In June 2004, we undertook the design of a cart that could be used by radiologists while interpreting soft-copy images. The purpose of our project was to create a single cart that would be suitable for any radiologist. The three-display unit had to be adjustable to meet the needs of radiologists of all heights and weights; with various vision characteristics (acuity, presbyopia, and myopia); and with existing pathologies of the spine, shoulder, wrist, and forearm. In addition, it was necessary to provide for radiologists who prefer to interpret images while standing, as well as to provide a telephone and dictation unit within easy reach. This called for the ability to change many attributes of the chair, the work surface, the monitor mountings, and the reading room itself.

SEATING REQUIREMENTS

The chair chosen for image interpretation must be both comfortable and adjustable. The ability to clean both its upholstered and hard surfaces is important, as is its cost. We chose a chair model that has a padded back, seat, and armrests for comfort; a five-spoke base for stability; and multidirectional wheels for easy movement. It is of critical importance, ergonomically speaking, for the radiologist’s chair to roll, so that all three displays can be seen straight ahead of the viewer, so that the telephone handset and dictation microphone can be reached without straining, and so that potentially harmful lifting and repositioning of the chair can be avoided.

The chair must be adjustable in its seat height, the position of its lumbar support, the height of its armrests, the width between the armrests, the positioning of the backrest forward or backward, and the tilt of the seat (and the ability to lock it into position). For the user’s maximal comfort, these adjustments should be quickly and easily made, without the need to get out of the chair.

TABLE REQUIREMENTS

The ergonomic table/cart is a sturdy piece of equipment with four main levels and a broad range of possible adjustments to meet individual needs. All of the motorized cart’s mounted devices and adjustment controls are within arm’s reach of the seated radiologist. The uppermost cart level consists of crossbars to which a large dual display and a smaller color monitor are mounted. The tables are sized to best fit the available space. The three monitor workstation table surfaces are 36 inches x 60 inches with the five monitor stations being 36 inches x 72 inches. The chief of radiology had a station built that has four monitors along with a laptop holder. In order to limit the footprint, this station is 24 inches x 72 inches. The displays’ supports can be moved up and down, independently from the table’s surface, to adjust them to the correct height for comfortable reading. They can also be moved forward and back to change the distance between the display and the reader’s eyes, which is very important because focal distance is highly individual (and users of progressive lenses for vision correction, in particular, need precise display positioning).

The second level, slightly below the display-mounting crossbars, incorporates swing-away, adjustable platforms holding a telephone to the user’s left and a transcription unit and its microphone to the right. A small, gooseneck lamp that can be aimed at the work surface is also mounted just behind the telephone’s swing bar.

The third level is the table itself, which is large (being wider than the three-display array and proportionately deep) and adjustable through a large range of heights. Ideally, it will be positioned at the same height as the seated user’s armrest. The table can also be raised enough to accommodate radiologists who prefer to interpret images in a standing position, whether from habit, to relieve back pain, or to improve comfort in spinal stenosis.

The keyboard sits directly on the table surface (not in a central tray or drawer), so it can be positioned as needed in front of any display. The entire surface of the table has a granulated texture that allows the mouse to be used anywhere and that makes long cursor movements possible without the need to lift and reposition the mouse. A movable cup holder is clamped to the edge of the table.

The cart’s lowest level consists of a shelf and padded cylindrical crossbar, both nearly as wide as the tabletop, and four large, multidirectional wheels. The shelf holds the workstation computer, and the padded bar in front of the shelf is a built-in footrest, which is essential for preventing pain in the lower back for users who spend long hours sitting.

Table adjustments should always be quick, easy, and silent. While a memory function that remembers the preferred settings of individual users is a helpful feature in an ergonomic cart, it is not strictly necessary.

ROOM REQUIREMENTS

Proper lighting, of course, is vitally important to the ability to interpret images efficiently and comfortably. In addition to the gooseneck lamp aimed at the table surface on the user’s left, a floor lamp, aimed upward, stands to the right of the cart. Both lamps are controlled by dimmer knobs on the cart. The reading room has dark walls to eliminate unwanted light bouncing and improve visual comfort, and there are no overhead lights that could create troublesome glare on the displays.

To reduce distracting noise, the reading room is carpeted and the cart is flanked by portable panels of corkboard covered with acoustic material. These partitions have panels of smoked glass at the top to allow the readers to see around them without serving as a distraction or causing light pollution.

CONCLUSION

An ergonomic radiology reading station must have multiple settings that the user can adjust quickly and easily over a wide range. At our facility, the motorized cart is the solution that has allowed us the greatest flexibility and has provided us with the highest level of user satisfaction. The application of ergonomic principles creates comfort, and comfort can affect efficiency, productivity, job satisfaction, and even radiologist retention.

Nogah Haramati, MD, is chief of radiology and professor, clinical radiology and surgery, Jack D. Weiler Hospital of the Albert Einstein College of Medicine, New York City.

Avital Fast, MD, is chairman, physical and rehabilitation medicine, Albert Einstein College of Medicine and Montefiore Medical Center. This article has been adapted from Ergonomic Radiologist Reading Carts: One Size Must Fit All, which they presented at the 2004 meeting of the Radiological Society of North America on December 2, 2004, in Chicago.