Dan Harvey

New Radiology Rooms – New Radiologist Role From Radiology Today Magazine Ergonomics Push Radiology Reading Rooms into the Future By Dan Harvey By now, everyone is aware of the importance of ergonomics at a radiologist’s workspace and in a radiology reading room. What’s new is the degree. Awareness been ramped up to acute awareness, observes Greg Patrick, president of Ontariobased RedRick Technologies, a designer and provider of ergonomic radiology furniture. He attributes that, in large part, to the American College of Radiology’s (ACR) Imaging 3.0 initiative. “There’s a strong focus area on radiology in the initiative, and it has made radiologists more attentive about how ergonomics impact their environment and, in turn, their health,” he says. Increased awareness also is attributable to the changes in that environment. “Emergence of PACS and digital imaging brought a major change in radiologists’ practice style,” indicates Claire E. Bender, MD, FACR, chair of the ACR Commission on Human Resources. Bender reports that the ACR HR Commission will soon publish a study “Workrelated Injuries of Radiologists and Possible Ergonomic Solutions” in the Journal of the American College of Radiology (lead author Gordon Sze, MD, FACR, Chief of Neuroradiology, Yale School of Medicine). The study states that the shift toward PACS and digital imaging led to an increase in repetitive strain injuries (most often manifested in pain in the upper extremities, neck and back) and eye strain. Previous studies have reached the same conclusions about physical strain and resulting injuries. Another study (“The Agony of it All: Musculoskeletal Discomfort in the Reading Room,” published in JACR in April 2017) revealed that 87% of radiologists reported ache, pain or discomfort in at least one body area at least once or twice a week. The most frequent locations were the neck (66% of respondents), lower back (61%) upper back (43%), right shoulder (36%) and right wrist (33%). Other pain symptoms reported involved carpal tunnel syndrome, eye strain and headaches. The authors that concluded that, as radiologists work eight to 12-hour shifts sitting in front of monitors, too much sedentary time not only causes pain but increases the risk of serious illness (e.g., diabetes, cancer). As such, Patrick offers a comment as succinct and insightful as a Shakespearean quote: “Ergonomics is the relationship between the person and the space they work in.” Radiologist as Consultant Recently, another reason for increased awareness has emerged. It is part of ACR’s Imaging 3.0 and it involves what could be termed as a new role paradigm for radiologists – a more consultative role. “The goal of the 3.0 initiative is to bring added value to what radiology does and stands for,” explains Bender. “It was meant to help develop and implement ways that radiologists can provide better patient and family care. Direct communication and consultation will help enhance the practice.” Further, the ACR indicates that Imaging 3.0™ requires facilities to create an environment that allows radiologists to be more accessible to technologists, referring physicians, and patients. The goal is to create an ergonomically correct, integrated service environment that allows the radiologist to provide patient-centric care. For health systems and facilities that seek to move in this direction, the environment means more than just a radiologist’s workplace. Environment involves the larger picture: the workplace and the entire radiology room. As such, ergonomics involves more than a padded, comfortable chair to alleviate strain on the radiologist’s musculoskeletal frame. “The additional environmental factors now being evaluated include lighting, noise reduction, wall colors, and additional workplace equipment, such as phones and dictation tools,” says Bender. There’s a good reason for this broadening focus. If radiologists are going to thrive in their new consultative role, they will need to be at the top of their game, so to speak. The proper environmental ergonomics will allow them to function at highest efficiency – as injury risks, discomfort and stress will be greatly reduced. “Radiologists are being asked to provide an additional contribution, to be an engaged participant.” says Patrick. “They will need the time and energy to do this. That entails greater consideration of how their working environment will allow for that.” Location, location, location That takes into account location as part of the ergonomic structure. Traditionally, radiologists have been “sequestered” – that is, sitting in a dark and solitary room. Ideally, the new reading room/radiologist workplace will be closer to the patient. “Often, this would lead to a major redesign of department facilities,” says Bender. Certain aspects of radiology isolate the department from the rest of the healthcare facility, observes