A little bit of science and a whole lot of creativity merge in putting together the perfect soft-copy reading room - whether new or retrofitted - which includes optimizing everything from lighting, ergonomics and acoustics to network connectivity and room size and design itself.
Going digital in radiology is a step in the right direction for greater department, facility and enterprise productivity - as long as that switch to soft-copy reading involves a carefully orchestrated re-do of the conventional reading room. Recent studies have concluded the same thing - radiologists will not benefit from soft-copy reading on picture archiving and communications systems (PACS) unless the environment is conducive to efficient soft-copy interpretation. Thus, specific design elements must be implemented in a hospital's PACS strategy to maximize its investment and smooth the journey to a digital reality.
"One of the huge things a lot of people lose sight of is you really want to make the PACS reading area as comfortable as possible so the radiologist is encouraged to stay within that space," says Ken Johnson, president of Kenneth Johnson and Associates Inc., a medical imaging consultancy company in Columbus, Ohio.
That "space" is usually occupied by radiologists for more than eight hours at a time. End-user performance will not improve unless space, lighting, acoustics, heating and cooling, furniture and workstation ergonomics and scalability are factored into the reading environment.
Design guidelines for PACS were a bit slow to catch on in radiology. "When we switched to the electronic era, one of the things we knew was that we were moving into an era where productivity was going to be higher," says Mukeesh Harisinghani, MD, an assistant professor of radiology at Massachusetts General Hospital. "Originally, the department did not focus on ergonomics, and just replaced the alternators with digital workstations. That's not the way to do it."
As anyone who has installed PACS knows, workflow in the analog world does not translate to effective workflow in a digital world. MGH realized this and has since initiated a redesign project that generalizes their efforts to the end user. Some changes were implemented immediately, says Harisinghani, while others have required more time.
Time is a factor in PACS installations since the system is most effectively implemented in a phased approach. As a result, reading rooms become hybrid environments of digital displays and lightboxes. "Think of the reading room as evolving in a number of phases," says Bill Rostenberg, FAIA, FACHA, principal of Ashen + Allen Architects of San Francisco, Calif. "Therefore, think about the space as something that needs to change over time. Do not build fixed-in casework but instead use movable, adjustable computer design furniture. It will make it easier to pull the alternators out and move closer to an entirely soft-copy reading environment."
ROOM TO RENOVATE
Filmless environments require a sufficient amount of planning, especially in terms of using space. Space is one of the cost-defining elements of PACS, since not every analog reading device needs to be replaced with a digital workstation.
The most common scenario is introducing PACS into an existing infrastructure. Too large of a reading room is not good, says Rostenberg, and the same goes for "tiny phone booth" cubicles. When Children's Memorial Hospital in Chicago went filmless, they divided their large ballroom-size reading area into two smaller rooms with the addition of a wall. Minimally, the room or workspace should measure 80 square feet, Rostenberg says.
Space - and how it is used - factors into the professional needs of the radiologists. "When dealing with the enclosure, there is an inherent contradiction that surrounds the needs of the reading room - privacy and containment," poses Rostenberg. While at the same time needing privacy for patient confidentiality, there is need for intense collaboration amongst radiologists and specialists. It is challenging to create an environment that is inherently quiet, but collaboration-friendly. Rather than positioning workstations around the perimeter of the room, newer designs position monitors in the center of the room, separated by sound-proofing partitions.
Some reading rooms require additional space. "In many cases, you can shut down some existing rooms and create some additional space," explains Johnson. "Hospitals may have a majority of reading rooms congregated