Author: Leona Werezak

09 Dec 2020

Sedentary Nature in Radiology

The occupational hazards of radiology are well known: exposure to radiation, splashes with contrast media, bodily fluid exposure, and stress to name a few. Another less recognized danger for those in the profession is the sedentary nature of the work.

It’s estimated that diagnostic radiologists spend more than 8 hours a day sitting at their computers and workstations. Understanding how the sedentary nature in radiology affects a radiologist’s health and the quality of their work is important for preventing health issues and optimizing patient care. Knowing how to reduce the risks related to this workplace hazard is also important so those working in the profession know how to protect themselves.


What Is a Sedentary Lifestyle or Career?

The U.S. Department of Labor defines sedentary work as “exerting up to 10 pounds of force occasionally or a negligible amount of force frequently to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs may be defined as Sedentary when walking and standing are required only occasionally and all other Sedentary criteria are met.” By this definition, most of the work performed in radiology meets this criteria.

Researchers confirm this stating most image interpretation done by diagnostic radiologists is sedentary with radiologists sitting at a computer workstation to perform this work.


How Being Sedentary Affects Quality of Work and Radiologists’ Health

The sedentary nature in radiology contributes to stress which has been shown to decrease job satisfaction and lead to poor mental health outcomes. However, it’s also thought that stress associated with sedentary radiology work may contribute to poor workstation ergonomics. This may lead to an array of work-related musculoskeletal injuries that 30%-60% of radiologists report such as eyestrain, neck & back pain, carpal tunnel syndrome, and headaches.

And experts like Rebecca L. Seidel, MD agree that correct ergonomics are essential for the productivity, performance, and well-being of radiologists.

The risks of a primarily sedentary lifestyle for the general population are well-known and include health problems that carry high risks of morbidity and mortality such as:

  • •Hypertension
  • •Obesity
  • •Diabetes

Other diseases attributable to a sedentary lifestyle include cardiovascular disease and certain types of cancer with even higher mortality rates resulting from these diseases as sedentary behavior increases.

In fact, researchers point out that being sedentary contributes to all causes of mortality—not just those listed above. And this increased mortality risk exists even in those who engage in physical exercise regularly outside of their sedentary jobs. Excessive time spent sitting or in minimal movement is believed to contribute to a slower metabolism and many of the negative effects mentioned above.


How Radiologists Can Improve Health at Work

While a significant amount of a diagnostic radiologist’s job is sedentary, there are things that can be done to mitigate the health risks of sitting for prolonged periods of time. Experts studying the sedentary behavior in radiology suggest radiologists can improve their health by understanding and applying the concept of NEAT to their work.

The acronym NEAT refers to “nonexercise activity thermogenesis”. It includes activities of daily living that require energy for the body to perform such as walking, standing, sitting, and fidgeting. NEAT excludes sleeping, eating, and sports or fitness activities.

The concept of NEAT was studied by Levine et al. to determine whether or not fidgeting-like activities could counteract weight gain in sedentary adults who were overfed. Surprisingly, they discovered even low energy expenditure fidgeting activities were effective in maintaining metabolic rate and deterring weight gain in study subjects.

Fidgeting-like activities that radiologists could incorporate into their work that have been shown to increase energy expenditure significantly and reduce the negative effects of prolonged motionless sitting include using a mouse at the computer, typing, and tapping one’s foot.

In addition to making these relatively small changes, researchers suggest there are other things radiologists can do to increase NEAT and help ward off chronic health problems related to being sedentary.

Some of these things include:

1.  Drink more water

Drinking enough water has a number of health benefits. Water is needed for several important bodily functions. It also helps suppress appetite and control weight gain. Eating more foods with a higher water content can help reduce caloric intake and result in increased satiety after eating. To incorporate more activity with higher water consumption, use a small water bottle so you’re required to get up and refill it often.

