1. Saving Your Body (Ergonomic
Design Considerations)
Eliot Siegel, M.D.
Chief Imaging VA Maryland Healthcare System
Professor and Vice Chair University of Maryland
School of Medicine Dept. Diagnostic Radiology
Imaging Informatics National Cancer Institute

2. Introduction to Radiology Reading Room Ergonomics
• There has never been a more critical
need for improved radiology reading
room ergonomics than today
• Volume and complexity of studies is at
an all time high
• Increasing numbers of radiologists are
complaining of repetitive motion
disorders, eye strain, neck pain, that in
many cases are impairing their work and
home activities

3. Ergonomic Model for Radiology?

4. Introduction
• Surprisingly little research in this area
in diagnostic radiology
• This was the inspiration for our
ergonomic “Radiology Reading Room
of the Future” project

5. Baltimore VA Medical
Center
PACS has been in operation more
than 14 years
Radiologists reading “soft-copy” using
computer workstations for 13 ½ years
Have had more experience with poor
reading room design for PACS than
any other facility
Initial experience has allowed us to
share with others how not to design a
filmless reading room

7. The Challenge
Completely redesign the old reading room
(approx. 23 x 23 feet or 532 sq. ft) to create:
Ergonomically optimized productive and low stress
environment for 5 radiology workstations (10 x 10 ft
space per reading area)
Create an environment that allows the radiologists to
collaborate easily yet minimizes distractions
Create showcase for ergonomic room design
Create “laboratory”/research environment for study of
physical and cognitive ergonomic factors

8. Charette Process
Concentrated effort to solve an architectural
problem
•Listen
•Envision
•Draw

9. Charette Process: Experts From Across the
Country
MD’s: Eliot Siegel, Bruce Reiner, David Channin, Khan Siddiqui, David Weiss, Steve Horii
GE Project system engineer (Mark Morita), GE lighting, GE Acoustics, Environments Group
(Schultz et al)
Ken Johnson

10. Charette Process

11. Room Layout
Single unpartitioned space was adequate in a film
based environment because:
Film room next door would bring a cart with
studies to be read
No partitions or special lighting requirements
because conventional light boxes are sufficiently
bright that glare is not a major problem
Thought we needed space for large number of
clinicians who would review imaging studies

12. Room Layout Solution
Best solution for us was to create custom
spaces using partitions in shared reading
room to encourage collaboration with
other radiologists and clinicians
Room design should allow radiologist can go
into either “independent study” when
necessary and collaboration mode when
required

13. Initial Proposed Reading Room Plan – 532 Square Feet
Radiologists Thought Too Much Like Traditional Offices

14. Final Design: Hybrid of “Cubicles” and Offices
Maximizes Flexibility
Each Room with Unique Ergonomic Approach
MRI Scanning Room

15. What is the best design for you?
Answer is dependent upon many variables.
No one solution is best for everyone.
Key factors to take into consideration:
• Traffic flow (e.g. Teaching institution
different from private practice)
• Number or radiologists
• Areas where they work and/or have offices
• Existing conditions and workflow
• Available space and funding

16. Start @1,000’ Height to Understand Existing Conditions
Courtesy: Kenneth Johnson and Associates, Inc
Link to MOB
Main Radiology
Department

17. 500’ View of Existing Conditions: All Persons Flow Past Secretary
Film
1 2
Library
Sec’y .
9
Chair .
Rad. 3 4 7 8
Admin . 5
6
Majority Of Studiesinitial assessment:
Conclusions from Are Read Within Main Department
•1. – 6 double as offices, 7 and 8 shared by others, 9 is ED viewer
1 Impossible to install 8 reading stations within Film Library
•2. Installing PACS Reading Rooms within existing offices.
Overall workflow within area is excellent
3. Rooms 4, 5 and 6 are very cramped.

