Siddiqui 2007 HFES Keynote

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Closing Session Keynote talk at the Human Factors and Ergonomics Society meeting in Baltimore, MD - October 5, 2007

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Siddiqui 2007 HFES Keynote

  1. 1. Human Factors And Ergonomic Issues In A Radiology Reading Environment Khan M. Siddiqui, MD Chief, Imaging Informatics and Cardiac CT/MRI VA Maryland Health Care System, Baltimore, MD Director, MR Imaging, University of Maryland
  2. 2. Disclosure Anthro Intel Corporation Barco View Knoll Bretford Redrick/Evolve Technologies Dell Computers Sonare Technology Environments Group Steelcase Herman Miller Virtual Radiology Humanscale Xybix
  3. 3. Overview Introduction User Interface and its components Ergonomic issues and occupational injury Ergonomic user interface and input options Conclusion Open discussion
  4. 4. CT During the Early 1970’s (a “Few” Slices)
  5. 5. CT During the Early 1980’s (40 Slices)
  6. 6. CT During the Early 1990’s (160 Slices)
  7. 7. CT During the Late 1990’s (560 Slices)
  8. 8. 2005 Trauma CT (2240 Slices)
  9. 9. 2006 Cardiac CT (4000 Slices)
  10. 10. Today
  11. 11. Introduction Today, the average study contains 1000-2000 images, now reading about 50 studies a day --- 50,000 images Reiner BI et al “An Impending Crisis for radiology: information overload.” Presented at SCAR annual meeting, 2005 Future shortage of radiologists Focus on prevention
  12. 12. Introduction Today, the average study contains 1000-2000 images, now reading about 50 studies a day --- 50,000 images Reiner BI et al “An Impending Crisis for radiology: information overload.” Presented at SCAR annual meeting, 2005 Future shortage of radiologists Focus on prevention
  13. 13. Poor conditions will have Impact on clinical care Work related MSK disorders Fatigue leads to errors Vision and Visual Strain Dissatisfied Clinicians Unhappy staff
  14. 14. Reading Room Design
  15. 15. Reading Room Design Workflow
  16. 16. Reading Room Design Perception Workflow
  17. 17. Reading Room Design Perception Ergonomics Workflow
  18. 18. Reading Room Design Perception Ergonomics Workflow Room Layout
  19. 19. Reading Room Design Perception Ergonomics Workflow Room Layout Secret Paper trail
  20. 20. Reading Room Design Perception Ergonomics Workflow Room Layout Secret Paper trail Film
  21. 21. Reading Room Design Seating Perception Ergonomics Workflow Room Layout Secret Paper trail Film
  22. 22. Reading Room Design Seating Workstations Perception Ergonomics Workflow Room Layout Secret Paper trail Film
  23. 23. Reading Room Design Seating Workstations Desks Perception Ergonomics Workflow Room Layout Secret Paper trail Film
  24. 24. Reading Room Design Seating Workstations Desks Temperature Perception Ergonomics Workflow Room Layout Secret Paper trail Film
  25. 25. Reading Room Design Seating Workstations Desks Temperature Ventilation Perception Ergonomics Workflow Room Layout Secret Paper trail Film
  26. 26. Reading Room Design Seating Workstations Desks Temperature Ventilation Perception Ergonomics Sound Workflow Room Layout Secret Paper trail Film
  27. 27. Reading Room Design Seating Workstations Desks Temperature Ventilation Perception Ergonomics Sound Noise Workflow Room Layout Secret Paper trail Film
  28. 28. Reading Room Design Seating Workstations Lighting Desks Temperature Ventilation Perception Ergonomics Sound Noise Workflow Room Layout Secret Paper trail Film
  29. 29. Reading Room Design Seating Workstations Lighting Desks Displays Temperature Ventilation Perception Ergonomics Sound Noise Workflow Room Layout Secret Paper trail Film
  30. 30. Reading Room Design Seating Workstations Lighting Desks Displays Temperature Task Ventilation Perception Ergonomics Sound Noise Workflow Room Layout Secret Paper trail Film
  31. 31. Reading Room Design Seating Workstations Lighting Desks Displays Temperature Task Ventilation Visualization Perception Ergonomics Sound Noise Workflow Room Layout Secret Paper trail Film
  32. 32. Research Studies of Workflow, Ergonomics, and Perception are NOT the studies of how to pamper radiologists more
  33. 33. Boeing 777 Cockpit http://www.flickr.com/photo_zoom.gne?id=149533605 Boeing 777 glass cockpit
  34. 34. Visual Perception
  35. 35. Game # 1 An image will appear on the next slide. See if you can pick the finding.
  36. 36. What did you see?
  37. 37. Visual Psychology
  38. 38. Visual Psychology
  39. 39. Visual Psychology
  40. 40. How Do These Illusions Impact Radiology?
  41. 41. Game # 2 - Grey Issues: Match the box
  42. 42. Grey Issues
  43. 43. Game # 4 – Motion??? What is better? Viewing images in cine mode – scrolling Viewing images in tile mode Cine Tile
  44. 44. Workflow
  45. 45. Workflow
  46. 46. Workflow The reading room is an environment where highly variable tasks are performed Long periods of solitary work Collaboration with individuals
  47. 47. Workflow The reading room is an environment where highly variable tasks are performed Long periods of solitary work Collaboration with individuals Collaboration with teams
  48. 48. Workflow The reading room is an environment where highly variable tasks are performed Long periods of solitary work Collaboration with individuals Collaboration with teams The reading room is a work area for more than just radiologists!
  49. 49. Baltimore VA Medical Center Hospital opened January 1993 connected to University of Maryland Hospital ~100,000 examinations per year Hospital and radiology department were designed for digital rather than conventional imaging