2.  Consider standing to perform some work

Researchers found that standing motionless or standing and fidgeting also increases NEAT significantly compared to sitting motionless or fidgeting while seated. Most PACS workstations can be elevated which allows some reading and dictating to be done while standing. It’s also important to add some of the fidgeting-like activities mentioned earlier while standing since this significantly increases energy expenditure compared to standing motionless. However, it’s also important to keep in mind that periods of prolonged standing may lead to venous stasis and back pain so it’s best to keep moving and avoid any one position for too long.

3.  Walk more throughout the day

The benefits of walking are well-known and include increased calorie expenditure. Consider communicating about a patient with a colleague in your facility face-to-face rather than via phone or email. In addition to ensuring better communication, you’ll be taking care of your own health. Taking short breaks from radiological workstations has also been shown to help one stay focused, reduce eyestrain, and calm the mind.

4.  Perform some simple exercises at your workstation

Incorporate some simple exercises throughout the day at your workstation such as neck rolls, side stretches, seated spinal twists, and leg lifts. These basic exercises have been shown to reduce fatigue and decreases in metabolism while increasing NEAT expenditure and only take a couple minutes to complete.

5.  Include a variety of calorie-burning activities in your workday

Although the following activities haven’t been studied specifically with radiologists or in relation to radiology reading rooms, researchers suggest radiologists consider incorporating some of these activities into their workday to keep metabolism elevated and help reduce the likelihood of chronic diseases associated with being sedentary.

  • •Increase fiber intake which is associated with increased and prolonged satiety and reduces the incidence of obesity, hypertension, diabetes, coronary artery disease, and stroke.
  • •Be mindful of your caloric intake versus energy expenditure.
  • •Avoid eating 2 hours before bed when you’ll be more sedentary.
  • •Try to get 7-9 hours of restful, uninterrupted sleep at night since 4 hours of sleep or less over a prolonged period of time is associated with reduced metabolism.
  • •Set the timer on your phone or smart watch as a reminder to get up and stretch or move for the last 5 minutes of each hour.
  • •Consider tracking your activity level such as your daily steps as well as your food and water intake on a smart device such as your phone or smart watch. Make small improvements each day.

6.  Explore radiology room fitness workstations

Treadmills and elliptical machines are no longer equipment found only in fitness facilities. The benefits of incorporating this kind of equipment at standing workstations include an energy expenditure 200% greater than standing at rest. These machines are designed to be quiet enough for use in reading rooms and work well for home offices too. While cost and having adequate space to accommodate equipment may be a concern, installing even a single treadmill workstation that staff can rotate through may help reduce time sitting and provide staff with healthier ways to work.


Why Work With Double Black Imaging to Build a Healthier Workstation?

Double Black Imaging is proud to be known for its exceptional and unparalleled customer service in addition to our high standards that exceed other industry providers. We use advanced technology combined with the latest research to design innovative and reliable medical displays, ergonomic workstations, and software solutions to help make imaging more efficient and reduce healthcare costs.

At Double Black Imaging, our specialists will work with you to create the perfect workstation that takes into consideration your health as well as cost and space constraints. Contact us today at (844) 879-2247.

Contact our diagnostic imaging experts


Source List:;year=2018;volume=25;issue=1;spage=28;epage=33;aulast=Ogenyi

09 Nov 2020

Wrong Radiology Image Interpretation Due to Non-Calibrated Displays

What is teleradiology?

Teleradiology is the exchange of digital images such as x-rays, MRIs, and CT scans between healthcare providers in different locations through electronic communication for the purposes of diagnosis and consultation.

What is required to perform teleradiology?

To perform teleradiology in the U.S., physicians must meet licensing requirements to practice telemedicine in the state in which they are acquiring and interpreting the study.

The ACR Task Force on International Teleradiology notes that “Physicians performing teleradiology services must have training equivalent to those physician providers of imaging services at that health care institution receiving these services.” The task force also states teleradiologists must engage in ongoing learning throughout their career to maintain skills related to the work they perform.

What’s the difference between diagnostic vs. non-diagnostic monitors?

