02/02 Diagnostic Imaging: Reading rooms should be designed to accommodate future cha... Page 1 of 4
Pacs & IT Designing For Productivity
Reading rooms should be designed to
accommodate future changes
Reconfiguration of modules would permit privacy and interaction as needed,
while also allowing future technology upgrades
By BILL ROSTENBERG, FAIA, FACHA
What if radiologists were able to build a new imaging facility from the ground up, designed for
tomorrow's technology and image management? Most radiologists don't have that luxury, but
even those who do soon find they need to upgrade yet again, because technology changes
faster than architecture. As radiologists continue to incorporate digital technology into their daily
practice, the need for renovating reading rooms becomes apparent.
Not all renovation projects need to be painful. Doing the job in discrete construction phases can
minimize disruption to operations. There are two basic types of renovation projects: in-place
and relocation. In-place renovation, as its name suggests, modifies a function without relocating
it-for example, converting an existing hard-copy reading room into soft-copy reading within the
same space.
Relocation renovation, on the other hand, requires an additional room to serve as an interim
soft-copy space while reading functions continue as usual in the old location. After construction,
the reading function is relocated to its new environment and the original location becomes
available as soft space for the next component of renovation.
Of the two strategies, in-place renovation tends to be more disruptive, because construction and
reading activities are going on simultaneously in the same place. So relocation works better if
there is soft space available elsewhere. When soft space is not available, reading may have to
be moved to an interim location to minimize disruption.
Because the relocation of any function alters workflow, several smaller reading spaces might
well replace one large reading area. Fortunately, soft-copy reading areas can be easily linked for
efficient transmission of images and other data. Critical to maintaining workflow, however, is
placing such areas close to where radiologists are on call.
MOVING TOWARD DIGITAL
A number of fully digital imaging departments exist, although until recently they were limited to
a handful of new military or academic medical centers. Some departments remain completely
film-based, but many are in the midst of switching from film to digital reading. This implies that
some reading areas may contain soft-copy workstations, some may still use film alternators,
and many have both soft-copy monitors and film illuminators. In time, alternators and film
illuminators will disappear and be replaced by soft-copy workstations. The transition rate varies
by modality and from one institution to the next.
Some modalities may spend time in a hybrid condition in which soft-copy and hard-copy
readings coexist. This hybrid stage is the most challenging to design for because good space
and lighting for traditional hard-copy reading are quite different from the right conditions for
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soft copy.
Reading room configurations vary, ranging from ballroom-type reading rooms of the past to
individual private offices. Large, open reading areas tend to be distracting and noisy, and they
are usually poorly lit. Private offices can be isolating and not conducive to group interaction.
Nonetheless, many radiologists prefer a private or semiprivate room near other radiologists.
They also want the ability to review images along with a small group, however.
The ideal reading room, in the view of most radiologists, enables them to read individually, in
small groups, or in larger groups. It is a room where they can confer with colleagues, control
the lighting, and control the acoustics. Ideally, it is an uncluttered environment where they can
work for hours without fatigue or eyestrain, easily access interventional procedure rooms, and
confer with referring physicians. Light from film illuminators creates glare on soft-copy monitors.
Noise from voice-recognition dictation systems can disrupt others in the reading room.
Reading rooms should be designed for continual modification. With hybrid reading, the room
should be able to accommodate changes in the equipment without requiring disruptive
construction. Where soft-copy reading takes place exclusively, the room should be able to
accommodate future equipment upgrades without necessitating physical changes to the room.
As facilities make the transition from hard-copy to soft-copy reading and beyond, the renovated
reading room must enable workstation configurations to change over time. But most renovation
designs are conceived as fixed solutions with built-in casework, permanent walls, and little
potential for modification. A more useful approach is to design the reading room as a
continuously evolving space that changes along with the implementation of digital image
management. Movable modular furniture is preferable to built-in casework. Movable, adjustable
acoustic partitions could prove better than solid walls.
LIGHTING
The lighting needs for working with film and with a monitor are different. A challenge for
reading-room designers is how to accommodate the low general luminance for computer work
while simultaneously attenuating other light, such as that from nearby film illuminators or
windows. Lighting that suits paperwork won't work around computers; the ambient lighting
around computer workstations must be calculated so the contrast between the screen and
surrounding surfaces does not create eyestrain, and yet the room must be dark enough and
sufficiently free of glare to make the screen image readable.1
For text entry, ambient lighting three times brighter than that of the display terminal works. But
for image review stations in a reading room, the ambient lighting should be equal to that of the
display. This is preferable to a darkened room, which can cause eyestrain. While separate task
lighting is often needed in such low light conditions, it must be arranged so it doesn't cause
glare on the monitor. Neutral-colored surfaces with low reflectivity can help minimize reflective
glare.
