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Siddiqui 2007 HFES Keynote
1. Human Factors And
Ergonomic Issues In A
Radiology Reading
Environment
Khan M. Siddiqui, MD
Chief, Imaging Informatics and Cardiac CT/MRI
VA Maryland Health Care System, Baltimore, MD
Director, MR Imaging, University of Maryland
2. Disclosure
Anthro Intel Corporation
Barco View Knoll
Bretford Redrick/Evolve
Technologies
Dell Computers
Sonare Technology
Environments Group
Steelcase
Herman Miller
Virtual Radiology
Humanscale
Xybix
3. Overview
Introduction
User Interface and its components
Ergonomic issues and occupational injury
Ergonomic user interface and input options
Conclusion
Open discussion
11. Introduction
Today, the average study contains 1000-2000 images,
now reading about 50 studies a day --- 50,000 images
Reiner BI et al “An Impending Crisis for radiology:
information overload.” Presented at SCAR annual
meeting, 2005
Future shortage of radiologists
Focus on prevention
12. Introduction
Today, the average study contains 1000-2000 images,
now reading about 50 studies a day --- 50,000 images
Reiner BI et al “An Impending Crisis for radiology:
information overload.” Presented at SCAR annual
meeting, 2005
Future shortage of radiologists
Focus on prevention
13.
14.
15.
16.
17.
18.
19. Poor conditions will have
Impact on clinical care
Work related MSK disorders
Fatigue leads to errors
Vision and Visual Strain
Dissatisfied Clinicians
Unhappy staff
62. Workflow
The reading room is an environment where highly
variable tasks are performed
Long periods of solitary work
Collaboration with individuals
63. Workflow
The reading room is an environment where highly
variable tasks are performed
Long periods of solitary work
Collaboration with individuals
Collaboration with teams
64. Workflow
The reading room is an environment where highly
variable tasks are performed
Long periods of solitary work
Collaboration with individuals
Collaboration with teams
The reading room is a work area for more than just
radiologists!
65. Baltimore VA Medical Center
Hospital opened January 1993 connected to University
of Maryland Hospital
~100,000 examinations per year
Hospital and radiology
department were designed for
digital rather than conventional
imaging
66. The Advantage of PACS is
Improved Workflow Rather
Than Just Filmless
We found 59 steps in the process of ordering,
obtaining, filing, retrieving, and reporting a Chest
radiograph in our department in 1989
67. Workflow Analysis
Performed 1989 by engineering firm, BAH
Analyzed workflow associated with an inpatient chest
radiograph performed in the radiology department
68. Ward Clerk
Referring Clinician Nurse
5. Flag order in chart
Get chart from clerk Medical Clerk
7. Take chart from bin
6. Place chart in “pending orders” bin
Write orders in chart 8. Document order in chart 54. Sort radiology reports
10. Contact radiology with patient info
9. Ask clerk to schedule study 55. Bring reports to wards
Give chart to clerk 12. Inform nurse of scheduled study
13. Contact transportation personnel
Fill out study request 56. Sort reports
57. File reports in chart
Transcriptionist
Film Room Clerk
Radiology Clerk 45. Retrieve tapes
Transportation Aide 46. Transport tapes for dictation
18. Check recently pulled films
11. Schedule patient
47. Transcribe and print reports
19. Search for films in library
14. Transport patient to dept. 15. Look up index card
48. Bring report to film room
20. Write new study on jacket
32. Transport patient back 16. Review card for old exams
50. Bring report to front desk
35. Combine with old studies
17. Give card to film room
51. Give report to radiologists
36. Bring films to reading room
21. Place request in pending bin
53. Take report to Medical Admin.
49. File report in film jacket
31. Call transportation
33. Re-file index card
Radiologist
37. Take films from “stack”
38. Remove films and requests
Technologist 39. Hang films
40. Review images and reports
22. Retrieve request and patient
Dark Room Tech 41. Dictate case
23. Obtain images
42. Take down films
25. Bring films to processor
24. Take cassettes to dark rm. Tech
43. Return films to jacket
26. Process films
28. Check films for quality
44. Return jackets to “stack”
27. Return films to tech
29. Update patient index card
52. Review and sign report
30. Return study card to clerk
34. Bring films to film room
70. 8 or 9 Steps Required in Integrated
(Workflow Optimized) Department
(8 Voice Recognition, 9 Digital Dictation)
Referring Clinician
1. Physician order entry on Transportation Aide
HIS Technologist
2. Transport patient to dept.
9. Report available on HIS 3. Choose patient from modality work list
6. Transport patient back
4. Obtain images
5. Check images for quality
Radiologist
7. Review images and reports
8. Dictate and verify study with voice
recognition system
76. Fatigue Levels as a Function
of Ambient Room Light
Low Fatigue
Medium Fatigue
High Fatigue
p=0.09
77. Ambient Room Light and Interpretation
Accuracy: “Clinically Significant Findings”
Off
Half On
On
78. The Challenge
Completely redesign the old reading room (approx. 23
x 23 feet or 532 sq. ft) to create:
Ergonomically optimized productive and low stress
environment for 5 very different radiology
workspaces (10 x 10 ft space per reading area)
Create a clinical reading room environment that
allows the radiologists to collaborate easily yet
minimizes distractions
79. The Challenge
Create showcase for ergonomic room design
Create “laboratory”/research environment” for study
of physical and cognitive ergonomic factors
Share with virtual and in-person visitors and
generalize this information to health care workspaces
81. Charette Process: Experts From Across the
Country and Partnership with GE Healthcare
Charette Process with Expertise in Radiology, PACS,
Digital Imaging, Industrial Engineering/Six Sigma,
GE Lighting and Partners in Technology and
Ergonomics
82. Final Design: Hybrid of “Cubicles” & Offices
Maximizes Flexibility Each Room with
Unique Ergonomic Approach
MRI Scanner
Room
83. Solution
Indirect individual and
programmable
computer controlled
lighting with dimmable
controls to allow
maximal flexibility for
each individual
radiologist
86. Acoustics in New Reading
Room
The new reading room has sound absorbing
materials and acoustic paneling
A sound masking system generates “noise” in
the general frequency range of human voice
(also works to attenuate MRI scanning noise)
We have conducted initial studies to
document the impact of “white noise” (actually
focused in the range of speech and MRI
scanner noise) on speech recognition
87. Music and Noise
Music or white noise may have a positive
impact on productivity and may reduce
fatigue
One room has focused “beam” of directed
sound to allow radiologist to enjoy music/
sounds without disturbing others
We plan to test the effect of ambient noise
on radiologists productivity and dictation
91. Miscellaneous Features of
New Room
Scented candles to appeal to the sense of smell which
is increasingly recognized by retail stores and hotels
and others as being important to promote calm and
pleasant feelings
93. Room 5 Will Serve as
Meditation/Hypnotherapy Room
94. Personalized Spaces
Although radiologist workstations are shared would like
to personalize the space (digital photographs in
display), light and furniture settings customized for user,
dashboard on PC optimized for user preferences (e.g.
stock market ticker, child care web cam, etc.)
96. Human Factors And
Ergonomic Issues In A
Radiology Reading
Environment
Khan M. Siddiqui, MD
Chief, Imaging Informatics and Cardiac CT/MRI
VA Maryland Health Care System, Baltimore, MD
Director, MR Imaging, University of Maryland