In the ACR–AAPM–SIIM Technical Standard for Electronic Practice of Medical Imaging, diagnostic monitors or displays are also known as primary interpretation displays while non-diagnostic displays are referred to as secondary displays. The standard identifies specific technical requirements important for the image quality of diagnostic monitors while non-diagnostic monitors do not require the same specifications. These technical specifications help ensure the correct spatial and contrast resolution of images that is necessary for accurate interpretation.

In their review article examining the impact of computer display performance on the quality of digital imaging, Butt, Mahoney, & Savage (2012) highlight  that compliance to the Digital Imaging and Communications in Medicine (DICOM) Part 14 Greyscale Standard Display Function “standards is considered critical and represents the most important difference separating medical grade displays from standard or commercially available devices.”

To understand the difference between diagnostic monitors vs. non-diagnostic monitors or commercial off-the-shelf (COTS) monitors, it’s helpful to review the ACR–AAPM–SIIM–SPR Practice Parameter for Digital Radiography. In this document, equipment specifications for diagnostic monitors are outlined and adherence to these guidelines is “strongly recommended”.

This document identifies specific display characteristics diagnostic monitors should have to ensure high quality imaging. These characteristics include luminance response and pixel pitch and display size.


Luminance Response

Luminance refers to photon energy that reaches the eye and is controlled by 3 factors:

  1. Ambient luminance (Lamb) – This refers to the brightness still visible on the monitor when the power is off as a result of diffusely reflected light in the room. The practice parameter states, “The ambient luminance should be less than one-fourth of the luminance of the darkest gray level.”
  2. Minimum luminance (Lmin) – This requirement is important because the human eye adapts poorly to contrast in very dark areas. Hence, the practice parameter states “the luminance of the lowest gray value, Lmin, should not be extremely low. The minimum luminance including a component from ambient lighting, L’min = Lmin + Lamb, should be at least 1.0 cd/m2 for diagnostic interpretation, 1.2 cd/m2 for mammographic interpretation, and 0.8 cd/m2 for secondary displays.”
  3. Maximum luminance (Lmax) – The ability of the human eye to detect contrast characteristics of an image “depend on the ratio of L’max (the luminance for the maximum gray value including the component for ambient lighting) to L’min.” This is called the luminance ratio (LR) and isn’t the same as the contrast ratio monitor manufacturers often refer to.

According to the practice parameter, a LR of 350 is required. For adequate contrast, LR should always be greater than 250 but not much greater than 350 since the human eye can’t detect contrast at significantly higher LR levels. The practice parameter states “The L’max of diagnostic monitors used for interpretation should be at least 350 cd/m2 with an L’min of 1.0 cd/m2. For the interpretation of mammograms, L’max should be at least 420 cd/m2 with an L’min of 1.2 cd/m2.”


Pixel Pitch and Display Size

Pixel pitch refers to the spacing of pixel structures and determines the amount of detail that can be shown on the display. While it’s common to see monitors classified by the number of pixels they display, the practice parameter recommends selecting diagnostic monitors based on pixel pitch and display size. A pixel pitch of approximately 0.200 mm and not larger than 0.210 mm is recommended.

When considering display size, it’s important to be aware that the viewer’s vision extends to the edges of the display due to peripheral vision. Therefore, it’s recommended that the diagonal display distance be approximately 80% of the viewing distance. The document explains “At 2/3 meter, this corresponds to a diagonal size of 53 cm (21 inches). Monitors with a pixel array size of 1,500 × 2,000 and a pixel pitch of 0.210 will have a diagonal size of 52.5 cm.”

This document also outlines other important display elements for diagnostic monitors that should also be considered such as several workstation characteristics and ergonomic factors important to radiological imaging.

In short, using a non-diagnostic monitor to make a diagnosis may result in diagnostic error and doesn’t meet the guidelines set out in the practice parameter.


