Progress in medical science can be painful.  It’s no joke.  Technology such as PACS and digital imaging can cause repetitive strain injuries for radiologists.  And that’s just the beginning.

Radiology workstations designed ergonomically can help decrease the frequency and severity of repetitive strain injury.  Use of ergonomic principles can vary from simple changes to equipment that changes the way radiologists work and eliminates the cause of many injuries.

You’ve heard the term for several years now.  But what exactly is an ergonomic workstation, and how does ergonomics in radiology work environments make things better?

Let’s start with the basics.

What is an ergonomic approach?

Almost every activity involved in a radiologist’s job can lead to some type of repetitive injury.

As a radiologist today, your job includes:

• Viewing high contrast images in a dark environment multiple hours per day
• Utilizing speech mics with Speech recognition software
• In certain cases, performing procedures
• Reporting test results
• Preparation of lectures and presentations
• More commonly, these tasks are being performed at home or from teleradiology workstations.

This is just a brief list of activities performed requiring repetitive motions.

Ergonomic workstations are designed to minimize the need for and impact of repetitive motions such as standing, bending, twisting, and leaning in performing your job.  Once these stressors are minimized, you can be more comfortable and productive when working.

What does an ergonomic workstation look like?

Ergonomic equipment for workstations varies by profession.  As it relates to radiology workstations, ergonomic equipment includes:

• Desks/tables that have:
  • Sit to stand adjustment capability
  • Ability to change monitor height independent of worksurface
  • Ability to easily and quickly change focal depth of monitors
  • Large usable worksurface to provide space for radiologist’s equipment: multiple keyboards and mice, voice recognition mic, trackball, etc. . . Ideally a single surface to maximize useable space in a given footprint
  • Ability to be quickly and easily adjusted/set up for each radiologist using the station
  • Dimmable back lighting to reduce eye strain
  • Electric sit to stand workstations/desks
• Monitors that:
  • Meet ACR and FDA standards for brightness and resolution, ensuring images are DICOM Calibrated for proper diagnosis
  • Include productivity tools with the ability to dim worklist panels, limiting ambient light causing eye strain.  Cursor wrap functions eliminating continuous scrolling over the worksurface
  • Maximize viewing clarity from various angles
  • Reduce stress by offering adjustable height and angle
• Radiology chairs that provide
  • Vertebral support
  • Head support

What should you consider before implementing an ergonomic approach in your radiology work environment?

Implementing ergonomics in radiology work environments is more than buying equipment that has a list of features. It is important to see how specific features impact your patient care, medical staff, and overall satisfaction of the team.

A comprehensive ergonomic workflow rollout address every aspect of the practice and includes proper training on the use of the equipment as well as how can prevent injuries.

Technicians can benefit from ergonomics in radiology as well. Important areas to consider for these team members includes:

• Manipulation of equipment necessary for performing procedures
• Transportation of the equipment
• Sit/stand desks for MRI and CT technicians
• Positioning of patients for completion of the procedure
• Ergonomic seating

How Does an Ergonomic Workstation Help Your Practice?

Ergonomics offers more than physical benefits. It results in increased productivity and efficiency, increased accuracy of reporting, a comfortable work environment, improved employee retention, and improved patient care.

The Association for Talent Development¹ indicated that there are several factors in radiology work environments that are improved when you focus on health and wellness:

• absenteeism
• retention and turnover
• productivity
• employee engagement

The costs associated with these factors is not small.

When an employee is injured, employers pay for more than the worker’s medical treatment. In its “NSC Injury Facts 2017,” the National Safety Council (NSC) calculates the average cost of an injury at $31,000².

Radiation therapists appear to be at considerable risk for work-related musculoskeletal injuries, which corresponds with findings of studies on health care employees. They are reported to have a high prevalence of injuries (76%)³.  In fact, 58% of radiologists report symptoms of repetitive stress injury (many spend over 8 hours per day at their desks).

The most common site-specific injury is the lumbar back, followed by the neck and shoulders³. Other injuries in radiology work environments can include repetitive stress injuries, visual problems, and headaches.

Productivity and Efficiency

When an ergonomic approach is used, staff can avoid bending, twisting, and awkward positions that cause fatigue, soreness, and lost time, as well as decreased comfort as the workday progresses.

