Revised reading rooms adopt new technology

Imagine a reading space that allows you to electronically fog a glass wall to signal that you do not want to be interrupted, or a system that directs sound only to you, so you don't have to share your conversations or music with unappreciative colleagues. Such features are envisioned for the reading room of the future, and GE is giving them a trial run to see how they'll be received by working radiologists.

First at the RSNA meeting and then at the SCAR conference, GE assembled a demonstration reading room to reflect how radiologists could operate in a few years. In addition to the privacy glass, special blue lights would reduce eye fatigue and could improve reading accuracy, according to GE. A reclining, infinitely adjustable chair and a 40-inch LCD monitor complete the amenities.

Beyond ergonomics, an electronic medical record would give the radiologist, at the touch of a button, patient history, prior reports and images, current images from all modalities, lab results, and a timeline with an overview of the patient's entire medical history. The user could drill down at any point to gather more information to assist in interpreting a difficult case.

An example illustrates how all of this might work. A young woman is worried about the prospect of breast cancer. The record includes information about family history and suggests a reason for concern: Her mother contracted breast cancer at an early age. Additional tests in the record reveal that she carries the BRCA1 gene. A 3D ultrasound scan finds a mass, a biopsy is scheduled, and the diagnosis is confirmed.

Much of this information is available today, but the future model centralizes it for quick action in an environment designed to enhance reader efficiency and accuracy. Combining information in a more accessible format was an important theme at the 2005 SCAR meeting.

"The significance of the electronic health record is marrying the images with the information and changing clinical outcomes by having decision support," said Nathan Cabbil, GE's general manager of customer solutions, imaging and information solutions.

At the SCAR meeting, GE introduced a work-in-progress system that will integrate the electronic health record into its Centricity PACS and another work-in-progress that will integrate features from its 3D imaging workstation into its Advantage workstation. A portal for business intelligence and workflow management is also in development.

"We're getting all of our different technologies on the same platform," Cabbil said. "This has gone way beyond radiology. Our customers are beginning to see the benefit of workflow throughout the enterprise."

An experimental radiology reading room that is being developed in cooperation with the Baltimore VA Medical Center will use existing best of breed ergonomics technology. A demonstration project based on the new reading room was launched at the end of July.

Real-world reading room makeovers also received attention at the SCAR conference. While they are not as sexy as virtual reading rooms of the future, departments that have undergone a makeover to accommodate the digital age offer practical tips from their experience.

Replacement of CRT displays with LCD monitors proved to be a key element in a reading room makeover described in one educational session at the conference. LCDs, with their compact footprint, opened up a range of opportunities for a 15-station reading room described by Paul G. Nagy, Ph.D., an assistant professor of radiology at the University of Maryland Medical System. The makeover took place at the Medical College of Wisconsin.

LCDs made it possible to develop workstations for the center of a ballroom-style reading room, Nagy said. The room was able to accommodate reading stations along its periphery as well. Even with the multiple workstations, the new room is quieter, has fewer interruptions, and is more efficient. It has a more professional aspect and has actually generated a cultural change: Voices are quieter and more businesslike.

Workstations in the center of the reading room are grouped into three-unit inverted triangle pods, a variation of the four-unit pods first suggested by researchers from the University of California, Los Angeles. The three-unit versions lack a center space that was intended originally to house computers to reduce their noise impact, but they make better use of the work area, Nagy said. Computers with increased amounts of RAM minimize disc drive searches and their attendant noise and can be placed under workstation desks. In the interest of better lighting, alternators were banished to another room.

Although the workstations are used by single readers, they can accommodate two radiologists side by side for consultations, with three sitting behind them. The workstations are grouped to allow collaboration.

The hospital tried to get the radiologists to adopt fluorescent lights, offering a variety of modifications to make them simulate natural light, but the fluorescents were still perceived as being too blue. They were scrapped in favor of 60-watt incandescent lights with frosted tips.

Workstation walls and the reading room ceiling are designed to minimize noise, but it is not eliminated. One conversation can be heard, but two conversations cancel each other out. Three or more conversations create a low-level din that actually increases productivity, according to Nagy.