Anatomy of the Digital Reading Room

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.gifPhysician: Physician input and buy-in is essential. Radiologists need to be involved early and throughout the design, build and equip processes.
e.gifErgonomics: Radiologists are dissatisfied with poor ergonomic arrangements.
o.gifOutside vendors: Use vendor expertise, says McGill. They know what is best of breed in the design world.
p.gifPersonnel: Don’t overlook other interested parties. Technologists, clinicians, specialists and IT staff use the reading room, too.
l.gifLighting: Take a comprehensive look at lighting needs; consider the varying needs of radiologists, IT and service staff.
e.gifEnvironment: 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 tablehiit040406c.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 should move up and down and back and forth to ensure minimal eye strain.

How to make a radiologist smile. Montefiore provides the total package: the chair, table and equipment chair work (and adjust) together so that each radiologist can find a reading position where the neck aligns with the body.

Fitting the chair to the use

Some experts recommend that reading room design begin with the chair. The comfortable radiologist reads longer and is more productive and less prone to injury than the colleague wallowing in a poorly designed chair.

hiit040406e_1.jpgSean Casey, MD, president of Virtual Radiologic Consultants offers some tips for selecting the right chair. “Begin by analyzing the work environment. What information systems are in use? Are users in a partial paper or paperless environment? What other constraints affect radiologists? Dedicated imagers sit for far longer than radiologists who move between PACS and 3D workstations or travel around the department. Do others consult with radiologists and need to view images with radiologists?”

Montefiore Medical Center surveyed radiologists to develop a list of chair criteria during its reading room redesign. The next step was to bring in a variety of chairs and solicit feedback on each before selecting a standard, adjustable chair for the department.

hiit040406f_1.jpg When you buy a new chair, make sure it has high back and neck support and these adjustments.

  • seat height
  • back rest height
  • swivel
  • back tilt adjustment
  • adjustable arms

Looking better

This conceptual arrangement works on all levels, says Bill Rostenberg of Anshen+Allen

hiit040406f.jpgThe chair and work surface adjust to accommodate radiologists of different heights and in different postures.

The individually controllable task light allows the radiologist to complete paperwork without straining his or her eyes. "It illuminates the work surface without creating glare," notes Rostenberg. What's more, the table provides adequate space for paperwork.

"Acoustics are often ignored, yet become increasingly important with speech recognition systems. Background noise may interfere with speech recognition,"explains Rostenberg. The acoustic panels mask background noise and gregarious colleagues, allowing the radiologist to focus on the task at hand.

Shedding some light on the matter

“It’s a common misconception to believe that the reading room should be completely dark. The light level of the monitor should balance with the ambient light in the room,” explains Rostenberg.

The Montefiore reading room incorporates a movable task light built into the table and warm, incandescent lighting that is easily replaced.hiit040406g.jpg

Can you hear me now?

Acoustics is another often-overlooked element of reading room design. Montefiore Medical Center uses corkboard partitions covered with acoustic fabric to isolate individuals. The top 12 inches of each partition is smoke-tempered Plexiglass that blunts the hall light yet allows the radiologist to see others approaching. VA Maryland researchers are studying the effects of individually controlled sound, including white noise and music, on reading.

Designing for flexibility

VA Maryland may be more experienced with reading room design and redesign than any other site in the country. Eliot Siegel of the Veterans Affairs (VA) Maryland Health Care System advises others to remain flexible during the redesign process. In fact, the VA redesigned its redesign. The first prototype room reflected radiologists’ desire for sound isolation. But when Siegel and his team unveiled the pseudo office cubicle arrangement, radiologists requested a redesign that facilitated collaboration.hiit040406h.jpg

The new design provides a front and back area with the front area configured to facilitate collaboration among a trio of radiologists sharing the space. The rear isolation chamber facilitates ‘crank-out’ mode.

Meeting the needs of radiologists who desire a high degree of collaboration and those who prefer isolated, focused reading is a common conundrum. Montefiore Medical Center uses shorter partitions in a gregarious area and longer partitions in isolated reading areas.

VA Maryland will study four unique configurations in its reading room laboratory. Poetic Technologies arrangement offers an adjustable and programmable chair, keyboard table and footrest. Each individual can control indirect ambient light to reduce glare and shadows.

Coming attractions

hiit040406i.jpgVendors are discovering ergonomics, says Alan Hedge, PhD, CPE, director, Human Factors and Ergonomics Laboratory and co-director, Design Concepts Laboratory at Cornell University in Ithaca, N.Y. The latest gadgets from the product world that may benefit radiologists include: flatter keyboards to minimize wrist strain and discomfort (break off the feet on keyboards, he recommends, and place them ideally on a negative slope to reduce wrist extension and thus strain) and multiple new mouse designs. For example, the sight-controlled mouse may be transferred from original applications for disabled users to heavy-duty uses like medical imaging.

  • The Perific Mouse provides flexibility and versatility, which helps users avoid repetitive stress injuries.
  • It can be used like a traditional mouse.
  • It can slide as a track ball.
  • It can be worn on the hand.

hiit040406j.jpg Anshen+Allen’s conceptual sneak peek into the reading room of the future removes the ubiquitous monitor from the room. The equipment is integrated with the environment, and the wall becomes the display via either 2D projection or a more interactive holographic overlay.

Though the holographic room of the future may be a few years off, the trends and needs are clear. Healthcare cannot afford for its most valuable players to be sidelined by injuries, and accepting less than optimal productivity is not an option. The redesigned reading room promises benefits on multiple levels; health and productivity top the list. A state-of-the-art reading room also may aid the recruitment process in today’s tight market. The how’s and why’s of reading room design are clear. The only remaining question for sites confining radiologists to an inadequate reading room hybrid is when.