Employees can be happier and have more energy when they can be comfortable when they work.  It’s easy to see that more energy put into helping patients results in patients who are happier with the care they receive.

Accurate Data Entry: A Surprising Benefit

Initially you might not consider that ergonomics in radiology could impact the accuracy of data entry. However, consider that you would have a higher level of fatigue throughout the day when you have a high level of stress on your body. Errors are more likely due to the higher level of stress and fatigue that results in decreased focus.

Ergonomic equipment in the radiology work environment increases safety and comfort throughout the day, meaning that employees are safer, more comfortable, and less fatigued.

A Comfortable Radiology Workstation adds Value and Savings

When care providers can adjust table height, view records through an optimally sized and correctly positioned monitor, and move easily around the facility/unit, they are more comfortable and experience less fatigue. This means that strain on backs, wrists, and necks is drastically reduced, or eliminated.  Ergonomic workstations designed to the unique demands of a job helps the radiology team do their job effectively and efficiently in comfort.

A ROI Comes in Many Forms

By now you realize that implementing ergonomics in radiology work environments requires investment of time and money.

Considering the costs of worker’s compensation, rehabilitation, and training of new radiologists, it is easy to see how you can quickly realize a return on your investment.

The biggest savings are seen in:

• Less time off for injury
• Fewer staff injuries and worker’s compensation claims
• Greater accuracy in reporting and patient care
• Healthier and happier staff with less turnover

When preventable injuries, burnout, and staff error are avoided, money typically spent on these items can now be spent where it is needed most.

Improved Patient Care is the Ultimate Reward

Imagine the improved patient care and improved patient satisfaction when:

• Procedures are completed once because the staff could effectively and efficiently do it correctly the first time
• Appropriate care is provided because errors are not made that might be related to fatigue or limited focus
• Patients are more confident in the services they receive because staff treating them are more positive and energetic when providing care

These are just a few ways that an ergonomic radiology work environment can improve patient care.

Why You Should Work with Double Black Imaging for Your Radiology Workstations

At Double Black Imaging, we don’t just sell you equipment to meet a standard ergonomic need.  We complete an onsite radiology work environment survey to assess what ergonomic equipment will be best for you and your radiologists.

We make specific recommendations for each surveyed workspace.  Our recommendations for your specific needs are based on our insider knowledge of PACS, mammography/tomography, clinical and surgical applications.

Contact us here, email us, or call us at (877) 852-2870, to arrange your Onsite Radiology Equipment Survey and determine what workstation will be best for you and your radiologists.

References:

1. ATD Releases 2016 State of the Industry Report | ATD, January 9, 2023
2. Employee Injuries: What Is the Real Cost to Employers? (workplacetesting.com), January 9, 2023
3. Prevalence of Musculoskeletal Work-related Injuries Among Radiation Therapists – PubMed (nih.gov), January 9, 2023 Hanania AN, Cook A, Threadgill MP, Conway SH, Ludwig M. Prevalence of Musculoskeletal Work-related Injuries Among Radiation Therapists. Radiol Technol. 2020 May;91(5):414-421. PMID: 32381659.

Mobile radiology imaging services mean that certified technologists and radiologists travel to a medical facility, residence, or place of business with any equipment needed to complete a procedure and provide those services at that location. It not only includes portable X-Ray imaging but also ultrasound and EKG.

Mobile services are increasing in popularity because of changes in the way facilities administer healthcare and assess improvement.  Because mobile imaging services can provide faster, more cost-effective, and more convenient services compared to third-party facilities, they are being used more often.

Patient Benefits of Mobile Radiology Imaging

Typically, patients would expect to receive radiology services such as X-Ray, ultrasound, or EKG by traveling to a third-party imaging center or an in-house imaging department, or as an inpatient in a hospital traveling within the facility to the imaging department.

Faster and Cheaper Services

Besides being able to schedule an appointment faster than with traditional service providers, mobile radiology imaging results can be communicated faster to the ordering physician  This is possible because mobile imaging services are available 24 hours per day and often have 24-hour turnaround times. Another factor that makes mobile services faster is that the scans are available via online portals such as PACS within minutes.

