Purpose:The conformance of Primary Diagnostic Monitors (PDMs) to the DICOM GSDF is increasingly required by several state and city regulators. Our purpose was to quantitatively characterize the luminance performance of the internal, built in photometer of BARCO monitors against an externally calibrated luminance meter.Methods:Thirty one PDMs (BARCO) were included in our analysis. An externally calibrated photometer (RaySafe Solo Light) was used to measure the luminance and illuminance values. Measured monitors were located at various hospital sites, radiology physicians’ offices and radiology reading rooms. All measured PDMs were equipped with the manufacturer's built‐in photometers and connected to Barco MediCal QA web service for manual and automatic quality control measurements. PDM combinations included 1, 2 and 4 monitors depending on the location. TG‐18 and SMPTE test patterns were used to evaluate monitor performance.Results:All the PDMs exceeded the luminance ratio of 250:1, as required by NYC PDM guidelines. One PDM failed the NYC requirement for the minimal luminance level of 350 cd/m2. As compared to the external photometer, the difference in measurement of the maximum luminance with the built‐in photometer was found to exceed 5% on 6 of the PDM measured, with a maximum deviation of 10%. The age of the monitors that failed was on average 5 years. All monitors passed the luminance uniformity test, which was 30% from the center of the monitor to the 4 corner locations. Four PDMs failed the Gray Scale Display Function (GSDF) calibration.Conclusion:For the consistent display of medical images and continued conformance with the DICOM GSDF standard, it is essential to compare the performance of the built‐in photometer with an externally calibrated photometer for monitors that are older than 5 years.