Medical imaging monitors

specification guidelines
 Medical imaging monitors specification guidelines

Document details

Contact for enquiries and proposed changes

If you have any questions regarding this document or if you have a suggestion for improvements, please
contact:
Contact officer: David Thiele
Title: Manager Statewide Medical Physics
Business area Biomedical Technology Services, Health Services Support Agency
Phone: +61 7 3646 4058
Email: David_Thiele@health.qld.gov.au

Version history
Version Date Changed by Description
1.0 July 2010 Lawrie Sim, Ben Keir, First issue
David Thiele
1.1 November David Thiele New template
2012
1.2 4 September David Thiele New template
2013

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 Medical imaging monitors specification guidelines

Contents
1. Purpose ............................................................................................................ 3
2. Scope ................................................................................................................ 3
3. Definitions ........................................................................................................ 3
4. Monitor specification guidelines .................................................................... 4
4.1 Non-Mammography Monitors ............................................................................ 4
4.2 Mammography Monitors .................................................................................... 5
4.3 Notes ................................................................................................................. 5
5. Records ............................................................................................................ 6
6. Associated documents ................................................................................... 6
7. References ....................................................................................................... 6
8. Monitors for radiological diagnosis—minimum specification..................... 6

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 Medical imaging monitors specification guidelines

1. Purpose
These guidelines recommend monitor specifications for the viewing of medical images.

2. Scope
These guidelines apply to monitors used for the viewing of medical images from all diagnostic modalities
used in Queensland Health facilities.

3. Definitions
GSDF Grayscale Standard Display Function – optimised relationship between
pixel value and monitor luminance

MP Megapixel: 1 MP = 1,000,000 pixels

Small matrix images Images of matrix size ≤ 1024x1024 e.g. CT, MRI, ultrasound

SOE Standard Operating Environment

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 Medical imaging monitors specification guidelines

4. Monitor specification guidelines

4.1 Non-mammography monitors
Tier 4 – Basic image
Type Tier 1 – Primary diagnostic Tier 2 – Clinical review Tier 3 – Remote diagnostic
viewing
Purpose Used for the interpretation of Used for the viewing of non- Not ideal but used for the Used for basic viewing of
non-mammography medical mammography medical images interpretation of small matrix medical images e.g.
images i.e. radiologist work- for non-interpretative purposes medical images (e.g. CT, patient consultation, chart
station or instances where the where a higher standard of image MR, ultrasound) when a review.
primary treatment decision is quality is required than can be primary diagnostic monitor is
made in the absence of a provided by a standard (e.g. not available
interpretative report e.g. SOE) PC. Typically used by
Emergency Department, ICU, medical staff and consultants
Orthopaedic Clinic (non-radiologists) when an
interpretative report is available.
Size (diagonal) 21 inch (54 cm) 21 inch (54 cm) 17 inch (43 cm)
Matrix Size 3 MP: 1536x2048 2 MP: 1600x1200 1.3 MP: 1280x1024
Max Luminance ≥ 500 cd/m (a)
2
≥ 300 cd/m 2
≥ 170 cd/m2 (c)
Contrast Ratio ≥ 600:1 ≥ 500:1 ≥ 500:1 (d)
Existing SOE monitors
Luminance ≤ 15% variation from centre ≤ 15% variation from centre ≤ 15% variation from centre can be used for the basic
Uniformity viewing of medical
Calibration Auto-GSDF Auto-GSDF Ability to accept 3rd party images. However caution
GSDF calibration should be exercised as
the image quality will be
Bit Depth 10 bits 10 bits inferior to that of Tier 1
Brightness / Locked out Locked out Manual and Tier 2 monitors.
Contrast Controls
Colour/Monochrom Monochrome (b) Either Either
e
Backlight Saving Yes Yes
2
a) This minimum standard should be easily achieved as primary diagnostic monitors are generally manufactured with higher luminance (up to 1000 cd/m ).
b) Monochrome recommended as backlight life double that of colour.
c) Rationale for this minimum standard is discussed in Sim et al (2007).
d) To achieve this contrast ratio, the monitor must be able to render very low luminance blacks.