Mobile radiology imaging services can be faster and cheaper than those available through traditional models at the sites discussed above. Reduced expense is achieved by having shorter response times and greater flexibility with mobile imaging. It is also cheaper for the patient because mobile imaging does not require patient travel to a facility for services.

Patient Care Benefits

Patient health is risked when the care team needs to interrupt the peace and quiet of the room to prepare the patient for transportation, transfer them to a different bed for travel, and/or disconnect treatment and transfer it to the transportation device.  When patients are already very ill, transportation increases risks.

Disruption of a tranquil environment presents health risks whether you are talking about the patient being transported or the patient in the room and who is also having their tranquility disrupted.  A quiet environment can help patients heal faster because it helps the patient sleep better.  When a patient is in a quiet environment, they experience fewer spikes in heart rate, decreased cortisol output, lower blood pressure, and reduced anxiety.

It should be noted that fewer staff need to enter the room and work with the patient when the imaging service comes to their room.  Because fewer people are entering the room and working with the patient at the same time, this results in less disruption to other patients in the room.

Avoiding Health Risks

Patients referred for imaging services while hospitalized face several risks to their health and safety during transportation to the Imaging department.  While being transported, the patient could be exposed to several health and safety risks, including:

• infections (air-born acquired illnesses, infections from wounds, contact-born pathogens)
• respiratory problems (ventilator, tracheostomy, and breathing assistance)
• traumatic injury (falls, lacerations, hematomas)
• medical complications (glucose regulation or acid-based homeostasis)
• death

Avoiding Hospitalizations

In the past, a large number of hospital admissions of patients from nursing homes and skilled nursing facilities were related to falls, respiratory infections, and digestive system inabilities.  Being able to assess these patients at their residence can decrease the need for hospitalization.  Now many patients can be diagnosed, and a treatment plan can be identified without the need for hospital admission.

Facility/Staff Benefits

Decreased Costs

Mobile radiology imaging can be integrated into current services without extensive overhead costs.

From the facility’s perspective, it requires far fewer personnel to provide a mobile scan than one that is required to prep and transport a patient, especially if they are very ill and have multiple devices that must travel with them.

Busy third-party imaging facilities and hospitals suffer financial losses when many patients cancel on the same day due to inclement weather.  With mobile services, the patients stay where they are, and the imaging services come to them.

Mobile radiology imaging services can be incorporated into your current facility and service delivery model without adding space, equipment, or training.

Faster Results and Better Patient Treatment

Mobile imaging services can provide support to in-house imaging departments.  This assistance provides a quicker response to patients when the in-house service is not able to meet the demand of both in and outpatients.

Another variable that makes mobile imaging faster and less expensive is the turnaround time for disinfection.  Most mobile units can be disinfected and ready to use again in as few as 5 minutes compared to the 45 minutes that is usually required for a radiology suite.

Greater Medical Team Satisfaction

When imaging services come to the patient, the medical team experiences less stress.  Since fewer professionals are required to assist the imaging team, the medical team on the nursing unit is freed up to help other patients. Therefore, there can be fewer simultaneous demands on the team member’s time and energy.

Types of Imaging Available in a Mobile Setting

Currently, mobile imaging services include X-rays, EKGs, and ultrasound.  It is reasonable to expect that this list of services will increase in the future.

X-Ray

X-Ray procedures are performed for a variety of reasons.  They are used to detect gallstones and kidney stones, injury to bones, bone deformities, pneumonia or bronchitis, and even aspiration.  X-rays can also be used to verify bone healing or the placement of medical devices such as catheters, implantable pumps, or feeding tubes.

EKG

EKGs performed by a mobile service are used for the same purposes as those performed in-house.  They are used to identify heart attack, pericarditis, or angina as a cause of chest pain.  Also, it can identify the cause of symptoms of heart disease like shortness of breath, dizziness, fainting or rapid heartbeat, irregular heartbeats, or palpitations.  EKGs can also monitor whether medications are improving a patient’s condition or whether they are causing side effects that impact cardiac functioning.  Finally, EKGs can assess heart health in the presence of concomitant conditions such as high blood pressure, high cholesterol, diabetes, heart disease, or smoking.

