Importance and Effects of Altered Workplace Ergonomics in Modern Radiology Suites

A Cross-Sectional Study of Circadian Stimulus in Swedish Radiographers' Light Environment

Background: Timely light exposure is a vital aspect to achieve better sleep and well-being. As there are risks with a disturbed circadian rhythm and benefits with light settings that stimulate the rhythm, the circadian effective light, circadian stimulus (CS), for radiographers was examined. Aim: The aim of the study was to compare radiographers' light environment on the workstations, at a university hospital in Southern Sweden in the form of CS and relate that to recommendations published by the Swedish Environmental Protection Agency. Method: A cross-sectional method has been applied. The measurements for CS were collected in all labs in the radiology department in the middle of January. Result: A total of 804 measures were evenly collected resulting in a median for the 19 labs, where the observed median for all labs was 0.091 CS which is significantly lower than the recommended value of 0.3 CS (p < .001). Comparing work light settings with maximum light levels in the brightest and darkest labs showed a significant difference (p < .001). Conclusion: The CS values in the labs, at the radiology department at a university hospital in Southern Sweden, do not reach the recommended values of circadian stimulus published by the Swedish Environmental Protection Agency when the radiographers themselves set the light. There is a potential for improvement as a significant difference could be seen between the chosen level of light and the maximum possible level of light.

Work-related musculoskeletal disorders affecting diagnostic radiologists and prophylactic physical therapy regimen

The shift from film to PACS in reading rooms, coupled with escalating case volumes, exposes radiologists to the issues of the modern computer workstation including computer work posture and work-related musculoskeletal disorders (WMSD). Common WMSDs affecting the neck and upper extremities include cervical myofascial pain, shoulder tendonitis, lateral epicondylitis, carpal tunnel syndrome, and cubital tunnel syndrome. This review examines each pathology along with its pathogenesis, clinical features, physical exam findings, and potential risk factors. Furthermore, a comprehensive 11-part physical therapy regimen that is both prophylactic and therapeutic is illustrated and described in detail. One of the objectives of this review is to advocate for the inclusion of a physical therapy regimen in the working routine of diagnostic radiologists to prevent WMSDs. A brief daily commitment to this regimen can help radiologists remain healthy and productive in order to deliver optimal patient care throughout their careers.

Assessment of Musculoskeletal Discomfort and Evaluation of Radiology Workstation Ergonomics in a National Radiology Workforce

RATIONALE AND OBJECTIVES

We assessed the presence of musculoskeletal discomfort and evaluated the ergonomics parameters of radiology workstations and the impact of poor radiology workstation ergonomics on musculoskeletal discomfort in a national radiology workforce.

METHODS

This was a cross-sectional, questionnaire-based study. All radiologist and radiology trainee members of the Canadian Association of Radiologists were eligible to participate. Radiology workstation ergonomics parameters and self-reported data on musculoskeletal discomfort were recorded. A binary logistic regression model was fitted to the data to ascertain the impact of participants' radiology workstation ergonomics parameters on the likelihood of experience of musculoskeletal discomfort while adjusting for demographic variables.

RESULTS

A total of 191 questionnaires were completed. The median (interquartile range) age of participants was 42.0 years (17.0 years) and 56.8% of participants were female. One hundred fifty participants (78.5%) self-reported the presence of musculoskeletal discomfort. Ergonomics parameters most commonly implemented included having monitors an arm's length away (82.6%) and hands being shoulder-width apart (77.1%). Binary logistic regression revealed participants either not having the top of the monitor screen at eye level when in a seated position or not having the wrists straight and relatively flat when using the mouse was associated with an increased likelihood of experience of musculoskeletal discomfort. The majority of participants (92.7%) self-reported their musculoskeletal discomfort to affect work productivity.

CONCLUSION

A high proportion of musculoskeletal discomfort, limited implementation of ergonomics parameters of radiology workstations, and an association of two of these ergonomics parameters with an increased likelihood of experience of musculoskeletal discomfort were observed in a national radiology workforce.

Young people's low back pain and awareness of postural habits: A cross-sectional study

BACKGROUND

Young people tend to spend most of their time in activities involving inappropriate positions, which can promote musculoskeletal alterations and disorders.

OBJECTIVE

To investigate the prevalence of low back pain (LBP) in young people and analyse its associations with daily postural habits.

METHODS

Cross-sectional and retrospective study evaluating 679 Brazilian young people (15 to 18 years old), using questionnaires about LBP and awareness of postural habits. The prevalence values were calculated for the present moment, the last three months and throughout life. The Mann-Whitney U test and the Chi-square test were applied.

RESULTS

The prevalence of LBP at the present moment was 27.2%, 57.7% over the last three months and 73.9% throughout life. Boys and girls presented significantly different values, a larger number of girls manifesting pain for the three moments. The associated postural habits were: turning the body, reduction of lumbar lordosis when seated, not placing the feet on the floor, crossing the legs when sitting in the classroom and at home, sitting or lying in an inappropriate position, and distributing the body asymmetrically on the legs when standing.

CONCLUSIONS

Young people from 15 to 18 years of age show a high prevalence of low back pain. Inadequate postural habits adopted during everyday activities are associated with this complaint. These findings could contribute to the implementation of prevention and rehabilitation strategies.

Musculoskeletal symptoms among radiation technologists in Saudi Arabia: prevalence and causative factors

BACKGROUND

Radiation technologists usually perform several physical tasks as part of their work routine that are related to imaging equipment and handling patients. These kinds of physical activities increase their risk of developing musculoskeletal symptoms (MSS).

PURPOSE

To determine the prevalence and causative factors of MSS among radiation technologists in Saudi Arabia.