Carrie Schmitz, Ergonomic & Wellness Research Manager at Ergotron, another ergonomic equipment designer and provider. “Radiologists sitting at a desk in front of four or five monitors are like office workers in a sense that they have to deal with a lot of computer equipment in front of them. Their shifts are 8 to 12 hours and they are so focused on the screen. They have issues separate from healthcare in general. They aren’t on their feet a lot. Unless you have a health system that is aware of what’s going on everywhere, radiologists could easily be missed and the department can fall through the cracks.” The relocated room should be designed to foster collaboration in group and oneon-one discussions, and be a place where imaging studies can be viewed by all concerned: referring physicians, specialist and patient. How to make it all Happen The combined tasked of upgrading workspace and workplace ergonomics, redesigning the reading room structure and relocating the entire radiology enterprise may seem daunting. But the ACR isn’t just advocating change or imposing new requirements; it offers help to sites in transition. One way it does this is with its Imaging 3.0 Accelerator Program. This I3AP provides onsite visits to practices moving forward with the new radiologist role and the value-based radiology concept. The ACR designed the program as a jump start. The onsite visit helps identify opportunities to fully engage all radiologists and team members in some aspect of care transformation, according to the ACR. Further, I3AP helps practices recognize what they are already doing to support the Imaging 3.0 concepts as well as both weakness and strength areas. Following that, the ACR provides the practice with actionable items to help make improvements for both the short and long term. The ACR indicates the accelerator program was designed for practices unsure how to appropriately integrate Imaging 3.0 concepts. In addition, the ACR readily provides tips in the form of success stories available at its website. For instance, the case study, “Imaging 3.0 Case Study: Redesigning Care” (available at www.acr.org/Advocacy/Economics-Health-Policy/Imaging3/Case-Studies/Patient-Engagement/Redesigning-Care), relates the successful effort at the Emory University School of Medicine’s Winship Cancer Institute in Atlanta, Ga. The case relates the engagement process involved in cancer treatment followed by PET/CECT or CECT. The Cancer Institute developed a process wherein:  The surgeon or nurse practitioner lets the radiologist in the clinic know when there is a patient who might benefit from a consultation.  If needed, the radiologist spends a few minutes reviewing the images and discussing the plan with the surgeon. It is critical that the whole team knows the treatment plan to avoid sending a mixed message to the patient.  The surgeon lets the patient know that a radiologist will be entering the consultation room to review the images and explain the findings.  After joining the patient in the consultation room, the radiologist briefly explains his or her role in the patient’s care, reviews the images on a virtual desktop PACS, and gives the patient an opportunity to ask questions about anatomy, findings, and post-treatment changes – all in five to 10 minutes. Schmitz was co-presenter (with Dave Minamoto, Healthcare Imaging Sales Anthro) during a recent webinar, “Essential Ergonomics Tips and Tricks,” geared toward both radiologists and healthcare facility administrators. The presentation offered advice about health and wellness and appropriate equipment. For instance:  Ergonomic assessment of what can lead to pain or injury – right arm extended toward mouse with elbow too far from body; left arm bent sharply to support microphone for long durations; monitor screens too low and small, chair seat too low resulting in knees higher than hips; low clearance between thighs and work top; head, neck and trunk twisted, not facing forward; ear not in line with hip  Proper equipment – padded chair that supports neutral posture with adjustable seat, back, armrest heights back tilt; seat tilt seat pan depth back with lumbar, neck, head support; adjustable task light angle intensity location; sit-stand desk  Work Practices – breathe, blink, break: frequent mini breaks, blink eyes to lubricate, breathe deeply “With ergonomics, there are three domains that have to be considered: the equipment, work practices and the administrative,” says Schmitz. The administrative domain involve shift considerations (making sure that people take their breaks every two hours) and establishing a wellness culture that reaches the most isolated people, even the remote radiologists. “That’s a challenging domain and that’s where education needs to come in,” advises Schmitz. Bender offers a good example of an education opportunity as well as an example of a