Consider ergonomics or incur hidden costs

The move from hard-copy to soft-copy reading has been accompanied by widespread discussion about ergonomics. Yet nearly all of the digital radiology reading rooms that I visited last year were breaking one or more fundamental rules regarding prolonged work in front of computer screens. Why is this? Are we concerned only with the quality of digital images? Do we think that ergonomically correct workstations are too expensive? Or do radiologists have no say in the purchase of reading room equipment?

Most soft-copy reading workstations consist of a chair and a table to put the monitors on. Room lights, mounted in the ceiling or on the walls, are generally independent of the workstation, and their positions were doubtless fixed before the workstations were located. Sound levels depend on the position of furniture and the number of people in the room. There is no chance to vary the body position during reading, either by standing up or leaning backwards-at least if you want a fixed distance between eye and monitor. Use of mouse and keyboard are limited to a stationary horizontal surface.

Some ergonomic issues have been solved despite our ignorance. Visual stress from low monitor frequency has been eased by the purchase of monitors with a higher frequency. The frequency increase was generally accompanied by an increase in brightness, though some departments bought their workstation monitors before manufacturers increased the luminance. Use of elevated mouse pads has also helped to protect against wrist injuries.

When we needed to purchase soft-copy reporting workstations for the radiology department at the Karolinska, we searched the market for an all-in-one table solution. The table chosen solves most ergonomic issues.

Individual workstations are shielded with a sound-proofing material that not only reduces unwanted noise but also helps provide a standardized reading environment and a nonreflecting surface for background light. This light is automatically regulated by measuring the varying light from the radiological images on the monitors. The brightness of the monitors is measured by a photometer, and the background light is regulated accordingly (brighter monitors, brighter background; darker images, darker background). This helps to maintain an optimal relationship between background light and diagnostic images. Additional reading light for the keyboard and possible literature such as referral notes is provided from above. It does not shine directly into the radiologist's eyes or at the monitors.

Table height can be changed easily according to individual preference for reading position. This includes reading while standing up. Tabletops can be tilted, allowing variance in the angle of the arm used in manipulating the mouse. The tilting tabletop also lets radiologists recline when dictating imaging findings without altering the fixed distance between eye and monitor.

The only additional pieces of equipment required are good chairs that can be individually adapted, especially in the lumbar region.

It is important to be able to change the position of both chairs and tables easily when reporting. Frequent changes in body position when sitting in front of workstations are necessary to avoid long-term musculoskeletal problems.

The answer to the question of why we keep ignoring ergonomics in the radiology reading room is not lack of good alternatives. The cost of an ergonomically acceptable solution surely pales in comparison with the cost of lumbar and cervical back pain, headache, and/or arm and wrist pain. The human cost adds to the economic cost if radiologists suffer in this way. This fact is missed not only by responsible bureaucrats. We radiologists are also guilty of overlooking the true implications of unergonomic working practices.

The reward for allocating a small chunk of the total reading room budget to ergonomics will be healthier radiologists and better productivity.

Prof. Ringertz is chair of radiology at Karolinska Hospital in Stockholm.