18. To gain consensus for design of individual PACS reading
stations, a mockup was created involving radiologists, IT
director and administration.
Mockup Actual Outcome

19. Room Lighting

20. Room Lighting
We have found sub-optimal monitor
brightness resulted in:
Increased radiology reading times
(radiologists are less productive)
Decreased radiologist accuracy
Increased radiologist fatigue
Will discuss in more detail in image
perception refresher course

21. Interpretation Accuracy
“Clinically Significant Findings”
100%
80%
60% Off
85%
79% Half On
40% 74%
On
20%
0%

22. Overhead Fluorescent Lights in
Old Reading Room
Controlled by on/off switch
Source of monitor glare and ambient light
No dimmable controls or task lighting
Source of luminance imbalance

23. Solution: Luminance
Balance
Contrast discrimination is optimal when
levels of ambient light and computer
monitor display are of similar intensity
Monitor luminance initially between 50 and 65
ft. lamberts (under 200 cd/m2) in 1993; we’ve
migrating to LCD monitors
400 to 500 cd/m2 probably better for typical
lighting conditions and brighter monitors improve
ability to perceive more shades of contrast

24. Past Mistakes: Fatigue
Upon transition to PACS, there was overall
improvement in radiologist productivity by
more than 40%
However, this was accompanied by
increasing complaints of fatigue and
eyestrain using the computer workstations

25. Past Mistakes: Fatigue
Increased radiologist fatigue was felt to be
multifactorial:
Decreased monitor brightness
Monitor flicker
Small cursor size
Active role required for image manipulation
Ambient room light

26. Visual Fatigue and Eyestrain
Increased myopization found in Video Display
Terminal operators working in excess of 4 hours
per day
Environmental factors with highest correlation
with eye discomfort
Ambient light
Monitor luminance
(Gobba et al. Int. Arch. Occup. Environ. Health 1988;
60:81-87)

27. Minimizing Eyestrain
Resting point of vergence (RPV)
Distance at which eyes converge (relax) in total
darkness
It is typically about 45” when looking straight ahead
and 35” with a 30 degree downward gaze angle
The farther away from the monitor, the less eyestrain
Distance from screen to eyes should be at least 25
inches (preferably greater)
http://www.office-ergo.com/viewing.htm
20/20/20 Rule:
Every 20 minutes look 20 feet away for 20 seconds

28. Lighting
Recommendations
Dimmable controls and individual task lighting
are preferred to allow maximal flexibility
New radiology room has PC controlled and
programmable lighting
We use blue background light with a blue shade
for the walls because it has been shown to have
favorable effect on visual acuity and minimizes
stress

29. Environmental Controls

30. Challenge: Ventilation and
Heat
Old Radiologist reading room currently has
no controls for temperature, ventilation, or
power
New room includes workstations with
individual controls for each workstation
user

31. Temperature/Ventilation
Recommendations
Provide individual controls for
temperature/ventilation at each
workstation
Switch from CRT to LCD monitors to
decrease heat dissipation

32. Carnegie Mellon Intelligent Workplac
Individual
Environmental
Controls

33. Ventilation and Temperature Controls:
New Radiology Reading Room

34. Lack of Integration of
Information Systems
Previously information
systems such as the
dictation system, PACS
workstation, and
electronic medical
record (including e-
mail, Internet and
Office Suite), phone
were separate units

35. Integration: Solution
These functions
including speech
recognition should be
integrated into a
single computer
workstation

36. Acoustics

37. Noise
We did not consider noise at all in
the design of old the reading room
It was a major factor in the new
reading room especially due to
concerns about speech recognition
and proximity to the MRI scanner

38. Acoustics in Old Reading Room
Background noise from multiple sources
No acoustic dampening devices/materials
Potential impediment with migration to
speech recognition

39. Noise in Old Room
Computer workstations generate a good deal of
noise
Radiologists dictating or talking on the phone, or
clinicians discussing cases with radiologists or
other clinicians can also create a distraction to
the others in the room

