Renee DiIulio
Renee DiIulio

The reading room is hot?so hot that people should be walking out of it with a tan. A tan would look good in the fluorescent lighting that creates the glare reflecting off the monitor that’s a little too close to the reader’s eyes, giving him a headache. So, he spends 15 minutes grabbing a glass of water. Half an hour later, it’s a trip to the bathroom. An hour after that, it’s another excuse, because, really, any excuse will do.

Productivity is down; dissatisfaction is up. Staff is absent more frequently, and complaints?and possibly claims?start to come in, including headaches, backaches, carpal tunnel, and cubital tunnel. At this point, it should be obvious that the reading room requires a redesign.

GE Healthcare's Mark Morita demonstrates ergonomic-friendly equipment.
GE Healthcare’s Mark Morita demonstrates ergonomic-friendly equipment.

Facility managers rarely make the move proactively. “If the department is producing at maximum capacity and there are no complaints, then a redesign might not be necessary. But, if people are reporting problems or productivity is way down, then it’s time to redesign,” says Mark Morita, emerging user interaction marketing manager for GE Healthcare (Waukesha, Wis).

The key to an ergonomically designed reading room is customization?in other words, adjustability. But what exactly needs to be adjustable, and how? Medical Imaging spoke to a few experts who offered tips for the ideal reading room.

1) Research

Ergonomics principles are fairly well-established, and interested parties easily can find a wealth of information about them. “You don’t need to evaluate every study. There are lots of studies with information on best practices, and you can use the Web to reference these,” Morita says. Data exists on the relationship between productivity and lighting, computer equipment, placement, furniture, sound, and temperature.

2) Evaluate

You’ll want to evaluate vendors and products carefully. “Every workstation has a long list of features to consider. Not all features have equal value to the user or the organization,” says David R. Carson, founder and VP of marketing for XYBIX Systems Inc (Littleton, Colo), a designer and manufacturer of ergonomic PACS workstations. “Strong ergonomic performance should be given greater weight in a purchasing decision than other features, which don’t have the same potential to enhance both individual and organizational performance.”

Furniture, such as that offered by XYBIX Systems, should be adjustable for seated and standing positions.
Furniture, such as that offered by XYBIX Systems, should be adjustable for seated and standing positions.


3) Test Drive

The best way to test products is to use them for more than 10 minutes in a showroom. “It’s very important to have users try chairs and surfaces for a week or so,” Morita says. When redesigning the reading room at the Baltimore VA Medical Center, administrators made deals with vendors to provide the equipment on loan. Morita suggests that other facilities should try to do the same.

4) Customize

One of the things users will have to look for is whether the products provide the adjustability required to prevent injury or discomfort. “Individual personal control of light levels?dimming, airflow, and temperature at the workstation?hold the potential for greater employee satisfaction and productivity, as well as a corresponding rise in the number and quality of images read,” Carson says.

Eliot Siegel, MD, professor and vice chair of information systems for the Department of Diagnostic Radiology at the University of Maryland School of Medicine (College Park, Md) and chief of radiology and nuclear medicine at the VA Maryland Healthcare System (VAMHS of Baltimore), notes five areas for customization in his presentation, “Thinking Out of the Box: Redesigning the Radiology Reading Room”: temperature, ventilation, power, lighting, and data/voice.1

5) Ventilate

Online Ergonomic Resources

In “Digital Eye for the Analog Guy,” an ergonomic spoof of the television show Queer Eye for the Straight Guy, Ryan Moffit, a research assistant on Siegel’s team, states that the ideal temperature lies between 68? and 75? Fahrenheit; the ideal humidity should be somewhere in the neighborhood of about 40%?60%.2

If the temperature rises too high, as is often the case with an increase in computer equipment, monitor life expectancy and radiologist productivity decrease. “Until the system was upgraded, our monitor life expectancy was less than three months. Radiologists had to keep the doors open and fans on, and they had to leave the room frequently, which decreased their productivity,” Siegel states.1 “Our plans for the new, redesigned reading room include … individual ventilation controls similar to those available in most automobiles. We believe that a small expenditure in improved air handling will result in improvements in productivity and decreased fatigue, although we have not yet rigorously tested this in our laboratory or reading room.” The team plans to use an interstitial floor plan that increases the number and accessibility of ventilation ducts.

However, such a solution might be impractical for some facilities. “There are some technologies that allow customization, but they don’t come cheap,” Morita notes. Simpler solutions include providing fans or switching to LCD monitors, which generate less heat.

6) Divide and Conquer

Partitions can help provide smaller environments to control. The decreasing need for consultations means that the wide, open space of the reading room is no longer necessary. “Probably the best of both worlds is to create custom spaces using partitions in shared reading rooms to encourage collaboration with other radiologists and clinicians,” says Siegel.1 Moveable, flexible, floor-to-ceiling panels allow the space to be rearranged and help to absorb light and sound.2

7) Dim the Lights

Adjusting the lighting often means turning off the fluorescent lights. Fluorescent lighting causes a flicker that, although not always clearly discernible, can cause headaches, eyestrain, and general eye discomfort. The ability to dim light to a comfortable, individual level is key.

