"Architecture is the learned game, correct and magnificent, of forms assembled in the light.” The turn of the century, Swiss-born architect Le Corbusier seems to understand the considerations of radiology reading room design, especially its dependence on proper lighting constructs.
As with most construction projects, starting from scratch is usually the best and easiest way. But most often when it comes to radiology reading rooms, renovations are in the plan for hospitals and radiology practices requiring providers to alter a space within the confines of an existing physical structure, says according to William N. Bernstein, AIA, principal of Architecture for Radiology, in New York City. Radiology practices often need to make alterations when they outgrow their current space, add more staff or especially when they add PACS.
Whether the project is in a new or renovated space, Bernstein suggests that the reading room considerations are the same, including: understanding the workflow within the reading environment, such as the desire for privacy versus collaboration; lighting; acoustics; HVAC; along with materials and colors. Comparing a private to a collaborative image reading environment becomes particularly relevant in an academic teaching hospital, where the reading of images often takes place in a group setting with residents.
Bill Rostenberg, AIA, director of research at Anshen + Allen in San Francisco, offers a similar methodology for reading room project planning, adding on the priorities of structural space, ergonomics and connectivity.
Let there be light
Lighting is key because of the effect it can have on the occupants of the reading room. Rostenberg sees lighting as the most important consideration in the design because of the evolution to reading soft-copy images; however, he notes that with flat-panel monitors, some of the reflection complications have become easier to solve. The misconception of a completely dark room also has been disproven.
“There is much more pressure to read more and more images, more quickly and more accurately in today’s reading [environment] due to the emergence of volume and dynamic quality certain modalities, like CT and MRI, which produce both 2D and 3D, anatomic and physiological data,” Rostenberg says. “As a result, the interaction between the radiologist and the image is much more intense and active, resulting in frequent repetitive work injuries and eye fatigue. In general, it becomes a lot more important to have the proper type of lighting.” Indirect lighting is superior, whether it is reflected off the ceiling or the walls.
Bernstein says that there are three current foci for lighting: what is the ideal lighting for working on a computer screen; how is the lighting controlled; and energy conservation. Aesthetics and the target of illumination also are important aspects of consideration.
The most common request with lighting is controllability, Bernstein says. “People who work at individual workstations want to control the lighting in their individual area,” he says.
“The basic goal is to have general room illumination that does not cause any interference with the monitors, which can be achieved with ambient lighting,” Rostenberg says. “It should be generally equal to the amount of light coming from the monitors. The reader should not have any contrast or distraction from the lighting in their peripheral view.” Task lighting is needed to assist with note-taking at the workstation.
From the ground up
New construction was the route Memorial Hermann Katy Hospital in Texas took in 2006 when it built new reading areas as part of a new building, says Steve Dinwiddie, director of imaging services. The hospital is one of 11 hospitals in the Memorial Hermann Healthcare System in Houston that each year completes 80,000 imaging exams.
At the facility, radiologists have their own individual reading room with no windows, equipped with an Anthro Carl’s Table workstation, four monitors, phone, fax machine and temperature control. Within the rooms are fluorescent lighting with two switches for control, Dinwiddie says.
Despite lighting controls, most of the radiologists prefer to shut the room lights off and use the back lighting on the workstation to create indirect light. To take notes and make phone calls, the radiologists often use their task lamp, too, which is attached to the workstation.
Outside the reading rooms, the hallway lighting is turned off, too. Only ambient lighting is used in the hall even though it is equipped with special fluorescent lighting with very small square grids, Dinwiddie says. The grids are “intended to force the lights to project straight down, instead of to sides, potentially creating reflective light,” he says.
Can you hear me now?
In choosing where the reading room should be placed within the hospital, Dinwiddie says they chose to put them next to the nuclear medicine department “which has relatively little foot traffic.” The hospital also disconnected the overhead speakers and alarms in the reading area, along with posted hallway signs requesting silence.
“Any sounds can interfere and distract from reading interpretations and could potentially interfere with voice recognition, so any way to reduce noise is helpful to the radiologists,” Dinwiddie says.
Naturally, noise is more of an issue in shared reading rooms. “If you can overhear intelligible conversation, it can be problematic, especially with the rise in voice recognition utilization,” Rostenberg says. Within academic institutions, there is a greater likelihood to have more readers in a room, so “there is always a compromise between privacy and collaboration,” he notes.
To mask extra noise and voices, there is a lot that can be done with partitions, such as modular furniture partitions, but “the smaller the partition, the less sound will be controlled,” Rostenberg says. However, he also says that “one of the best ways to control sound is to not align partition walls in parallel. If they are slightly out of parallel, it actually minimizes the amount of reverberation of sounds.”
Bernstein says that as a step down from placing walls and doors around each workstation, “you can treat surfaces within a more open work environment in a way that they absorb sound, by using softer surfaces, including the ceiling.”
“There is an advantage to uniformity when designing a series of reading areas or workstation within the same project,” Bernstein says. In general, you want to give equivalent people equivalent accommodation, therefore creating more flexibility,” Bernstein says. “There is a risk in over-customization, especially due to the mobility of individual physicians.”
While there is not one standard solution to combat ergonomic issues, “workstations and monitor arrangements come in a huge variety of options. Therefore, the department or practice needs to determine what makes the most sense for how they read,” says Rostenberg. However, he notes that adjustability remains important for the comfort and usability of several radiologists sharing the same workstation. As a result, even if the department or practice purchases several of the same workstation, there is variability within that one choice.
Flexibility from sitting to standing and vice versa is preferred, too. One of the radiologists at Memorial Hermann Katy Hospital, for example, prefers to read while standing in the latter half of the day. He adjusts the workstation to the highest setting, regardless of which room he is using.
“While I often support standardization, it’s probably helpful to form a committee during the transition process to develop standards that work for that particular organization for continuity. There is a definite value for standardization, as long as that standard has enough variability to work for different sizes and ages [of users],” Rostenberg concludes.