MATERIAL AND METHODS

A previously validated and published questionnaire was sent electronically to 800 radiation technologists in Saudi Arabia. It focused on the presence and prior diagnosis of MSS. Questions to determine risk factors were included.

RESULTS

A total of 381 responses were obtained. MSS were indicated by 326 responders (85.6%). Furthermore, it was reported that 309 responders (81.1%) spent more than 2 h per day in awkward postures. Of the responders, 164 (43%) stated that they worked 4 h per day on a personal computer or PACS. The most frequently selected reasons for MSS included patient transfer (50.6%), chairs (38.5%), lead aprons (25.6%), moving heavy equipment (23.1%), and fixed table height (19.4%). An association between work-related MSS and gender was observed (χ²(1) = 5.338; P = 0.021). Similarly, an association between work-related MSS and age was also observed (χ²(3) = 48.58; P = 0.000).

CONCLUSION

Radiation technologists in Saudi Arabia reported a fairly high incidence of MSS, more commonly among female and senior workers. To have a better and safer workplace for radiation technologists, this study suggests preventive measures on organizational and individual levels.

What Influences the Way Radiologists Express Themselves in Their Reports? A Quantitative Assessment Using Natural Language Processing

Although using standardized reports is encouraged, most emergency radiological reports in France remain in free-text format that can be mined with natural language processing for epidemiological purposes, activity monitoring or data collection. These reports are obtained under various on-call conditions by radiologists with various backgrounds. Our aim was to investigate what influences the radiologists’ written expressions. To do so, this retrospective multicentric study included 30,227 emergency radiological reports of computed tomography scans and magnetic resonance imaging involving exactly one body region, only with pathological findings, interpreted from 2019–09-01 to 2020–02-28 by 165 radiologists. After text pre-processing, one-word tokenization and use of dictionaries for stop words, polarity, sentiment and uncertainty, 11 variables depicting the structure and content of words and sentences in the reports were extracted and summarized to 3 principal components capturing 93.7% of the dataset variance. In multivariate analysis, the 1^st principal component summarized the length and lexical diversity of the reports and was significantly influenced by the weekday, time slot, workload, number of examinations previously interpreted by the radiologist during the on-call period, type of examination, emergency level and radiologists’ gender (P value range: < 0.0001–0.0029). The 2^nd principal component summarized negative formulations, polarity and sentence length and was correlated with the number of examination previously interpreted by the radiologist, type of examination, emergency level, imaging modality and radiologists’ experience (P value range: < 0.0001–0.0032). The last principal component summarized questioning, uncertainty and polarity and was correlated with the type of examination and emergency level (all P values < 0.0001). Thus, the length, structure and content of emergency radiological reports were significantly influenced by organizational, radiologist- and examination-related characteristics, highlighting the subjectivity and variability in the way radiologists express themselves during their clinical activity. These findings advocate for more homogeneous practices in radiological reporting and stress the need to consider these influential features when developing models based on natural language processing.

The effects of using a footrest during computer tasks varying in complexity and temporal demands: A postural and electromyographic analysis

Prior research has found that office workers may not be fully utilizing their chair's back support. This may be due in part to cognitive demands or other psychological stressors. Not using the back support may increase the muscle tension and contribute to muscle fatigue and discomfort. Historically, footrests have been advocated to address anthropometric disparities in office settings. In this laboratory study, it was hypothesized that a footrest may facilitate the use of the backrest and mediate the biomechanical demands on the back and neck muscles, especially when cognitive workload is elevated. Twenty participants performed computer tasks, which varied in their complexity levels, both with and without an angled footrest. Using a footrest increased workers' use of a chair's backrest, increased pelvic rotation towards the backrest, and had a corresponding change in spine flexion. However, no changes were found in the sampled electromyographic activities due to the footrest.

Comparison of muscle activity while using different input devices in digital pathology

INTRODUCTION

The high prevalence of musculoskeletal disorders in pathologists, together with the current trend towards the digitization of pathology, prompted us to study the different types of input devices employed during the revision of whole slide images, in order to investigate the pattern and extent of muscle activity involved in their use.

MATERIAL AND METHODS

A comparative study was made of 10 input devices (conventional and vertical mouse, three trackballs, the Ergopointer™, the Rollermouse™, an optical pen mouse, a touchpad, and the Leap Motion™). Six medical students performed a standardized circuit using a Fitts' Law based tissue array, digitized. The electrical activity of seven upper limb muscles (adductor pollicis, extensor pollicis longus, extensor digitorum, flexor digitorum, middle deltoid, upper trapezius, and middle trapezius) was measured using surface electromyography.

RESULTS

Statistically significant differences in the overall electrical activity among the different input devices, both absolute values in mV as well as normalized values to the upper limb at rest, were observed (p<0.001); the Rollermouse™ (0.1027mV; 139%), Logitech M570 trackball (0.1053mV; 145%), Ergopointer™ (0.1151mV; 167%), conventional mouse (0.1251mV; 191%), and vertical mouse (0.1312mV; 205%) required less activity, while the optical pen mouse (0.1717mV; 299%), Leap Motion™ (0.1803mV; 319%), Expert Mouse trackball (0.1845mV; 329%), EIGIIS trackball (0.2442mV; 468%) and the touchpad (0.2560mV; 496%) required greater muscle mobilization.

CONCLUSION

We designed a system based on Fitts' Law to compare input devices in digital pathology. Variability between compared devices and muscle activity was found. Long-term use could result in different muscular fatigue patterns. Even though the selection of an input device is a matter of personal preference, its impact on ergonomics should be considered.