Examples of Diagnosis Gone Wrong

Miller & Zois state about 31% of all practicing radiologists will be sued for malpractice at least once during their career. 75% of these malpractice lawsuits have “diagnostic error” or “failure to diagnose” as their basis. In addition, they note that radiology has one of the highest rates of malpractice in medicine.

Painter shares the following case of a neuroradiologist who faced a lawsuit related to work she performed at home:

  • • A male patient was admitted to the ER with a “severe, unrelenting headache that had been going on for a few days.” A CT scan without contrast was done and sent for interpretation to a neuroradiologist working from home. The only clinical information provided was “headache with dizziness and giddiness”. However, the ER physician testified this wasn’t completely accurate for the patient but was the closest option on the pull-down menu in the hospital’s electronic medical record system. The ER doctor testified the “real reason” he ordered the CT scan was to check for signs of a stroke or other cerebrovascular abnormalities. The neuroradiologist said she thought she saw artifact on the CT scan at home but did not recommend repeating the CT scan because of this concern nor did she recommend an MRI which provides higher resolution to assist in diagnosis. She also did not phone the ER physician to obtain more information. She interpreted the CT scan as normal. The patient was discharged from the ER that day and suffered a massive stroke shortly thereafter.


Miller & Zois provide the following example of a lawsuit against a radiologist group.

  • • A 56-year-old female has a diagnostic mammogram that is interpreted as normal. A subsequent mammogram the following year shows she has a large tumor that results in a diagnosis of breast cancer. However, by that time, the cancer has spread outside of the breast and she dies two years after she is diagnosed. Her family sues the radiologist group for negligence in failing to identify the tumor during the first mammogram. The case goes to trial and the family are awarded $2.5 million in damages.


In Error and discrepancy in radiology: inevitable or avoidable?, Brady (2017) states “errors will always happen, but some can be avoided”. The question is “Which errors can be avoided?”

To answer this, Bruno, Walker, & Abujudeh (2015) suggest safety and quality in medical care may be improved considerably by reducing the variability in radiological processes. For example, this may be done by standardizing radiologists’ approach or the diagnostic imaging protocol. They also point out improvements to processes within systems of care are believed to contribute to fewer diagnostic errors.


Benefits to moving to diagnostic workstations for all radiology employees

Studies have shown improved accuracy as well as higher physician confidence with image interpretation using diagnostic monitors compared to COTS. This results in faster interpretation and diagnosis saving time and money while reducing the potential for litigation due to diagnostic error or failure to diagnose.

Although a more costly initial investment, medical grade monitors often prove their worth with ease of use, better quality images, and significantly longer life spans than non-diagnostic monitors that must be replaced up to four times more often than medical diagnostic monitors.

The ACR–AAPM–SIIM Technical Standard for Electronic Practice of Medical Imaging states consistent image presentation at workstations is essential for:

  • • Technologists acquiring images
  • • Radiologists interpreting images
  • • Physicians using imaging to provide patient care

Consistent image presentation on diagnostic monitors combined with the most current workstation characteristics and ergonomics set out in the standard enable all radiology employees to do their best work.

Working with Double Black Imaging to create the perfect radiology workstation

Double Black Imaging is an industry leader producing technologically advanced medical display systems that meet the high-quality standards radiologists have come to trust and rely on to provide accurate and timely diagnosis.

For information about quality medical grade displays, efficient workstations, the use of automated calibration tools and other benefits of purchasing monitors from Double Black Imaging, please contact our diagnostic imaging experts. We can answer your questions, provide demos, and show you how our monitors outperform those of the competition.

Contact our diagnostic imaging experts today to discuss your radiology department requirements.

Contact our diagnostic imaging experts

Sources List:

17 Sep 2020

Radiologist Burnout

Why Does It Happen and How Can You Prevent It?