40. Acoustics in New
Reading Room
The new reading room has sound absorbing
materials and acoustic paneling
A sound masking system generates “noise” in
the general frequency range of human voice
(also works to attenuate MRI scanning noise)

41. Music and Noise
Music or white noise may have a positive impact
on productivity and may reduce fatigue
One room has focused “beam” of directed sound to
allow radiologist to enjoy music/sounds without
disturbing others

42. Impact of Ambient Noise on
Speech Recognition Accuracy

43. Reading Room Furniture
including Tables, Chairs, etc.

44. Workstations

45. Seating

46. Furniture Ergonomics
Issues in Old Room
Lack of adjustable keyboards/monitors
Limited adjustability of chairs with lack of
lumbar support
Improper ergonomics results in:
Eye strain
Fatigue
Low back pain
Occupational repetitive stress disorders

47. Ergonomics
Occupational repetitive stress disorders
well described in computer-related
workers
Two common types of upper extremity
compressive neuropathies
Carpal tunnel syndrome (median nerve)
Cubital tunnel syndrome (ulnar nerve)

48. Ergonomics
Upper extremity compressive neuropathies
in radiologists practicing in an academic
filmless department
4 cases of cubital tunnel syndrome
1 case of carpal tunnel syndrome
(Reuss et al. ARRS 2001)

49. Ergonomics
Recommendations
Chairs – should have adjustable
height/armrests with lumbar support
Keyboards – should be adjustable in
height/position with keyboard trays
(Lincoln et al. Am J Prev Med 2000;18:37-
50)

50. Ergonomics: Adjustability
Optimal Viewing Distance = 24” to 36”
Optimal
Viewing Angle = 100 to 200
Adjustable
Keyboard
Tray
& Monitor
Base
Position Monitor & Body Within Optimum Parameters

51. Input Devices
Want to reduce stress while maximizing
efficiency for interpretation of imaging
studies

52. Methods and Materials
Conventional 2 button mouse

53. Methods and Materials
Game controller

54. Methods and Materials
Roller Mouse Pro

55. Methods and Materials
Up to 3 training cases were provided per device
for each user
Each device was programmed and mouse and
keyboard shortcuts were mapped
Standard instructional handouts were also
provided

56. Function Mapping

57. Accuracy – Renal length measurement
120
110 103.7
100.2 100.1 100.6 101.7 101.9
100
mm
90
Conventional Mouse
Game Pad
80
Roller Mouse
70
60
50
Right Left
p=0.987 p=0.794

58. Interpretation Time
445.1 464.4
500
450
400
Seconds
350 306
300
Conventional Mouse
250
Game Pad
200 Roller Mouse
150
100
50 p=<0.001
0
Interpretation Time

59. Reading Spaces Swapped Out Over
Time Over Time
Most Complex First to Go
Poetic Technology

60. Miscellaneous Features of New
Room
Scented candles to appeal to the sense of
smell which is increasingly recognized by
retail stores and hotels and others as
being important to promote calm and
pleasant feelings

61. Meditation/Hypnotherapy Room

62. Productivity
Improvement??

63. Personalized Spaces
Although radiologist workstations are
shared would like to personalize the space
(digital photographs in display), light and
furniture settings customized for user,
dashboard on PC optimized for user
preferences (e.g. stock market ticker, child
care web cam, etc.)

64. Privacy
Radiologists should be able to work in
environment that is open and that invites
collaboration yet be able to maintain
privacy when appropriate
Computer controlled LCD privacy glass

65. Conclusion
Radiologists are increasingly exposed to
occupational stress especially as a result
of the transition to the use of computer
workstations from reading environments
designed for film
Our experience suggests that relatively
small investments in time and money can
result in major reductions in stress and
improvements in productivity and even
accuracy

66. Reading Room and
Ergonomics
Eliot Siegel, M.D.
Chief Imaging VA Maryland Healthcare System
Professor and Vice Chair University of Maryland
School of Medicine Dept. Diagnostic Radiology
Imaging Informatics National Cancer Institute