Role of Ergonomic Improvements in Decreasing Repetitive Stress Injuries and Promoting Well-Being in a Radiology Department

RATIONALE AND OBJECTIVES

To determine if ergonomic improvements in a radiology department can decrease repetitive stress injuries (RSIs), advance ergonomics knowledge, and improve well-being.

MATERIALS AND METHODS

Radiologists in an academic institution were surveyed regarding physician wellness, workstations, RSIs, and ergonomics knowledge before and after interventions over 1 year. Interventions included committee formation, education, wrist pads and wireless mice, broken table and chair replacement, and cord organization. Mann-Whitney U test was used for analysis.

RESULTS

Survey response was 40% preinterventions (59/147), and 42% (66/157) postinterventions. Preinterventions, of radiologists with RSI history, 17/40 (42%) reported the RSI caused symptoms which can lead to burnout, and 15/40 (37%) responded their RSI made them think about leaving their job. Twenty-three of 59 (39%) radiologists had an active RSI preinterventions. Postinterventions, 9/25 (36%) RSI resolved, 13/25 (52%) RSI improved, and 3/25 (12%) RSI did not improve. RSI improvements were attributed to ergonomic interventions in 19/25 (76%) and therapy in 2/25 (8%). Radiologists who thought their workstation was designed with well-being in mind increased from 9/59 (15%) to 52/64 (81%). The percentage of radiologists knowing little or nothing about ergonomics decreased from 15/59 (25%) to 5/64 (8%). After ergonomics interventions, more radiologists thought the administration cared about safety and ergonomics, equipment was distributed fairly, and radiologists had the ability to ask for equipment (p < .01). Fifty-three of 64 (83%) of radiologists after interventions said improving workstation ergonomic design contributed to well-being.

CONCLUSION

Ergonomic improvements in radiology can decrease RSIs, advance ergonomics knowledge, and improve well-being.

Creating joy in the workplace

Creating a joyful workplace is not the same as dealing with issues of stress, fatigue, burn-out, and resilience. It requires a proactive approach to augment feelings of worth, appreciation, and well-being in the members of the team. The sense that one is pursuing worthwhile, valuable activities requires a wholesale commitment to the mission, vision and values of the organization. These tenets are often created through an organic consensus of collegial workmates and then put to action by a leadership team. Reassessing the goals and virtues of the organization at appropriate intervals leads to ongoing loyalty and commitment to the team and a positive attitude. Well-being is addressed through the creation of a bright and cheerful physical and psychosocial workplace that offers programs that encourage mindfulness, humor, playfulness, and fitful lifestyle choices. The sense that one's work is appreciated and valued stems from an attitude of gratitude on behalf of all levels of the organization including management and peers where such encouragement flourishes. Those expressions of appreciation may be in the form of celebrations in the workplace and/or compensation and benefits that appropriately value the contributions of the employee. The organization's executive team should be dedicated to crafting an environment that leads to delighted, healthy employees.

TSR guidelines for the practice of teleradiology: 2021 update

This update of Turkish Society of Radiology's (TSR) guidelines for the practice of teleradiology is intended to provide a reference framework for all parties involved in delivering imaging services away from the immediate vicinity of the patient. It includes relevant definitions and general principles, features organizational modes and qualifications of the practicing parties, lists technical issues, and addresses such management and legal aspects as archiving and documentation, security and privacy, reliability, responsibilities, quality inspection and improvement, reimbursement and accountability.

Study protocol for a randomized controlled trial to improve the quality of life of housewives with musculoskeletal disorders: a health promotion intervention based on a participatory ergonomic approach-the Housewives Ergonomic Intervention (HEI) trial

Background

A variety of household chores expose women to a variety of biomechanical and psychosocial risk factors. A result of this is many housewives with musculoskeletal disorders. Given the interactive effects of these risk factors, it is necessary to consider multiple strategies to mitigate their effects. Accordingly, the present study will investigate the impact of a health promotion training program based on a participatory ergonomic approach towards a reduction in the prevalence of musculoskeletal disorders and an improvement in the quality of life of housewives.

Methods

Iranian housewives aged 20–65 years currently attending a specialist health clinic due to a painful musculoskeletal complaint will be invited to join the study. Recruitment will continue until a sample of 160 women provides informed consent to participate. The study will be conducted using a mixed-methods protocol in two phases. In the first phase, psychosocial and biomechanical risk factors will be identified using a qualitative approach. In the next phase, the results from the qualitative approach will be used to develop a conceptual framework based on health promotion theories and an intervention program based on a participatory ergonomic approach designed. Participants will be randomly allocated into one of four groups: (1) biomechanical intervention group, (2) psychosocial intervention group, (3) multidisciplinary intervention group (both biomechanical and psychosocial intervention), and (4) a control group. Data will be collected using Rapid Entire Body Assessment (REBA), Visual Analog Scale (VAS), Work Ability Score (WAS), Hospital Anxiety and Depression Scale (HADS), and the 36-item Short-Form health survey (SF-36) at baseline in 3-month and 6-month follow-up assessments. The impact of the three interventions on musculoskeletal disorders, work ability, stress, and quality of life will then be evaluated.

Discussion

The study will provide a practical approach to reducing stress, reducing musculoskeletal disorders, enhancing the ability to work, and improving the quality of life of women with musculoskeletal disorders associated with housework. If the designed interventions in the present study are effective, they will have the great practical potential for generalization to all housewives.

Trial registration

ClinicalTrials.gov IRCT20200602047640N. Registered on 07 September 2020 with the IRCTID.