Although most physicians choose to become a radiologist because they see it as a meaningful career, burnout in radiology is at an all-time high compared to other medical specialties. In the 2018 Medscape National Physician Burnout and Depression Report, radiology was ranked as the seventh highest specialty for burnout among physicians. This is compared to its 20th highest ranking in 2017. The 2018 report found that 42% of 15,543 physicians surveyed reported burnout, with 45% of these physicians being radiologists.
Radiologist Burnout

What is Radiologist Burnout?

Burnout is characterized by feelings of being emotionally depleted, and a sense that one is accomplishing less and experiencing less satisfaction in one’s role. It is often accompanied by depersonalization where the physician feels disconnected from his or her work and peers, and where patients are no longer treated with empathy as individuals in pain or crisis due to indifference.

Impact of Radiologist Burnout

Burnout in radiology can lead to patient errors and omissions as well as other adverse events. In addition, there is the potential for lost productivity, and therefore lost income, when a physician is not able to function optimally or is absent for physical or mental health reasons. These are high costs to pay for burnout, not to mention the toll it takes on a physician’s mental and physical well-being.

Other results of burnout include:

  • • Physician attrition from the profession
  • • Early retirement resulting in more physician shortages
  • • Increasing health care costs
  • • Increased risk of substance abuse
  • • Increased risk of suicide


Early Warning Signs of Radiologist Burnout

Being able to recognize when you or one of your colleagues is beginning to show signs of burnout is important so it can be caught and addressed as soon as possible. Some early warning signs include:

      1. Complete exhaustion

        Exhaustion may be a feeling of emotional, mental, and/or physical fatigue. Signs of exhaustion or fatigue include:

        • • Difficulty waking up or getting out of bed in the morning
        • • Inner resistance to going to work
        • • Feeling of having no energy
        • • Irritability
        • • No desire to socialize after work with friends or family or participate in activities and hobbies
        • • Lack of desire to engage in personal wellness activities such as exercise and cooking at home


    1. Emotional detachment

      One way of coping with emotional fatigue and burnout is by detaching emotionally from patients. This emotional detachment can look different for different people, but may include cynicism towards patients and a more critical attitude when dealing with colleagues and staff. For others, sarcasm is used to emotionally detach from patients and deal with frustration.

    2. Work is dominating your life

      If you feel like your work is taking over your life in an unhealthy way, it probably is. If you find yourself constantly thinking about work even when you are trying to do non-work-related things, this is a warning sign. Because of the exhaustion that accompanies burnout, you may find your personal and social relationships suffering as well. And if you have no desire or ability to do anything but work, this is a sign you are in trouble.

    3. Feel like work is pointless and/or without a purpose

       Having bad days and feeling frustrated at times is part of any job. However, if you find yourself questioning why you are doing the work you are doing, or feel what you do is not making a difference, you are likely experiencing burnout from your job.

    4. Mistakes are more frequent

       When you are exhausted, frustrated, and emotionally detached from your patients and those you work with, mistakes are more likely to happen. If you find yourself making mistakes more often than usual, or making errors you would not usually make, it may be time to step back and reevaluate what is happening since this can be a sign of burnout.


Steps to Address Radiologist Burnout

Healthcare facilities and organizations are able to play an important role in helping reduce burnout and increase radiologist job satisfaction. Some strategies include:

  • • Recruit and assign radiologists to work in areas they prefer, enjoy, and are skilled and certified in.
  • • Avoid assigning work to radiologists who lack the certification or skill to perform the work competently and safely.
  • • Identify ways to reduce time radiologists spend on administrative activities by hiring assistants and considering virtual scribes to perform these activities instead.
  • • Support and encourage strong teams of healthcare professionals that interact regularly to assess workflow efficiency and work-related needs and difficulties of team members.
  • • Learn how to assess and recognize ongoing frustration and impending burnout in healthcare professionals and identify caring ways to offer assistance.


