Radiologist weighs in on ?ideal? workstation

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The well-appointed diagnostic imaging workstation should fit like a tailor-made suit, providing clinicians both comfort and efficiency in order to generate their reports, according to David L. Weiss, MD, clinical head of imaging informatics at Geisinger Medical Center in Danville, Penn.

“Your workstation should fit you like your favorite pair of jeans,” he said in a presentation at last month’s Digital Healthcare Information Management System (DHIMS) conference in San Antonio, Texas.

Weiss said the ideal integrated workstation should allow the interpreting physician to minimize time spent on any other tasks other than image interpretation. It should maximize eye dwell time on images, minimize distraction, and minimize fatigue.

According to Weiss, there are seven attributes clinicians should consider when selecting a workstation:

  • Worklist functionality;
  • Hanging protocols;
  • Graphical user interface (GUI);
  • Mechanical user interface;
  • Ergonomics;
  • Integration; and
  • Future functionality.

Worklist functionality should allow the clinician more than one way to move a study from the worklist onto the workstation, he said. In addition, it should include the capability to easily drag or assign the case to a secondary worklist, such as one for additional views or second opinion as well as copy the study to a teaching file.

Hanging protocols, in addition to allowing automatic customization of views for individual clinicians, should provide patient history and demographics, Weiss said. These protocols should also provide advanced visualization capabilities, such as those needed for multi-detector CT interpretation.

“We need to have adequate hardware and software tools at the workstation,” he noted.

The ideal GUI should be able to be controlled by hand or voice, Weiss said. Unlike other software applications, the ideal diagnostic imaging workstation GUI would have no visual input to distract the interpreting clinician from patient images. This means it would have no pull-down menus, no tool palette, and would require no keyboard strokes by the user.

Radiologists working in the digital environment, by and large, are limited to the conventional mechanical interfaces of keyboard and mouse. The keyboard still uses the basic format developed by C. Latham Sholes and patented in 1872, he observed; while the push-pull-click action of the mouse created by Douglas Englebart is more than 20 years old.

More buttons (5-, and 8-, and 15-button configuration) on mice have seen some success in diagnostic imaging interpretation environments, he said. Research is still ongoing as to the most efficient and ergonomic mechanical interface and has encompassed devices such as joysticks, gyroscopic mice, virtual reality gloves, integrated speech microphone/mouse hybrids, eye tracking, pen tablets, gestures, and voice control, Weiss said.

He would like to see more vendor involvement in this area, with the creation of PACS-specific devices.

“The ideal user interface device must control PACS, speech recognition, and reconstruction,” he said.

Equally important as the workstation is the ergonomics of the environment in which the clinician performs their image interpretation. It should be quiet, private, minimize traffic flow, have individual climate control, subdued lighting, and generally be a comfortable place in which to work for many hours each day.

The ideal workstation should integrate the display of all modalities that a clinician will encounter as part of their diagnostic duties, as well as advanced visualization capabilities, Weiss said. It should also allow for the integration and presentation of RIS and EMR data along with computer-assisted detection (CAD) and reporting technology.

Lastly, the ideal workstation should be able to support future functionality such as real-time decision support with image matching, automated teaching file creation and maintenance, data warehousing and mining, virtual procedure training, and the next-generation of advanced visualization tools, Weiss said.

“Don’t sacrifice efficiency or comfort to accommodate workstation flaws,” he advised.