Ultrasound

Ultrasound performed by a mobile radiology imaging service can detect various medical conditions, including abdominal aneurysms, arterial occlusion or blood clots, carotid occlusive disease, carotid artery disease, renal vascular disease, hypertension, and early signs of kidney failure.

Double Black Imaging Can Help With your Mobile Radiology Imaging Needs

Double Black Imaging has been working to make imaging more efficient since 2002.  We focus on keeping in step with new technology and trends in the industry.  It is also our passion to help you, our customers, stay on top of those trends.

We are known for our customer service and pride ourselves on providing the best in the industry.  Why?  Because we believe our job is to make your job easier.

One way to make work easier at your facility is to help you integrate mobile imaging services.

Are you ready to make that happen?  We are here to help you make it effortless, effective, and efficient.

Contact us here, email us at sales@doubleblackimaging.com or call us at (877) 852-2870.  We look forward to helping you succeed!

No Surprises Act Summary & Key Factors

What is the No Surprises Act in Radiology?

When treated by facilities or physicians outside their insurance network  patients could receive large, unexpected bills. This is known as surprise billing.

Simply stated, these providers do not participate in an insurance plan and typically bill and are reimbursed at a different rate.

The No Surprises Act 2022 is a federal surprise medical billing law that limits the financial obligations of patients to out-of-network providers. This applies to emergency and non-emergency situations.

No Surprises Act 2022 billing rules state that a patient’s out-of-pocket expenses should be the same for out-of-network providers as it is for providers in-network. Depending on the patient’s insurance plan, this will be the co-payment, co-insurance, or deductible that is normally owed to in-network providers.

When was it voted on?

In December 2020, Congress signed the Consolidated Appropriations Act.  The No Surprise Act is part of that legislation.

When did it go into place?

The No Surprises Act effective date was January 1, 2022, so you are now expected to follow the law.

What has changed because of the No Surprises Act 2022?

If your state has already enacted no surprise billing legislation, the No Surprises Act will not supersede it.

For states that have not yet enacted a surprise billing law, the No Surprises Act will result in several changes.

For non-emergency care, you will need to obtain consent prior to providing services.

Secondly, the patient cannot be billed directly.  You will need to bill and negotiate reimbursement through the insurance provider.

Once you have received payment, you have 30 days to negotiate or appeal the amount.

Finally, you will need to use the established system to negotiate and/or request arbitration of reimbursement rates.

Services Covered

If a patient requires emergency care, you should provide services until they are stabilized.  As an out-of-network facility, you must then address the issue with the patient to obtain consent to be transferred to an in-network facility or physician.

The patient can also consent to continue receiving out-of-network services from you.

Patients who sign consent waivers will then be responsible for the balance of uncovered expenses.

In a non-emergency situation, if your facility has in-network providers, you are permitted to request a consent waiver.  This allows you as the provider to balance bill the patient.

In these non-emergency situations, it is important to note that you need to give the patient a written consent waiver 72 hours prior to the procedure/medical service.

You need to include the following in the consent waiver:

1. A declaration that you are not in the patient’s insurance network
2. An estimate of the cost of your services that is as accurate as possible
3. If your facility is in-network, a list of in-network providers at your facility
4. A summary of any prior authorization or care management requirements that must be in place prior to the procedure/service
5. A statement that the patient can opt to receive care from an in-network provider

When the non-emergency procedure will occur in less than 72 hours, you must provide the notice/consent waiver at the time the appointment is made.

Independent Dispute Resolution (IDR)

The No Surprises Act provides a system for negotiating reimbursement.  Please note, you only have 30 days to come to a resolution with the payer or to file a dispute if you cannot come to an agreement.

If you fail to reach an agreement with the payer, you or the payer have four days to activate the Independent Dispute Resolution (IDR) system.

Once the IDR is initiated, you and the payer will each submit an amount to an arbitrator, who will select one of those amounts as the settlement.

You cannot split the difference or request further negotiation.

Once decided, neither you nor the payer can repeat the process for the same service or procedure with each other for 90 days.

The losing party pays the cost of the arbitration process.

Over time, you will learn what level of payment is acceptable to the arbitrator, and this should limit the need for IDR appeals.

