Wednesday, November 19, 2008

Dalai's Workstation Salvation!

I love Radiology, or at least I used to before the governmental bureaucracy and other joys of modern medicine crept into the field. Still, I can't see myself doing anything else, except perhaps for retiring, and that ain't happening any time soon. One major problem with the field, however, is that it does not encourage physical activity. With the advent of PACS, we don't even have to lift a film-jacket, and as my group employs P.A.'s, I don't even have to lift my carcass out of my chair to sling barium much these days.

These circumstances help radiologists fit right in with the rest of the population:

Obesity is a major health epidemic in the United States. It is estimated that more than two-thirds of the population is overweight and one-third obese. Both of these numbers have significantly increased over the past 25 years. Obesity increases the risk for many diseases, including hypertension, dyslipidemia, type 2 diabetes, coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea, and some cancers.

But apparently not the heartbreak of psoriasis, at least.

Jeff L. Fidler, M.D., and colleagues at the Mayo (rather ironic since were talking about overfed, obese radiologists) decided to investigate ways to help our profession with this problem, which they also note to be sedentary, and their work is presented in this month's JACR.

Fidler, et. al., note that

. . . even small repeated movements throughout the day can lead to increased caloric expenditure by a process termed nonexercise activity thermogenesis. In one study, the mean increase in energy expenditure for walking and working over sitting was 119 +/- 25 kcal/h. It was estimated that the incorporation of walking and working 2 to 3 hours per day could lead to weight loss of 20 to 30 kg/yr (44-66 lb/yr) if eating is not correspondingly increased. In addition, other studies have shown that cerebral blood flow, oxygen extraction, and brain metabolism may be increased with exercise and activity.

So what's a radiologist to do? Walk on a treadmill while working? You betcha!

Potentially, these or otherdevices could be incorporated with image interpretation workstations, allowing radiologists to review imageswhile increasing their background activity. However, such a device has not been studied in this setting to determine if there is a negative impact on the detection of abnormalities. The purpose of this study was to evaluate the feasibility of a walk-and-work image interpretation workstation for computed tomographic (CT) image interpretation and to assess interpretation accuracy. If it can be shown that accuracy is maintained, this device could be implemented in clinical practice, allowing increased caloric expenditure and subsequent improvement in overall health for radiologists.

So, this is what they did:

A worktable was constructed that could be adjusted from a height of 38 to 52 in above the treadmill track using a hydraulic device. Thus, it could be adapted to accommodate the different heights of the radiologists (5 ft 9 in and 6 ft 1 in) in this study. This height range would be suitable for individual heights of 5 ft 7 in to 6 ft 10 in but could be revised for other heights. Because of the configuration of the table, the front support and control panel for the treadmill was not attached, and the treadmill control panel was mounted on the wall adjacent to the treadmill. The tabletop size was 4 ft wide by 2 ft 10 in deep. This allowed placement of a 2 monitor workstation, keyboard, fan, and dictating machine while still leaving ample room for note taking. The desktop was designed to have an overhang of 10 in. This allowed ample space for legs to extend forward without making contact with the support during a low rate of walking. The total cost for the worktable construction was approximately $1,500. A commercial-grade treadmill (C954i; Precor Inc., Woodinville, Washington) was used (Figures 1 and 2). The cost of the treadmill was $3,000. The retrospective review was performed in a remote location, and a computer with electronic medical record access, electronic dictating machine, and telephone were not present. Reviewers wore tennis shoes while walking on the treadmill.
The cost of the tennis shoes was not given. The researchers then interpreted 10 cases whilst walking on the treadmill at 1 mile per hour. Average interpretation time under these conditions was 9.2 minutes, a little longer than we usually spend on a case. The results are surprising:

As the study was developed, the main concern was that the use of the treadmill would cause the investigators to miss a significant number of findings because of the associated motion. It was surprising to discover that a significant number of findings were detected while on the treadmill that were not mentioned on the initial interpretations. Many (60%) were very subtle findings, and 13% likely would rarely be seen. Although it is intriguing to think that the walking technique may have led to this increased detection by increasing blood flow and alertness, there are several other issues that may have accounted for this.
Why did they have to go and spoil it? The other factors involve the fact that the images were evaluated twice, only 10 cases were read at a time, and the bloody phone wasn't ringing off the hook during the interpretation. Then, there is the Hawthorne effect which says we perform tasks better in response to a change in environment. Sounds like we ought to at least move offices every hour or so.

The bottom line is that it is feasible to read from PACS whilst exercising, and your accuracy might even improve. This is wonderful news, of course. However, the researchers were probably in good shape and had good coordination. Get me up there on the treadmill, give me a tough case, and I'm likely to go George Jetson within 30 seconds.

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