A slow but steady video revolution is underway in operating rooms across America. Count me among the converted who believe in the power of 4K video. For us it was partly a matter of good timing. About a year ago, we were looking into upgrading to 3D high-definition monitors at our surgery center. That was just about the time 4K was hitting the market. Our doctors said, let's see what it can do. Shortly thereafter, we became the first facility in the country to make the leap. Why? Because our doctors fell in love with it. And now, a year later, they're still in love.

If you haven't seen 4K yet, all I can tell you is it's like looking at an internal organ with your own eyes. The definition is unbelievable. We put a scope into a bell pepper to show our board members exactly how much of a difference it made. And wow! You could see every little seed and vein in that pepper. It's like watching a 3D movie, but with more detail.

From a practical standpoint, our doctors tell me they're now able to make diagnoses while doing surgery that they wouldn't have been able to make before. I think 4K is eventually going to push past HD, just the way HD has made standard definition essentially obsolete. And more and more manufacturers are getting into the act. Still, admittedly, it isn't cheap. Technology and competition are bound to bring prices more into line eventually, but in the meantime, if you're in the market to upgrade your OR video monitors, there's a lot to consider — regardless of whether you're ready to make the 4K leap.

• Screen size. Bigger isn't always better. The optimal size depends on the distance between your surgeons and your monitor. If your setup lets you pull a monitor down to within close range, you're better off with a smaller model. On the other hand, if you have to look across the room, you'll be better off with a bigger screen.
• Color rendering and resolution. This can be a big factor for some docs. Orthopedic surgeons who are dealing with cartilage that's shades of white and gray may not care as much, but if you're doing gynecology or gastroenterology, color matters. Don't take anyone's word for it. Make sure you have a trial, so your physicians can see it for themselves.
• Compatibility. Be careful that you don't buy a monitor only to find out that it isn't compatible with the scopes and other video equipment you already have. Some, for example, require different sized cables. Again, a trial is key to making sure you're on top of all the details.
• Warranties. Keep in mind that not only are monitors expensive, but they get used hard. Most vendors offer a one-year warranty. But don't be afraid to demand better. Usually I insist on 2 years. Some vendors offer scratch-resistance guarantees. That's an attractive option, seeing as things do tend to bang into each other in the OR.
• Cleaning. How easy is it going to be to clean? Monitors that have antimicrobial covering help prevent infection.
• Be wary of bundling claims. A lot of companies say you have to buy their monitors or they won't guarantee that their scopes and other devices will provide optimal visualization. But don't take their word for it. If you're just replacing a monitor, often you can do better by shopping around. Again, just make sure it's compatible with your equipment. On the other hand, if you're upgrading a whole suite of equipment, it might make sense to stick with one company.
• Input/output signals. Remember to assess the maximum number of visuals you might want to be viewing on the screen at any one time, and make sure any equipment you consider has enough inputs and outputs to keep up. Typically, we like to view the patient's hemodynamics and surgical images.
• Be sure to try it out. If you buy something your users don't like, everyone's going to be unhappy. Sales reps should be more than happy to haul their equipment into the OR, set it up and let your surgical staff actually see what they'll be working with. OSM

ConMed
VP4826 HD LED/LCD (26 inches)
VP4832 HD LED/LCD (32 inches)
advancedvisualization.conmed.com
(800) 237-0169
Pricing: $15,065 or $17,505
FYI: Designed to provide optimal surgical images for multi-specialty procedures, ConMed's monitors display artifact-free HD images. They come calibrated with industry standard color and settings can be customized to suit user-preference. Other features include integrated image pan, zoom, freeze, picture-in-picture and picture-by-picture. A multi-channel wireless system enhances safety by eliminating loose wires from around the surgical table. Thanks to LED technology, they consume less total power and energy than traditional LCD type monitors.

Eizo
CuratOR LX490W
eizo-or.com
(800) 800-5202 ext. 220
Pricing: not disclosed
FYI: With a 49-inch screen, numerous input/output signals and the ability to combine pictures, Eizo's LX490W works well for viewing DICOM X-ray images or as a second monitor in the OR. Its high-brightness LED backlight can be set to luminance levels of up to 700 cd/m ? (HD monitors range from 450 to about 1000 cd/m2). To maintain the backlight at its calibrated luminance, it uses an integrated stability system with a contrast ratio of 1300:1 and 178 ?-wide viewing angles. There's no fan, the monitor is watertight and the front surface is easy to clean.