“Indirect incandescent lighting is great, providing less reflection,” Morita says. For paper-based interactions, he recommends task lighting with focused beams?fluorescent or incandescent.

Studies led by Siegel have shown that the percentage of fatigue complaints dropped when the room light matched monitor brightness, and that diagnostic accuracy rate dropped by 11% when the ambient light was high.2 Balancing the two is key.

8) Upgrade Monitors

According to a study by Siegel and Bruce Reiner, MD, director of radiology research at VAMHS and an associate professor at the University of Maryland School of Medicine, “The use of newer-generation, higher-brightness, active-matrix LCD displays is likely to permit radiologists to, once again, increase the background lighting levels in reading rooms, freeing them from the constraint of reading ?in the dark.’ “3

Adds Khan Siddiqui, MD, in “Digital Eye,” “CRT monitors create too much heat and require calibration too often.”2

Siegel’s research2, 3 indicates that the use of two-monitor workstations produces greater radiologist efficiency when compared with a single-monitor configuration but similar efficiency when compared with the more expensive four-monitor configuration.

The monitors should be at least 25 inches from the reader, and preferably farther; the viewing angle should be between a 15? and 50? downward slant.2

9) Navigate Ergonomically

Input devices should reduce the risk of repetitive-motion injury. Alternative devices, such as foot pedals, game pads, and ergonomic mice and keyboards, should be available.2 If users must operate a mouse, they should hold it straight in front of them, alternating hands and employing wrist rests.2

10) Adjust Furniture

“In order to achieve a natural arm and shoulder position and neutral wrist alignment, the input surface should be adjustable from the elbow height of the seated, fifth-percentile female [23.5 inches] to the elbow height of the standing, ninety-fifth-percentile male, [46.7 inches],” says XYBIX’s Carson.

Knee space should be free of obstruction, and the desk height should be adjustable to allow radiologists to stand. “Standing puts less strain on the back,” Siegel says.2

Chairs should be adjusted to the proper height to avoid slouching or pushing forward, and the backrest should provide support for the spine.2 The computer and monitor should be directly in front of the user, and other needed items should be within easy reach?with no need for twisting and turning.

11) Integrate

Quick Tip!

When reading images, remember the 20-20-20 rule: Look at a spot about 20 feet away for 20 seconds every 20 minutes.

Radiologists at the Baltimore VA Medical Center currently require access to the PACS workstation, the Internet and intranet, a speech-recognition or digital-dictation system, the hospital “paperless” electronic medical record, email, office software (such as word processing), and the telephone. These functions should be able to run on a single multitasking workstation that should be designed to allow easy access to all of the features on demand.3 In “Thinking Out of the Box,” Siegel notes that this will require vendors to provide open system support for multiple additional computer systems.1

12) Provide Single Sign-On

Staff should also have a single sign-on for all systems. Typically, a radiologist has a dozen sign-ons, but he or she should find it as easy as possible to sign on and off.2 Biometric devices and RFID technology can automate the process.2

13) Shhh!

The technology, combined with consultations and phone conversations, creates ambient noise with a potential to negatively impact speech-recognition software.2 Curtains, carpet, acoustic paneling, and other sound-absorbing materials can help to alleviate the interference. Music or white noise, which is great at drowning out background noises, could have a positive impact on productivity and might reduce fatigue.2 “Sound should be kept below 65 decibels,” says Steve Severance, part of the “Digital Eye” team.2

14) Prioritize

Of course, all of these changes might exceed the budget, and facilities will have to prioritize. Where to start? With lighting, Morita recommends. “If you have to prioritize, lighting is paramount, in my opinion. Radiologists use their eyes to perform diagnoses, and they are constantly looking at displays,” Morita says.

Small investments can have big effects. Experience and research performed at the Baltimore VA Medical Center suggest that relatively small investments in room design and workstation ergonomics can result in major gains in radiologist productivity and accuracy, with a concomitant decrease in radiologist fatigue.1

15) Ask for Feedback

“You want to get feedback from users as to comfort and adjustability,” Morita says. Siegel notes that this requires a collaborative approach between radiologists, administrators, technologists, engineers, and architects.1

To best use the information, facilities will have to stay flexible. “The key to a successful transition to filmless imaging is largely dependent upon developing an infrastructure that maximizes individual user flexibility without sacrificing productivity,” Siegel says.1

References

  1. Siegel EL. Thinking out of the box: redesigning the radiology reading room. Presented September 19, 2005, as a visiting professor to the University of Massachusetts.
  2. Society for Computer Applications in Radiology. SCAR University 2004, Section 12. Digital eye for the analog guy. Presented by: Eliot L. Siegel, MD, and the Baltimore Research Team.
  3. Siegel E, Reiner B. Radiology reading room design: the next generation. AR. 2002:31(4);11?16.