Reading Room Ergonomics

As digital reading rooms are leading radiologists to discover the aches and pains of repetitive motion disorders, like carpal tunnel syndrome, and neck, back, and eye strain, ergonomic products and practices are being introduced to combat problems and optimize workstations.

Diagnostic Imaging spoke to several experts in ergonomics who offered their insight into the top ways radiologists can position themselves for hours of pain-free image reading.

1. Sitting 101

Poor posture and awkward body position can account for a number of problems among radiologists, including nerve damage, said Alan Hedge, PhD, CPE, director of the Human Factors and Ergonomics Laboratory in Cornell University’s design and environmental analysis department.  

An ergonomic, dynamic-back chair can go a long way to fixing those aches and pains, he said.

“The chair should move with you and have head and neck support,” Hedge emphasized.

But even after selecting the perfect chair, it must be adjusted properly, said Woojin Kim, MD, an assistant professor of radiology at the Hospital of the University of Pennsylvania.

“Back away from your workstation,” Kim said. “Sit on the chair. Be very comfortable in the chair. Make sure your feet are not hanging in the air, but are firmly on the ground.  The arm rest should be symmetrically raised and depressed so that your arm is resting at a 90-degree angle.”

2. Monitor management

Height- and tilt-adjustable monitors that swing in different directions are among the biggest improvements available for enhancing the ergonomics of a radiology workstation, said Mukesh Harisinghani, MD, associate professor of radiology at Harvard University and assistant radiologist with the department of abdominal imaging at Massachusetts General Hospital.

Hedge also suggested radiologists take a page out of the Wall Street trading room playbook and look for monitor arms that arch horizontally.

“When you go to see an OMNIMAX movie, the screen is curved because that is how our visual world works. It’s not a flat world,” he said.

Similar to using dynamic-back chairs, it doesn’t help to have the top-of-the-line monitor arms if they aren’t adjusted properly, Kim said. To properly adjust the monitor, push it away from you.

Since the ideal viewing distance is 18-to-24 inches, Kim said he recommends radiologists begin by pushing the monitors back as far as they will go.

“If the screen resolution is too small, it is better to enlarge the font size and still sit back from the monitors,” he said.

Next, lower the monitors so you are looking straight or, ideally, down at a 14-degree angle, Kim said.

“If you ever find yourself looking up, then the monitor is too high,” he said.

3. Up and Down

Workstations should be height-adjustable so they fit a radiologist who is 5-feet-2-inches tall as easily as one taller than 6 feet.

Finding one that allows radiologists to sit or stand offers the best range, letting radiologists change positions throughout the day.

“Somebody could sit and adjust the height to suit them, and another person can get rid of the chair and stand,” Harisinghani said, adding that someone can still slouch or sit improperly in a properly-adjusted chair.

“If you stand, you are forced to maintain a good posture,” he said.

4. Take an eye break

Hedge recommends the 20-20-20 micro-break.

"After 20 minutes, take a 20-second break, and look at least 20 feet away,” he said. “Your eyes relax when you look at a distance. By doing this you’re maintaining the ability of the eye to focus on images over the day.”

These breaks eliminate the eye-muscle fatigue that comes with looking at the same distance all day. Without them, it becomes difficult to focus.

5. Lighting in darkness

Radiologists tend to set the monitors at a brighter level than needed because they use the monitor light as ambient light, Harisinghani said. But that practice contributes to visual fatigue.

Instead, floodlights, task lighting, or other designated ambient lighting are a must have inside any reading room.

“There should be no direct light hitting from the ceiling,” Kim said. “I tell my residents, ‘That’s not for you. They are for the janitors. Turn them off.’”

A floodlight should be on the back of the workstation on the wall and should be bright, so that the light matches the luminance from the monitor, Kim said.

Task lighting, used for looking at paperwork and documents, should be attached to the furniture and should include a good blue light component because it helps the pupil constrict, making it easier to see, Hedge said.

6. Don’t ignore the walls

Use a matte finish. It reduces glare and, therefore, reduces visual fatigue and strain, Kim said.

7. Be a wannabe gamer

When looking for the newest, most advanced solutions, pay attention to video gamers, Kim suggested.

“If you want to see who are the most efficient, look at the gamers,” he said. “Every second counts for the competitive ones, and since they can’t waste a single second, you see all kinds of useful peripherals that they use.”

For instance, Kim has found left-hand devices that save repetitive clicks of the mouse or keyboard, as well as microphones and headsets that can make reaching for the phone obsolete.

8. Hands-free talking

Bluetooth rules the day in a car, but many radiologists are still picking up a handset to talk on the phone.

A microphone or headset can be used for conference calls or dictation, Kim said.

And voice recognition software can significantly reduce the turnaround on reports while eliminating injury-associated motions, such as typing and clicking.

9. Solutions, not products

It’s costly, but many radiology departments have found cost benefits with major ergonomic overhauls, Hedge said.

But those re-designs can be complicated, and there is not a one-size-fits-all solution for every radiologist or radiology department. Oddly-angled walls and tight corners might mean working with a vendor that can customize workstation designs.

“You need to be able to change the module to fit those tight spots,” Harisinghani said. “You need some kind of a company that offers solutions, not just products.”

10. Empty space

Optimizing workflow, down to the placement of a coffee cup, improves efficiency and wards off musculoskeletal disorders. But don’t forget the empty space. A workstation should include areas to the left and right where there are no permanent features except a plain desktop.

“Adequate workspace is really important,” Hedge said. “To find the optimal amount of space, sit down at the space. If you put your elbow on edge of work surface and make two windshield wiper areas with your arm … that shouldn’t be cluttered up.”