repetitive stress injury that involves what can happen with an ultrasonographer. “Key factors in reducing injury include correct handling of the US transducer, patient position, the understanding and best application of body mechanics, and preventive training (stretching and strengthening exercise) specific to the task,” she says. “My ultrasonography training program has successfully instituted a required course for understanding body mechanics of scanning and has regular musculoskeletal training classes.” Ergonomics and ROI The benefits of ergonomics not only positively impact health; they also make for sound economics. Good ergonomics make for happy and healthy radiologists. A healthy radiologist is someone who is productive and experiences job satisfaction. In this way both burnout and injuries are greatly reduced. Both negatively affect departmental productivity and, thus, are costly. In her webinar presentation, Schmitz emphasized the healthy ergonomics return on investment: “The median productivity increase following an ergonomic intervention was 12 percent. New studies suggest that employees who are provided with well designed ergonomic furniture and are trained to use it see an average 18 percent increase in productivity.” Again, a healthy radiologist is a productive one. That’s why the focus on health keeps increasing. “It is important because it allows the radiologist to work longer and work more efficiently,” says Patrick. “The benefits for both the radiologist and administration are longer careers, no lost time due to injury, and no worker compensation problems for the employer.” The increases in productivity, validated by studies, compel Patrick to comment, “It’s a no brainer. Ergonomics makes for a good investment with solid financial return. Injuries related ergonomics are no less real and certainly no less costly than a worker in another industry breaking a leg.” Further, when you combine all of the above, that leads to easier recruitment and longer retention. “Provide the tools and you’ll spend less time recruiting and you’ll retain your work force,” adds Patrick. Vendor Support for 3.0 Meanwhile, ergonomic equipment providers keep upgrading their offerings to further the 3.0 driven transition. RedRick Technologies designs and builds customized equipment to suit its customers’ specific ergonomic needs, specifically with radiology in mind. Though customization is key to its service, all of Redrick’s products include three major functions. The first is expanded adjustability of the desk tops, to accommodate 95 percent of the population in a sitting or standing position, due to its range. Second, the company offers the capability to adjust an entire monitor set, not just one monitor at a time. “In some places, you’ll find as many six monitors at each work station,” observes Patrick. “Each one needs to be adjusted in height in relation to the desktop, the location of your keyboard and mouse. Monitors need to adjust in relation to that desktop surface.” All adjustments align the shoulder, elbows and wrists and allows for proper alignment of the neck. The third function adjusts the monitor depth, or the focal depth – the distance from the radiologist’s eyes. “That helps avoid undue eye strain,” says Patrick. RedRick also offers light solutions that provide ambient light around the monitor. “The monitor itself already gives off illumination, so if you surround it with equal illumination, eyestrain is lessened,” explains Patrick. “The environment should not be overly bright. But we don’t want an environment to be darker than the monitors. Both of those extremes cause eyestrain due to pupils dilating.” Lighting also accommodates foot traffic, the people coming and going into the radiology rooms’ new environment. “We are turnkey organization, as we provide a full reading room solution,” says Patrick. “We are not just a furniture provider. We bring a lot of experience and gained knowledge into the reading room environment.” One of Ergotron’s latest offering is the Table CT15 for Radiology, a radiologic imaging workstation desk. The table’s height and tilt can be easily adjusted, essentially with the push of a button. This enables the radiologist to work while sitting and standing. In this way, the user can stay energized and productive. It also includes the electric Monitor Control System that allows for adjustment of the entire bank of displays up and down, forward and back to the perfect focal distance. Both company’s products play their part in the new environment of the 3.0 inspired reading room. “The driver for that improved radiologist reading room is to keep a healthy workforce in this very demanding world,” says Bender. “Keeping staff healthy and happy will hopefully keep them professionally satisfied, motivated, and performing high quality and safe work which results in high quality patient care.”