How to Avoid Burnout as a Radiologist

Some important steps you can take to avoid burnout in radiology include:

  • • Avoid working in isolation when possible
  • • Work with your peers and staff to create a positive work environment that supports one another
  • • Take frequent breaks from your workstation
  • • Get outside or away from your work area entirely during breaks
  • • Consider setting up an ergonomic sit/stand combination workstation
  • • Identify and engage in regular self-care habits that help you recharge physically, mentally, and emotionally
  • • Schedule days off regularly and take personal or vacation time off work
  • • Revisit regularly why you chose to become a radiologist and all the people you are helping (and have helped) with your expertise



30 Jun 2020

Ergonomic Desk Setup

As a radiology or medical professional working from home, you need a comfortable ergonomic desk setup to help prevent repetitive strain injuries and unnecessary fatigue while maximizing your efficiency and productivity. When deciding on your office ergonomics at home, there are specific factors to consider when setting up and evaluating how you will use your home workstation. These include:

  1. Screen position

    Your monitor should be located directly behind your keyboard, and in front of you at approximately an arm’s length away. Adjust the top of the screen so it rests at or just below your eye level. Lower the monitor another 1-2 inches for ease of viewing if you wear bifocals. When reading images, try to reduce light as much as possible and focus on placing monitors on dark surfaces to help keep glare to a minimum.

  1. Chair position

    Be sure to select an office chair that supports your natural spinal curves and that feels comfortable to sit in. Adjust the height of your chair so your feet rest flat on the floor. If the height of your desk requires, use a footrest and place your feet flat on its surface. Adjust the armrests of your chair so you can comfortably rest your arms on the armrests while keeping your arms close to your body and your shoulders relaxed.

  1. Keyboard and mouse placement

    Place your keyboard and mouse on the same surface and make sure they are within easy reach. When using your keyboard or mouse, keep your upper arms close to your body, your hands at elbow height or slightly lower, and your wrists straight. Consider alternating hands to use your mouse or getting an adjustable mouse that responds to light touch for operation. Use keyboard shortcuts when possible to minimize how much you need to use your mouse.

  1. Key object placement

    Keep commonly used desk items within easy reach when you’re sitting. This includes items like pens, stapler, notepad, phone and other office items you use often when seated. If you’re not able to comfortably reach an item, it is better to stand up to retrieve an item rather than reach for it.

  1. Natural posture

    Many people have a tendency to start leaning forward when working from a desk or office chair. You want to ensure you are sitting back completely in the seat of your chair with your back against the back of the chair. This will help maintain the most natural posture for your body and back. For your legs, you want to sit so there is a 90° – 100° angle between your legs and back.

  1. Head and neck position

    The position of your head and neck is just as important as a position of the rest of your body when seated at your workstation. The head can tend to drift downward when working at a computer. This can cause pain in the neck, shoulders, and back. To avoid this, adjust the position of your monitor so your eyes focus on the middle of the screen. Add monitor arms to adjust monitors forward/backward and up/down when sitting or standing at your desk. Using a headset may also help keep the head and neck in a more relaxed and neutral position.

  1. Physical activity

    Having an ergonomic desk setup at home does not negate the need to get up and move—often. Experts recommend getting up from your desk and stretching, moving about your office, or grabbing something to drink every 25 to 28 minutes. If something doesn’t feel right or you feel uncomfortable, consider readjusting and reevaluating your desk setup. We offer free ergonomic consultations for home desks.

  1. Give your eyes a break

    In addition to moving your body, it’s also important to move your eyes off your computer screen approximately every 20 minutes, for 20 seconds, looking 20 feet away if possible, to give your eyes a rest (20/20/20 rule). Also, be sure your home office space is dimly lit and that there is no glare or reflection coming off your screen as you work.

Setting up an ergonomic workstation at home can take some time and effort – although the benefits such as fewer injuries, reduced strain, and increased productivity make it worthwhile.

To save radiology and medical professionals time and effort in setting up their own ergonomic home workstations, Double Black Imaging provides a custom workstation design service to meet your work needs at home. Our diagnostic imaging experts can make recommendations and help assemble every piece that’s needed for an ergonomic solution outside of the hospital or medical clinic.

Contact us for more information about our custom workstation design service.