Ergonomics in Interventional Radiology: Awareness Is Mandatory

Ergonomics in interventional radiology has not been thoroughly evaluated. Like any operators, interventional radiologists are exposed to the risk of work-related musculoskeletal disorders. The use of lead shielding to radiation exposure and the lack of ergonomic principles developed so far contribute to these disorders, which may potentially affect their livelihoods, quality of life, and productivity. The objectives of this review were to describe the different situations encountered in interventional radiology and to compile the strategies both available to date and in development to improve ergonomics.

Ergonomics in IR

Ergonomic research in the field of interventional radiology remains limited. Existing literature suggests that operators are at increased risk for work-related musculoskeletal disorders related to the use of lead garments and incomplete knowledge of ergonomic principles. Data from existing surgical literature suggest that musculoskeletal disorders may contribute to physician burnout and female operators are at a higher risk of developing musculoskeletal disorders. This review article aims to summarize the existing ergonomic challenges faced by interventional radiologists, reiterate existing solutions to these challenges, and highlight the need for further ergonomic research in multiple areas, including burnout and gender.

Physical exercise among radiologists in Saudi Arabia: a cross-sectional study

Background

The practice of clinical radiology has become more sedentary in the era of the Picture Archiving and Communication System. Physical inactivity is a well-known risk factor for various chronic diseases. This study aimed to determine the frequency and pattern of physical exercises among radiologists in the Eastern Province of Saudi Arabia and the association between physical exercises and the prevalence of work-related musculoskeletal symptoms.

Methods

An online survey was sent to radiologists in all hospitals (academic, public, and private) in the major cities of the Eastern Province of Saudi Arabia. It covered information about demographic characteristics and the frequency and pattern of physical exercises. It also included an evaluation of work-related musculoskeletal symptoms using the Nordic Musculoskeletal Questionnaire. This survey of 263 radiologists was conducted in April 2019. The study outcome was the presence of disabling musculoskeletal symptoms in any body region which restricted the performance of normal activities within the last 12 months. The study results were analyzed descriptively using the Chi-square test.

Results

The survey was completed by 198 participants (111 men and 87 women) with a response rate of 75.3%. Most participants (71.2%) were less than 40 years. Eighty-three men (74.8%) did a physical exercise at least weekly, compared to 45 (51.7%) women. Men were more likely to engage in various physical exercises than women. Overall, 60.9% of participants who did not do any physical exercise regularly (less than monthly) reported having disabling neck pain. This figure was found lower among participants who did physical exercises monthly (45.8%) or at least weekly (32.8%). A similar pattern was observed with shoulder pain, with 45.7% found in participants who did not exercise and only 25.8% in those engaging in physical activities at least weekly.

Conclusions

Physical inactivity is common among radiologists, especially female ones, in the Eastern Province of Saudi Arabia. The physical inactivity was significantly associated with work-related musculoskeletal symptoms. Gender-specific health promotion programs are needed to mitigate the negative health outcomes due to the sedentary nature of the radiology current practice.

The Road to Wellness: Engagement Strategies to Help Radiologists Achieve Joy at Work

Physician wellness is recognized as a critical component of enhancing the quality of health care. An epidemic of symptoms related to stress and burnout among medical professionals, including radiologists, in the workplace is threatening not only health care providers at a personal level but also the entire health care system. In this review, the authors highlight recognized stressors in the contemporary radiology workplace and offer practical suggestions for mitigating burnout, improving professional engagement, and promoting wellness. Thematic goals to focus on include fostering an integrated and harmonious community at work, diminishing workplace detractors, creating opportunities to cultivate positive attitudes and intellect, and implementing effective leadership practices. ^©RSNA, 2018.

Perceptual and Interpretive Error in Diagnostic Radiology-Causes and Potential Solutions

Interpretation of increasingly complex imaging studies involves multiple intricate tasks requiring visual evaluation, cognitive processing, and decision-making. At each stage of this process, there are opportunities for error due to human factors including perceptual and ergonomic conditions. Investigation into the root causes of interpretive error in radiology first began over a century ago. In more recent work, there has been increasing recognition of the limits of human image perception and other human factors and greater acknowledgement of the role of the radiologist's environment in increasing the risk of error. This article reviews the state of research on perceptual and interpretive error in radiology. This article focuses on avenues for further error examination, and strategies for mitigating these errors are discussed. The relationship between artificial intelligence and interpretive error is also considered.

Visual adaptation and the amplitude spectra of radiological images

We examined how visual sensitivity and perception are affected by adaptation to the characteristic amplitude spectra of X-ray mammography images. Because of the transmissive nature of X-ray photons, these images have relatively more low-frequency variability than natural images, a difference that is captured by a steeper slope of the amplitude spectrum (~ − 1.5) compared to the ~ 1/f (slope of − 1) spectra common to natural scenes. Radiologists inspecting these images are therefore exposed to a different balance of spectral components, and we measured how this exposure might alter spatial vision. Observers (who were not radiologists) were adapted to images of normal mammograms or the same images sharpened by filtering the amplitude spectra to shallower slopes. Prior adaptation to the original mammograms significantly biased judgments of image focus relative to the sharpened images, demonstrating that the images are sufficient to induce substantial after-effects. The adaptation also induced strong losses in threshold contrast sensitivity that were selective for lower spatial frequencies, though these losses were very similar to the threshold changes induced by the sharpened images. Visual search for targets (Gaussian blobs) added to the images was also not differentially affected by adaptation to the original or sharper images. These results complement our previous studies examining how observers adapt to the textural properties or phase spectra of mammograms. Like the phase spectrum, adaptation to the amplitude spectrum of mammograms alters spatial sensitivity and visual judgments about the images. However, unlike the phase spectrum, adaptation to the amplitude spectra did not confer a selective performance advantage relative to more natural spectra.

