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. 1997 Feb;10(1):40–45. doi: 10.1007/BF03168549

Processes involved in reading imaging studies: Workflow analysis and implications for workstation development

Spencer B Gay 1,✉, Amy H Sobel 1, Linda Q Young 1, Samuel J Dwyer 1
PMCID: PMC3453185  PMID: 9147527

Abstract

Software development for imaging workstations has lagged behind hardware availability. To guide development and to analyze work flow involved in interpretation of cross-sectional imaging studies, we assessed the cognitive and physical processes. We observed the performance and interpretation of body computed tomography (CT) scans and recorded the events that occurred during this process. We studied work flow using a bottleneck analysis. Twenty-four of a total of 54 cases (44%) involved comparing the images with those of prior scans. Forty-seven of 54 scans (87%) were viewed using windows other than soft tissue, or compared with precontrast scans. In 46 cases (85%), the interpretation stopped to return to a previous level for review. Measurement of lesions was performed in 24 of 54 (44%) cases, and in 15 (63%) of these cases, measurements were taken of lesions on old studies for comparison. Interpretation was interrupted in 14 of 54 cases (26%) by referring clinicians desiring consultation. The work flow analysis showed film folder retrieval by the film room to be the bottleneck for interpretation by film. For picture archiving and communication system (PACS) reading, the CT examination itself proved to be the bottleneck. We conclude that workstations for CT interpretation should facilitate movement within scans, comparison with prior examinations, and measuring lesions on these scans. Workstation design should consider means of optimizing time currently not used between interpretation sessions, minimizing interruptions and providing more automated functions currently requiring physician interaction.

Key words: PACS, workstation design, time and motion analysis, radiology, computers

