Optimizing the reading room: Lessons on visual perception, ergonomics and design

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A well-designed reading room can optimize the interpretation process, workflow and the comfort of the radiologist, said Elizabeth Krupinski, PhD, Society for Imaging Informatics in Medicine (SIIM, formerly SCAR) reading room section head and research professor of radiology and physiology at University of Arizona in Tucson. Experts presented best practices for facilitating optimal visual perception, ergonomics and reading room design during the SIIM 2006 annual meeting yesterday in Austin, Texas.

Visual perception in the digital environment

Physiology and the environment affect spatial resolution; ambient light is a major factor affecting contrast sensitivity. The challenge for radiology departments is to minimize environmental distractions and correct for factors that make visual interpretation more difficult for the radiologist. Areas to consider include ambient light, workstation interfaces and placement of ancillary equipment.
Optimal ambient light conditions depend on the type of monitor. Conventional wisdom that dictates turning off the lights is incorrect, warned Krupinski. She shared a study that demonstrated a little bit of ambient light (between 25 to 40 lux) may maximize observer performance. Other variables that affect accuracy and visual search include display luminance, calibration and viewing angle. “An optimized display and [reading] environment can minimize diagnostic time without compromising accuracy,” summed Krupinski.

The View on Ergonomics

Alan Hedge, PhD, department of design and environmental analysis at Cornell University in Ithaca, N.Y., discussed ergonomic principles and shared current research.  
Simple changes can reduce ergonomic risk factors, said Hedge. For example, he recommended implementing a micro-break, a 60 to 90 second rest with stretching every 15 minutes, to reduce muscular fatigue and improve performance.
Hedge also shattered myths regarding ergonomic seating; a 90 percent upright posture is not necessary for ergonomic seating and the ability to adjust all chair parameters is not required. Reclined postures reduce lumbar disk pressure and back injury risks. A dynamic chair with backrest inclination provides the preferred seat angle; however, radiologists should change positions during the day. Hedge cautioned that an ergonomic chair does not guarantee that radiologists will sit ergonomically. Moreover, the chair is a function of and interacts with the entire environment.  
Input devices such as keyboards also can increase the risk of injury. Smaller, flatter keyboards with a negative incline can reduce musculoskeletal strain, said Hedge. Mouse design does not affect risk of injury, but workstation interfaces that require a high degree of pointing and clicking do increase risk of injury.  

Digital design considerations

“The reading room has been neglected in design and is typically designed as an office, which is wrong,” according to Bill Rostenberg, principal with Anshen+Allen Architects of San Francisco. The transition to soft-copy reading exacerbates the need for a well-designed reading room to reduce risk of injury and maintain diagnostic accuracy.
Rostenberg compared the reading room to a well-designed car where there is no distinction between the driver (radiologist) and the environment. Five aspects of reading room design are: enclosure, lighting, acoustics, ergonomics and connectivity. The enclosure must support privacy and collaboration, which are often at odds with each other. Both dimmable, ambient lighting and supplemental task lighting are required. Hospitals can gain acoustic control via sound-absorbing floor, wall and ceiling finishes. Hedge urged the audience to consider three ergonomic points of contact: the eye to the screen, fingers to the keyboard and body to the chair. Integrated raceways and wireless communication systems can minimize cable management problems.
Rostenberg concluded by urging the audience to consider adjustability, flexibility and scalability in reading room design.