Work-Related Injuries of Radiologists and Possible Ergonomic Solutions: Recommendations From the ACR Commission on Human Resources

Increasingly, radiologists' workplaces revolve around PACS and digital imaging. Use of these technologies can lead to repetitive strain injuries, many of which can be exacerbated by specific features of a radiology practice environment. Ergonomic approaches, such as proper reading room structure, lighting, temperature, noise, and equipment setup, can help decrease the frequency and severity of repetitive strain injuries and improve radiologist productivity. However, ergonomic approaches are complex, include all aspects of the radiology practice environment, and are best implemented along with proper training of the practicing radiologists. The ergonomic approaches considered most important by members of the ACR Commission on Human Resources are presented in this report, and this information may serve as an aid in departmental planning.

INTRAOPERATIVE IMAGE NAVIGATION: EXPERIMENTAL STUDY OF THE FEASIBILITY AND SURGEON PREFERENCE BETWEEN A STERILE ENCASED NINTENDO WIITM REMOTE AND STANDARD WIRELESS COMPUTER MOUSE

Diagnostic imaging plays an important role in the operating room, providing surgeons with a reference and surgical plan. Surgeon autonomy in the operating room has been suggested to decrease errors that stem from communication mistakes. A standard computer mouse was compared to a wireless remote-control style controller for computer game consoles (Wiimote) for the navigation of diagnostic imaging studies by sterile personnel in this prospective survey study. Participants were recruited from a cohort of residents and faculty that use the surgical suites at our institution. Outcome assessments were based on survey data completed by study participants following each use of either the mouse or Wiimote, and compared using an analysis of variance. The mouse was significantly preferred by the study participants in the categories of handling, accuracy and efficiency, and overall satisfaction (P <0.05). The mouse was preferred to both the Wiimote and to no device, when participants were asked to rank options for image navigation. This indicates the need for the implementation of intraoperative image navigation devices, to increase surgeon autonomy in the operating room.

Imaging Informatics: 25 Years of Progress

The science and applications of informatics in medical imaging have advanced dramatically in the past 25 years. This article provides a selective overview of key developments in medical imaging informatics. Advances in standards and technologies for compression and transmission of digital images have enabled Picture Archiving and Communications Systems (PACS) and teleradiology. Research in speech recognition, structured reporting, ontologies, and natural language processing has improved the ability to generate and analyze the reports of imaging procedures. Informatics has provided tools to address workflow and ergonomic issues engendered by the growing volume of medical image information. Research in computeraided detection and diagnosis of abnormalities in medical images has opened new avenues to improve patient care. The growing number of medical-imaging examinations and their large volumes of information create a natural platform for "big data" analytics, particularly when joined with high-dimensional genomic data. Radiogenomics investigates relationships between a disease's genetic and gene-expression characteristics and its imaging phenotype; this emerging field promises to help us better understand disease biology, prognosis, and treatment options. The next 25 years offer remarkable opportunities for informatics and medical imaging together to lead to further advances in both disciplines and to improve health.

Simple and efficient method for region of interest value extraction from picture archiving and communication system viewer with optical character recognition software and macro program

RATIONALE AND OBJECTIVES

The objectives are: 1) to introduce a simple and efficient method for extracting region of interest (ROI) values from a Picture Archiving and Communication System (PACS) viewer using optical character recognition (OCR) software and a macro program, and 2) to evaluate the accuracy of this method with a PACS workstation.

MATERIALS AND METHODS

This module was designed to extract the ROI values on the images of the PACS, and created as a development tool by using open-source OCR software and an open-source macro program. The principal processes are as follows: (1) capture a region of the ROI values as a graphic file for OCR, (2) recognize the text from the captured image by OCR software, (3) perform error-correction, (4) extract the values including area, average, standard deviation, max, and min values from the text, (5) reformat the values into temporary strings with tabs, and (6) paste the temporary strings into the spreadsheet. This principal process was repeated for the number of ROIs. The accuracy of this module was evaluated on 1040 recognitions from 280 randomly selected ROIs of the magnetic resonance images. The input times of ROIs were compared between conventional manual method and this extraction module-assisted input method.

RESULTS

The module for extracting ROI values operated successfully using the OCR and macro programs. The values of the area, average, standard deviation, maximum, and minimum could be recognized and error-corrected with AutoHotkey-coded module. The average input times using the conventional method and the proposed module-assisted method were 34.97 seconds and 7.87 seconds, respectively.

CONCLUSIONS

A simple and efficient method for ROI value extraction was developed with open-source OCR and a macro program. Accurate inputs of various numbers from ROIs can be extracted with this module. The proposed module could be applied to the next generation of PACS or existing PACS that have not yet been upgraded.

Musculoskeletal symptoms amongst clinical radiologists and the implications of reporting environment ergonomics--a multicentre questionnaire study

This multicentre study aimed to assess compliance of the reporting environment with best ergonomic practice and to determine the prevalence of musculoskeletal symptoms related to working as a radiologist. All 148 radiology trainees and consultants in 10 hospitals across the region were invited to complete a musculoskeletal symptoms and reporting ergonomics questionnaire. Best ergonomic reporting practice was defined, following literature review, as being able to alter the following: monitor, desk, chair and armrest height, chair back support, ambient light, and temperature. The frequency that these facilities were available and how often they were used was determined. One hundred and twenty-three out of 148 (83%) radiologists responded, and 38% reported radiology-associated occupational injury. Lower back discomfort was the commonest radiology associated musculoskeletal symptom (41%). Only 13% of those with occupational injury sought the advice of occupational health. No reporting environments conformed completely to best ergonomic practice. Where certain facilities were available, less than a third of radiologists made personal ergonomic adjustments prior to starting a reporting session. Radiologists who had good self-assessed knowledge of best ergonomic practice had significantly less back discomfort than those with poor self-assessed knowledge (P < 0.005). We demonstrated high prevalence of musculoskeletal symptoms amongst radiologists. Poor compliance of the reporting environment with best ergonomic practice, in combination with our other findings of a low level of ergonomic awareness, low rates of making ergonomic adjustments and seeking appropriate help, may be implicated. We hope this study raises awareness of this issue and helps prevent long-term occupational injury amongst radiologists from poor ergonomic practice.

