Additional Articles

"The Perfect Reading Room: Doing It Your Way", (c) Amy Buttell Crane, Health Imaging & IT, April 1, 2008

When it comes to reading rooms, perfection exists in the convergence of science and personal preference. Many factors, such as the distance from your eye to the monitors, aren’t in dispute; for others, such as the type of chair, ideal room temperature and reading position are personal to individual radiologists. An environment that merges essential ergonomics with individual needs creates the perfect reading room with more comfortable, less stressed, more productive radiologists.

The convergence of science and personal preference creates a dilemma, especially for large radiology groups that want to capitalize on cutting-edge research that establishes a connection between improved reading room design and higher productivity when designing a reading room, but who also don’t want to get caught up signing blank checks to personalize every aspect of the reading room for physicians with widely differing preferences.

The answer? A carefully crafted mixture of scientifically tested qualities designed to appeal to the broadest range of radiologists possible, coupled with a mixture of features that allow each radiologist to customize his or her environment to his or her individual needs. “Many factors combined make for an optimal reading room where radiologists are less stressed and happier at work, leading to improved productivity for a relatively tiny investment,” says Eliot Siegel, professor and vice chairman of the Diagnostic Radiology Department at the University of Maryland School of Medicine and chief of imaging for the VA Medical Healthcare System in Baltimore, Md., and well-known reading room researcher.

“The typical view of radiologists at hospitals is that they are already pampered, so they see the addition of better ventilation and lighting controls as well as high-tech chairs and adjustable desks as frills,” Siegel continues. “But when the stoicism typical of many in medicine interferes with making these adjustments, it is to the detriment of the patients and the health of the radiologists.” Radiologists who work in poor environments tend to have more eye strain, a higher level of repetitive stress injuries, poor job satisfaction and lower productivity than radiologists who work in optimal reading room environments.

Mark Herbst, MD, PhD, president of St. Petersburg Independent Diagnostic Radiology in Clearwater, Fla., couldn’t agree more. After revitalizing his reading room with a new Anthro Carl’s Table and Verte Chair, he says, “my productivity has increased by 50 percent. I do all the work that I have to do in a day and do it faster and am more comfortable. I am much happier at work, and that’s something you can’t put a price on.”

Characteristics of the Perfect Reading Room

Experts cite a number of factors that are present in a perfect reading room, including:

	Lighting. “Lighting is a major issue in reading rooms,” says David Hirshorn, MD, of Massachusetts General Hospital and Staten Island University Hospital, in New York, who specializes in radiology informatics. “The biggest mistake people make is to use direct overhead lighting, which causes glare and can lead to eye strain as can working in a dark room. I’ve found that indirect light that is dimmable and where the light bounces off the wall is best.” Eliot Siegel, professor and vice chairman of the Diagnostic Radiology Department at the University of Maryland School of Medicine and chief of imaging for the VA Medical Healthcare System in Baltimore, Md., notes that when a number of radiologists work together in the same room, installing individual adjustable lighting in each work area allows each doctor to adjust the light to his or her own preferences.
	Monitors. Flat-panel monitors are best because they tend not to generate much heat, unlike older CRT monitors. Studies reveal that the optimal number of monitors for interpreting radiology studies is two; installing three or four shows no discernable increase in productivity or accuracy, and is generally much more expensive. Ideally, the monitors should be placed 40 centimeters from the eye. Also, the monitor should be no taller or not much taller than eye level; otherwise you have to look too far up or down, which can cause eye, neck and shoulder strain.
	Computer mice. Traditional computer mice can cause fatigue and even repetitive stress injuries to a radiologists’ wrists, so many experiment with varying designs. Hirshorn uses a RollerMouse Pro, which allows him to quickly move through CT scans and other studies that have hundreds or thousands of slices, while slowing down for studies that require more time to interpret. Mark Herbst, MD, PhD, president of St. Petersburg Independent Diagnostic Radiology in Clearwater, Fla., uses a KVM Video mouse that allows him to control multiple computers from a single device so he can move images from one computer to another with a flick of the mouse.
	Chair Height. Chair height and armrests should be adjustable. “Your forearms should be parallel to the ground and your wrists should be straight,” says Hirshorn. “The armrests should be at the same level as the desk.”
	Desk Adjustments. Herbst’s adjustable workstation allows him to work sitting down during the day and then to work standing up later in the day, when he needs a change from sitting down. A desk, table or workstation that permits adjustment of its overall height as well as adjusting the height at which the keyboard and mouse sit is vital, says Hirshorn. Siegel notes that his laboratory is testing a new system designed to model a treadmill, where a radiologist could stand, walk slowly or walk more quickly while reading images.
	Temperature Control. Because temperature and ventilation are so personal to each radiologist, Siegel recommends that each reading area have individual controls that can be adjusted for both temperature and the level of ventilation. “Some people really like air blowing on them; others hate it,” says Siegel. “So it’s important to allow each radiologist some control over ventilation and temperature when they are interpreting scans.” Herbst has an entirely separate part of his office building for him and another part for his assistant where each can independently adjust both the temperature and ventilation controls. “She likes it much warmer than I do, so this way we each can set the temperature for exactly how we want it,” he says.
	Noise. The widespread adoption of PACS has in most cases allowed hospitals and imaging centers to decouple reading rooms from their former proximity to scanning medium. That has eliminated the noise that formerly distracted radiologists from concentrating on interpreting images. However, noise is still an important factor to consider, especially when radiologists work together in a larger room or are in a hospital or multi-specialty group. A solo practitioner, Herbst has installed high-quality speakers in his office to listen to podcasts and music while he interprets studies. Hirshorn also listens to music, but if he is in a room with others, he does so using headphones. Noise canceling partitions and barriers in walls can help insulate radiologists from outside noise, minimizing distractions.