Editorial: Sitting is the new smoking

By E Simon Schwartz

If you’re like most radiologists, you’re sitting at a workstation 8-10 hours a day (or night!). And guess what—that may be killing you.

According to James Levine, MD, director of the Mayo Clinic-Arizona State University Obesity Solutions Initiative (and inventor of the treadmill desk), “Sitting is more dangerous than smoking, kills more people than HIV and is more treacherous than parachuting. We are sitting ourselves to death.” 1

Want more bad news? While you’re sitting yourself to death, you’re probably getting repetitive stress injuries (RSI). Too often we think only of carpal tunnel syndrome when we hear about RSIs, but other musculoskeletal injuries are becoming increasingly common in those who work at a computer for hours at a time each day.

Recently, an international panel of experts convened to provide guidance and promote the avoidance of prolonged periods of sedentary work, which may “significantly and independently increase the risk of cardiometabolic diseases and premature mortality.”2 They determined that, for those occupations which are full-time and “predominantly desk based,” workers should initially aim for 2 hours per day of standing and light walking at work, with the goal of reaching 4 hours per day.2 They recommend that seated work be “regularly broken up with standing-based work,” best achieved with the use of variable-height sit/stand workstations, and by taking “short active standing breaks.”2

Essential components of a well-designed reading room include a highly adjustable and supportive chair, with neck support to minimize neck, arm/shoulder and lower back strain. Monitor height is another commonly overlooked feature that can lead to neck injuries; extending your neck to look at images is asking for trouble. Monitors should be positioned such that you are looking directly across or slightly down, ideally at a 15- to 20-degree angle. 3

“Blind Radiologist” may be a great teaching exercise for trainees, but our eyes are our most precious asset. Preventing eyestrain can go a long way toward extending your professional longevity, reducing headaches and improving productivity. The 20-20-20 rule is easy to follow and easy to remember: Every 20 minutes, look 20 feet away for at least 20 seconds. Careful lighting design in a reading room can also help prevent eyestrain. Indirect and task lighting are best. A blue light cast on the wall behind each workstation with a luminescence that matches your monitors has been shown to help with pupillary constriction and to reduce eyestrain, particularly when interpreting gray scale images. Siegel et al have shown that too much ambient light, however, substantially increases fatigue and decreases interpretation accuracy.4

Other reading room features, such as temperature, humidity and air quality can also have significant impact on the health and productivity of radiologists. Having control over the indoor climate is a key feature of effective reading room design. The highest productivity occurs at approximately 72 degrees Fahrenheit (22 degrees Celsius).5 The American Society of Heating, Refrigerating, and Air Conditioning Engineers recommends that ventilation systems pump in 15-20 cubic feet of fresh air per minute for every person in an office setting. If your reading room ventilation is not up to this standard (and most aren’t—5 cubic feet per minute per person is common), you may be breathing bad indoor air.6 Headaches, nausea, dizziness, irritability, itchy eyes and respiratory illnesses may all result.

Also pay attention to reading room acoustics. A noisy environment negatively impacts concentration and adversely affects voice-recognition dictation software. Options include sound-absorbent materials on the walls and in the flooring, and more active sound-masking systems that can produce white noise in a frequency similar to that of human speech, which helps to reduce distractions. Background music (without lyrics) has been shown to increase productivity, and recent research by the Rensselaer Polytechnic Institute found that the sounds of nature are just as effective as white noise in masking distracting sounds and speech while “enhancing cognitive functioning, optimizing the ability to concentrate, and increasing overall worker satisfaction.” 7

Finally, reading room placement in the overall design of a radiology department or hospital can have a substantial impact on the number and quality of your consultations with providers. At New York University Langone Medical Center, integrating a reading room into the urologic oncology clinic resulted in an extremely high level of provider satisfaction, with more than 90% of consultations having “benefitted patient care,” even when only manned three hours per day.8

We radiologists and administrators need to rethink the role of the reading room in the Imaging 3.0 era. According to Woojin Kim, MD, co-founder and Director of Innovation at Montage Healthcare Solutions and former Director of the Center for Translational Imaging Informatics at the University of Pennsylvania, a “well-designed reading room is no longer enough. It has to be located in a place that can allow the radiologists to demonstrate their value better … . The layout cannot simply be all about the radiologists, but should also take into account the referring providers.”9 Kim goes on to say that, “too often people design radiology reading rooms as an afterthought. Even for a brand new building with a new radiology area, the radiology reading room is the last thing to be considered in the overall design process. When you build a new house, you don’t wait until the blueprint is nearly completed and then decide to pick an odd-shaped corner space somewhere and designate that area as the master bedroom. Yet, I have seen this happen time after time—even with new construction.”

Fellow radiologists, I implore you: Stand up for your health, invest in the highest-quality task chairs, take care of your eyes, optimize your environment, and help demonstrate the added value you bring to patient care by strategic reading room placement whenever possible.


  1. Macvean M. ‘Get Up!’ or lose hours of your life every day, scientist says. Los Angeles Times. http://www.latimes.com/science/sciencenow/la-sci-sn-get-up-20140731-story.html. Accessed Sept. 23, 2015.
  2. Buckley JP, Hedge A, Yates T, et al. The sedentary office: An expert statement on the growing case for change towards better health and productivity. Br J Sports Med. 2015 Jun 1. pii: bjsports-2015-094618. doi: 10.1136/bjsports-2015-094618. [Epub ahead of print]
  3. Occupational Safety & Health Administration. We Can Help – Computer Workstations eTool. https://www.osha.gov/SLTC/etools/computerworkstations/components_monitors.html.
  4. Siddiqui KM, Chia S, Knight N, Siegel EL. Design and ergonomic considerations for the filmless environment. J Am Coll Radiol. 2006 Jun;3(6):456-467.
  5. Seppanen O, Fisk WJ, Lei QH. Effect of temperature on task performance in an office environment. Lawrence Berkley National Laboratory. 2006; https://indoor.lbl.gov/sites/all/files/lbnl-60946.pdf. Accessed Sept. 23, 2015.
  6. OSHA Technical Manual, Section III: Chapter 2. https://www.osha.gov/dts/osta/otm/otm_iii/otm_iii_2.html. Accessed Sept. 23, 2015.
  7. DeLoach AG, Carter JP, Braasch J. Tuning the cognitive environment: Sound masking with “natural” sounds in open-plan offices. J Acoust Soc Am. 2015;137: 2219.
  8. Rosenkrantz AB, Lepor H, Taneja SS, et al. Adoption of an integrated radiology reading room within a urologic oncology clinic: Initial experience in facilitating clinician consultations. JACR.J Am Coll Radiol. 2014;11(5):496-500.
  9. Woojin Kim, MD, personal communication.
E Simon Schwartz. (Oct 03, 2015). Editorial: Sitting is the new smoking. Appl Radiol. 2015; 44(10):4-6.

Dr. Schwartz is the Editor-in-Chief of Applied Radiology. She is the Chief of the Division of Neuroradiology and holds the Robert A Zimmerman Chair in Pediatric Neuroradiology in the Department of Radiology at The Children’s Hospital of Philadelphia. She is also an Associate Professor of Radiology, Perelman School of Medicine, University of Pennsylvania.

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