[Ergonomically designed radiology workplace]

An ergonomically designed radiology workplace is a key factor for concentrated work during the whole day and is essential in preventing negative long-term effects due to inappropriate physical strain. To avoid such negative effects it is of paramount importance to know the factors that might cause strain on the radiologist, the appropriate application for workplace design to address these factors and how work-related disorders emerge. To minimize physical strain due to long-lasting and repetitive movements, the workspace must be adapted to the physical needs of the radiologist. Adjustable settings for the work desk and seat, together with correct screen positioning and distance from the screen, are examples of such important factors in an ergonomic workplace design. In addition, adjustable ambient light, an adjustable conditioned climate, an appropriate color design for the environment and a reduction of unnecessary noise are also crucial factors for an ergonomic workplace. This review gives an overview about the factors that influence the radiology workspace and summarizes the current literature on this topic.

ACR white paper on teleradiology practice: a report from the Task Force on Teleradiology Practice

Teleradiology services are now embedded into the workflow of many radiology practices in the United States, driven largely by an expanding corporate model of services. This has brought opportunities and challenges to both providers and recipients of teleradiology services and has heightened the need to create best-practice guidelines for teleradiology to ensure patient primacy. To this end, the ACR Task Force on Teleradiology Practice has created this white paper to update the prior ACR communication on teleradiology and discuss the current and possible future state of teleradiology in the United States. This white paper proposes comprehensive best-practice guidelines for the practice of teleradiology, with recommendations offered regarding future actions.

On the choice of acceptance radius in free-response observer performance studies

OBJECTIVES

Choosing an acceptance radius or proximity criterion is necessary to analyse free-response receiver operating characteristic (FROC) observer performance data. This is currently subjective, with little guidance in the literature about what is an appropriate acceptance radius. We evaluated varying acceptance radii in a nodule detection task in chest radiography and suggest guidelines for determining an acceptance radius.

METHODS

80 chest radiographs were chosen, half of which contained nodules. We determined each nodule's centre. 21 radiologists read the images. We created acceptance radii bins of <5 pixels, <10 pixels, <20 pixels and onwards up to <200 and 200+ pixels. We counted lesion localisations in each bin and visually compared marks with the borders of nodules.

RESULTS

Most reader marks were tightly clustered around nodule centres, with tighter clustering for smaller than for larger nodules. At least 70% of readers' marks were placed within <10 pixels for small nodules, <20 pixels for medium nodules and <30 pixels for large nodules. Of 72 inspected marks that were less than 50 pixels from the centre of a nodule, only 1 fell outside the border of a nodule.

CONCLUSION

The acceptance radius should be based on the larger nodule sizes. For our data, an acceptance radius of 50 pixels would have captured all but 2 reader marks within the borders of a nodule, while excluding only 1 true-positive mark. The choice of an acceptance radius for FROC analysis of observer performance studies should be based on the size of larger abnormalities.

Development and evaluation of an office ergonomic risk checklist: ROSA--rapid office strain assessment

The Rapid Office Strain Assessment (ROSA) was designed to quickly quantify risks associated with computer work and to establish an action level for change based on reports of worker discomfort. Computer use risk factors were identified in previous research and standards on office design for the chair, monitor, telephone, keyboard and mouse. The risk factors were diagrammed and coded as increasing scores from 1 to 3. ROSA final scores ranged in magnitude from 1 to 10, with each successive score representing an increased presence of risk factors. Total body discomfort and ROSA final scores for 72 office workstations were significantly correlated (R = 0.384). ROSA final scores exhibited high inter- and intra-observer reliability (ICCs of 0.88 and 0.91, respectively). Mean discomfort increased with increasing ROSA scores, with a significant difference occurring between scores of 3 and 5 (out of 10). A ROSA final score of 5 might therefore be useful as an action level indicating when immediate change is necessary. ROSA proved to be an effective and reliable method for identifying computer use risk factors related to discomfort.

Efficient radiologic reading environment by using an open-source macro program as connection software

PURPOSE

The objectives are (1) to introduce an easy open-source macro program as connection software and (2) to illustrate the practical usages in radiologic reading environment by simulating the radiologic reading process.

MATERIALS AND METHODS

The simulation is a set of radiologic reading process to do a practical task in the radiologic reading room. The principal processes are: (1) to view radiologic images on the Picture Archiving and Communicating System (PACS), (2) to connect the HIS/EMR (Hospital Information System/Electronic Medical Record) system, (3) to make an automatic radiologic reporting system, and (4) to record and recall information of interesting cases. This simulation environment was designed by using open-source macro program as connection software.

RESULTS

The simulation performed well on the Window-based PACS workstation. Radiologists practiced the steps of the simulation comfortably by utilizing the macro-powered radiologic environment. This macro program could automate several manual cumbersome steps in the radiologic reading process. This program successfully acts as connection software for the PACS software, EMR/HIS, spreadsheet, and other various input devices in the radiologic reading environment.

