The Digital Dilemma
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Advancements in radiology come with real human drawbacks.
Computers have changed the way we all work everyday—and the medical field is no exception. So in 1993, when the Veterans Affairs Medical Center in Baltimore introduced the first filmless reading room, it completely revolutionized the way radiologists work. Gone were the days of bulky light boxes and alternators that fed film across a conveyor belt. For the first time, radiology had gone digital—which meant radiologists needed to change the way they work.
And with this new way of working came numerous benefits—digital reading rooms are more cost-effective in part because they eliminate the need to use couriers, because all of the studies are sent over a computer network, as well as the possibility of studies being lost. In addition, digital reading rooms are safer because some of the chemicals used for processing film are a biohazard.
The change from film-based radiology to digital-based radiology also made doctors more efficient.
“The time it took to take an X-ray, process the film to development, get the film in a jacket, hand carry the film to the radiologist, hang the film, write on paper the history and other patient demographics, is all done instantaneously now,” said Dr. Hugh Scott of the National Naval Medical Center—which converted its reading room to a digital environment in 2000.
It’s no wonder that since the VA Medical Center first introduced digital technology to the field, 90 percent of military radiology rooms have become digital-based. And in the civilian world, it is expected that 90 percent of hospitals will also convert from film to digital technologies.
New Technology, New Challenges
Although digital radiology has gone a long way to making doctors’ lives easier, radiologists at the VA Medical Center soon found after the conversion that progress sometimes comes with a price—and the doctors paid in full through industrial injuries.
“The problem that we had was that the reading room itself—the lighting, the acoustics, the furniture, input devices, the carpeting, and everything else— was pretty antiquated,” said VA Chief Radiologist Dr. Eliot Siegel. “Even though it was a brand new hospital in 1993, it was really designed for the reading room of the past, rather than a filmless digital environment.”
As a result, radiologists began to complain about things like eye strain and pain to their necks, wrists and fingers. Repetitive motion injuries—which tend to be fairly debilitating—such as carpal tunnel syndrome, became more and more common among radiologists around the country. These issues caused radiologists’ work to suffer, and they reported increased fatigue, while the amount of time it took them to report studies increased and their level of accuracy suffered a decrease of 11 percent.
The technology that was meant to make radiologists more efficient was now also making it harder for them to work.
“A lot of the things that we take for granted in our car—such as individual ventilation and temperature control and individual lighting control—most people really don’t expect when they’re in a health care environment,” said Siegel. “I’m just amazed that more of us in health care don’t have occupational- related industries, particularly people who are interacting with the computer all day. It is really surprising what people will put up with. I think that it would make you laugh if someone tried to put it in a car they were going to sell you, as far as how awful the furniture is and how poorly adjustable it is. And we radiologists don’t really pay attention to the saying, ‘physician, heal thyself’ and we’re willing to put up with an environment that not only causes us injury, but also reduces our efficiency and is associated with errors.”
The solution to these problems came in the form of ergonomic furniture that is designed to help users be more comfortable and more productive.
Ergonomics: The Wave of the Furniture
Exactly what is ergonomics anyway?
Although it may sound like some meaningless buzzword or a fad soon to be forgotten with the pet rock, it is an effective way of improving your workplace by adding furniture that can be adjusted to each individual that uses it. Stephen Barlow-Lawson, president and design director of Biomorph, considers ergonomics the process of “putting the user at the center of their circle of power,” and likens ergonomic office furniture to the comfort of your car.
“The perfect example of good ergonomics is the interior of a car. As a driver, you have everything within reach and see everything without having to crane your neck,” he said. “You’re comfortably supported and all the controls are designed to be easily operated. There’s a lot of thought that goes into that.”
Barlow-Lawson began putting a lot of thought into office furniture in response to his own uncomfortable experiences with computers—and as a result, Biomorph created its first ergonomic designs in 1992.
“Generally speaking, the way that people used computers didn’t make any sense,” said Barlow-Lawson. “It was like, here’s a computer, stick it down on a piece of furniture that was designed probably in the 1940s for something else all together.”
And this pretty much describes what happened in radiology reading rooms around the country as they adopted a filmless environment.
In order to remedy this, institutions—including the VA Medical Center and the Navy Medical Center—have replaced their conventional desks and chairs with those that are adjustable to fit any member of the radiology staff.
Can You Not Hear Me Now?
Because the digital reading rooms have introduced voice recognition software to replace transcription in radiologists’ work, sound abatement measures have also become a challenge for institutions to tackle.
“A radiologist has to sit in front of a workstation and see a lot of studies—so they need to get into a zone, into a groove, into a momentum,” said Scott. “Once that starts, they do not like that being disrupted—they kind of get in that frame of mind. So they don’t like phones ringing all the time and they don’t like interruptions. Anything that keeps them in the zone, basically translates into more studies.”
To keep the Naval Center’s radiologists in the zone, it is currently sound proofing its radiology room and working on segregating work stations into cubicles. Barriers such as these are also important in order to maintain privacy. Because radiologists’ work stations also function as their offices, the privacy of doctors and patients alike can be compromised.
In addition to sound proofing, the VA Medical Center addressed the issue of privacy by installing glass around work stations that allows the radiologists to alter its color to alert colleagues that they need privacy: If the glass is opaque, they are in private mode; if radiologists want to share information with each other, they can change the color back to clear.
Radiology and Relaxation
In addition to furnishings and sound proofing, the VA Medical Center has also worked to make its reading room a more relaxing and productive environment. It has added votive candles with pleasant smells to the room, as well as blue lighting—which studies indicate reduces stress levels while increasing visual acuity.
In the end, changes like these are not just for radiologists—all professionals who use computers can benefit from an ergonomic workplace.
“Anybody who works with a computer, anybody who has an office and a desk, really has to think about ergonomic issues related to sound, lighting, and the user interface,” said Siegel. “A lot of the work that we’ve done, in addition to helping out our radiology colleagues and helping out our other colleagues in health care, is really generalizable to actually anybody who is interfacing with a computer.” ♦