PACS monitors: an evolution of radiologist's viewing techniques

When initially evaluating picture archiving communication systems (PACS) many radiologists try to duplicate the film environment and believe that multiple monitors are required to maintain the productivity of the radiologist. The authors were under the same impression initially but found that they underwent a paradigm shift over a period of time. This report documents the evolution that the radiologists underwent. The author's department consists of 28 diagnostic radiologists and 21 residents who actively read cases on a PACS. The department has been filmless for 6 months, although they have been reading soft copy films for 2 years. All modalities except mammography are included. The authors conducted interviews with both attending radiologists and residents to evaluate the change in methodology from the preconceptions to initial use to current use. The number and kind of monitors preferred for plain films, ultrasound scan, computed tomography (CT), and magnetic resonance imaging (MRI) were recorded. Additionally, viewing methods of different modalities were discussed. The authors found that there was a decrease in the number of monitors from preconceptions to actual use. Furthermore, to a lesser degree, there is a reduction of monitors used initially to that which is currently being used. The style of viewing cross-sectional images has changed. There has been a decrease in the number of images displayed on each monitor. The use of the roller ball on the mouse has affected this viewing style. Changing from a film-based reading environment to PACS environment not only brings about change in the overall technology in image delivery but also in the viewing techniques by radiologists. At our institution we have evolved from initially expecting to use 4 monitors all the time to actually preferring 2 monitors and occasionally 1 monitor to view images. Presentation software and viewing aids such as the roller ball on a mouse for viewing CTs in stack mode are key contributions to this paradigm shift. The decrease in monitors makes PACS more affordable and will allow further penetration of filmless radiology. The authors have found that after using PACS, radiologists prefer using 2 monitors. The style of reading films has changed with experience. Hospitals that plan to purchase PACS should consider this and ensure that the vendor has presentation software that optimizes the 2 monitor system.