The increasing numbers of large and complex imaging studies can often be daunting for radiologists in trying to keep up with demands for image retrieval, analysis, and reporting in today’s busy practices. Speech recognition, advanced visualization, and the electronic medical record add even more complexity to a radiologist’s workflow as well as creating clutter in the radiologist’s workspace. In many situations, the radiologist is continually transitioning between three separate monitors, or even two separate workstations. The human machine interface devices, such as a mouse or trackball, are becoming increasingly ineffective from an efficiency perspective and an increasing number of radiologists, technologists, and clinicians are being adversely affected by repetitive motion disorders of the hands and wrists. One possible approach to improve the radiologist’s workflow is the use of multi-touch monitors and workstations. Not only can these assist in the ability to organize large amounts of information, but also they can have significant potential to improve productivity, as well as work-flow, for analysis and reporting. Our goal was to investigate the potential for practice improvement made possible by the use of a technology referred to as multi-touch sensing and to share our initial data utilizing a prototype which couples a generic multi-touch system with a commercial PAC system. We are not aware of any previous studies of this technology using a commercial PACS workstation.

A prototype multi-touch sensing device interfaced to a commercially available PACS system was evaluated as a comprehensive radiologist’s workstation. The multi-touch screen has the capability to sense multiple inputs simultaneously. This feature allows for numerous degrees of freedom and rapid response for image retrieval, display, and navigation. Images can be rapidly sorted, zoomed, panned, and rotated, as well as efficiently compared with previous studies and information from a hospital and radiology information system and educational information and communication tools from the Internet. Furthermore, unique finger gestures can be used to perform specific tasks. For example, two adjacent fingers can cue scrolling and a single finger can be used to pan or window and level. Furthermore, a circular finger stroke can cue an options menu. Our initial evaluation of multi-touch screens suggests that a single large multi-touch monitor can effectively replace a three monitor conventional PACS workstation. Additionally, a multi-touch sensing system provides a superior input device to the conventional mouse. The device can also be utilized for template reporting for certain types of studies, such as mammography and conventional chest radiography. The use of such a device will require a different ergonomic solution for radiologists than is currently in general use. The use of the multi-touch workstation distributes repetitive motion to more of the arm and hand than with the focal muscles involved with the use of a conventional mouse. Thin section CT studies were evaluated for this study, with comparison made between current and prior examinations. The studies were evaluated in the axial, coronal, and sagittal planes with the time required to interpret a study and the accuracy in finding lung nodules recorded. Comparison was made to a conventional PACS workstation utilizing a mouse input device.

Initial experience with multi-touch sensing has been that it is a reliable and unique tool in the interpretation of radiologic studies. An initial learning curve exists when using such a system; however, there is significant potential to improve workflow and productivity using such a device. Difficulties encountered while evaluating a multi-touch workstation included ergonomic solutions, monitor obscuration from the dirt and oil on a user’s hands, and integration. Standing in front of or being seated at such a workstation can be fatiguing for the radiologist and creating an optimal ergonomic solution will require additional research. One promising approach is to emulate an architect’s drawing board. Another difficulty faced by the radiologist was the fingerprints and markings created on the workstation with constant use. The continuous creation of these artifacts could affect image study interpretation. Although the current prototype allows navigation of multiple radiologic studies, further development will require much tighter integration with existing PACS workstations, and advanced visualization systems, as well as reporting and EMR software.

As multi-touch displays become more prominent in consumer products, for example the Apple iPhone, Microsoft’s Surface, and Dell’s Latitude Multi-touch tablet PC, their functionality in radiology seems more promising, if not inevitable. Initial experience suggests that the use of multi-touch workstations provides a unique format for evaluating radiologic studies. Furthermore, the use of these devices could result in substantial improvements in productivity and access to complex information. Current challenges include an optimal ergonomic solution, improved protection from fingerprinting artifact, tighter integration with existing PACS workstations, advanced visualization systems, and reporting and EMR software. Based on our initial results, we believe that multi-touch monitors may revolutionize the way in which radiologists, clinicians, and technologists interact with imaging and hospital information systems in the near future.

http://en.wikipedia.org/wiki/Multi-touch