  50. 50. The Advantage of PACS is Improved Workflow Rather Than Just Filmless We found 59 steps in the process of ordering, obtaining, filing, retrieving, and reporting a Chest radiograph in our department in 1989
  51. 51. Workflow Analysis Performed 1989 by engineering firm, BAH Analyzed workflow associated with an inpatient chest radiograph performed in the radiology department
  52. 52. Ward Clerk Referring Clinician Nurse 5. Flag order in chart Get chart from clerk Medical Clerk 7. Take chart from bin 6. Place chart in “pending orders” bin Write orders in chart 8. Document order in chart 54. Sort radiology reports 10. Contact radiology with patient info 9. Ask clerk to schedule study 55. Bring reports to wards Give chart to clerk 12. Inform nurse of scheduled study 13. Contact transportation personnel Fill out study request 56. Sort reports 57. File reports in chart Transcriptionist Film Room Clerk Radiology Clerk 45. Retrieve tapes Transportation Aide 46. Transport tapes for dictation 18. Check recently pulled films 11. Schedule patient 47. Transcribe and print reports 19. Search for films in library 14. Transport patient to dept. 15. Look up index card 48. Bring report to film room 20. Write new study on jacket 32. Transport patient back 16. Review card for old exams 50. Bring report to front desk 35. Combine with old studies 17. Give card to film room 51. Give report to radiologists 36. Bring films to reading room 21. Place request in pending bin 53. Take report to Medical Admin. 49. File report in film jacket 31. Call transportation 33. Re-file index card Radiologist 37. Take films from “stack” 38. Remove films and requests Technologist 39. Hang films 40. Review images and reports 22. Retrieve request and patient Dark Room Tech 41. Dictate case 23. Obtain images 42. Take down films 25. Bring films to processor 24. Take cassettes to dark rm. Tech 43. Return films to jacket 26. Process films 28. Check films for quality 44. Return jackets to “stack” 27. Return films to tech 29. Update patient index card 52. Review and sign report 30. Return study card to clerk 34. Bring films to film room
  53. 53. Workflow How Many of the 59 Steps Are Eliminated With Filmless Operation?
  54. 54. 8 or 9 Steps Required in Integrated (Workflow Optimized) Department (8 Voice Recognition, 9 Digital Dictation) Referring Clinician 1. Physician order entry on Transportation Aide HIS Technologist 2. Transport patient to dept. 9. Report available on HIS 3. Choose patient from modality work list 6. Transport patient back 4. Obtain images 5. Check images for quality Radiologist 7. Review images and reports 8. Dictate and verify study with voice recognition system
  55. 55. Old Reading Room
  56. 56. Recognize This Interior?
  57. 57. Yugo
  58. 58. After Transition to Digital Increasing Complaints of Eyestrain, Neck, Back and Wrist and Hand Pain, and Complaints of Excess Noise and Ventilation
  59. 59. Studies of Impact of Reading Room Environment on Clinical Practice
  60. 60. Fatigue Levels as a Function of Ambient Room Light Low Fatigue Medium Fatigue High Fatigue p=0.09
  61. 61. Ambient Room Light and Interpretation Accuracy: “Clinically Significant Findings” Off Half On On
  62. 62. 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 very different radiology workspaces (10 x 10 ft space per reading area) Create a clinical reading room environment that allows the radiologists to collaborate easily yet minimizes distractions
  63. 63. The Challenge Create showcase for ergonomic room design Create “laboratory”/research environment” for study of physical and cognitive ergonomic factors Share with virtual and in-person visitors and generalize this information to health care workspaces
  64. 64. Charette Process Concentrated effort to solve an architectural problem Listen Envision Draw
  65. 65. Charette Process: Experts From Across the Country and Partnership with GE Healthcare Charette Process with Expertise in Radiology, PACS, Digital Imaging, Industrial Engineering/Six Sigma, GE Lighting and Partners in Technology and Ergonomics
  66. 66. Final Design: Hybrid of “Cubicles” & Offices Maximizes Flexibility Each Room with Unique Ergonomic Approach MRI Scanner Room
  67. 67. Solution Indirect individual and programmable computer controlled lighting with dimmable controls to allow maximal flexibility for each individual radiologist
  68. 68. Ventilation and Temperature Controls: New Radiology Reading Room
  69. 69. Acoustics
  70. 70. 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) We have conducted initial studies to document the impact of “white noise” (actually focused in the range of speech and MRI scanner noise) on speech recognition
  71. 71. 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 We plan to test the effect of ambient noise on radiologists productivity and dictation
  72. 72. Reading Room Furniture including Tables, Chairs, etc.
  73. 73. Seating
  74. 74. Workstation Design, Ambient Conditions, and Posture
  75. 75. 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
  76. 76. Security Biometric room entry option or room card or key fob controller
  77. 77. Room 5 Will Serve as Meditation/Hypnotherapy Room
  78. 78. 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.)
  79. 79. Digital Eye for the Analog Guy
  80. 80. Human Factors And Ergonomic Issues In A Radiology Reading Environment Khan M. Siddiqui, MD Chief, Imaging Informatics and Cardiac CT/MRI VA Maryland Health Care System, Baltimore, MD Director, MR Imaging, University of Maryland

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