Archive September 2019 XX, No. 9

Thinking of Buying... Video Monitors

Sorting through the wide variety of OR display options.

Suraj Soudagar, MS, MBA, LEED AP

Suraj Soudagar, MS, MBA, LEED AP

BIO

There's a universe of surgical monitors out there of varying sizes, features and functionality. Where do you start in evaluating your options? As a healthcare equipment planner, I've consulted many facilities on these important decisions. Here are the factors you need to consider.

  • What procedures do you do? One size doesn't fit all with monitors. Some are better for certain types of surgeries. Take 4K monitors, which offer super-high and more lifelike video resolution than HD. In many cases, an HD monitor will suit your surgeon just fine. Orthopedists looking more broadly at bone rather than at finer things like tissues and tendons probably don't need a 4K monitor. 3D sounds dazzling, but make sure your surgeons rigorously trial the 3D system and confirm that they really need or want it — and the glasses.

Color rendering might be important to surgeons for procedures that involve examining tissue, so you'll want to make sure the monitor presents colors exactly as the surgeon wants them to appear. Also account for where viewers will be standing in the OR. While this is very rarely an issue with modern LCD screens, which approach absolute 180-degree viewing angles, you don't want anyone to get the distorted "screen door effect" — like viewing something through the mesh of a screen door — if they're looking at the monitor from a sharp angle.

  • Size matters. You might assume "the bigger the better," but that's not the case in the OR. If you're at home and sitting 3 feet away from your TV, a massive 70-inch screen would overwhelm your eyes. Screen sizes should be determined by viewing distance; there are formulas out there that let you calculate how large a screen you need based on how far away the viewer is. Same goes for the OR. Just as a 58-inch monitor might be overkill for some surgeons, a 27-inch monitor might be too small. It comes back to how your OR is configured, the type of procedures you do, where you'd like to place the monitor and of course your surgeons' preferences. Also keep in mind the aspect ratio you need; that's the width of the screen versus the height. It preferably should match those of your video sources so they fit the full screen just right.
  • Keeping it clean. You might dust your TV every now and then at home, but cleaning a surgical monitor is mandatory, and vendors design them to be much easier to clean and disinfect than your living room set. All those nooks and crannies where dust can land or hide on your home TV? Surgical monitor vendors try to make surfaces smoother all around, in some cases eliminating bezels entirely, to prevent contaminants from collecting in tiny spaces. Some surgical monitors are specifically designed to handle splattering of liquids and being bumped into. Vents are a no-no because they can blow contaminants back into the sterile field. Bottom line, your monitor should be extremely easy and very quick to clean thoroughly as required.
  • What resolution(s) are your video sources? No matter what a vendor tells you, if you're not feeding 4K video to a 4K monitor, you're not going to see true 4K. The whole video chain needs to be natively 4K to produce the best results. Many vendors offer optional "upscaling" of standard-definition (SD) and HD video to 4K, but because upscaling is a digital enhancement where the screen is "guessing" what the video would look like in 4K, it's not entirely exact, and so can be hit or miss for certain procedures. An upscaled picture could look grainy to a trained eye. So if your input is, say, HD from your laparoscopic equipment, and you're not planning to upgrade that equipment to 4K anytime soon, just buy an HD monitor to appropriately match that to your video source.
  • What inputs do you need? Make sure the monitor has the correct types and amount of video inputs for the video equipment you use — like HDMI, DVI, DisplayPort, BNC and others, some of which might include unique or uncommon connectors. You want to avoid having to use adapters or "dongles," which create clutter and could degrade the signal, as much as you can. On another note: Do your surgeons want to see multiple video feeds or images from multiple inputs on a single big screen? First of all, this is great if you don't want 4 monitors cluttering the OR. Many monitors offer this all-in-one capability, leveraging features like picture-in-picture and split-screen. Some even offer the ability to change the size and position of different feeds on the fly.
  • Other important features. "Lag" or latency is a very slight delay that could throw the surgeon off in certain procedures, so investigate related specs like refresh rate and frame rate if this is a concern. Do you want to mount the monitor to a wall, ceiling or C-arm? Make sure the monitor is VESA (Video Electronics Standards Association) compliant, and that the mount you use can handle the monitor's weight. If you want to minimize clutter, cable management lets you route all of the video and power cables behind an easy-to-clean cover. And don't forget ease of use: How easy is it for your staff to make video adjustments on the monitor, like brightness, color saturation and so forth?
  • Try before you buy. Have prospective vendors bring in the monitors you're considering and let your surgeons put them through their paces for a week or 2. After all, they're the ones who are going to use them. Get their feedback and opinions, and purchase accordingly.
  • Use your leverage. If you have many ORs and thus need many monitors, throw your weight around a little. If there are 2 or 3 vendors you like, play them off one another — and not just in terms of price. Also negotiate things like warranty lengths and service contracts. You want the best overall package with the best value for your organization. Keep this in mind, however: try not to put all your eggs in one basket. If you're buying, say, laparoscopic equipment and OR integration and monitors from one vendor, you're locked in to that vendor, and now you're kind of stuck with that relationship (although it may very well turn out to be a great one). You want to keep your vendor honest, to create a situation where they feel the need to work with you to earn and keep your business.
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