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 Medical imaging monitors specification guidelines

4.2 Mammography monitors

Tier 1M –
Type Tier 2M – Clinical review
primary diagnostic
Purpose Used for the interpretation of Used for the viewing of mammography images for non-interpretative purposes where a
mammography images by higher standard of image quality is needed than can be provided by a standard (e.g. SOE)
authorised readers PC.
Size (diagonal) 21 inch (54 cm) 21 inch (54 cm)
Matrix Size 5 MP: 2048x2560 2 MP: 1600x1200
Max Luminance ≥ 700 cd/m2 ≥ 300 cd/m2
Contrast Ratio ≥ 800:1 ≥ 600:1
Luminance Uniformity ≤ 15% variation from centre ≤ 15% variation from centre
Calibration Auto-GSDF Auto-GSDF
Bit Depth 10 bits 10 bits
Brightness / Contrast Locked out Locked out
Controls
Colour/Monochrome Monochrome* Either
Backlight Saving Yes Yes

*Monochrome recommended as backlight life double that of colour.

4.3 Notes
1. The manufacturer’s dead pixel policy should be reviewed as part of the purchase.
2. Use a graphics card recommended by the monitor manufacturer.
3. For image viewing in operating theatres use a Clinical Review monitor taking into account screen size, viewing distance, ingress, and sterility
issues. Highest spatial resolution monitors may not represent best value for money. Contact Biomedical Technology Services for advice.
4. Performance of the monitor will depend on environmental conditions e.g. ambient lighting.
5. To maintain optimum performance, quality control testing is recommended. Contact Biomedical Technology Services for advice

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 Medical imaging monitors specification guidelines

5. Records
Nil

6. Associated documents
Nil

7. References
AAPM On-Line Report No. 03, Assessment of Display Performance for Medical Imaging Systems, 2005
http://www.aapm.org/pubs/reports/OR_03.pdf
PS3.14 DICOM Part 14: Grayscale Standard Display Function http://dicom.nema.org
Sim L.H., Manthey K., Stuckey S. (2007), Comparison of performance of computer display monitors for
radiological diagnosis; “diagnostic” high brightness monochrome LCD, 3MP vs “clinical review” colour
LCD, 2MP, Australas. Phys. Eng. Sci. Med. 30(2), 101-104

8. Monitors for radiological diagnosis—minimum

specification.
When considering viewing monitors for radiology applications it is necessary to also consider the
modality. These can be defined as:
1. Small Matrix (The image matrix is less than or equal to 1K x 1K. e.g. CT, MRI, Ultrasound)
2. Large Matrix (The image pixel array is greater than 1K x 1K e.g. Plain Images (CR, DR).
The performance of a monitor in a radiological viewing application can be characterised by a small
number of quantitative metrics that are often used to describe “Image quality”. These metrics generally
fall into the categories of spatial resolution and contrast resolution.
Spatial resolution
The spatial resolution characteristic involves more than simply specifying specific minimum monitor
matrix sizes (e.g. 2MP or 3MP) for each modality. The physical size of the monitor is also an important
consideration. (e.g. there are notebook screens in excess of 1600 x 1200 that have a small pixel pitch
that will display a chest x-ray – but at an inappropriate image size).
It is more appropriate to define the screen size (e.g. 21” diagonal) as well as the required matrix size.
This will determine the pixel pitch which determines the smallest sided object that can be resolved when
the image is displayed in a 1:1 spatial map from image pixel data to image display data. Note though that
magnification features of the display application software on the workstation will determine achievable
displayed spatial resolution.
The monitor should be capable of displaying the complete image at close to life size (not necessarily at
full spatial resolution) and should be capable of displaying the entirety of a region of interest (e.g.
pathology) and its relationship with its surroundings in a 1:1 spatial map from image pixel data to image
display data (i.e. maximum achievable spatial resolution). It is not necessarily a requirement to display
the complete image in the same 1:1 relationship.

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 Medical imaging monitors specification guidelines