The single most effective way to control glare is by properly selecting and placing artificial
lighting within the room. The actual source of light should be completely screened from view. No
light source should be directly visible by the user or in the user's peripheral field of vision when
seated at the workstation. Dimmable indirect ambient lighting fixtures should be used in
conjunction with carefully placed dimmable narrow-beam task lights. Effective indirect lighting
typically needs a relatively high ceiling to be effective, but where that is impossible, wallmounted light sconces can do the job.
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ENVIRONMENT
Reading radiological images is an intense, repetitive process, and without adjustable,
ergonomically designed workstations, productivity will decline and health hazards like repetitive
strain injuries will increase.
Three points of contact contribute to a healthy work environment: where your eyes interact with
the computer monitor, where your fingers contact the keyboard, and where your body rests in
its chair.2 Many eye problems can be avoided with proper ergonomic design. Poor ergonomic
conditions such as improper lighting and glare can cause eyestrain of workers using computers
repetitively. Many hand- and wrist-related problems are linked to the increasing use of
computers. Adjustable seating, work surfaces, keyboards, and monitors can reduce the
incidence of repetitive motion injuries and fatigue. Adjustable furniture specifically designed for
computer systems instead of built-in casework is one way to reduce ergonomically caused
health problems.
In terms of acoustics, reading activities require containment not only to protect confidential
findings but also to avoid creating disturbance. Private offices offer an easy way to control noise
but make conferences difficult. Several workstations placed in a single room with adjustable
acoustical partitions between them allow reading functions to take place in small groups and
afford a degree of acoustic separation. The rooms can be designed to accommodate both private
and semiprivate uses.
MODULAR CONNECTIONS
From the beginning, and not as an afterthought, cabling and infrastructure should be fully
integrated into the work environment. If the reading room is designed for flexibility, electronic
devices will be connected neatly, without a clutter of wires and cables. Telephone, data, and
power lines can run out from outlets at the workstation. Cable raceways can be integrated into
workstation panels and adjustable acoustic partitions. All radiologists should be able to control
their individual environment without disrupting others in the room.
Our proposed redesign (a prototype in progress) divides the reading-room suite into work
modules, each with four walls and a ceiling of modular panels. Within the larger suite, modules
can be configured individually or in multiples of two, four, or more. The work modules are
installed in an unfinished space, like those with exposed ceiling, ducts, etc. Sprinkler lines run
through the ceiling panels for fire protection, along with heating and air conditioning ducts.
Cables run through partition panels.
A common arrangement consists of two work modules, side by side and separated by an
adjustable acoustic partition. The partition can be closed for privacy, best for individual reading,
or open for group conversations or rounds.
Ambient light comes from outside of the module, filtered through transparent doors and wall
panels outside the user's field-of-view. Adjustable blinds within the transparent panels can
control the light. Movable task lights on either side of the workstation supplement the ambient
lighting.
SEPARATE ZONES
Just as an operating room consists of a sterile zone and a circulating zone, the reading room
should have a work zone and an interaction zone. In the work zone, where primary reading
activities take place, the radiologist is shielded from glare and outside noise. Solid partitions are
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full height around the monitor to screen light.
The work zone is equipped like an airplane cockpit with frequently used devices within arm's
reach-trackball, keyboard, telephone, and microphone. In the closed position, the adjustable
acoustic partitions enable the work zone to accommodate three or four people working together.
A step away from the workstation, the interaction zone with its transparent doors and windows
opens onto the space beyond the reading area. Cloistered but private, this zone provides a
quiet, climate-controlled spot for small group discussions.
Immediately beyond the interaction zone is interstitial space to accommodate group rounds. A
standing height keyboard and monitor allows access to digital files.
BIG SCREEN
Our concept anticipates the arrival of plasma technology, in that it incorporates picture images
and demographic data (now requiring multiple monitors) into one large, flat screen. This is hung
on an adjustable track so it can be raised for group viewing. When larger groups need to view
images, the adjustable acoustic partitions can be opened to provide more floor space.
Because each work area has modular panels, many configurations are possible. Individual,
semiprivate, or group workstations can be placed within the imaging department. Or if face-toface interaction between radiologists and referring customers is desired, satellite reading areas
can be set up in the critical care unit or surgery.
References
1. Rostenberg B. Success by design: maximizing your digital environment. Advance for
Administrators in Radiology and Radiation Oncology 1998;8(12)
2. Rostenberg B. The architecture of imaging. Chicago: American Hospital Publishing, 1998:256262.
MR. ROSTENBERG is vice president of SmithGroup Architects and Planners in San Francisco
and the author of The Architecture of Imaging (American Hospital Publishing, Chicago).
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