Strategies to improve the radiologist-computer interface
CHICAGO, Nov. 29—“Ergonomics is serious business from the productivity and health perspectives,” Eliot Siegel, MD, chief of imaging at VA Maryland Health Care System (Baltimore, Md.) asserted during an advanced imaging informatics session at the 93rd annual meeting of the Radiological Society of North America (RSNA). 

The diffusion of digital image management systems correlates with an increase in repetitive motion injuries and eye strain among radiologists. The exponentially increasing image count exacerbates these health concerns. The upshot? Radiology departments must improve the interface between the radiologist and the workstation and create productive, healthy, low stress reading environments. Siegel and his colleagues provided a wealth of insight into optimizing the reading environment during a Wednesday morning session.

Workstation Design—Better Ways to Interface with Machines

“PACS workstations aren’t keeping pace with the increase in imaging volume,” according to Steven Horii, MD, FACRF, FSCAR, clinical director of Medical Informatics Group at the Hospital of University of Pennsylvania.
Horii shared challenges and research related to software, workstations and user interface devices. Among the findings shared:
  • Complaints run the gamut from fatigue to repetitive motion pain to longer reading times and increased errors such as selecting the wrong exam or accidental deletion of a file.
  • The proliferation of icons and toolbars can be counter-productive. Studies show that it can take longer to view images and fixate on abnormalities with many menus and buttons. (Krupinski et al. 1996) That’s because users may fixate on the menu rather than the image area.
  • A good user interface can reduce errors. The formula includes an easily understandable design, logical mental model, fast response to input, low visual effort required to move controls and the ability to vary the interface according to task.   
Radiology can learn from other industries, said Horii, who encouraged sites to focus on integration, automation, task-appropriate controls and user interfaces and environments conducive to task management. Integration is particularly key; PACS-integrated 3D, CAD, decision support and EMR can help radiologists cope with demands. On the downside, Horii admitted user fatigue could remain a problem even in an optimal environment.

Coping with the crisis

The image overload crisis is here, said Khan Siddiqui, MD, chief of imaging informatics and cardiac CT/MRI at VA Maryland Health Care System. The average imaging study has reached the one to two thousand image range, which translates into a daily workload in the 50,000 image range. “We need different hardware to improve interactions between the radiologist and computer,” asserted Siddiqui.
Conventional user input devices like the mouse and keyboard that have been adapted for PACS use are associated with occupational injuries including carpal and cubital tunnel syndromes. Consequently, researchers are evaluating other user input devices.
Siddiqui shared research analyzing alternative input devices including trackballs, Tablet and game controllers and roller mouse. Researchers link five and eight-button mouse configurations to increased repetitive motion and greater physical effort. In general, however, two devices in combination outperform a single device. Other studies show that the use of dropdown menus reduces distractions away from image. Finally, Siddiqui shared a productivity study; use of a roller mouse correlated with a significant drop in reading time without any drop in lung nodule detection or measurement accuracy, and it enabled faster scrolling. These results could be enhanced by mapping input device functions to workstation software, said Siddiqui.
Siddiqui also shared an evaluation of various monitors and reported that researchers detected no significant difference in radiologists’ ability to diagnose cervical fracture on 1, 2, 3 or 5 megapixel medical-grade displays. 

Next-generation reading room design

VA Maryland Health Care System is a PACS pioneer and guinea pig. Radiologists at the center functioned in a poorly designed room for more than decade. Over the last several years, Siegel and his colleagues have focused on improving the reading environment and detailing the impact of changes in the environment.
The project redesigned a 532-square-foot reading room. Its goal was to create a low-stress clinical reading room that allows for collaboration while minimizing distractions for five radiologists. The solution, says Siegel, offers the best of both worlds.
In the new room, radiologists can create custom spaces using partitions. It also incorporates one open area for collaboration and two office space areas for privacy.
Other elements include dimmable task lighting with individual controls, a gray background that has a favorable effect on visual acuity and minimizes stress, individual controls for temperature and ventilation, acoustic panels to absorb noise and an adjustable height workstation to allow review and dictation in seated and standing positions.