Sunday, November 15, 2015

Reading Rooms

Back before most people could even spell PACS, we read from film, and nothing but film, and our offices reflect that legacy. This is the plan of one of our hospital reading room suites from 1990, still in use today:

The plan consists of eight similarly-sized offices, with X-ray view boxes on one wall, built-in shelves and a big wooden desk. The room hanging off the edge is the restroom, if you couldn't tell. Today, four of these offices have hospital PACS workstations, with one of these also having a PACS station for our PACS, and another having a Nuclear Medicine workstation. Another only houses our PACS computer. Two of the remaining offices have no workstation, and the third is used by one of our administrative assistants.

The computers are scattered in a haphazard manner. Some sit on the old wooden desks, some sit on (sort of) ergonomic tables. Some sit on the old built-in mini-desks.

Aesthetically, the offices are, well, not very aesthetic. We have dark carpet, beige walls, and white ceiling tiles. And whatever chairs happened to find their way in there, from an old leather and wood extravaganza bought for me 25 years ago, to several Herman Miller Aeron Office Chairs. There are bright fluorescent lights on the ceiling, and maybe a lamp here and there for more subdued illumination.

There is a lot of room for improvement, which will eventually happen. To be prepared if the department wins the lottery, I've been looking into the office suite I would like to have should cost be no object. (Well, if cost were no object we would all be on vacation in the Caribbean, but you know what I mean.)

Eliot Siegel, M.D., Chief of Imaging at the Veterans Affairs (VA) Maryland Healthcare System in Baltimore, has done extensive research into the ergonomics and design of radiology reading spaces:
Through trial and error, Dr. Siegel and colleagues discovered that redesigning the entire reading room is vastly more effective than simply adding computerized workstations to the previous film-based environment. Initially a single, unpartitioned space, the Baltimore VA reading room now features areas where radiologists can work independently and others where they can collaborate when necessary.

“In a digital environment where we are interacting with computer workstations, it is really critical to rethink the entire design of the room in terms of lighting, sound, temperature and other elements,” Dr. Siegel said. “Some factors that were less important in a film-based environment become extraordinarily important in this new digital environment.”
One of those factors is lighting. Back in the days of film, the light-boxes were the most important occupant of the room. Turn out the lights, turn on the box, flick the film onto the clip (I became far more adept at making the film lodge in the holder by flicking it with my ring finger from a foot away than I ever was at actually interpreting the images...)
(L)ighting is a key to improving the overall radiology work environment in a digital workspace. Because overhead fluorescent lighting cannot be adjusted for brightness and often flickers and causes glare, Dr. Siegel switched to indirect, incandescent lighting which helped reduce physician eye strain. In addition, using a blue light behind the workstations decreases radiologists’ stress level while increasing visual acuity, the team discovered.

“It is a very calming and relaxing environment,” Dr. Siegel said. “In fact, it is so relaxing we’ve had clinicians and visitors say that they would love to take a quick nap in the low-stress environment.”
And Dr. Siegel reminds us to keep ambient noise in mind:
If a facility can make only one change, Dr. Siegel recommends implementing a sound-masking system. At the Baltimore VA, the system emits a constant sound at a frequency close to human speech, which helps minimize noise distractions from the lobby and MR imaging scanner, both which are immediately adjacent to the reading room. Although the ideal reading room includes sound-proofed walls to eliminate ambient noise, the sound-masking system is a more affordable option.

“We found that just using the sound-masking system, which costs about $500 for an approximately 500-square-foot room, can significantly decrease distractions associated with noise in and outside the room,” Dr. Siegel said. “In our experience it has been effective, and it can even increase the accuracy of the speech-recognition systems being used now.”
And we mustn't forget that radiologists breathe:
Because controlling temperature and ventilation is also critical and can impact productivity, the facility’s new reading rooms have a subset of workstations equipped with individual controls for each user, Dr. Siegel said.

“Many of us work in environments where the air doesn’t move much and gets stale,” Dr. Siegel said. “Nobody would drive a car where they didn’t have air blowing or couldn’t control the temperature, but how many radiologists will sit in a room for 8 or 10 hours without being able to easily adjust the temperature or ventilation?”
These factors influence radiologist comfort, and help to minimize workplace injuries and complaints. Hey, if my thumb hurts, I can't trigger the microphone and so I'll have to go home on disability. Let's do what we can to prevent this.

Extensive work on workstation environments had been performed at Cornell, and Dr. Siegel applies the lessons in a humorous manner in this video:



Using Dr. Siegel's VA reading room sketch


and the concept of an "Imaging Interpretation Theatre" as seen in THIS paper from Hugine, et. al.,




as a starting point, I used my HGTV planning software (really!) to revamp our current space:







video


I'm childish enough to be thrilled with the ability to "walk through" this imaginary space I've created!

I've toned down the "theatre" to a small conference area, and I've made the reading areas a little too office-like in this first attempt, but much can change when (and if) we actually get into design mode. Personally, I like the idea of a "pod" as seen in Hugine's article,



but I don't see that happening in our neck of the woods.

Going through the Cornell checklist tell me this will be a tedious project, but well worth the effort.

By the way, we do NOT plan to have a glass door on the bathroom. There's nothing to see in there but plumbing...

Addendum: 

The Visage booth at RSNA 2015 had a very nice implementation of the Image Theater concept:


1 comment :

Stacey Gordon said...

I think it would be nice to design a department with the reading room in the "central area" of the all the modalities. Even though we have PACS now, it seems that they still put individual reading rooms in each area, that are dedicated to reading that specific area. In the days of film it made sense, but now it would be nice not to have to chase docs all over the place and find them all in one place. Everyone can chat with each other and consult with each other without having to look at the schedule and track down where each doc is physically located that particular day.

Scary case in point...
At one particular hospital, they had a this one room, with a light box and dictation station on each wall. The "rad assistant" would hang the film for the doc, and the doc would come in and read. As each dictation was completed, the doc walked to the next light box where the images were ready. Behind the doc, the assistant would pull down the study that had been dictated and put up a new one. And so forth. The doc would continuosly walk around the room to the next study that was ready to be read. Probably pretty efficient for film.

When we did a PACS conversion at this hospital it was obvious that they had no understanding of how computers worked. Of course the sales guy was happy to sell them 4 workstations. They requested 4 computers, placed in the room exactly where the light boxes were. These docs expected that their assistant would "pull the study up on the computer for them, they would view it, then dictate, then walk around the room to where the next study was "pulled up and ready for them". You can imagine the task I had as an application trainer when it was revealed to them that they would have to touch the computer for themselves. The notion of scrolling through a CT or MR blew their minds and at first they insisted that everything be displayed tiled, just like their film.
True story.