hospital’s goal is to extend this legacy by having a complete plan for its technology before moving into the new building. “We’re trying to have all the issues resolved before we build the new hospital?instead of waiting until it opens to understand the technology,” he says. “We’re pretty much one year away from opening the new hospital, and we have prepared the environment to be totally digital.”

UCLA and its planners are not alone in wanting to move toward a completely digital, flat-panel future. But what are the advantages of using LCDs over older digital monitors with CRT technology? Is it worth the cost to transfer to these kinds of systems? And if so, which of the products from several flat-panel display companies should you choose? These are questions for which vendors have been actively vying to provide answers in recent months. And their answers lie primarily in the small, but very important, details.

MOVING UP

For Ratib, LCD technology showed a natural improvement in quality over CRT. “It’s just a better, cheaper, higher-quality device than what we had before,” he says.

When UCLA first considered using LCDs instead of CRTs, he explains, many employees argued that there wasn’t enough proof of how well the new monitors worked to justify making the change. But, as anyone who’s ever tried an LCD next to a CRT monitor knows, there’s no comparison. “People requested the CRTs, so we did purchase them,” Ratib says, adding that if the CRT monitors arrived after people had the chance to try flat-panel displays, the CRTs stayed where they are still: in their boxes.

Now the facility uses about 140 3-megapixel (MP) flat-panel displays throughout the facility. Once in place at the new hospital, the technology will help things run more smoothly.

“The whole value proposition?the reason hospitals want to deploy digital imaging?is that it’s much more cost-effective than past technologies,” says Matt Harris, VP of marketing and business development for Planar Systems Inc (Beaverton, Ore), the manufacturer of the displays at UCLA.

Lynda Domogalla, marketing manager of medical imaging systems for BarcoView LLC (Duluth, Ga), agrees that LCDs are more efficient and offer a big advantage in cost of ownership. “They last longer, take up less space, and require less power; so overall, they’re more affordable to own,” she says.

Ken Compton, strategic marketing manager for National Display Systems Inc (Morgan Hill, Calif), notes another advantage over CRT: “Flat panels provide a more definitive answer in terms of luminance response because of the contrast threshold. A flat panel can actually create a full bright pixel next to a full black pixel; a CRT can’t do that. You can actually display some very small targets with very subtle luminous differences.”

George Scott, marketing manager for Siemens Display Technologies (Lafayette, Colo), doesn’t think flat-panel displays have significantly improved a radiologist’s diagnostic performance over CRT products. However, he notes, “Advantages in terms of size and weight, heat dissipation, and flexibility of the resolutions certainly make flat panels more appealing than CRTs were.”

EVALUATING THE MARKET

As medical flat-panel-display technology has improved over the years, an increasing number of vendors have entered the market. The biggest companies in flat-panel technology are still Barco, Planar, and Siemens Display, but a handful of other vendors?Eizo Nanao Technologies Inc (Cypress, Calif), National Display Systems, NEC Display Solutions of America Inc (Itasca, Ill), and Totoku North America Inc (Irving, Tex) among them?have joined the fray. (See the downloadable PDF table “Compare and Contrast” for a full list of manufacturers and product offerings.)

Still, enough room is available for a wealth of varying innovations. Every player claims to bring something new and different to the table.

For example, Planar offers a variety of displays and associated products under the Dome brand name. Harris claims the company was the first to create a flat-panel display for use with patient monitoring in 1986, and the first to use a DICOM calibration system. “We have quite a bit of history in the medical marketplace,” he says. “And we consider it the most important part of our business.”

He says Planar’s competitive edge lies in its strategy to “spread digital imaging throughout the hospital.” To do so, the company has recently launched less-expensive display products for departments other than radiology, because an OR surgeon, Harris offers as an example, doesn’t need to view an image on the high-end display that the radiologist requires. “[Our competitors] are saying, ?Put this $20,000 display everywhere in the hospital.’ We’re saying, ?Put that display in the radiology department, and then put a $3,000 display in the doctor’s office,'” he explains. “Our approach is more tailored to how the display is being used.”