CONCLUSION

A user-friendly efficient radiologic reading environment could be established by utilizing open-source macro program as connection software.

The use of human factors methods to identify and mitigate safety issues in radiation therapy

BACKGROUND AND PURPOSE

New radiation therapy technologies can enhance the quality of treatment and reduce error. However, the treatment process has become more complex, and radiation dose is not always delivered as intended. Using human factors methods, a radiotherapy treatment delivery process was evaluated, and a redesign was undertaken to determine the effect on system safety.

MATERIAL AND METHODS

An ethnographic field study and workflow analysis was conducted to identify human factors issues of the treatment delivery process. To address specific issues, components of the user interface were redesigned through a user-centered approach. Sixteen radiation therapy students were then used to experimentally evaluate the redesigned system through a usability test to determine the effectiveness in mitigating use errors.

RESULTS

According to findings from the usability test, the redesigned system successfully reduced the error rates of two common errors (p<.04 and p<.01). It also improved the mean task completion time by 5.5% (p<.02) and achieved a higher level of user satisfaction.

CONCLUSIONS

These findings demonstrated the importance and benefits of applying human factors methods in the design of radiation therapy systems. Many other opportunities still exist to improve patient safety in this area using human factors methods.

Alternative user interface devices for improved navigation of CT datasets

The workflow in radiology departments has changed dramatically with the transition to digital PACS, especially with the shift from tile mode to stack mode display of volumetric images. With the increasing number of images in routinely captured datasets, the standard user interface devices (UIDs) become inadequate. One basic approach to improve the navigation of the stack mode datasets is to take advantage of alternative UIDs developed for other domains, such as the computer game industry. We evaluated three UIDs both in clinical practice and in a task-based experiment. After using the devices in the daily image interpretation work, the readers reported that both of the tested alternative UIDs were better in terms of ergonomics compared to the standard mouse and that both alternatives were more efficient when reviewing large CT datasets. In the task-based experiment, one of the tested devices was faster than the standard mouse, while the other alternative was not significantly faster. One of the tested alternative devices showed a larger number of traversed images during the task. The results indicate that alternative user interface devices can improve the navigation of stack mode datasets and that radiologists should consider the potential benefits of alternatives to the standard mouse.

Radiology faculty compliance with recommended health guidelines: comparison with residents

RATIONALE AND OBJECTIVES

The aims of this study were to determine diagnostic radiology faculty members' compliance with recommended health guidelines for physical activity, body weight, diet, and related health indicators and to compare faculty members' compliance with that of radiology residents.

MATERIALS AND METHODS

A request to complete an online health survey was electronically sent to members of the Association of University Radiologists in September 2008. Results were compared to those from a similar survey completed by radiology residents in May and June 2007. Frequency counts and Fisher's exact tests were used to summarize results and to determine statistically significant relationships.

RESULTS

The sample consisted of 193 of 801 members of the Association of University Radiologists (24%). A greater percentage of faculty members than residents complied with recommendations for physical activity (52% vs 37%, P < .001) and the consumption of vegetables (67% vs 52%, P < .001), saturated fat (51% vs 37%, P < .001), and sodium (53% vs 37%, P < .001). A greater percentage of faculty members felt that they got enough sleep (51% vs 38%, P = .002) and did not think about stress on most days (39% vs 26%, P = .001). Most faculty members (59%) worked 51 to 60 hours a week, whereas most residents (59%) worked > 60 hours, and greater work hours were correlated with less resident physical activity (P = .017). More female than male faculty members (78% vs 57%, P = .010) and residents (83% vs 62%, P < .001) had body mass indexes < 25 kg/m(2).

CONCLUSION

A substantial percentage of faculty members were out of compliance with federal health guidelines, although less so than residents in many categories. Comments from both groups suggest a possible benefit from modifications to the work environment.

Missed lesions at abdominal oncologic CT: lessons learned from quality assurance

The evaluation of oncology patients represents a substantial volume of the workload in many radiology departments. Interpreting the results of oncologic examinations is often challenging and time-consuming because many abnormalities are identified in the same examination and must be compared with the findings in previous studies. However, errors in the interpretation of oncologic computed tomographic (CT) scans can have significant effects on patient care. These effects may range from withdrawal from a clinical trial or cessation of therapy to repeat CT examination because of a technically inadequate study, CT-guided biopsy of newly identified lesions, or initiation of therapy for previously unrecognized lesions. A root cause analysis of reported errors in the interpretation of abdominal and pelvic CT scans led to the identification of potential pitfalls that may be encountered when interpreting oncologic CT scans and factors that contribute to these errors. Awareness of the spectrum of factors that contribute to misinterpretation of CT scans in oncology patients may improve the performance of the individual radiologist and ultimately translate into improved patient care.

One size (doesn't) fit all

The current radiology workflow model is inherently flawed by its emphasis on quantity over quality, limited accountability, and relative inflexibility of the technology. This adverse affect of technology inflexibility is of particular importance within radiology, because it is the single medical specialty completely dependent on technology for all its existence. For practicing radiologists, the human-computer interaction involves a multitude of individual events that collectively constitute the interpretation process. These individual workflow steps include image retrieval, display, presentation, navigation, processing, manipulation, decision support, and reporting. Considering the heterogeneous nature of the diverse population of end users, it is no surprise that the relative rigidity of the supporting technology creates a tremendous burden on radiologists' performance. The ideal scenario would be the creation of adaptive technology, which would consist of flexible and intuitive software that adapts to the unique needs and preferences of each individual end user, as well as the specific task at hand, while maintaining "best practice" guidelines. This interactive software would take into account a number of variables (education and training, computer experience, personality, visual perception, motor skills) to create user-specific profiles, which can be stored in a centralized database, independent of the specific vendor and technology being used. This user-specific software would also integrate affective computing technologies to dynamically adjust to end users' ever changing emotional states and stress levels. The end result would be the creation of intuitive technology that dynamically adapts to the changing needs and abilities of users, as opposed to the current inflexible technology paradigm.