Impact on Radiologists

Radiologists and other ancillary service providers are not able to use consent waivers. This means you must abide by the in-network payment policies of the Act.

The No Surprises Act does not exempt patients from financial responsibility. You can expect them to pay what they would pay if you were in-network. This will be clearly communicated to you on the Explanation of Benefits (EOB) that the insurance company sends with their payment to your practice. You can bill the patient for this amount once you have accepted the payment or a payment has been negotiated. You can bill them for their co-payment, co-insurance, or deductible as indicated in their insurance plan.

Time and resources spent negotiating rates and engaging in arbitration, will impact finances for you and the payer. It is in your best interest to establish a system to minimize this impact.

One solution is to try to reach an agreement with out of network (OON) payers. This will eliminate potential disputes about reimbursement, special claim handling and costs of arbitration via IDR, so it will be beneficial to them to make this agreement with you.

Importance of developing an internal process

You will learn about the charges and reimbursement for OON patients as you settle disagreements with the payer.  However, handling charges for these patients will require a different system than what you use for in-network billing.

Be sure in-network vs. out-of-network status is clearly determined from the beginning for these patients so their reimbursement claims can be processed correctly.

Even though patients are out-of-network, you should submit your initial claim to the insurance company for your full fee.

Your system should tag accounts so that you can review payments when they are received.  This will avoid billing the patient for the balance rather than the allowed amounts.

You also want your staff to determine whether the payment is acceptable to your practice within the 30-day negotiation window.  This way, you don’t miss the opportunity to negotiate a rate or file a dispute.

Your staff can respond quickly and know if negotiation is necessary. If you take the time to create a list of reimbursement rates that you find acceptable for your procedures. Also, over time you will learn from the arbitrator what is an acceptable reimbursement level.

Claim processing can be more efficient if you create a fee schedule within your accounting system.

About Double Black Imaging

Since 2002, Double Black Imaging has brought high quality computing and imaging products to the market in response to changes in the market technology and medical care. We offer solutions that will help you implement these changes effectively and with minimal effort.

Contact us today at (877) 852-2870 or email us at sales@doubleblackimaging.com to learn more about how our products can help you comply with these new requirements without a negative impact on your budget.

Why Human-Computer Interaction in Radiology?

Focus on Human-Computer Interaction (HCI) in the field of radiology has increased significantly over the years.  It is now common to use the terms HCI radiology and HCI imaging to refer to the study of radiology as it pertains to human-computer interaction.

The emphasis on HCI radiology, or HCI imaging, has changed the way we look at equipment purchases, report writing, and E-Learning.

The influence of HCI considerations not only has had a major impact on these areas to date but could continue to influence these and other considerations for the field of radiology in the future.

HCI Radiology and Equipment Purchases

Jogia, et.al. (2021)¹ reported a human-computer interaction study to consider HCI factors when purchasing X-ray equipment.  While they looked at ergonomic factors such as force to operate machines, the primary emphasis was on the HCI between Medical Radiation Technologists (MRTs) and the control room console.

They focused on the tasks involved in operating the control room console as these are the actions that make up the HCI.  Further, they looked at actions at the console that could result in wasted images and which aspects of the design might reduce repeated and wasting (rejecting) X-ray images.

A primary focus of the assessment involved heuristic evaluation.  This allowed them to judge the usability without speaking to the users.

They identified three sources of the task workload for HCI activities:  mental demand, frustration and performance.

Consistency and Standards, User Control and Freedom, Error Recovery Problems, Help and Documentation, and Error Prevention and Memory were all areas of errors when using the console.

They summarized the following questions:

Should HCI factors be included in a purchasing guide?

Can HCI factors be identified using HCI tools while observing MRTs working with the equipment?

Can we determine the most relevant method and tool for evaluating HCI between MRTs and the X-ray equipment?

Jogia, et. al. (2021) called for additional human-computer interaction studies employing the use of heuristic evaluation that focuses on factors that can be easily identified and tested during the purchasing process.  They suggested that these HCI factors could be instrumental in planning and designing an X-ray suite.

HCI Imaging and Reporting

Ganapathi, et.al. (In print)² studied HCI for the development of a structured reporting process that incorporated eye-gaze and speech signals.  The primary objective was to generate data to create an HCI to automate generation of a structured radiology report that captures key image findings and a radiologist’s subsequent spoken descriptions of those findings.

