After revolutionizing reading rooms more than a decade ago, ergonomics is still a concern.
Carpal tunnel syndrome, repetitive motion injuries, shoulder impingement syndrome, severe eye strain, headaches, and lower back pain are just some of the problems radiologists can experience when spending a bulk of their time reading images at workstations.
Since the development of PACS, however, radiologists have worked with furniture manufacturers, interior designers, electricians, and others to find ways to reduce physical stress and maintain workflow.
Historically, radiologists have been concerned about ergonomics — the science of creating safe and efficient interactions between people and objects — since before PACS, according to Greg Patrick, president of RedRick Technologies in Mount Brydges, Ontario, Canada, which develops ergonomic solutions for radiologists and other professionals. Before digital imaging was introduced, Patrick says that radiologists recognized that they needed to be able to adjust the view boxes throughout the day to fit their needs and body posture. But there was little that was done until the view boxes themselves became obsolete.
At the end of the 20th century, however, computer monitors replaced view boxes. And, while the new PACS technology marked the most significant change to the field since Wilhelm Roentgen imaged his wife's hand, it also created potential physical problems for the radiologist. "PACS is a wonderful thing, but it is a double-edged sword," explains Patrick.
Big Monitors, Small Spaces
The evolution and transition to PACS was slow, and initially, radiologists' problems were more logistical than ergonomic. Each PACS monitor weighed 50 to 100 pounds, so furniture needed to accommodate three or even four of these monoliths, explains Michael Mullen, senior product designer for Anthro Inc., an ergonomic design firm in Tualatin, Ore. "As a result, the practices installed the large systems wherever they could find room and wedged the radiologists in the extra space," he explains. The workspace was not optimized for the reader's comfort.
As radiology shifted from film to digital images, radiologists, on the whole, became more sedentary, so comfortable workstations were even more essential. The radiologists also found that the monitors were not optimally set up — the height was often incorrect and was not adjustable. In addition, the keyboard height was also inadequate, creating discomfort and stress on the wrists, shoulders, necks, and backs of the readers.
"The approach at that time was 'ok, we've got a problem; we need to adjust this, but where do we find the appropriate mechanisms?' Off-the-shelf products weren't cutting it," explains Patrick. At that point, several manufacturers, including RedRick and Anthro, began to assess the new needs of the radiologist.
Finding the Perfect Workstation
Some of the physical constraints surrounding radiologists were alleviated through the advent of LCD display technology and other flat-panel monitors. Radiologists no longer needed to wonder whether their furniture would sustain the weight of several cathode ray tube monitors or squeeze themselves in wherever there was room. Nevertheless, imagers still spent much of their time focusing on several bright screens and moving a mouse repetitively at desks and stations designed generically for office work and not specialized for any particular purpose. As radiologists began to feel the effects of these ill-designed workstations, they also started to recognize the need for ergonomic solutions.
With radiologists' feedback, designers and manufacturers pinpointed some of the most notable ergonomic requirements:
• The monitor height needed to be customizable for each individual working at that workstation.
• The desk height needed to be adjustable so that individuals could change their posture and position during the day (e.g., from sitting to standing).
• The input devices, including mouse, keyboard, and dictation equipment, needed to be repositioned or replaced.
• Ambient lighting needed to be added to reduce eye fatigue.
When designing an optimal workstation, explains Mullen, "you have to fit the task to the user, not the user to the task."
Tools of the Trade
According to Patrick, input devices should be positioned so that "your shoulders are relaxed, your elbows are bent at 90 degrees, and your wrists are straight and not bent," he explains. Then, the monitor is placed so that the user is looking slightly downward to view the monitor and their neck is in a neutral position.
Because the monitor and input devices necessitate different heights, manufacturers began creating desks with split surfaces. In other words, the monitors sitting on the back could be adjusted independently from the front of the desk, where the input devices were located.
Avoiding eye fatigue can also be addressed with monitor height. "If you have bifocals, you will want your monitor at a lower position relative to your head. If you have 20/20 vision, you may need the monitor at a higher level," explains Mullen. Additionally, distance from the eyes to the monitor, which is typically an arm's length, can also depend on an individual's vision, according to Edward R. Parker, design consultant with Evolve Technologies Corporation in Salem, N.H., which designed with the workstations for "Reading Room of the Future" at the ACR Education Center.
To further reduce eye fatigue, manufacturers light the workstations with lamps placed behind monitors. When workstations are placed near a wall, the light bounces off the walls, creating an ambient glow that equals the light emitted by the monitor. Not only does the presence of ambient light reduce eye strain, but it also improves acuity, note both Mullen and Patrick. Some of the more technologically advanced workstations on the market include photo cells that dim the ambient light based on the brightness of a specific image on the screen.
Made to Move
No one can doubt the benefits of the last decade's ergonomic technologies, but one of the most important tools for improving radiologists' ergonomics comes from within. "I think the biggest problem is that people aren't addressing ergonomics. And if they're not, then they are making do with what they have," Mullen says. "For example, [they] place telephone books under the monitors to try to get them to the proper height."
To help imagers avoid injury, Patrick suggests that they make a conscious effort to change positions approximately every 30 minutes. It can be from sitting to standing or from perching on the front of the chair to sitting at the back. Such practices can stave off repetitive strain on the back, neck, and arms. "The best position to be in is the next one you move to," he says.
Another significant issue that causes radiologists to have repetitive motion-related injuries is dictation, explains Mullen. "I've seen people with a wire coat hook wrapped around their neck to hold their dictation device because their arm is so sore from holding it all day," he says.
To combat dictation-related problems, Mullen suggests using an external microphone that can be plugged into the computer system and is compatible with your voice-recognition software. "Then you can just sit back in your chair and talk just like you were in a broadcast booth. You don't have to hold that dictation device all day; you just have to control the voice-recognition software," he says. Not only are external microphones more ergonomic, but they also tend to be cheaper than dictation devices.
For those without appropriate workstations, or who make do with telephone books or coat hangers, Patrick strongly suggests looking into a long-term solution. He says it's important to "work in an environment that helps you stay comfortable and ultimately healthy and be as productive as you can be."
By Brett Hansen