Reading Room takes the spotlight
SCAR U Section 8 focused on elements of reading room design on June 4th at the Society for Computer Applications in Radiology (SCAR) Annual Meeting in Orlando, Fla. Paul G. Nagy, PhD, director of informatics research at University of Maryland addressed reading room design. Alan Hedge, PhD, director, human factors and ergonomics laboratory at Cornell University, focused on reading room ergonomics, and Kenneth C Johnson, MSc, of Kenneth Johnson and Associates presented architectural case studies.

Reading room design: What you need to know

Nagy presented reading room design experience at his former employer, Medical College of Wisconsin (Milwaukee) as the site implemented digital radiology. Prior to implementing digital, Medical College of Wisconsin relied on a traditional ballroom design in its reading room. Problems with this configuration include light pollution, stray film, noise and clutter, which compromised alternators.
Nagy says digital provides an opportunity to redesign the reading room, but redesign competes with other budget items-specifically the PACS purchase price and hospital IT infrastructure to support PACS.
Medical College of Wisconsin radiologists divided into two camps. The first preferred a closed, 'office' approach; the other wanted to embrace a team approach to clinical care. According to Nagy, the design process should begin with goals. Sample goals include:
  • Maintain access for clinicians
  • Increase productivity
One of the challenges of designing the new room at Medical College of Wisconsin was the lack of a radiology workspace during the transition time, so the transition time needed to be minimized.
After defining local goals, the next step is to conduct research about how other sites approached design. Sites on the leading edge include UCLA and Baltimore VA Medical Center.
Nagy offered industry rules of thumb for the digital reading room:
  • Don't mix alternators and workstations. Place an alternator in a separate room.
  • Don't have workstations face each other.
  • Don't ignore ergonomics of the desk and chair.
  • Create space for consultation.
  • Don't ignore ambient and task lighting.
  • Take step to reduce noise pollution.
  • Don't limit workstations to one for every two alternators.  
Finally, solicit radiologists' input on items like reading session length, mouse placement and headache incidence.
Medical College of Wisconsin eventually implemented three workstation pods with more private areas along the walls and one private reading office. In order to minimize transition time, the college scheduled the project over two 72-hour weekend shifts with radiologists temporarily relocated to a conference room. Ceiling drops for power, communications and the network facilitated the fast track project.

Ergonomics of the reading room

Alan Hedge's session focused on defining ergonomics as a process not a label. He also offered tips for implementing ergonomics into practice. Hedge says the ergonomic design process centers on seven questions and corresponding answers.

1. How do you know if you have an ergonomic design?
Check user sources like employee complaints and medical records, and conduct discomfort surveys. An ergonomic audit, either systematic observation of users or a work environment checklist, can provide additional data.

2. How can you quantify injury risk factors?
Postural targeting methods and subjective and objective measures can help determine injury risk.

3. How can you develop ergonomic guidelines for the reading room?
Specify environmental conditions, space and layout, work postures, furniture and equipment and work patterns and include the rationale for each in guidelines.

4. How can you minimize injury risks and maximize comfort and performance?
Decrease postures like wrist extension, ulnar deviation and perching that place users at risk.

5. What are comfortable environmental conditions for the reading room?
Apply standards for thermal air quality, lighting, noise, vibration and indoor air quality.

6. How can you evaluate the impact of ergonomic design changes?
Conduct ergonomics evaluation after any changes.

7. How can you facilitate a participatory ergonomics process?
Train users in work postures and provide them with appropriate tools to enable the ergonomic process.

Architectural Case Studies

Kenneth Johnson demonstrated an improved four-step process for reading room design, claiming the traditional process is flawed and costs time and money.
Sites should obtain computer aided design (CAD) and have all drawings sent in CAD, allowing users to get a feel for the proposed room. Use functional drawings to analyze workflow. Spend 1/2 a day or longer in sites that have implemented the desired outcome, and discuss design plans and issues with them. Simulate the design with all key stakeholders with a scale model or crude mockup. Johnson concludes, "The best configuration is a function of many factors. Well-designed space is a necessity, not a luxury. Johnson also shared that designs can be changed or refined throughout the process even after plans are 'finalized' if authors of proposed changes can demonstrate a positive impact on workflow, cost or other factors