Design avoids injuries, increases productivity

Prior to the advent of soft-copy reading, ergonomic issues in radiology workspaces drew little attention. But as more sites make the transition and embark on reading room redesigns, interest in ergonomics-which includes lighting and acoustics as well as furniture-is on the upswing.

"Ergonomic issues were never really addressed in reading areas before," said Bill Rostenberg, vice president of Smith Group Architects and Planners in San Francisco. "People could get away with poorly designed reading areas in a film environment much more easily than they can now in a soft-copy one."

The problem becomes apparent when departments try to retrofit existing reading areas to accommodate soft-copy equipment. Alternators and computer monitors don't mix. Nor does a line of data tables topped by banks of computers, keyboards, and accessories make for a productive, much less ergonomic, environment.

"We have just taken our original rooms and replaced film panels with workstations. Workplace ergonomics or radiologist fatigue was not taken into consideration," said Dr. Mukesh Harisinghani, an instructor in radiology at Massachusetts General Hospital.

The need to address ergonomic issues in PACS environments became evident earlier this year with the release of a study documenting carpal tunnel and cubital tunnel syndrome injuries among radiologists working in a filmless environment. The research, published in the American Journal of Roentgenology (2003:181:37-42), focused on a small group of users but was the first to document musculoskeletal injuries tied to the PACS environment, said Dr. Eliot Siegel, chief of radiology and nuclear medicine at the VA Medical Center in Baltimore.

"Since the study's release, I've heard some amazing stories and found that a surprisingly high percentage of radiologists are having musculoskeletal problems associated with soft-copy readout," Siegel said. "I think it's very much underreported."

Even at the Baltimore VA, perhaps the most experienced PACS installation in the U.S., radiologists continue to struggle to create an optimal soft-copy workspace. Working with Dr. Alan Hedge, a professor of ergonomics at Cornell University, the Baltimore team is reconfiguring its digital department. The collaboration has been an eye-opener, according to Siegel.

"One thing I have learned is how little expertise we in radiology have in many areas outside our own narrow field," he said. "For example, when it comes to optimizing productivity, there are all sorts of lessons in industrial engineering that we could be adopting."

While the new department will be open for use early this year, Siegel and his team will continue to study ways to create user-friendly radiology reading areas. One of these is the impact of white noise, or even music, on productivity. Some reports in the literature suggest that blue lighting increases visual acuity-another topic for research by the VA team.

An important aspect of creating optimal environments is empowerment of radiologists in helping shape reading room and workstation design. That's the tack taken at Froedtert Hospital in Milwaukee, where extensive user surveys were conducted to guide the reading room redesign.

"Much of the way radiologists work is based on adapting to an existing workspace, not necessarily because it's the way they would prefer to work," said Tom Hanson, an applications specialist in the radiology department at Froedert, an affiliate of the Medical College of Wisconsin.

When asked about preferred choice of seating for the new room, for example, radiologists at Froedtert mentioned stools, which made it easier to get up and down frequently when putting films up on the alternator. Realizing that they would not have to do that in a filmless environment meant rethinking how they might work.

It all adds up to better job performance and satisfaction, Siegel said.

"If you could decrease fatigue and stress and improve productivity by as little as 1% or 2%-and we think we can do better than that-think about the impact on productivity," he said. "When you consider what radiologists are paid, the payback for some of these systems might be as little as a few weeks to a month."

Experts advise getting ergonomic consultants involved early in the reading room design process so that the solution is not an after-the-fact reactionary approach.

"Ergonomics is a science that goes beyond the realm of architectural and interior design, which is why most radiology department designs in the past left much to be desired," said Carlos Amato, a senior associate at RBB Architects in Los Angeles.