Radiologists transitioning from film-based to digital reading rooms are experiencing a host of new workplace maladies ranging from neck and back problems to repetitive motion disorders like carpal tunnel syndrome.
Although not always accessed, ergonomic solutions that will not only reduce injuries but also maximize productivity are simple and often easy to implement, according to Eliot Siegel, M.D., chief of imaging at the Veterans Affairs (VA) Maryland Healthcare System in Baltimore, one of the nation’s first filmless healthcare facilities. Dr. Siegel, who spearheaded “The Reading Room of the Future” project at the Baltimore VA, presented findings from the project at RSNA 2012.
“Ergonomics is a topic that has not received anywhere near the attention that it should,” said Dr. Siegel, also professor and vice-chair of Information Systems, Department of Radiology and Nuclear Medicine, the University of Maryland, Baltimore. “A relatively small amount of effort reaps huge benefits. It is an investment in an area where radiologists spend much of their time.”
Through trial and error, Dr. Siegel and colleagues discovered that redesigning the entire reading room is vastly more effective than simply adding computerized workstations to the previous film-based environment. Initially a single, unpartitioned space, the Baltimore VA reading room now features areas where radiologists can work independently and others where they can collaborate when necessary.
“In a digital environment where we are interacting with computer workstations, it is really critical to rethink the entire design of the room in terms of lighting, sound, temperature and other elements,” Dr. Siegel said. “Some factors that were less important in a film-based environment become extraordinarily important in this new digital environment.”
For example, lighting is a key to improving the overall radiology work environment in a digital workspace. Because overhead fluorescent lighting cannot be adjusted for brightness and often flickers and causes glare, Dr. Siegel switched to indirect, incandescent lighting which helped reduce physician eye strain. In addition, using a blue light behind the workstations decreases radiologists’ stress level while increasing visual acuity, the team discovered.
“It is a very calming and relaxing environment,” Dr. Siegel said. “In fact, it is so relaxing we’ve had clinicians and visitors say that they would love to take a quick nap in the low-stress environment.”
If a facility can make only one change, Dr. Siegel recommends implementing a sound-masking system. At the Baltimore VA, the system emits a constant sound at a frequency close to human speech, which helps minimize noise distractions from the lobby and MR imaging scanner, both which are immediately adjacent to the reading room. Although the ideal reading room includes sound-proofed walls to eliminate ambient noise, the sound-masking system is a more affordable option.
“We found that just using the sound-masking system, which costs about $500 for an approximately 500-square-foot room, can significantly decrease distractions associated with noise in and outside the room,” Dr. Siegel said. “In our experience it has been effective, and it can even increase the accuracy of the speech-recognition systems being used now.”
Because controlling temperature and ventilation is also critical and can impact productivity, the facility’s new reading rooms have a subset of workstations equipped with individual controls for each user, Dr. Siegel said.
“Many of us work in environments where the air doesn’t move much and gets stale,” Dr. Siegel said. “Nobody would drive a car where they didn’t have air blowing or couldn’t control the temperature, but how many radiologists will sit in a room for 8 or 10 hours without being able to easily adjust the temperature or ventilation?”
A surge in such work-related complaints from radiologists led researchers at Cornell University in Ithaca, N.Y., to develop the Cornell Digital Reading Room Ergonomics Checklist in 2006 as a means of quickly evaluating the radiologist work environment to determine what areas need improvement.
Created by then-masters of science candidate Hrönn Brynjarsdóttir and overseen by Alan Hedge, Ph.D., director of the Human Factors and Ergonomics Laboratory at Cornell, the checklist is divided into five sections:
Each section asks questions about the physical environment (such as desk height or room temperature) and the user (posture of the radiologist and how he/she uses the equipment). Users who complete the checklist are asked to refer to accompanying guidelines regarding what steps to take to address problems.
“Our premise is to control the things that we can, and controlling the design of the reading room is certainly something that falls into that category,” Dr. Hedge said.
In more than a decade of researching ergonomics issues, Dr. Hedge has determined that as many as half of all radiologists will suffer from various musculoskeletal problems.
“Although it is now a given that radiologists are going to spend much of their time using computers, the reality is that hospital and facility folks somehow don’t realize what the issues are,” Dr. Hedge said. “There is a significant problem because time and again we have seen radiologists injured through poor design of their workstations.”
Dr. Hedge cites financial concerns as a primary reason that ergonomic improvements are often sidetracked even though many upgrades are comparatively inexpensive.
“These improvements don’t cost an arm and a leg,” Dr. Hedge said. “Hospitals may spend millions on an MR imaging system, but completely renovating a reading room costs more like thousands, not millions, of dollars. It is hugely cost-effective to do this. Unfortunately it seldom happens.”
Need inspiration for developing the Radiology Reading Room of the Future? In “Digital Eye for the Analog Guy,” Eliot Siegel, M.D., chief of imaging at the Veterans Affairs (VA) Maryland Healthcare System, and professor and vice-chair of Information Systems, Department of Radiology and Nuclear Medicine, the University of Maryland, both in Baltimore, and a team of experts (the Digital Five), offer a fast-paced, reality-show inspired tutorial on redesigning the Radiology Reading Room at the VA Maryland Healthcare System. Video courtesy of Eliot Siegel, M.D.
To access the Cornell Digital Reading Room Ergonomics Checklist, go to ergo.human.cornell.edu/CDRREC.htm.
Learning to manage distractions and interruptions in the reading room is another way radiologists can improve their day-to-day experience and minimize potential harm to patients and themselves, said Stephen D. Brown, M.D., chair of the RSNA Professionalism Committee.
But that is often easier said than done, said Dr. Brown, an assistant professor of radiology at Harvard Medical School and a radiologist at Children’s Hospital Boston.
For example, a radiologist asked to monitor an MR imaging study for a sedated child must put aside a complex CT study on another child. That interruption could cause the radiologist to lose track of a subtle, or even not-so-subtle finding on the CT exam.
“It is a challenge not to be stressed by a disruption and it is a challenge to maintain the work flow,” Dr. Brown said. “It is a challenge to get your concentration back once you’ve been distracted by one issue.”
Ergonomics is closely linked to reading room interruptions and distractions that affect efficiency and productivity; overall health of the radiologist (stress); and patient care.
Distractions can come in the form of poor lighting, noise, an uncomfortable temperature and even technology. For example, radiologists who must keep their e-mail accounts open while working clinically are often interrupted by incoming e-mails.
Education on actual management strategies is also essential, he said.
“When it comes to people, radiologists need to develop the art of being firm—of being diplomatic about saying, ‘Can you please wait until I complete this task before I attend to your question?’” Dr. Brown said. “That means forming relationships with clinicians and others to allow you to say something thing like that comfortably. It takes time and a certain level of assertiveness.”
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