They used an eye-gaze tracking device to establish an eye-gaze-voice span parameter which they defined as a unit of time from when the radiologist fixates on an image to the start of speech.

They looked at factors such as anatomy imaged, image modality, image resolution and radiologist interpretation.

They concluded that because the individual radiologist was the key to designing a system of automated reporting that utilizes eye gaze, a system based on these parameters would need to be customized to the individual radiologist.

The order of items targeted did not produce significant variability, nor did the anatomy being imaged, image resolution, and modality, so customization is not needed for these items.

They suggest a “next step would be to use the gaze and speech signals together to identify diagnostic regions-of-interest from the gaze signals and corresponding speech content to incorporate key image findings into a structured report.”

The authors believe that a system using eye gaze – voice span could improve structured acceptance and implementation.

The article concludes with the suggestion that the best success with the system could be achieved through training the radiologist to better use the HCI.

HCI Radiology and E-Learning

Den Harder, et.al. (2016)³ looked at how learning outcomes and perspectives of medical students and teachers were influenced using image interaction in radiology e-learning programs.

They defined e-learning as us of electronic media, including audio, digital images, and web-based learning for educational purposes.

Advantages of e-learning include flexibility in when and where a student can learn, the types of materials that can be used (animation, video, interactive programs), and the ability to increase class sizes.

Two primary forms of HCI that are of benefit to radiology in e-learning are:

Navigation or scrolling through a stack of images in different planes)

Manipulation (adjusting contrast setting, rotating 3D models)

In the past, Computed tomography (CT) and magnetic resonance imaging (MRI)  in hospitals were viewed by physicians as single images printed next to each other.  In radiology, they are viewed as a stack of images (volumetric image).  Now that images are digitalized and used in Picture Archiving Systems (PACS), the volumetric images are available to all in-house doctors.

This highlights the importance of medical students learning to interpret radiological images and understanding the relationship between the anatomical and pathological structures.

This article suggests that a “first step can be the use of videos of volumetric image stacks.  However, ultimately, human-computer interaction with images should be possible since this is more representative to clinical practice and more reliable than tests with 2D CT images.”

They indicate that allowing for image manipulation is a key method e-learning can improve radiology education.

This was supported by the finding that tests that used stack images were more reliable and more representative of clinical practice compared to tests that used 2D images.

Now that in-hospital doctors have stacks of images available for review, and the study found that stack image and 2-D image review require different cognitive processes, the argument is made that medical students could benefit from similar exposure.

The study also noted that scores using stack viewing and image manipulation correlated with scores on human cadaver anatomy tests.  This same correlation did not occur for tests without stack viewing.

The authors suggest that radiology anatomy courses should use radiological images with stack viewing and other image manipulation tools.

They concluded that the use of image interaction in e-learning could be beneficial for medical students.

About Double Black Imaging

Double Black Imaging makes radiology imaging and reporting easier and less time consuming for you.  Implementation of new information about HCI is just one way we hope to accomplish that.

We are here to help you solve your imaging issues and improve your process in your radiology department.  Give us a call at (877) 852-2870, email us at sales@doubleblackimaging.com, or go here to submit a request.  Let us know how we can help you use the latest knowledge to make your department work smarter.

References:

1. Jogia, A; Brunet, J-P; Ramos, D; Lintack, J; Di Raimo, L; Sharpe, M; Rowr, K; Paul, N; Lall, D; Cheadle, S; Smith, J; Macdonald, R; Plastino, J.  Human Computer Interaction (HCI) in General Radiography:  A Case Study to Consider HCI Factors When Purchasing X-ray Equipment (2021).  Proceedings of the 21^st Congress of the International Ergonomics Association (IEA 2021), IV.
2. Ganapathi, T; Vining, D; Bassett, R; Garg, N; and Markey, M. A Human Computer Interaction Solution for Radiology Reporting:  Evaluation of the Factors of Variation.  Journal Preprint.
3. den Harder, A.M., Frijlingh, M., Ravesloot, C.J. et al.The Importance of Human–Computer Interaction in Radiology E-learning. J Digit Imaging 29, 195–205 (2016).