Design and Ergonomic Considerations for the Filmless Environment

Planning and executing the redesign of a traditional institutional radiology reading room to conform to the radically different requirements of digital imaging are reviewed, with examples drawn from the authors’ experience and from the growing body of literature on this subject. Included are best-practice recommendations and real-life examples on initial design and planning, stakeholder involvement, identifying and hiring consultants, architectural planning, the designation of a radiology point person, rethinking room and workstation design, the selection of ergonomic furniture and fittings, identifying optimal environmental elements, fine tuning and lessons learned, and going digital.

Introduction

A broad range of technologic, educational, and even cultural change is needed to maximize the benefits of transition to filmless imaging. Whether the topic is workflow, choosing a picture archiving and communication system (PACS) vendor, incorporating teleradiology practice, or even managing the sometimes delicate psychologic aspects of the transition, the most challenging task is to make sure that all these changes are integrated and implemented with the basic goals of good radiology practice in mind: high-quality images acquired and interpreted in a cost-effective and time-effective manner to yield optimal levels of responsiveness to referring clinicians and maximum diagnostic benefit to patients. An important contributing goal, however, is the creation and maintenance of a well-adjusted workplace in which each staff member is encouraged and supported in efforts to do his or her best work.

The individual most often forgotten in the quest to create an optimal working environment in imaging is the radiologist. This is ironic, because it is radiologists who have been most challenged by the profound changes in imaging over the past decade. A number of factors, including dwindling reimbursements, an undersupply of diagnostic radiologists, and increasing volumes of studies, have combined to require the average imaging specialist to interpret more studies at faster rates than ever before. The use of PACSs has been reported in many case studies and longitudinal surveys that may result in improved departmental efficiency, especially when associated with the reengineering of departmental workflow [1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11]. Technologic developments, such as enhanced network infrastructure and speed, faster workstations with more reliable and brighter monitors, improved image presentation and navigation software, image enhancement, computer-aided diagnosis, and integrated speech recognition, have received a good deal of attention in the research community as candidates for the improved efficiency and productivity of radiologists.

One result of all these changes has been a fundamental and radical alteration in the nature of the interpretation process, including a range of mental and physical aspects [12]. Surprisingly little attention has been paid by most hospitals and imaging facilities, whether private or academic, to the potential of improvements in radiology-reading room design as a means to enhance the performance and well-being of radiologists. This topic has also received scant attention in the medical imaging literature. Experience and research performed at our facility suggest that relatively small investments in room design and workstation ergonomics can result in major gains in productivity and accuracy, with an accompanying decrease in radiologists’ fatigue.

The transition from a film-based to a soft-copy, filmless environment presents the ideal opportunity to redesign not only workflow but also the reading environment. Most reading rooms, even those installed in the past few years, were designed with film or film-based conventions in mind. It is clearly time for radiologists to think “outside the box” in planning the interpretation environment of the 21st century: outside the light box; outside the rigid, plywood workstation cubicle; and outside the utilitarian, one-size-fits-all central reading room square. To do this effectively, we must look at the experience of groups that have worked with specialists in office space architecture, ergonomics, and environmental factors to identify the most promising elements that can support and enhance radiologists’ performance.

In this article, we look at a number of these elements and offer practical advice on benefits, implementation, and potential pitfalls on the road to rethinking the imaging interpretation environment. We should note at the outset that much of the reported experience in this area has been from academic or large-institution reading rooms, such as that at our own hospital. Not all solutions will transfer seamlessly to the private practice setting, in which cost considerations, decision-making hierarchies, and the ability to accommodate work interruptions for redesign and installation will vary considerably. Every practice will have unique needs, and identifying and responding to these should be crucial parts of any consultation process with architects, designers, and vendors. Our purpose here is to introduce general pointers and promising approaches in rethinking the reading room environment.