Ergonomics evaluation of Picture Archiving and Communication System implementations in two X-ray departments

Two large X-ray departments in the County of Stockholm have changed from traditional analogue technology to digital imaging, including the implementation of Picture Archiving and Communication Systems (PACS). One of the departments was moved to a completely new purpose-built building and equipped with the latest technology, but for the other one the change merely meant rebuilding and adaptation of existing rooms on the premises. The objectives of the present study were to evaluate the ergonomics effects of the new technique in the two X-ray departments and to find out whether the implementation of digital imaging technique came up to expectations of improved ergonomics and work environment. Another purpose was to compare the outcomes for the two departments, in order to learn about the importance of the different implementation approaches. Questionnaires were sent out to the two departments both before the implementation of PACS and after the transition. The questionnaires covered several aspects of work conditions, such as working time, the physical and psychosocial environment, physical work load and musculoskeletal complaints, expectations from the digital technology, etc. The changeover went better than expected and even high expectations were fulfilled and surpassed. However, there were also some unexpected and distressing results; for example, a substantial increase in headaches and musculoskeletal symptoms as well as the use of pain killers among the radiologists of one of the X-ray departments.

Radiologist assessment of PACS user interface devices

INTRODUCTION

The process of radiologic interpretation has been revolutionized with the adoption of filmless imaging. Despite the radical change in viewing techniques and a rapidly expanding array of display, navigation, and manipulation tools, the keyboard-and-mouse configuration remains the standard for user interaction during radiologic interpretation.

METHOD

In this study, 6 readers evaluated 6 alternative user interface devices (UIDs), including 5-button and 8-button mice, a gyroscopic mouse, a multimedia controller, a handheld mouse-and-keyboard combination device, and a gaming joystick. Each participant assessed each device during the real-time daily imaging interpretation of magnetic resonance, computed tomographic, and general x-ray studies over a 2-week period and completed a detailed questionnaire on the ease of use, comparative utility as an alternative device to mouse and QWERTY keyboard, efficiency, workflow, and the ease of customized programming.

RESULTS

No single device was completely able to replace the mouse and keyboard in the estimation of participants, and the 5-button mouse was preferred over the 8-button mouse, although several participants noted that this might be a function of learning curves that exceeded the 2-week study period for each device. Several specific functionalities of the alternative UIDs were praised by users, who also suggested the possibility of combining these alternative devices for 2-handed use.

CONCLUSION

Consideration should be given to the potential for the increased acceptance of and efficiency with alternative UIDs that can be integrated into picture archiving and communications system (PACS) workstations. Additional studies are planned to use software applications to evaluate different UIDs at PACS workstations.

Influence of liquid crystal display monitors on observer performance for detection of diffuse pulmonary disease on chest radiographs

PURPOSE

The purpose of this study was to assess the influence of liquid crystal display (LCD) monitors on the detectability of diffuse pulmonary diseases depicted on chest radiographs by comparing them with a high-resolution cathode ray tube (CRT) monitor.

MATERIALS AND METHODS

A group of 17 radiologists interpreted 87 soft-copy images on LCD monitors with pixel arrays of 1024 x 1280, 1200 x 1600, 1536 x 2048, and 2048 x 2560 and on a CRT monitor with a pixel array of 2048 x 2560. They were asked to indicate their individual confidence levels regarding the presence of diffuse pulmonary diseases. The luminance distributions of all monitors were adjusted to the same distributions, and the ambient illumination was 200 lux. Observer performance was analyzed in terms of the receiver operating characteristics (ROC).

RESULTS

The average ROC curves for the five monitor types were similar, and there were no statistically reliable effects of the five monitor types on the readers' diagnostic performances (P = 0.7587).

CONCLUSION

The detectability of diffuse pulmonary disease on the LCD monitors with a spatial resolution equal to or higher than a matrix size of 1024 x 1280 was found to be equivalent to that on the high-resolution CRT monitor.

User questionnaire to evaluate the radiological workspace

Over the past few years, an increase in digitalization of radiology departments can be seen, which has a large impact on the work of the radiologists. This impact is not only demonstrated by the increased use of digital images but also by changing demands on the whole reading environment. In this study, we evaluated the satisfaction of our radiologists with our digital Picture Archival and Communication System environment and their workspace. This evaluation was performed by distribution of a questionnaire consisting of a score sheet and some open questions to all radiologists and residents. Out of 25 questionnaires, 12 were adequately answered and returned. Results clearly showed that most problems were present in the area of reading room design and layout and comfort and ergonomics. Based on the results from this study, adaptations were made and the results were also used in the planning of the redesign of the entire department of radiology.

Choosing a radiology workstation: technical and clinical considerations

Choosing a workstation for daily use in the interpretation of digital radiologic images can be a daunting task. There are numerous products available on the market, but differentiating among them and deciding on what is best for a particular environment can be confusing and frustrating. There is no "one-size-fits-all" workstation, so users must consider a variety of factors when choosing a workstation. This review summarizes the critical elements in a radiology workstation and the characteristics one should be aware of and look for in the selection of a workstation. Issues pertaining to both hardware and software aspects of medical workstations, including interface design, are reviewed, particularly as they may affect the interpretation process.