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Furnishing the Pilot’s Seat:
Outfitting Digital Reading Rooms So Production Takes Off As imaging facilities make the change from reading rooms using traditional light boxes and tables to digital reading rooms utilizing PACS, so must the workspace for these areas change to improve comfort and functionality. In the past, a hospital’s radiology department often held the “boardwalk” position within the facility, occupying prime real estate because with film images, it was crucial that the radiologists be accessible to the departments utilizing their services. Now, as hospitals are using PACS, it is more feasible to move parts of radiology—specifically reading rooms—to other areas of the facility. As hospitals, imaging centers, and radiology groups make the move to PACS, so does the need to create workspaces designed for digital technology. Today, PACS workstations are available in numerous configurations and at a wide range of price levels. While in the past, radiologists moved from light box to light box to read films, PACS technology enables them to remain at a workstation for a full shift, which can increase productivity but also places new physical demands on the radiologist. “You have to understand that with PACS, radiologists are going from reading a film on a light box to sitting in a chair all day,” says Steven Barlow-Lawson, president of Biomorph, a New York City-based company specializing in interactive computer desks. “It’s very intense work to spend eight—or often more—hours per day doing this,” he adds. To assist in making the working environment as functional and comfortable as possible, PACS workstations can be built to suit any physical workspace, whether a virtual home office, imaging center, or large hospital. And because there are often three shifts per day at a facility, the space has to accommodate physicians of all shapes and sizes. There are, however, many considerations beyond simply choosing the furniture that need to be addressed when planning and implementing the new reading room. These include room size, lighting, and ventilation, as well as the personnel that will be using the space. Time Frame Vince Bocchimuzzo of AFC Industries in College Point, N.Y., has helped many facilities work backward from the “go live” date and says that from start to finish, furniture can be ordered and in place in one to three months. In some cases, delivery can be made in two to three weeks, according to Barlow-Lawson. “A hospital itself, while in the process of putting together the paperwork for deployment of PACS, will also approach the aspect of functional furniture for the new reading room,” Bocchimuzzo says. He says it’s important to consider the area you will use in terms of size, lighting, and how many people will be working there, as well as what items a facility deems necessary for the reading room based on its users’ particular needs. “Once a decision is made to install PACS, considering the furniture for the reading room should run parallel to that decision,” says Bocchimuzzo. In reality, the decision of whether to deploy PACS takes longer than furniture delivery, and ultimately, the work consoles are delivered simultaneously. So decisions such as the color of the workstation, wood grain choices, wall color, and lighting must be executed in a manner that will enable the room to be functional at deployment. Barlow-Lawson notes that lead time when planning a space also depends on such issues as whether you are repurposing an existing space or planning space for a new facility. Biomorph provides free space planning solutions that allow a client to send in the room dimensions, and Biomorph professionals come up with possible configurations. Things to Consider Workstations The workstations must accommodate all the people scheduled to work in the room. Hospitals often have three shifts sharing the same workspace over a 24-hour period. With the right workstation, radiologists can use the touch of a button to electronically position them in just the right working position that is preset to their size and preference. Some workstations come “off the rack,” while others are height-adjustable, wall-mounted, or include carts and racking systems. For those needing something special, custom applications provide options that accommodate each facility’s special needs. In addition, it is important to test and choose chairs that are not only functional but also comfortable. “The more comfortable you are, the more productive you are,” says Bocchimuzzo. Lighting Going Ergonomic Ergonomics is about fitting the user. The workstation must take into account that there will be multiple users over multiple shifts. “The key is that it must be adjusted easily,” says Barlow-Lawson. “A very simple ergonomics concept is that the keyboard and monitor must be separate, and various other adjustments, such as allowing for tilt, are available in all Biomorph desk products,” he adds. Barlow-Lawson also mentions that working standing up is a valuable option for several reasons. “Sitting for an entire shift is not great for physical reasons,” he says. In addition, sharing scans or images with colleagues is much easier to do standing rather than sitting huddled around a chair. Therefore, products that enable the table to rise to a level where the radiologist can stand merit serious consideration. Successful Redesign “As part of a strategy to become a paperless and filmless network, AEMC completely redesigned and rebuilt its reading room,” says Matalon. The process was done in conjunction with an architect who had experience with designing PACS reading rooms. In the initial vendor search, Matalon and colleagues visited many facilities that used PACS and learned information that helped in planning their new reading room. “We saw a lot of things that we didn’t like,” he says. He notes that while the facilities had PACS, the workspaces were often not as functional as they could be. Taking note of what worked and what didn’t, as well as incorporating key elements important to AEMC, they carefully considered the most important details that would be incorporated into their new space. “It was important for the architect to have an understanding that we were going to be using voice recognition, so we had to have significant sound isolation,” says Matalon. Therefore, products were chosen based first on sound absorbency, and then aesthetic effects. “We also wanted to preserve a tremendous amount of collegiality and the ability to share cases among staff,” he says. To accommodate that, vertical partitions that stop at shoulder level were used among the more than 20 reading stations. This enabled face-to-face interaction while also maintaining sound absorbency. Because of the substantial amount of cabling that more than 20 stations create, the divider system provided the capacity to contain the cables in a neat and concise way. In addition to the radiologists’ reading stations, the designers also included a clinician’s viewing area, incorporating a large screen so a team of doctors can view images simultaneously. This frees them from having to borrow a radiologist’s station and, therefore, increases productivity. They also invested a large amount on an appropriate heating, ventilation, and air conditioning system, as the heat production of PACS is different from standard film readers. The architects calculated the expected heat capacity and strategically installed three separate thermostats that provide flexibility in matching cooling and ventilation with the expected loads. “We also used ambient light at a low level so there would be no interference with the ability to view images,” adds Matalon. The choice of seating in the workstation is also paramount. To ensure that staff would have the best seating, the planners brought in premium ergonomic chairs from a variety of vendors and used them for roughly six weeks to identify which were the best for the long term. As far as workstation choice, AEMC uses a split table configuration that incorporates the monitor on the back half and keyboard and mouse on the front half. It also includes a flexible height adjustment and is adjustable electrically rather than manually. “With this workstation, anyone can adjust it to their preference within 15 seconds,” says Matalon. Even with the new reading room in place for three years, “people still love it,” says Matalon. “Visitors still comment on how positive this aspect of our site is. “We feel fortunate that we could afford to create this workspace,” he adds. “We had a lot of good guidance, and it came out so well.” For anyone in the beginning stages of planning and purchasing furniture for a PACS reading room, Matalon strongly recommends viewing a video made by Eliot L. Siegel, MD, and his colleagues at the Baltimore Veterans Administration, “Digital Eye for the Analog Guy,” which is available for viewing here. The 30-minute video addresses ergonomic issues related to the soft-copy reading room environment, including sound, furniture, lighting, ventilation, and technology. — Annie Macios is a freelance medical writer based in Doylestown, Pa. Healthy Positioning for
PACS • Position the keyboard surface at a level that forms a right angle at your elbows. This helps relieve stress in your shoulders and arms and straightens out the wrists, adding wrist support. • Adjust the monitor surface so the screen is facing directly toward you. Make sure your back is straight and you’re looking straight ahead, 10 to 15 degrees down and 24 to 32 inches from your eyes. • Pull yourself into the center of the desk, relax, and lean back in your chair for full support. Take frequent breaks and adjust your position regularly. Industry experts also stress the importance of following Alan Hedge’s 20-20-20 rule, which suggests that a person working at a computer workstation should stand up or at least stop every 20 minutes to gaze at least 20 feet away for at least 20 seconds to minimize eye strain. — AM
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