[Intl_DxMedPhys] [EXTERNAL] Re: Barco 32 MP mammo monitor

Thu May 1 15:08:16 EDT 2025

I have a somewhat related question and would appreciate any feedback.

We have several mammography workstations configured with Unity monitors as well as two MDNC-3421 monitors for viewing other modalities. The Unity monitors can be set to a max luminance of 1000 cd/m2 while the 3421’s are usually set at 450.

Considering allowable ambient light level as it relates to monitor luminance and reader eye fatigue switching between the monitor sets, are there any recommendations for how all of these levels should be set?

I can appreciate that there may be improvement in detectability using a higher luminance for mammo, but if two different types of monitors are used in conjunction is there a possibility of increasing eye fatigue?

Thanks in advance,

Glen.

Glen E. Naekel, M.S., D.A.B.R.
Medical Physicist
Department of Radiation Safety and Imaging Physics
Lehigh Valley Health Network
2100 Mack Boulevard
Allentown, PA 18103
Phone: (484) 224-1623

From: Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list-bounces at lists.osu.edu> On Behalf Of Xthona, Albert via Intl_dxmedphys_wd_osu_list
Sent: Wednesday, April 30, 2025 9:46 PM
To: Alisa Walz-Flannigan <walzflanniga at wisc.edu>; Jerry Thomas <jerry.thomas at ascension.org>; Douglas Pfeiffer <xraydoug at me.com>
Cc: intl_dxmedphys_wd_osu_list at lists.osu.edu
Subject: Re: [Intl_DxMedPhys] [EXTERNAL] Re: Barco 32 MP mammo monitor

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Hello Alisa, We also seek to minimize the number of remote visits. In our QC recommendations for the current models, the physicist in-person is reduced to a minimum, although still a requirement for newly commissioning a reading room. After
Hello Alisa,

  1.  We also seek to minimize the number of remote visits.  In our QC recommendations for the current models, the physicist in-person is reduced to a minimum, although still a requirement for newly commissioning a reading room.  After that, usually the doctor can perform the annual test and the physicist review can be remote.  See notes on p2 that support this.

  1.  The study of human visual performance is fun!  The short explanation is that studies show perception of higher spatial frequencies  improves with increases in luminance & contrast.  I’ve added a column for the Coronis Uniti in the degrees/pixel table and a row in the “Retinal displays?” table.  There you can see that for some of the detection and discernment tasks, we have come closer but are not yet at the limit.  Gerald Westheimer is one of my favorite authors on the topic of acuity.
Specification
PACS display
(3MP)
Breast Imaging
Coronis Uniti (12MP)
Breast Imaging
Coronis OneLook (32MP)
iPhone 16
(3MP)
Google Pixel 9
(3.7MP)
Native Resolution
1536 x 2048
2800 x 4200
6848 x 4656
2532 x 1170
2858 x 1280
diagonal size (inches)
21.3
33.6
33.6
6.1
6.3
Pixel Pitch
0.2115
0.1686
0.103
0.055
0.051
Typical Viewing distance (cm)
75
75
75
30
25.4
pixels per  centimeter
47.3
59.3
97.1
181.1
194.9
Degrees per pixel at viewing distance
0.016
0.012
0.008
0.011
0.012

[cid:image001.png at 01DBBAA9.BA66F2F0]

  1.  Re fixed adaptation and “with TG18-QC , I can’t see “OL” unless I cover up the brighter squares with my hand”, the QC and OIQ patterns present very bright areas near the very dark areas probably because it looked organized.  It doesn’t necessarily reflect the most common usage, but I understand your concern.  For the purpose of our QC recommendations, masking is expected.  The question of how much simultaneous contrast is desirable is one we let doctors and physicists decide.  We know that for rapidly changing images, the eye will be adapted close to the brightest objects in that part of the field, though the adaptation is not uniform over the field of vision during cine.  And importantly, when the scene does hold still, the eye rapidly begins to adapt and make use of the contrast in the image – unless someone has really reduced the contrast of the display to ~350.  Fortunately this is rare, as clinicians generally weigh in and get the contrast restored to a more useful level.  Also we are aware that images are processed by the modality with the typical displays and multiple PLUTs for typical workflows in mind, so this can help to make sure everyone has an effective system.

