Best reading room practices promote ergonomics

Tapping into ergonomic best practices in the reading room involves more than identifying the right keyboard tilt. It's a complex process that includes evaluating the entire workspace as well as individual workstations. Improper lighting and glare, for example, cause eyestrain among computer users, and incandescent lighting is easier on the eyes than fluorescent.

Adjustable seating, work surfaces, keyboards, and monitors reduce risk of repetitive motion injuries and fatigue. Adjustable furniture specially designed for computer systems, instead of built-ins, increases comfort and reduces risk of repetitive injury.

These are just a few of the lessons learned at the Baltimore VA Medical Center, which has logged 10 years of experience with soft-copy reading. When the site went fully digital in the early 1990s, ergonomic considerations were not a part of the design. With a grant from GE Medical Systems, the center hopes to redesign its reading room from the ground up-with ergonomics at the forefront, said Dr. Eliot Siegel, chief of radiology and nuclear medicine.

"We started out with what I think is a really awful reading room and have been living with that ever since," Siegel said. "We've talked about what's bad about it, what we'd like to change, and have consulted experts about how to move forward."

An ergonomic redesign ideally involves five factors: space, lighting, acoustics, traditional ergonomics, and connectivity, said Bill Rostenberg, vice president of Smith Group Architects and Planners in San Francisco. Space is the "envelope" that encompasses the materials and finishes. Lighting is key, whether users are reading in a hybrid environment where film interpretation is still ongoing or in a purely digital setting. Acoustics is one aspect that is often neglected.

"It can be tough to meet acoustic requirements because you often have multiple people conferring over images, particularly in an academic environment," Rostenberg said. "There usually needs to be some degree of compromise between how many people can confer together and how noise can be controlled."

Traditional ergonomics refers to furniture. Adjustability here is critical, according to Rostenberg.

"Avoid built-ins and use adjustable furniture designed for computer use whenever possible," he said. "You should be able to adjust seating, distance from viewer to monitor, and horizontal and vertical distances of devices. Whether it's a keyboard or trackball, it should be adjustable for the multiple people who may be using that workstation throughout the day."

The fifth aspect to consider-connectivity-involves managing components such as wires and cables so that they are not a hazard.

"This is an approach commonly used in workplace design, where cable management is integral with the workstation," Rostenberg said. "A well-designed space doesn't have cables and cords all over the place, but it does have all necessary devices readily available."

One way to avoid the problem of cords and cables is to convert to cordless devices. At Froedtert Hospital in Milwaukee, a key PACS upgrade this year will permit use of USB devices that support cordless mouse and keyboard configurations, said Tom Hanson, applications specialist.

In addition to the five basic design factors, experts offer specific tips:

?Invest in ergonomic chairs, which provide good lumbar support and are adjustable in multiple directions, with large wheels capable of rolling on carpet, said Paul Nagy, director of the radiology informatics lab at the Medical College of Wisconsin. A good chair allows users to comfortably rest their feet on the floor, with thighs fully supported and parallel to the floor. The chair should permit frequent posture changes, and a meshed back promotes air circulation and comfort.

?Upgrade to flat-panel monitors. Not only do these devices take up less desktop space than CRTs, the luminance is a "surefire" winner for reducing fatigue among radiologists, according to Nagy.

?Consider designing one work area that can be used for sitting or standing. After sitting for hours, standing not only gives the back a break but can potentially increase concentration and focus, Siegel said.

?Place the keyboards on height-adjustable, negative-tilt trays.

?Position screens at arm's length.

?Center monitors so the user's body and/or neck isn't twisted when looking at the screen.

?Position monitors at a comfortable height that does not require users to tilt their head up or bend their neck down to view it. The user's eyes should be in line with a point about 2 to 3 inches below the top of the monitor casing.

?Provide wrist support.

?Make sure that frequently used devices are placed within a convenient and comfortable reach for users.

Other ergonomic best practices for users to employ during the workday have been developed by ergonomics professionals and adapted for radiology workspaces.

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Ergonomic radiology best practices

?Ensure that wrists are straight.

?Relax shoulders.

?Ears, shoulders, and hips should line up vertically

?Keep elbows bent at 90º.

?Use a footrest if chair is too high.

?Sitting back in the chair at a slightly reclined posture, instead of erect at 90º, is recommended for best back health.

?Follow the 20/20/20 rule: Every 20 minutes, look away from the monitor for a distance of 20 feet, for 20 seconds. This tactic minimizes fatigue and can reduce eyestrain.

?Bifocals wearers: Seated as described above, tilt monitor backward slightly and place at comfortable height. These adjustments should allow viewing without head tilted back or neck craned forward.