Radiologist and ergonomic specialist Les Folio, DO, with others has embarked on a two-year project to identify best practices for radiology monitor and workstation configuration in the reading room.
PACS, digital image interpretation, and increasing imaging volumes and tools means that radiologists are sitting more and viewing three to five monitors in the process of their daily work, according to Folio, imaging informatics section chief in radiology services at James A. Haley's Veterans' Association Hospital in Tampa, FL.
By participating in the ergonomics poll, radiologists can signal opportunities for improvement, said Folio, a 66-year-old U.S. Air Force combat veteran who has been redesigning radiology reading rooms for years using best practices from his experience in the military and beyond.
Workstation design has long been considered a significant factor contributing to occupational health and work-related musculoskeletal disorders (MSDs). Comfort and strategies grounded in good ergonomics principles may prevent repetitive stress injuries (RSIs) such as carpal tunnel syndrome and radiologists' elbow, as well as back, shoulder, and neck pain.
Some studies reflect that a majority of radiologists have some form of repetitive stress injury (RSI), according to Folio.
Affecting productivity
Ergonomics can also impact productivity in the radiology reading room. There are many factors, Folio explained, noting among others lighting, furnishings, monitors, mouse design, paint sheen and color on reading room walls, and voice dictation systems.
The Society for Imaging Informatics in Medicine (SIIM) has highlighted ergonomics during its conferences, along with ways radiologists can reduce physical strain and fatigue. Folio, who presented at RSNA 2025, recommended using the "three-points-of-contact rule."
Three points of contact for radiologists means: 1) where eyes meet the monitor (top one-third), 2) where the hands meet the devices (elbow should be greater than 90 degrees), and 3) where the feet meet the floor or where the seat meets the chair, with back straight, Folio explained for AuntMinnie and demonstrated in the video below.
Folio demonstrates the three points of contact rule. Also, using a photo analysis, he compared radiologists' seat positioning to find how workstyles varied.
"Back straight and greater than 90 degrees at the elbow," Folio explained. "If you're less than 90 degrees, you may be hurting yourself. Every 12 minutes that I go through a chest CT," Folio explained. "When I see compression deformities and hyperkyphosis on the sagittal reformats, I remind myself to sit up straight, tighten those rhomboids, and assure I am abiding to those three points of contact. And even after 10-hour days, I can leave pain-free."
For the past year, Folio and other investigators have been polling radiologists to learn about their current workstation configurations -- and PACS vendors to optimally map how their systems present information to radiologists across monitor configurations.
Needs assessment survey
The poll, titled "Monitor Configuration Needs Assessment" and presented in a Google form, remains open to radiologists. The survey consists of 17 questions about monitor configuration and orientation, where the current exam most commonly hangs, types of peripheral devices such as keyboard or gaming hyper-scrolling mouse, percentage of time standing versus sitting while reading, and shared workstation space habits.
According to Folio, data gathered throughout 2025 and at RSNA 2025 has highlighted the following:
- Most radiologists now use sit-stand workstations. Those who do stand 10% to 30% of their shift.
- In shared workspace arrangements, radiologists must frequently adapt to various workstation configurations and user interfaces.
- Radiologists' preference for the number of monitors used varies. Most of those polled use more than four.
- Worklist and dictation are most often displayed on the far-left monitor, rather than the right.
- Most radiologists now use gaming mice with hyperscrolling capability, and the most-used mouse in radiology is the Logitech G502 Hero, often with common programming for window/level/center, measure, ROI, and arrow (for example).
Folio plans to present more detailed findings in a forthcoming manuscript submission to the Journal of Imaging Informatics in Medicine. However, practice patterns are limited so far, and more radiologists need to participate, he emphasized.
With joint society efforts to standardize, there is no consensus on best practices, he continued, adding that the monitor needs assessment is a must.
"The ultimate goal is to come up with best practices, with accepted variations, something to refer back to, and for this to be a dynamic process," Folio said.
Folio on adapting to different workspace configurations.
"The bottom line to do this is to have consistent presentation of images on workstations, which we're actually addressing for the most part, the similar appearance," Folio said.
"We're going to do something about this at some point, get a more consistent agreement on fulfilling these standards," he concluded.
Find Folio's Google form poll here.