Contrast resolution
Monitors applied to radiographic interpretation and/or clinical review of medical images should be
capable of the following:
1. Contrast ratio of greater than or equal to 500:1
2. Maximum luminance of not less than 500 cd.m-2 for interpretation and 300 cd.m-2 for clinical
review. The recommendation of ACR1 for this parameter is171 cd.m-2 . In practice this value is
readily achieved.
3. Luminance uniformity of less than +/- 15% deviation from the central measured luminance value
across the area of the screen. (High quality AMLCD panels should be capable of better. This is
an important conformance issue)2.
4. An ability to have its luminance transfer characteristic conformed to the DICOM Part 14
Grayscale display function (GSDF)3.
5. Minimum 10 bit greyscale output from Look Up Table (LUT)
6. The monitor(s) should be supplied complete with automatic luminance calibration capability and
automatic DICOM GSDF conformance software.
The maximum luminance output (white level or Lmax), minimum luminance output (black level or Lmin)
and luminance uniformity. The ratio Lmax/Lmin is the dynamic range of the monitor. The interval Lmax – Lmin
on the GSDF will define the maximum achievable number of Just Noticeable (contrast) Difference
indices (JNDs) for the display (ignoring any contrast reduction effects of ambient light reflected from the
screen).
ACR1 recommend a value of 50 foot lamberts (171 cd.m-2) as the minimum value of Lmax for a monitor for
application in radiological diagnosis. ACR does not provide a recommendation for Lmin. Inspection of the
GSDF demonstrates that a luminance value of 171 cd.m-2 will provide 550 JNDs. Most LCD monitors
have a minimum luminance output of at least 0.3 cd.m-2 to 0.4 cd.m-2, corresponding to 40 JND indices
above zero luminance. This leaves about 510 JNDs achievable in the displayed image. A majority of
current display applications use 8 bit presentation values (or 255 luminance intervals) in any presented
images. Thus a monitor with luminance characteristics of Lmax = 171 cd.m-2 and Lmin = 0.4 cdm-2 will allow
a transfer of presentation values to luminance values at the monitor output with approximately two (2)
JND indices per luminance interval.
The parameter Lmin is important as a higher value of Lmin will have a similar effect to a higher level of
ambient light; i.e. both circumstances will reduce the effective dynamic range of the display and reduce
achievable display contrast.
Higher luminance capable monitors can achieve higher numbers of JND indices per luminance interval
and deliver increased image contrast. Currently available monitors can readily achieve the luminance
values recommended above.
A 10 bit greyscale output (remembering that the presentation values on the input side are generally only
8 bit) can be mapped to wider separations on the output greyscale thereby achieving a smoother
approximation to the GSDF curve and improved use of available JND indices.
There is a body of opinion that suggests the use of higher performance commercial colour monitors for
radiographic interpretation (i.e. diagnosis) may be appropriate. There is some recent scientific evidence
in support of this view6, 7 and there is also ongoing work that suggests caution8. The specification of
colour or monochrome may be quantifiable in terms of noise characteristics but this may be less
important than the performance specification of the monitor in terms of luminance characteristics and
greyscale rendering ability.
Consideration should be given to standardisation of monitors across a practice – to enable reporting of
all (or most) modalities from any workstation. Another advantage is that all monitors will display the same
image similarly so consistent presentation of images is facilitated.

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 Medical imaging monitors specification guidelines

(NOTE: Mammography may be an exception as it is likely that cost would be an impediment to fitting a
practice out completely with mammography capable monitors).
1. ACR, (2001), ACR Standard for Digital Image Data Management, American College of
Radiology
2. Kimpe T., Sneyders Y., (2006), Effect of non-uniformity on DICOM GSDF compliance, Int. J
Cars 1:p.35.
3. NEMA, (2003), Digital Imaging Communications in Medicine (DICOM) Part 14: Grayscale
Standard Display Function, PS 3.14
4. Leachtenauer J.C., (2004), Electronic Image Display: Equipment Selection and Operation, SPIE
Press, Chapter 7.
5. Sim L.H, Manthey K.L., Keir B., (2006), Soft Copy Radiology – How do I know which monitor to
use? (Proc.) Computer Assisted Surgery & Radiology, Osaka, Japan.
6. Hirschorn D.S., Dreyer K.J., Smith G., The Evaluation of Consumer Displays for the Primary
Interpretation of Radiography. RSNA2006; Abstract SSQ19-04
7. Sim L.H., Manthey K., Stuckey S., (2007); Comparison of Performance of Computer Display
Monitors for Radiological Diagnosis; “Diagnostic’ High Brightness Monochrome LCD 3MP vs
“Clinical Review” Colour LCD, 2MP; Australasian Physical and Engineering Sciences in
Medicine, In Press – Accepted for Publication – March 2007.
8. Roehrig H., Krupinski E., Fan J., Yoneda T. (2007), Are color LCD displays ready for radiology?,
Hot Topic – presented at CARS2007, Berlin.