FSN
FS-P2602D
fsnmed.com
(714) 300-0540
Pricing: $3,900
FYI: FSN's enhanced LCD panels with LED backlight are designed to improve contrast ratio and brightness, while minimizing glare, making them suitable for high-ambient-light conditions in surgical suites. User-preset modes allow practitioners to customize color settings and screen layouts that can be stored and recalled later. The FS-P2602D has a slim profile and ergonomic design but is built to resist humidity and breakage. There's no fan and it's designed to work with all popular endoscopy systems.

Karl Storz
karlstorz.com
(800) 421-0837
Pricing: not disclosed
FYI: Karl Storz's Panasonic monitors use in-plane switching — a technology developed to eliminate viewing-angle dependence — so they provide exceptional color and high contrast ratio from virtually all viewing angles. They offer both picture-in-picture and picture-out-of-picture capabilities. There's also the option for a side-by-side display of HD images that can be adjusted independently. Multiple HD inputs are standard, so there's no need to buy optional input boards.

NDS
Radiance Ultra 4K/UHD
ndssi.com
(866) 637-5237
Pricing: not disclosed
FYI: NDS just launched its new 4K monitor (the technology that provides 4 times the resolution of HD). With ultra-wide-gamut color technology and a high-brightness LED backlight that can increase the visibility of recessed anatomy, the Radiance Ultra 4K/UHD 32-inch monitor offers what the company says is an unprecedented level of detail, sharpness, and clarity. Scratch-resistant, splash-proof, edge-to-edge glass helps eliminate display scratches caused by IV poles and surgical light heads, and the monitor comes with a 10-year scratch-resistance guarantee. For your tech-minded staff, a quad-link SDI input supports both 2-sample interleave and square division 4K formats to ensure compatibility with 4K/UHD endoscopic camera systems.

NDS
Radiance Ultra TruColor
ndssi.com
(866) 637-5237
Pricing: not disclosed
FYI: For facilities that don't have the budget for 4K, NDS's Radiance Ultra TruColor 32-inch display is engineered to broaden the range of colors an LCD display can produce, with a goal of more accurately rendering anatomy. Like its 4K counterpart, it has splash-proof, edge-to-edge glass and comes with a 10-year scratch-resistant glass guarantee. An optional embedded wireless video receiver can reduce the number of external devices required during a procedure, as well as the number of power and video cables.

Olympus
Visera 4K UHD
medical.olympusamerica.com/products/VISERA-4K-UHD-System
(800) 401-1086
Pricing: not disclosed
FYI: The product of a joint venture between Olympus and Sony, the Visera 4K UHD provides 4 times more information than conventional HD and supports both 4K UHD (3840 x 2160 pixels) and full 4K (4096 x 2160 pixels) resolution. Its 8.29 million pixels and BT-2020 format reproduce a broader spectrum of colors than HD, including subtle differences in reds and yellows, allowing surgeons to better visualize fine patterns and structures. A resin layer behind a full glass panel reduces glare from ambient light and increases durability.

Sony
LMD-X310MD
sony.com/4kmedical
(201) 930-7320
Pricing: not disclosed
FYI: Along with offering 4 times the resolution of standard HD with virtually no pixilation — even with extreme close-ups — Sony's slim 31-inch 4K (4096 x 2160 pixels) monitors are compatible with a range of 4K products and systems. They feature extremely bright panel technology, a wide color gamut and the ability to use a "quad-split" view, which allows users to see 4 full HD signals at once. Corner-to-corner uniformity and LED backlighting provide intricate detail and high-contrast images in both dark and well-lit rooms.

Steris
Vividimage 4K Surgical Field Display (31 inches)
Vividimage 4K Wall Display (65 inches)
steris.com/products/surgical-displays-and-wall-displays
(800) 548-4873
Pricing: not disclosed
FYI: Steris has a pair of 4K offerings with its 31-inch Vividimage Surgical Field Display and its 65-inch Vividimage Wall Display. Both offer 4 times the detail of HD, providing enhanced visualization of fine structures, greater depth perception and tissue variation. Additionally, a minimal amount of rear enclosure venting holes and a fan-free display help support infection prevention.

Stryker
32-Inch 4K Surgical Display
stryker.com
(800) 624-4422
Pricing: not disclosed
FYI: Designed to optimize its 1588 Advanced Imaging Modalities (AIM), Stryker's new entry into the vivid and colorful world of 4K has multiple input options and allows users to customize surgeon profiles. It weighs just over 23 pounds, so it's easy to install in both integrated and cart-based rooms, says the company.