  1.  We’ll consider bringing back the forced choice test, it is something that was used by some customers in Europe.  Just have to weigh it against the other requests…

Regards,
Albert

From: Alisa Walz-Flannigan <walzflanniga at wisc.edu<mailto:walzflanniga at wisc.edu>>
Sent: Tuesday, 22 April, 2025 08:14
To: Xthona, Albert <albert.xthona at barco.com<mailto:albert.xthona at barco.com>>; Jerry Thomas <jerry.thomas at ascension.org<mailto:jerry.thomas at ascension.org>>; Douglas Pfeiffer <xraydoug at me.com<mailto:xraydoug at me.com>>
Cc: intl_dxmedphys_wd_osu_list at lists.osu.edu<mailto:intl_dxmedphys_wd_osu_list at lists.osu.edu>
Subject: RE: [Intl_DxMedPhys] [EXTERNAL] Re: Barco 32 MP mammo monitor

Albert,

It’s good to hear from you.

1.Will you be updating QC manual to align with  AAPM MPPG 17 (https://urldefense.com/v3/__https://aapm.onlinelibrary.wiley.com/doi/10.1002/acm2.14625__;!!KGKeukY!yE1910jhSIshkpZGVld8bb25MFMN2sA8inPZVEhW_cRHIKsbSsPsY2-4PsmhcTLicV6s-Y1bDsxRk8RKcn_Hx45S-tql7EdM_PThkO3ObmI$ <https://urldefense.com/v3/__https://aapm.onlinelibrary.wiley.com/doi/10.1002/acm2.14625__;!!KGKeukY!0C4SW-t1-S8tpp65uw9IP4OwUANKIVj0IBW4r4vpqu9WGjQMUKNBlJh6zsGxHGjFvWycjmNuJoDm-3mwVutTcROW22pSU7l-2ibUKY1cac5mVQ$>), current difference being  that the responsible physicist is able to  train a radiologist, PACS professional or other person to be able to run a visual test and assess environmental lighting (esp when you have integrated ambient light sensors) for AT as well.
For many health system with remote mammo readers, flying a physicist across the country is not necessary or practical for reading a test pattern.
A physicist could do AT in house with full workstation setup, then have shipped off for someone to do the remaining visual test, environmental checks. So long as we can lock out any viewing mode changes which wouldn’t be caught by remote (integrated) luminance check.

2. I do appreciate that the new 32 MP does exhaust the entire possible range of human visual system contrast resolution with spatial frequency at typical viewing distance, but it is out to the tail end and I’d be curious if you all had studies to support the value ?
[cid:image002.png at 01DBBAA9.BA66F2F0]

3. The high level of brightness is not new to this monitor, but I do still have concerns about this for fixed adaptation at high brightness conditions limiting contrast resolution in the darker regions of an image. You can appreciate this on the OneLook with TG18-QC , I can’t see “OL” unless I cover up the brighter squares with my hand and let my eyes adjust. Are people really finding that they can pass the visual test without such measures on these monitors?
I did modify the calibration from default to reduce max and raise min to accommodate (1000cd/m^2 max, 1.3 min). Hopefully that will be sufficient.
I did modify LUT for apps with the Barco system setup tools, but it’s limited in what it can configure.

[cid:image003.png at 01DBBAA9.BA66F2F0]

4. Will Barco ever bring back a forced choice object detection test  like they had on the old QA web server,  that might be a better end-user visual test  ?

-Alisa

From: Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list-bounces+walzflanniga=wisc.edu at lists.osu.edu<mailto:intl_dxmedphys_wd_osu_list-bounces+walzflanniga=wisc.edu at lists.osu.edu>> On Behalf Of Xthona, Albert via Intl_dxmedphys_wd_osu_list
Sent: Monday, April 7, 2025 6:37 PM
To: Jerry Thomas <jerry.thomas at ascension.org<mailto:jerry.thomas at ascension.org>>; Douglas Pfeiffer <xraydoug at me.com<mailto:xraydoug at me.com>>
Cc: intl_dxmedphys_wd_osu_list at lists.osu.edu<mailto:intl_dxmedphys_wd_osu_list at lists.osu.edu>
Subject: Re: [Intl_DxMedPhys] [EXTERNAL] Re: Barco 32 MP mammo monitor

Hello Jerry and Doug, Needless to say, I have an obvious bias in this discussion topic yet can contribute some background context. The ACR-AAPM-SIIM point, that details cannot be created, is entirely correct, so the advantage with smaller source
Hello Jerry and Doug,

Needless to say, I have an obvious bias in this discussion topic yet can contribute some background context.