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References

  • 1.Arenson RL, Chakraborty DP, Seshadri SB, et al. The digital imaging workstation. Radiology. 1990;176:303–315. doi: 10.1148/radiology.176.2.2367643. [DOI] [PubMed] [Google Scholar]
  • 2.Beard DV. Designing a radiology workstation: A focus on navigation during the interpretation task. J Digit Imaging. 1990;3:152–163. doi: 10.1007/BF03167601. [DOI] [PubMed] [Google Scholar]
  • 3.Gur D, Good WF, King JL. Simultaneous and sequential display of ICU AP-chest images. Proc SPIE. 1992;1653:159–163. doi: 10.1117/12.59495. [DOI] [Google Scholar]
  • 4.Beard DV, Hemminger BM, Perry JR, et al. Interpretation of CT studies: Single-screen workstation versus film alternator. Radiology. 1993;187:565–569. doi: 10.1148/radiology.187.2.8475309. [DOI] [PubMed] [Google Scholar]
  • 5.Bellon E, Houtput W, Bijnens B, et al. Combining fast response and low cost of an intensive care unit viewing station. J Digit Imaging. 1994;7:91–94. doi: 10.1007/BF03168429. [DOI] [PubMed] [Google Scholar]
  • 6.Beard DV, Hemminger BM, Denelsbeck KM, et al. How many screens does a CT workstation need? J Digit Imaging. 1994;7:69–76. doi: 10.1007/BF03168425. [DOI] [PubMed] [Google Scholar]
  • 7.Wilson AJ. Filmless musculoskeletal radiology: Why is it taking so long? AJR. 1995;165:105–107. doi: 10.2214/ajr.165.1.7785566. [DOI] [PubMed] [Google Scholar]
  • 8.Stuck BW, Arthurs E. A Computer and Communications Network Performance Analysis Primer. Englewood Cliffs, NJ: Prentice-Hall; 1985. pp. 140–148. [Google Scholar]
  • 9.Foley WD, Jacobson DR, Taylor AJ, et al. Display of CT studies on a two-screen electronic workstation versus a film panel alternator: Sensitivity and efficiency among radiologists. Radiology. 1990;174:769–773. doi: 10.1148/radiology.174.3.2305060. [DOI] [PubMed] [Google Scholar]
  • 10.Stewart BK, Aberle DR, Boechat MI, et al. Clinical utilization of grayscale workstations. IEEE Eng Med Biol. 1993;11:86–102. doi: 10.1109/51.195945. [DOI] [Google Scholar]
  • 11.Gur D, Good WF, Oliver JH, et al. Sequential viewing of abdominal CT images at varying rates. Radiology. 1994;191:119–122. doi: 10.1148/radiology.191.1.8134556. [DOI] [PubMed] [Google Scholar]
  • 12.Hunter TB, McNeil KM. The radiologist's workstation. Invest Radiol. 1990;25:282–284. doi: 10.1097/00004424-199003000-00014. [DOI] [PubMed] [Google Scholar]
  • 13.Mulligen EM, Timmers T, Heuvel F, et al. A prototype integrated medical workstation environment. Comput Methods Programs Biomed. 1993;39:333–341. doi: 10.1016/0169-2607(93)90036-K. [DOI] [PubMed] [Google Scholar]
  • 14.Bhushan V, Valentino DJ. A radiologist's guide to diagnostic workstation user interfaces. Radiology. 1993;189:414–414. [Google Scholar]
  • 15.Taira PK, Breant CM, Chan HM, et al. Clinical results of HIS, RIS, PACS integration using data integration CASE tools. Radiology. 1994;193:430–430. [Google Scholar]
  • 16.Valentino DJ, Bhushan V, Lufkin R. Virtual reality in radiology: Prototype of a virtual view box. Radiology. 1993;189:249–249. [Google Scholar]
  • 17.Steven PM, Cobb ME, Miller KD: Assessing tradeoffs between high-end performance and low-end standards in display systems: Proceedings of SPIE Medical Imaging 94, Newport Beach, CA, February 1994
  • 18.Ito Y, Ishigaki T, Sakuma S, et al. Influence of CRT workstation on observer's performance. Comput Methods Programs Biomed. 1992;37:253–258. doi: 10.1016/0169-2607(92)90035-6. [DOI] [PubMed] [Google Scholar]
  • 19.Steckel RJ. Current applications of PACS to radiology practice. Radiology. 1994;190:50A–52A. doi: 10.1148/radiology.190.3.50a. [DOI] [PubMed] [Google Scholar]
  • 20.Straub WH, Gur D, Good WF, et al. Primary CT diagnosis of abdominal masses in a PACS environment. Radiology. 1991;178:739–743. doi: 10.1148/radiology.178.3.1994411. [DOI] [PubMed] [Google Scholar]
  • 21.Chang PJ, Ziegelbein K. Performance of a multiband cine workstation vs film in interpretation of MR studies. Academic Radiology. 1994;1:116–116. [Google Scholar]
  • 22.Seltzer SE, Judy PE, Adams DF, et al. Spiral CT of the chest: Comparison of cine and film-based viewing. Radiology. 1995;197:73–78. doi: 10.1148/radiology.197.1.7568857. [DOI] [PubMed] [Google Scholar]
  • 23.Horii SC, Horii HN, Mun SK, et al. Environmental designs for reading from imaging work stations: Ergonomic and architectural features. J Digit Imaging. 1989;3:156–162. doi: 10.1007/BF03168035. [DOI] [PubMed] [Google Scholar]
  • 24.Horii SC, Horii HN, Kowalski P. An eclectic look at viewing station design. Medical Imaging. 1988;914:920–928. [Google Scholar]
  • 25.Hunting W, Laubli T, Gradjean E. Postural and visual loads at VDT workplaces. Ergonomics. 1981;12:917–931. doi: 10.1080/00140138108924914. [DOI] [PubMed] [Google Scholar]
  • 26.Grandjean E, Hunting W, Pidermann M. VDT workstation design: Preferred settings and their effects. Human Factors. 1993;25:161–175. doi: 10.1177/001872088302500203. [DOI] [PubMed] [Google Scholar]

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