PACS, radiology information systems and electronic medical record systems are designed to quickly and effortlessly bring information to the user with the click of a button. As healthcare facilities deploy and integrate these technologies, the end-users, particularly radiologists, must re-engineer their workflow. At the same time, radiology reading rooms also must be re-engineered and renovated for digital image interpretation. The task is challenging, but more healthcare facilities are sharing their success stories and proving their creativity in the task of deploying a digital and ergonomic radiology reading room.
The foundation of digital radiology reading room design are lighting, ergonomics, acoustics, room design and connectivity. The Baltimore VA has a lot of experience in these areas — having been a PACS pioneer and since then a well-known think-tank for fine-tuning reading efficiency. Just this fall it took another big step, going live with its Radiology Reading Room of the Future.
“Part of the challenge is that reading in a digital environment is very different from reading in a conventional film-based environment,” says Eliot Siegel, MD, professor and vice-chair of the Diagnostic Radiology Department at the University of Maryland School of Medicine and chief of imaging for the VA Maryland Healthcare System. When film boxes are replaced by computer monitors, radiologists spend most of their time sedentary, primarily using a keyboard and mouse. A poorly designed room that overlooks the importance of ergonomics can cause occupational injuries such as eye strain, lower back strain, carpel tunnel syndrome and fatigue.
The Radiology Reading Room of the Future — now the main clinical radiology reading room at the Baltimore VA — consists of five separate reading areas with five different furniture and lighting solutions in each, and serves three purposes. “This is an actual clinical reading room used by five radiologists,” Siegel explains. “It is also a show room and demonstration area. Lastly, it is a research laboratory where we make changes and modifications [to the workstations] for various studies.”
The room features individual ventilation and light controls, adjustable workstations so radiologists can read standing up, reclining chairs with monitors that adjust according to the angle at which the radiologist is sitting, biometric security, white noise generators, adjustable LCD windows that can be made clear or opaque using a program on the workstation, self-calibrating Barco monitors (Coronis 3MP and Coronis Color 3MP DL systems) for remote QA, 4MP 30-inch Barco monitors for teaching and collaboration, a focused sound speaker, and acoustic baffles on the walls and ceilings.
A works-in-progress, the room is changed and improved based on user feedback. “There are so many issues to consider other than taking down light boxes and putting in workspaces once PACS is implemented,” opines Siegel. “Not paying attention to the essentials, radiologists will be less productive, less accurate and they are going to be setting themselves up for increased stresses.”
Essentials of design
It is important to consider when is the right time to outfit a digital radiology reading room. Many suggest it be accomplished at the same time PACS is installed. “This sort of thing needs to be planned well before the PACS goes in because there is significant opportunity to redesign the layout of the room as well as the furniture, wall mountings and utilities,” says John Romlein, managing partner, Qualiteering Labs, LLP. “A lot of things really need to change in a reading room to really redesign it.”
Is it affordable? “Yes, not everyone needs to go building new walls and changing the floor plan,” says Romlein. “You can easily put up partitions of a less permanent nature that provide light and sound baffling between reading positions without having to build walls.”
However, Romlein explains some basic elements to consider in designing a digital reading room:
- Light control: “You want to darken the room more than it has been in a film environment,” he says. “Computer images are not as bright as film images.” Electronic patient images should be the brightest thing in the room. Solutions include light dimmers as well as wall colors, paint and rough (not glossy) textures that absorb light, such as grays, blacks, blues or dark red.
- Sound control: Now that light boxes and the traffic associated with them are eliminated, hospitals can make the