The document summarizes scenarios related to interruptions and hassles experienced by radiologists during dictation. It describes scenarios where a radiologist has trouble contacting an attending physician to sign off on a critical case, experiences technical errors with dictation software, and is interrupted by noise from a nearby station. It also outlines scenarios where radiologists take paper notes to stay on track during interruptions or discuss cases with physicians. The document analyzes radiologists' workflow and proposes design ideas like adjustable workstations, partitions, and integrating dictation devices and mice to reduce posture changes during reading and dictation.

1. Scenarios [Dictation]
Cogs 160 Final Presentation
Jenny Chang, Jingwei Li, Samantha Tse
June 2, 2011

2. Key
• Blue= interruption
• Green = hassle
• Red= breakdown
• Bolded text in diagrams = specific scenario focus
These arrows
indicate time These arrows
indicate
causation

3. Talk Station
Dictaphone
These four
programmable
buttons are not
used at all
Record button used most
often (only button used)
Both the optic mouse
and scroll bar not used
because not precise

4. Overview
Night shift: resident Morning shift: resident
does pre-lim in IBOX opens up PACS and pre-
(PACS). dictates studies using
IBOX as a guide.
Attending sends pre-
dictation back to resident to
dictate again. It is not Pre- dictation goes to
correct or insufficient the attending.
information.
Dictation is finalized and goes
back to whoever ordered it
Attending signs
(dictation will have attending’s
off on dictation.
name on it).

8. Overview Scenario
• Resident radiologist is dictating a case from a ER patient.
• Notices that he must get a hold of the attending radiologist
immediately because this patient’s condition is critical.
• Must get a hold of the attending to sign off on the dictation
before the results can go back to the ER physician who
ordered the scan.
• Radiologist phones attending but there is no answer.
• Radiologist phones other radiologists to see where the
attending may be or how to get a hold of the attending.
• Calls older radiologist to see what call should be made.
• The whole process has come to a halt because attending
cannot be reached.
• Tension with the ER as they pressure radiologists to expedite
the process. ER wants it done fast, RADS want it done
thoroughly.

9. Talk Tech Error Scenario
• Radiologist is dictating a study (Dictaphone in hand, thumb on record
button, eyes are on images).
• He dictates the word “pachyperitonitis”.
• Lets go of the recording button.
• Right after dictates that word, takes eyes of images and looks at talk
station screen to double check that word was correctly dictated.
• Notices that the word has not been dictated.
• Presses record and speaks into the microphone “pachyperitonitis”.
• Sees the software did not recognize the word again.
• Dictates the word into microphone. Word is not recognized again.
• He puts down the Dictaphone on the desk.
• He uses his mouse to click where the word should be dictated.
• He starts typing the word “pachyperitonitis”.
• He picks up his Dictaphone again and continues dictating the rest of
his study.

10. Dictating
Interruptions Noise
• Get up and move body • Sound from others’
workstation (phone,
• Time loss music)
• Tension • Sound from others
• Forgets place in dictating
dictation • Room conversations
• Phone calls (phone and in person)

11. Dictating & Noise Scenario
• Radiologist 1 is dictating a study.
• Radiologist 2 is listening in on a phone conference on speaker
phone at his station in the same room.
• Radiologist 1 looks to see where the noise is coming from and
continues dictating.
• Radiologist 1 is finally annoyed by the noise and stops
dictating.
• Radiologist 1 gets up out of his chair and walks over to
Radiologist 2.
• Rad 2 notices Rad 1 wants to talk to him and stops his work.
• Rad 1 asks Rad 2 to please turn down the volume. Rad 2
complies.
• Rad 1 walks back over to his station, sits down, and continues
dictating his study.

12. Dictating
Interruptions Artifacts
• Taking notes on
• Get up and move body paper helps with
remember place if
• Time loss there is an
• Tension interruption
• Forgets place in • Paper notes help
dictation with guiding
dictation
• Phone calls
• Time consuming
• For work arounds

13. Using Paper Scenario
• Radiologist is dictating a study.
• Radiologist uses several pieces of paper to write down
what he observes on the images (does not record with
Dictaphone).
• Phone rings and interrupts and stops radiologist from note
taking. Picks up phone.
• He listens to the content over the phone and hangs up.
• Radiologist looks back at his notes. Easily finds his place
where he left off.
• Continues with dictation (taking notes).
• When finished with taking all notes, starts using
Dictaphone and records words in talk station.
• Looks at notes to help guide his recording.

15. Dictating
Interruptions Agents:
• Physicians (in person)
• Physicians (phone)
• Other radiologists
Advice/Discussion
Social Interaction
• Human interaction
• Personal contact

16. Doing a Reading Together Scenario
• Radiologist is sitting at his station dictating a study.
• There is a knock at the door.
• He stops dictating by putting down the Dictaphone.
• He gets up from his chair to walk over to open the door.
• A bunch of physicians come in asking for advice and more
information about a particular study.
• Radiologist stops his current study by closing it.
• He opens that particular study through PACS.
• Physicians come in and huddle behind radiologist.
• The radiologist uses the mouse to explain his observations while
talking/discussing with physicians.
• Physicians point a lot. But only radiologist uses mouse to point.
• The physicians thank him and they exit he room.
• Radiologist resumes his previous study by opening it in PACS.

18. Dictation 1 (Study 1) Dictation 2 (Study 2)
Interruptions: agents,
phone calls, noise, talk tech
errors (software), posture
Dealing with interruptions
(workarounds):
• Time loss
• Loses place in dictation Overall
• Tension
Workflow
• Social interaction
• Use of artifacts Model

19. Design Ideas
• Padding for wrists and elbows as part of the desk
• Adjustable table heights, distance (monitor and person)
• Adjustable monitors
• Foot rests
• Chairs that align spine
• Partitions/ curtains
• Ambient lighting
• Designing for better acoustics (dampen noise)
• Multiple mice? Or have a way of accurate pointing to images.
• Some type of better integration of mouse and Dictaphone (less
going picking up and putting down and switching between these
two)
• Portable Dictaphone, either on clothes, workstation (bluetooth?)

22. Questions?