Soft-copy reading takes more than meets the eye. It turns out that the move from film to filmless dramatically affects a department in unanticipated ways. The process of optimizing and managing the effect of soft-copy operations has even generated its own term: change management.

"Shifting to filmless involves change management for radiologists but also staff, clinicians, nurses, and support staff in clinicians' offices," said Dr. Lucy Glenn, chair of radiology at Virginia Mason Medical Center in Seattle. "It's a huge project. Even with a year of planning and then phasing it in, the transition has been rocky."

Changing the physical and technological environment in which the radiologist works affects everything from interpretation accuracy to reading room etiquette. Adapting best practices in design to modern reading rooms means incorporating the five "E"s: economics, environment, equipment, ergonomics, and ease of use. (See "Function follows form in Feng Shui of soft copy,")

Radiologists lose time and, potentially, accuracy adjusting to new workstations. When those stations are placed with little thought to ergonomics or design, performance can suffer. Even in the best circumstances, trading spaces from old to new reading environments involves a learning curve.

"It's difficult to go from reading films and being very good at that to reading soft copy and learning new ways to be efficient," Glenn said. "Our radiologists had various comfort levels with using computers and manipulating data. But everyone is now at the point that you couldn't take the PACS away if you tried."

Acquiring the skills to become expert soft-copy interpreters is an evolving process, abetted in no small part by emerging technologies. (See "Practice makes near-perfect in soft-copy reading,")

Other examples of change management include redefined roles for some department staff, such as film librarians, said David Melson, manager of PACS and imaging applications at Mallinckrodt Institute of Radiology at Washington University in St. Louis.

Investing in soft-copy operations also requires an outlay of time and resources in developing quality-control programs for displays. Devising a practical, useful QC program is possible, even without an onsite physicist. A step-by-step plan outlines how it can be done. (See "Practical parameters guide workstation monitor QC,")