The ACR-AAPM-SIIM point, that details cannot be created, is entirely correct, so the advantage with smaller source matrix images is dependent on people using multiple viewports to review many views at once as noted by Jeff.  And people do want to review many views at once to facilitate comparisons using both small and large-matrix images.

The pixel pitch is reduced to come closer to the limit of human acuity, and because this allows images from modern DX detectors to be displayed such that their highest frequency components result in visible modulation.  The human eye is wonderfully complex, and uses various mechanisms to generate hyperacuity, especially the Vernier sensitivity generated in our brain from the line-like elements present in medical imaging.

Similarly, the high brightness of modern displays enables more acuity than was possible to achieve in the early years of digital medical imaging.  Our eyes work better with more light.  Some conclusions about what we can/cannot see (resolution, shades of gray, etc.) were drawn when displays were 1/5th as bright as they are today.  These conclusions may no longer be as valid now as they were in 1996 when people were introducing 5MP grayscale CRT displays.

While we have very positive qualitative feedback on the smoothness and perception of margins, we are always interested in pursuing more quantitative perception measurements with the clinical and medical physicist community.

Please feel free to reach out to me if you would like to get more deeply into the technical aspects of this display system.

Regards,
Albert

Albert Xthona

Product Manager and Portland Site Leader
T +1 503 748 6060
[cid:image004.png at 01DBBAA9.BA66F2F0]

Visioneering a bright tomorrow
Barco Inc. | https://urldefense.com/v3/__http://www.barco.com__;!!KGKeukY!yE1910jhSIshkpZGVld8bb25MFMN2sA8inPZVEhW_cRHIKsbSsPsY2-4PsmhcTLicV6s-Y1bDsxRk8RKcn_Hx45S-tql7EdM_PThuYk6d5Q$ <https://urldefense.com/v3/__https:/www.barco.com/__;!!KGKeukY!34fK2tgpku5oatc9OUuTN0yd-7fk7wAVsKVwXTo547awqD3o8ad1Zzuo3IaG5ZZo7YJb0q1WianoobNEypIoPhwNbSbFxe1yOCBXnFnOYov-Hw$>
735 SW 20th Place, Suite 100
Portland OR 97205 | USA

From: Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list-bounces at lists.osu.edu<mailto:intl_dxmedphys_wd_osu_list-bounces at lists.osu.edu>> On Behalf Of Jerry Thomas via Intl_dxmedphys_wd_osu_list
Sent: Monday, 7 April, 2025 13:26
To: Douglas Pfeiffer <xraydoug at me.com<mailto:xraydoug at me.com>>
Cc: intl_dxmedphys_wd_osu_list at lists.osu.edu<mailto:intl_dxmedphys_wd_osu_list at lists.osu.edu>
Subject: Re: [Intl_DxMedPhys] [EXTERNAL] Re: Barco 32 MP mammo monitor

This message was sent securely using Zix® There is a limit as to how small a pixel can be before the eye/brain fuses them into a single pixel. When I did some early work with the IBM Sarnoff Labs in NY, I seem to remember that the limit
This message was sent securely using Zix®<https://urldefense.com/v3/__http:/www.zixcorp.com/get-started/__;!!KGKeukY!2DeYNET5qPSGEPJHb0vIMwb3oFuu2JVRbe5_GCyU7MSejOz3019a1zSnin5goedh7cpqZbe0IIGCnmMC-6YcLPsMnztEQp1DvAGkmpVjr83Y5AM$>

There is a limit as to how small a pixel can be before the eye/brain fuses them into a single pixel.  When I did some early work with the IBM Sarnoff Labs in NY, I seem to remember that the limit was on the order of 100 um.  I had them make a special display for me that has 125 um pixels -- GREAT images.  I know Albert Xthona well and am sure that he is aware of this physiological fact -- so if they have a 103 um pixel the eye/brain is not fuzing the pixels -- but much smaller and that will happen.  The images should be EXQUISITE!! with the smaller DEL

Jerry

Jerry Thomas, MS, FAAPM, DABR, CHP, DABSNM
Diagnostic Medical Physicist / Radiation Safety Officer
Ascension Via Christi Hospitals Wichita
Wichita, KS  67214

