Like America's obsession with going green—radiology has a new appreciation for ergonomic-driven reading productivity for radiologists. Rightly so. Procedures are increasing in most locales as are the number of images per study, while radiologists are reading more and more studies each year, most often with no increases in staff or radiologists. The answer is more adjustable and ergonomic furniture to make radiologists more comfortable and thus more productive. If you look down the hall, chances are the radiology room has some new creative comforts or plans are in the works. If not, grab some inspiration.
Movement is key
At Staten Island University Hospital in Staten Island, N.Y., which performs about 300,000 imaging procedures a year, ergonomic awareness brought about new two-tiered reading stations for the reading room environment, says Director of Radiology Informatics David Hirschorn, MD. The AFC Industries’ two-tier units have a front section, which holds the keyboards, and a back section, where the monitors are positioned. Each of these sections can be moved independently.
“The ability to change the heights of the monitors and the keyboards independently benefits our workflow,” he notes. “While stored settings are an appealing option, those functions often go unused due to the volume of radiologists at our facility. However, radiologists truly appreciate the ability to stand up or sit down during their viewing periods.”
The adjustability also improves the length of time and the ergonomic benefits for viewing purposes for the radiologist. “The ability to adjust either the monitor or the desk itself allows radiologists, who’ve been sitting all day, to reposition themselves and still have the same viewing capabilities,” Hirschorn says.
The adjustments also are beneficial for individuals of varying heights. “Even while seated, a taller radiologist may need a different height setting, and the adjustable features of the monitors lend to the optimal viewing level for the body,” Hirschorn says.
Another plus is the desks are easy to clean. “They can easily be moved away from the wall for cleaning purposes. Many of the rooms are being used 24 hours a day, and cleaning is important to keep the equipment running. The units are on wheels, making them easily mobile,” he says.
Mobility of radiological furniture also is important when precious hospital real estate fluctuates. “From time to time, rooms need to be evacuated for construction or other purposes, so instead of telling radiologists that they cannot work on that particular day, we are able to wheel the whole workstation to a different location,” Hirschorn explains. “Without a mobile workstation, it would be an arduous process to move a computer and four monitors for each station.”
“Radiologists are not your typical computer users. They are very often glued to the screen for long periods of time, and the strain from using a desk that doesn’t conform can cause tremendous stress to one’s body,” Hirschorn says.
Transitioning toward improvement
The radiology department at Mercy Hospital in Chicago converted to a PACS-based environment in August 2005, completely redesigning their reading room environment—which in turn has completely altered workflow for the better, says Peter Jabeck, administrative director of radiology. As a facility that performs about 90,000 imaging exams annually, Mercy has two reading environments: a reading room with five cubicles, plus some of the radiologist’s offices have been furnished with Biomorph reading desks as well.
“We redesigned the whole reading room around our new PACS, so the five separate reading desks were all new for us,” Jabeck says. Within the new room, each of the reading areas has sound-proof dividers, its own adjustable table supporting the PACS reading station, an adjustable desk, as well as ergonomic chairs. Lights in the reading room have dimmers, allowing individual radiologists or residents to adjust to their personal preference at each desk.
Due to the popularity in the reading room, “we also bought the same designs for some of the radiologists’ offices,” Jabeck says. At Mercy, which is staffed by 15 radiologists and five residents, the reading room space is often sought-after and in great demand—so the hospital chose to accommodate certain radiologist’s offices with the same capabilities to expand productivity and comfort there, too.
Better reading rooms coupled with PACS have meant better report turn-around time too—which is now down to about 3.3 hours, Jabeck says. “It’s just a lot easier for the radiologists to bring up images—even old images. Prior to the installation, you had to pull the patient’s folder if you wanted to view older images. Now, if the patient has been imaged at Mercy in the past three to three and a half years, we are able to bring those images up on the screen right away, making things a lot quicker and easier for the radiologist,” he explains. The conversion also has made the residents, who do the majority of pre-reads at Mercy, more efficient because they are able to spend less time looking for priors.
Biomorph also worked with Mercy to customize the desks according to the desired modality because some modalities often have more residents who need to view images, and thus need larger desks to accommodate more viewers. Also, due to the limited space of the hospital reading room, the company customized the desks, which are either flat to sit against the wall, or curved to fit into the corners.
“Compared to the reading environment we came from, this is a huge improvement, and the cubicles are always full,” Jabeck concludes.
New methods, better results
The VA Maryland Health Care System in Baltimore has long been the poster-kid for innovative reading rooms. Their 532-square-foot reading room that was renovated a year and a half ago is divided into five separate reading areas as a combination of clinical space, showcase and laboratory.
