Reading is Fundamental: Making Image Viewing More Efficient

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hiit040306.jpgThe impetus for re-designing a radiology reading station varies by institution and preference of the radiologists who use them. Upgrades in technology or PACS configurations may necessitate some changes, while ergonomic principles may lend urgency to the task as personnel recognize that their environment is causing them harm. Sometimes a revision of the philosophy of how a radiology department should function lies at the heart of dramatic shifts in the way radiologists read studies.

Shawn McKenzie, MPA, CRA, who serves as president and CEO of McKenzie Stephenson in Rockland, Calif., gained both a clinical and IT background as the director of imaging for many years. As a consultant to imaging departments and healthcare systems, he observes a number of driving forces in the re-design of reading cockpits. Among them are increased integration of applications, stand-alone IT platforms with built-in voice recognition capabilities, and increased emphasis on ergonomics as vendors work to provide smooth department workflow.

In the future, McKenzie believes there will be continued attention to physical ergonomics of the workspace, but in addition he predicts that “social ergonomics” will rise in importance. He suggests that just as in academic facilities radiology reading spaces must accommodate group viewing, the same paradigm will move into small community hospitals so that referring physicians will be welcomed into the reading area for increased interaction with radiologists in collaborative image review.

In this configuration, radiology would serve as the hub in the wheel of patient care. He envisions specialists and primary-care physicians entering the radiology domain and the radiologist sitting in the “hot seat” to read with them. In higher traffic areas such as the ICU, the radiology reading station is placed on the unit. The challenge is finding real estate on the patient care units.

Finally, McKenzie envisions greater use of biometrics for one-step log-on activities using the clinicians’ thumbprints or retinal scans or perhaps badge proximity for authentication purposes. While those systems are in use at some institutions, he believes they will become more widespread. Clinicians often complain about multiple log-on passwords that they must remember to access important clinical data. (For more on single sign-on software, see "Single Sign-on: One Authentication for All Applications.")

While his ideas reflect anticipated changes in the future, in today’s world, there are healthcare systems that have already instituted major changes to their radiology reading stations.

Medical University of South Carolina, Charleston, S.C.

Jay Crawford, MHA, who serves as radiology informatics manager at MUSC describes a multiphase project that involved renovation of the radiology informatics area, a re-engineering of the file room and an expansion in the primary reading room. The department switched from analog to digital in 1990 and went completely filmless in 1996 when they installed CR units. They began with an Agfa IMPAX mini-PACS for ultrasound and nuclear medicine and then obtained the funding to improve the rest of the department by 1996.

A major overhaul was necessitated when they recognized that they had just gone from a film reading room with a row of alternators to a row of desks with monitors for digital reads. The walls were painted a deep eggplant (nearly black) and the lighting was inadequate.

“Just the addition of five workstations meant the thermal load was tremendous, so we put in a cold spot air conditioning station that was very noisy,” Crawford relates. They realized that there were numerous deficiencies in the environment, and they also needed to expand the utilization of the workstations, so a re-vamp was imperative.

In the new reading room, they placed a mix of 2 megapixel (MP) and 3 megapixel (MP) Barco Coronis high-brightness active matrix LCD monitors placed into different configurations based on the types of images being reviewed. The new department features a total of eight, three-monitor computer stations, with appropriate lighting based on current radiology standards, central air conditioning and a reading room that is nearly triple the size of the old one.

“We have places where we primarily read CT and MRI, versus places where we read CR radiographic images … those are on the 3 MP portrait configuration. CT or MRI [images] are read on the 2 MP [display] in a landscape configuration where they can look