One of our newest educational resources, “Medical Imaging Reading Environment Optimization – A Planning Guide,” is the result of a very long, personal “radiology adventure” for me – and I must share some background information on it.
The adventure began in 1998 when my previous firm was hired to create the University of California Los Angeles (UCLA) Ronald Reagan Westwood Replacement Hospital and part of our task was to design the Radiology and Imaging Departments. Since this was 1998, it was the days before digital imaging and Picture Archiving Computer Systems (PACS) were fully developed. The notion of a filmless clinical environment was first described around the early 1980s, but it was not until the late 1990s that PACS technology proved mature enough for widespread implementation. It was also around that time when I met my dear friend, Dr. Osman Ratib.
Carlos Amato (left) learning to “read” conventional film in 1999 to understand various problems and limitations associated with existing “hybrid” reading rooms in which conventional film-based readings are performed on lightboxes adjacent to digital softcopy workstations.
Dr. Osman Ratib, currently a professor and the chair of radiology at University Hospital of Geneva in Switzerland, was then a vice chair of radiology at UCLA where he was involved in implementing a PACS network at UCLA’s medical center. Ratib was frustrated by the inability of PACS software at the time to handle large datasets, and thought he could build a better mousetrap. While at UCLA, he enlisted the aid of Dr. Antoine Rosset, a radiology resident and computer programmer who was also from Switzerland, to develop a homegrown application for viewing DICOM-based medical images. They created OsiriX, an image processing application for Mac dedicated to DICOM images.
At an early stage, Ratib and Rosset decided to base their work on open-source software code, which can be shared and improved upon by anyone. They also decided to run the software exclusively on Apple Macintosh computers, due to the graphics capabilities of these machines. The first official version of OsiriX became available in early 2005.
But, rewind back to 1999 before Dr. Ratib had achieved all of this…and there was a point when he and I teamed up to try to discover what a paperless digital imaging department would look like. We took the opportunity to reengineer radiologists’ working space by developing new diagnostic workstations. In collaboration with radiologists and computer scientists, we used three dimensional computer modeling (it was still the heydays of AutoCAD) and simulation techniques to create and evaluate different ergonomic designs for diagnostic workstations and radiology reading rooms.
Dr. Ratib and I revealed our prototypes, in an infoRAD exhibit at the Radiology Society of North America (RSNA) annual meeting.
The cyber models emphasize ergonomics with integrated high-resolution flat-panel displays, advanced navigation software, customer cabinets and indirect dimmable lighting. Our project won the InfoRad Cum Laude Award, and earned publication in several radiology media and journals.
Encouraged by this, we continued to race against east coast thought leaders like Dr. Eliot Siegel from the VA in Baltimore and Dr. Steve Horii who had also begun studying the same issues. Our research on the subject of digital radiology continued over the years, leading to multiple publications in clinical journals and presentations at clinical congresses in the US, Germany, Switzerland, Italy and Spain.
And, all of this brings us back to the new planning guide. Last year I ran into Greg Patrick, an old colleague and owner of Redrick Technologies. While talking about the future of imaging and how we got to where we are today, I pointed out to him that although hundreds of resources had been written about reading rooms over the last 15 years, I was not aware of what I would consider, “the definitive guide.” There were bits and pieces, but none covering ALL planning aspects. So, I proposed to Greg that we write it.
The document we’ve created takes readers through key fundamental design goals and provides specific design guidelines for reading rooms.
It also provides insight on what the future will hold. For those ideas, I once again reached out to Dr. Ratib who contributed one of the most through provoking pieces in the guide. He brought focus to the contradiction between the concept of mass reading (the radiology factory) and a future view which considers radiology as integrated with the clinical management environment. In this future view, radiology is aided by intelligent patient models that could potentially eliminate the reading room altogether.
I hope you enjoy the planning guide. More importantly, I hope it triggers new ideas about what is yet to come.