The facility, which performs approximately 90,000 imaging procedures annually, is continuously researching reading room design and ergonomics, including lighting, acoustics and the impact of other modifications, says Eliot Siegel, MD, chief of imaging at the VA Maryland Healthcare System, professor and vice-chair of radiology at the University of Maryland Medical School in Baltimore.
“Each of the five rooms, which are about 10 x 10 feet, utilize different furniture, lighting and ergonomic solutions,” Siegel explains. The rooms were created along with four different vendors: Anthro Corporation, Xybix Systems, Details/Steelcase, and RedRick/Evolve Technologies. Why not standardize on one solution? Then you don’t know what works best.
Despite the physical differences of each of the workstations and desks, there is some continuity throughout the room because they all share one common space. For example, Barco monitors are used at each station, and they are all networked into a computer server for automated quality control, Siegel says.
Also, the hospital has installed a sound system—the Confidante Speech Privacy System from Details/Steelcase—which utilizes sound-masking technology by emitting a low-level noise in a frequency that minimizes distractions associated with human speech throughout the room. “Our reading room is located next to the MRI scanner room, which has potential to create a great deal of distraction for the radiologists, but the sound-masking system has done a tremendous job of not only masking the sounds from within or outside the room, but also the MRI scanner,” Siegel says.
“Radiology has just accepted one of our clinical studies in which we found that at low-levels, the sound-masking system actually increases accuracy of speech recognition with a speech recognition system, which is something that we did not anticipate,” Siegel says.
“At the individual reading workstations, we have a variety of different chairs and a number of different desks. Most of the desks are automated to control for the movement of the desks and to accommodate the radiologists’ preference for sitting or standing,” Siegel notes. Each of the workstations has unique characteristics, such as the Xybix station that provides ventilation options.
The VA Maryland radiology department also has been investigating the effects of concentrated, background sounds, such as music or nature sounds. Stay tuned for the results.
Siegel is keeping the radiologists on their toes, too—literally. The fifth reading room is a Walkstation from Details/Steelcase—that includes a treadmill where the radiologist walks (at about one mile per hour) while reading studies. “We also are researching the increase in metabolic rate of radiologists, and the potential for radiologists to use it and stay fit. We did a study that we submitted as an RSNA abstract, where we found that radiologists might be a little more sensitive in finding lung nodules while walking on a treadmill, in comparison with sitting down,” he adds.
“We’re constantly experimenting with new technologies,” Siegel says. “It’s really important that radiologists have certain conveniences for the 10 hours that they can spend in front of a workstation per day. These technologies can have a significant impact on productivity, as well as on stress reduction and even diagnostic accuracy”
All the innovations to the reading environment and furniture are constantly geared toward allowing the radiologist to be as comfortable as possible, to diagnose images properly and efficiently. “The importance of a well-designed desk should not be underestimated,” says Hirschorn. “It shouldn’t be an afterthought. Oftentimes, it’s unfortunately not considered technology-related. A well-designed and ergonomically designed reading space is invaluable to the radiologist.”
|Clinical Studies to Learn from - What Works in the Reading Room|
|Designing the Reading Room in the Academic Environment|
Journal of Digital Imaging 2003; 16: 31-40 springer.com/medicine/radiology/journal/10278
Eliot Siegel, MD | Redesigning the reading room is key to optimal use in a filmless, PACS environment.
From Traditional Reading Rooms to a Soft Copy Environment: ?Radiologist Satisfaction Survey
Journal of Digital Imaging 2003; 16: 262-269 springerlink.com/content/bqb7qhc5tmdeglke
Lori L. Rumreich, MBA | There may be a direct relationship between radiologist efficiency and satisfaction and the image interpretation environment.
Choosing a Radiology Workstation: Technical and Clinical Considerations
Radiology 2007; 242:671-682 radiology.rsnajnls.org/cgi/content/abstract/242/3/671
Elizabeth A. Krupinski, PhD | Issues pertain to hardware, software and medical workstations, including interface design, particularly how user interfaces affect the interpretation process.
Optimization of Reading Conditions for Flat Panel Displays
Journal of Digital Imaging 2006; 19:181-187 springerlink.com/content/n2128x701wm73335
J. A. Thomas, CAPT | To avoid possible nonlinearity of luminance response at low room lighting for flat-panel displays used in this study, a minimum amount of lighting is recommended.
Carpal Tunnel Syndrome and Cubital Tunnel Syndrome: ?
Work-Related Musculoskeletal Disorders in Four Symptomatic Radiologists
American Journal of Roentgenology 2003; 181:37-42 ajronline.org/cgi/content/abstract/181/1/37
Lynne Ruess, MD | Some technologies put radiologists at risk for work-related, upper extremity musculoskeletal disorders, including carpal and cubital tunnel syndromes. Proper equipment, ergonomics and professional consultation should be used in all radiology departments.