Anatomy of the Digital Reading Room

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hiit040406.jpgThe rationale for redesigning the radiology reading room for the digital era is clear to anyone who has interpreted digital images in an environment intended for analog radiology. Kind of like wearing shoes on the wrong feet — they work, but they’re awkward, annoying and need to be changed. And some others equate it to one-arm paper-hanging, impossible.

“Ergonomics has a much greater impact in the soft-copy environment than in the film world,” says Bill Rostenberg, San Francisco-based principal with Anshen+Allen, an international architecture firm. But many facilities overlook ergonomic needs. Instead, they invest in digital image acquisition devices that increase revenue, neglecting the human element of the equation.

As a result, radiologists are suffering. “We’re seeing several classes of injuries among radiologists,” reports Nogah Haramati, MD, chief of radiology and professor, clinical radiology and surgery at Jack D. Weiler Hospital of the Albert Einstein College of Medicine in New York City. Injuries affect the cervical spine, shoulders, trapezius, wrists and lower back. Long hours in front of the computer screen translate into a higher incidence of vision problems as well.

The problems transcend the physical. When the radiologist suffers, the enterprise pays a price. Think lost productivity and workflow. Not only do sick days add up, but the minutes click away as the radiologist stretches to relieve his or her aching back. On the clinical level, studies show that radiologists are more prone to errors when they are fatigued, says Ric McGill, PACS applications manager at University of California Los Angeles Medical Center.

Radiologists’ cries are getting louder—and being heard—as hospitals are beginning to attend to reading room design. This month Health Imaging & IT takes you inside some of the country’s best (and one of the worst) reading rooms.

People first

“Reading room design is all about people,” asserts Ric McGill of the University of California Los Angeles Medical Center. He refers to the PEOPLE acronym to steer decisions as he collaborates with radiologists, architects and administrators to design the reading room at UCLA’s newest hospital.

p.gif Physician: Physician input and buy-in is essential. Radiologists need to be involved early and throughout the design, build and equip processes.
e.gif Ergonomics: Radiologists are dissatisfied with poor ergonomic arrangements.
o.gif Outside vendors: Use vendor expertise, says McGill. They know what is best of breed in the design world.
p.gif Personnel: Don’t overlook other interested parties. Technologists, clinicians, specialists and IT staff use the reading room, too.
l.gif Lighting: Take a comprehensive look at lighting needs; consider the varying needs of radiologists, IT and service staff.
e.gif Environment: Don’t forget carpet, wall color, air circulation, sound and IT integration.

How not to design

These “before” shots of the Veterans Affairs (VA) Maryland Health Care System reading room may seem achingly familiar to most radiologists. That’s because it represents the typical scenario where the hospital uses an analog set-up for the digital world.

  • Shedding some light on the matter. The overhead lighting is all wrong; it’s not adjustable, controllable or evenly dispersed, and the radiologist does not have an individual task light.
  • Oh, my aching back. Ouch. The chair forces the radiologist into an unnatural posture to interpret and dictate studies. The table cannot be adjusted to accommodate radiologists of different heights or allow users to read in a standing position.
  • Can you hear me now? The panels do little to mask noise and voices among dictating radiologists.
  • Look out below. The radiologists whose feet get tangled in those cords could wind up on the floor.

Setting the table hiit040406c.jpg

The table or work surface should be designed around the chair, says Nogah Haramati of the Jack D. Weiler Hospital of the Albert Einstein College of Medicine, who sites here in the reading room at Montefiore. Montefiore experimented with a variety of shapes before selecting a scalloped, adjustable table for its new reading room.

A radiology department can diminish the utility and comfort of a great table with poor planning. The ideal keyboards are movable (wireless) for maximum comfort and flexibility. Flatter keyboards reduce unnatural postures that can lead to carpal or cubital tunnel syndromes. Haramati’s research also revealed that optical mice are more comfortable than analog mice. Finally, the monitor