Planar also has recently introduced corollary products to its displays, such as the Dome Dashboard, a software console application that allows IT managers to centrally control all displays within a facility.

Barco has two lines of flat-panel display products: Nio and Coronis. Domogalla notes that although Coronis has been available since 2001, many vendors have only recently introduced similar products. She sees a major differentiator in Barco’s offerings with its I-Guard, a sensor on the front of the Coronis displays that provides automatic DICOM calibration as well as monitors the backlight. In other words, she says, “it’s intervention free, even while a radiologist is looking at an image.”

NEC Display recently entered the market with its MD Series. Todd Fender, product line manager/specialty marketing for NEC Display, says that these displays are different because of the company’s patent-pending X-Light technology. It controls the luminance and whitepoint of the displays through an internal backlight sensor, and it can be adjusted per a user’s specifications. Fender says the technology also provides improved monitor matching because all the products are set for the same whitepoint during production. “So if one display goes down, [a user] could find any monitor on-site with a sensor that’s still working, copy that brightness, and be perfectly matched,” he says. “That helps radiologists be more efficient.”

Siemens Display’s primary differentiator, Scott says, is its proprietary backlight technology for its 3 MP and 5 MP displays called Planon. “It’s a technology developed with a Siemens sister company that lends itself to a very long life, a very stable performance, and a very uniform brightness,” he says. Scott sees primary competitors to Siemens Display in this market as Planar and Barco; but he, like others, has noticed the smaller up-and-comers as well.

One of these, National Display Systems, has a medical display product line called Axis. About 1 year old, Compton says it, too, provides unique functionality for radiologists. For example, with the company’s new software, MD-CAL, a radiologist can use a pull-down menu to choose a desired luminance and click on it; the panel will automatically reconfigure to that luminance. Because this technology is independent of the video card, the display can be taken from a dark reading room to a bright clinical area and be plugged into a similar video card, where it will show just as clear an image. “You can take any one of our color or monochrome displays and move them anywhere,” Compton says. “They’re completely portable.”

FUTURE BREAKTHROUGHS

Looking at the differences in features that each of these companies has chosen to focus on, it is apparent that they also all have ideas of where the technology is going?or at least should be.

Domogalla believes that just as CRT was honed over several years to solve its problems, LCD technology will continue to improve. “With CRTs, the technology itself wasn’t perfect?there were some problems with the focus and geometry. But over time, a few companies, including Barco and Siemens Display, worked really hard to perfect that technology for imaging,” she says. “I think that’s what you’ll see with LCDs. There will be advancements in the backlights, because they don’t last forever, and there will be advancements in the uniformity across the screen.”

For its mammography LCDs, she adds, Barco already has announced technology that makes every pixel on the display DICOM-compliant. “So there’s room to bring that type of solution in to all the products,” she notes.

Harris of Planar sees two trends on the horizon: an increase in display size so that monitors can be used for teaching and other presentation purposes, and improved rendering of 3-D images. “As more 3-D data is being captured, the viewing of that data is becoming a bigger issue?as well as an opportunity for display companies,” he says.

Fender foresees a potential shift toward different backlight technologies. Cold-cathode fluorescent lamps (CCFLs), a similar technology to the long-tube lighting of office buildings, will switch to using light-emitting diodes (LEDs), he says?an improvement, because LED doesn’t turn yellow like CCFL does with age. “This will provide a whiter color gamut to the end-user, whether it be grayscale, color, or white,” he says. “It will help radiologists see better colors or better grayscale steps.”

Ratib of UCLA is looking forward to the time when color displays achieve the same quality in brightness and resolution as current grayscale monitors. “That will bring together the best of both worlds,” he says, adding that current technology could be improved by providing the same resolution in larger panels as it does now in smaller displays.

Scott of Siemens Display says the future of flat-panel technology lies primarily in small, gradual advances. “We’ve seen significant improvements over the past couple of years. I think those will continue to develop, and the overall market will benefit from those quality improvements,” he says. “Not that the quality’s bad now; it will just get better.”

Sarah Schmelling is a contributing writer for Medical Imaging.