Phone:  316-268-5958  (office)
            240-447-1014  (cell)

On Fri, Apr 4, 2025 at 11:44 AM Douglas Pfeiffer via Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list at lists.osu.edu<mailto:intl_dxmedphys_wd_osu_list at lists.osu.edu>> wrote:
I’d have to think it through more (thinking is hard on a Friday), but one benefit of the smaller pixel size is that it would possible to see a larger field of view at full resolution. 5 MP makes that possible with current systems, but it’s possible,
I’d have to think it through more (thinking is hard on a Friday), but one benefit of the smaller pixel size is that it would possible to see a larger field of view at full resolution. 5 MP makes that possible with current systems, but it’s possible, I guess, that future systems could possibly have smaller pixels to require the monitor to be equivalent.

Best regards,
Doug

Douglas Pfeiffer, MS, DABR FACR, FAAPM
Medical Physicist, Radiation Safety Officer
Boulder Community Health
xraydoug at me.com<mailto:xraydoug at me.com>
303.415.7515

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The opinions expressed in this message are the product of the gray and white matter loitering in my cranium. I speak for myself and no one else, unless I say otherwise.

On Apr 4, 2025, at 10:22 AM, Jeff Frimeth via Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list at lists.osu.edu<mailto:intl_dxmedphys_wd_osu_list at lists.osu.edu>> wrote:

Not me and I don't believe these are Health Canada (our FDA) approved.

The pixel size is 103 um, where as say 5 MP or even 12 MP all have about 150 um instead. I don't believe this decrease in pixel size (pitch) is really that advantageous. Quoting the ACR-AAPM-SIIM "The finer pitch will not improve the spatial resolution of the underlying image data, which is determined by the imaging system, and the benefits over a pixel pitch of 0.200 mm are negligible at a viewing distance of 60 cm because of the limitations of the human visual system discussed earlier. However, the larger array size allows for viewing a larger region of the mammography image at the native, or full, resolution (ie, 100% zoom, no interpolation)."

The only real potential reasons I could see why a rad would want a 32 MP display is to buy something fancy or potentially view many sequences/images at a time (like in neuro or ENT imaging).

My two cents.

Jeff Frimeth, M.Sc., MCCPM, CIIP, MRSO (MRSCTM), MRSE (MRSCTM), CDIP
President & Chief Medical Physicist
JF Medical Physics Inc.
P: (416) 779-9674
E: jf at jfmedphys.com<mailto:jf at jfmedphys.com>
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From: Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list-bounces+jf=jfmedphys.com at lists.osu.edu<mailto:jfmedphys.com at lists.osu.edu>> on behalf of Travis White via Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list at lists.osu.edu<mailto:intl_dxmedphys_wd_osu_list at lists.osu.edu>>
Sent: April 4, 2025 9:25 AM
To: intl_dxmedphys_wd_osu_list at lists.osu.edu<mailto:intl_dxmedphys_wd_osu_list at lists.osu.edu> <intl_dxmedphys_wd_osu_list at lists.osu.edu<mailto:intl_dxmedphys_wd_osu_list at lists.osu.edu>>
Subject: [Intl_DxMedPhys] Barco 32 MP mammo monitor

We recently had a Barco MDMC-12133 12 MP mammo monitor die.  Barco provided a quote for a new MDMC-32133 32 MP monitor as a replacement.
Coronis OneLook (MDMC-32133) - Breast imaging displays - Barco<https://urldefense.com/v3/__https:/www.barco.com/en/product/coronis-onelook-mdmc-32133__;!!KGKeukY!1F8q0GbgwPfa48bPuCNIO6XrLB49rJCBro01N9fR8Mtm7abnsH4FqtpM7FQsLSiY1o4FMj3vuLaVg3yoUGEGXRSHabsZeo266i6Ij-RxfIHQYf4LQw$>

I haven’t been able to find any references to monitors with this pixel size – experience, advantages, etc.

Does anyone have experience with the 32 MP monitors in mammography?

Thanks.

Travis White, MS, DABR
Diagnostic Medical Physicist
Radiation Safety Officer – Upstate

Prisma Health
701 Grove Road
Greenville, SC 29605
864-455-3720 (office)

<image001.jpg>

Inspire health. Serve with compassion. Be the difference.

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