Case Study | November 12, 2007

From Manual “Puck” Calibration to Remote DICOM LCD Calibration in a Multifacility PACS System

Zwanger Pesiri’s journey to improve image quality and consistency, while reducing the diagnostic LCD service burden on the IT Staff

Dr. Steven L. Mendelsohn, Zwanger Pesiri, reading the DBI self-calibrating 5MP displays.

Dr. Steven L. Mendelsohn, Zwanger Pesiri, reading the DBI self-calibrating 5MP displays.

Zwanger Pesiri is a progressive radiology practice that has served New York’s Long Island for 55 years. With a corporate charter to utilize advanced technology to improve patient care and efficiency, Zwanger employs a multitude of diagnostic imaging modalities. These include 128 and 64-slice CTs, 3.0 and 1.5 Tesla MRIs, ultrasound, digital mammography, Dexa, PET/CT, nuclear medicine and DR/CR.
Zwanger completed over 230,000 exams in 2006 and is on target to easily surpass that number in 2007. This accelerated growth has led to the expansion from four facilities in late 2004, to eight in 2007. Zwanger is also on the technology forefront with the use of Cedara’s iReadMammo for digital mammography along with Merge Fusion and eFilm for PACS.
The Challenge
Saddled with LCD support issues and the inconvenience of manually calibrating to the DICOM standard with a hand-held photometer, also known as a puck, the IT department targeted a way to ease the LCD service burden. DICOM LCD calibration must be done from the front of the LCD, either with a built in front sensor or a puck. In the cases of LCDs with only backlight sensors (as with the previous vendor), DICOM calibration must be done with a puck. The manual puck calibration process requires excessive labor. This is magnified when multiple locations are involved, in addition to causing interruptions to the radiologists’ workflow.
According to Matt Dewey, PACS Administrator for Zwanger Pesiri, “Service was one of the factors driving us to look for a new monitor vendor. The previous vendor would let us languish with tech support problems, such as drivers causing failure of the calibration software, or routinely asking for a reformat of the machine in order to fix driver issues. That is not something tech support staff likes to hear, especially when you are talking about reinstalling a reading station.”
Being such a large practice with multiple locations, Zwanger was also facing a lack of onsite service units.
As Dewey noted, “We also had to purchase our own hot spares, even though we have many monitors and video cards.”
Vendor Selection
When the time came for Zwanger to re-evaluate their LCD vendor, the key factors were price, calibration and remote monitoring, according to Dewey. Since DICOM calibration can only be done through the front of the LCD, Zwanger was most interested in self-calibrating LCDs with front sensors. One main interest when looking at self-calibrating LCDs was remote administration.
“With such rapid growth, adding more than an office a year, we have had to set up more and more automation and remote administration. Going onsite daily to observe monitors for problems is not an option,” Dewey explained.
Service also played a very important role in the selection process, given the struggle Zwanger was facing with the current vendor. Zwanger also requires FDA 510k certification for mammography on all 5MP systems.
After evaluating various vendor offerings and taking into consideration key factors such as remote administration, calibration, pricing, FDA 510k for mammography and service, Zwanger chose Double Black Imaging as their display system and calibration software provider.
Double Black Imaging’s proprietary software, X-CAL, provided the key components Zwanger was looking for in calibration and remote administration. With X-CAL, Zwanger has set up their displays to be calibrated on a schedule which does not interfere with the radiologists’ workflow. X-CAL also runs as a service, so the user doesn’t have to be logged on, unlike other calibration software that runs as an application requiring a user to be logged on or present. X-CAL also allows commands to be sent and reports to be pulled remotely, visual test logs to be displayed remotely and email alerts to be sent in case of failure.
As Dewey relates, these features have made workflow more efficient and been
a time-saver.
“Our physicists have been able to get their reports in an easier manner, not to mention the increased convenience to the head of our QC. In fact, she can check on the output of the monitors from her house.”
In addition to the remote calibration, these LCDs have also been more stable, according to Dewey.
“We have not noticed any need to manually calibrate monitors as we have noticed for monitors that have only a backlight calibration.”
Double Black Imaging was able to address Dewey and Zwanger’s service concerns as well. They provide a full three-year all-inclusive warranty that includes the LCD, backlight, electronics and graphic controller, as well as updates and upgrades to their X-CAL Calibration software throughout this period.
Double Black Imaging also offers remote technical support and onsite training and configuration for Zwanger. Also, given the service requirements based upon the size of their enterprise, Double Black Imaging also provides onsite spares for immediate
hot-swap purposes, while taking care of all other service needs via their standard 24-hour hot-swap service. The new LCD systems are stable and seamlessly
calibrated without IT intervention. The outdated pucks are gathering dust.

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