Microphone Styles for Radiology Dictation

Headset vs. Handheld vs. Fixed Microphones

There are three main form factors for microphones in the context of a radiology setup.

You can hold a dictaphone, as radiologists have done since time immemorial. You can wear a microphone like a headset. Or you can have a microphone that is not in any way on your person.

There are pros and cons to each solution.

The pro of the old standby handheld microphone is that it contains dictation controls, allowing you to manipulate dictation software with your nondominant hand. As I’ve discussed elsewhere, this is the wrong solution for efficiency and for ergonomics. The limitations of the built-in dictaphone tools are too numerous for it to be the right answer—even though it is the default solution.

I believe every radiologist should drop the dictaphone and use something else with their off hand. An off-hand device like the one I use can more effectively manipulate both dictation software and PACS and is less likely to cause repetitive strain or ulnar neuropathy.

An off-body solution has the benefit of freeing up your hands while also remaining plug-and-play. The microphone stays where you put it and just works when you log in. No effort needed and—with the right microphone—can be very effective.

There are infinite options. The Rode VideoMic NTG, a shotgun microphone I attach to my monitor and point at my face, has been my home dictation solution for several years now. It is efficient, effective, and works every time. I find it effortless and surprisingly resilient to slouching. The main downside to that solution is that you are still somewhat more susceptible to ambient room noise and posture (note: some users have reported intermittent problems with this microphone of varying degrees of annoyance, so another USB shotgun may or may not be better).

For some radiologists, the preferred solution is a headset microphone, which has the added benefit of moving with you so that it always accounts for position regardless of where you are relative to your desk and is less susceptible to ambient noise.

While you could also use a lav mic clipped to your clothing, but a headset also allows you to use headphones with your computer, meaning you can handle meeting requests like Zoom/Teams and listen to music without needing a second device.

For many years, headsets for dictation functionally required a wired USB connection, as Bluetooth and wireless dongles were simply too unstable, slow, and choppy for dictation accuracy. But if you don’t mind a little lag, that is no longer the case.

Headsets, like headphones more generally are very much a personal preference thing. I included several fan favorites in the equipment post, but my preferred headset solution is these Shokz bone-conduction headphones, specifically the Shokz OpenComm2 UC for several reasons. This style has become very popular with runners because you can’t lose them as easily as earbuds and you can still hear the ambient world around you for safety (I still like the AirPods Pro 2 with transparency mode).

One perk is that the Shokz are incredibly light and comfortable for long periods of time. Over-ear headphones can feel hot and are often heavier, resulting in fatigue over a long shift. There was a time as an early attending that I often used a cheap wired Plantronics headset, but I actually usually wore them around my neck with the mic arm angled toward my mouth for comfort. I think the over-the-ear behind-the-head form factor is overall more comfortable for long-term use. The Shokz are light enough that it’s basically possible to forget you’re wearing them, which I would say is ideal.

The bone-conduction pads on your tragus are non-intrusive and do not block ambient noise. This can be both a pro and a con—in the sense that if you are working in a loud place (such as next to the magnet or at home while doing laundry), you are not going to block out the room noise.

But it also helps if you want to deploy a headset while working with other human beings and wanting to be able to hear the noise around you. It means people can talk to you, and you can hear them—and that you can answer the phone and still use a receiver without needing to remove your headset.

So, for some work situations, this is ideal.

The battery lasts for a long time (reported 16 hours of dictation, 8 hours if playing music), though one downside is that the charging cable is proprietary—so you’ll have to keep the cord handy for charging (it fits in the included carrying case). A 5-minute quick charge provides 2 hours of talk time. I haven’t had battery issues yet, but since the tiny battery inside is like literally every other lithium battery in the world, I expect this to degrade eventually.

You can connect via Bluetooth, but it also plugs in easily with a USB-C (or USB-A) dongle that is safely secured in the carrying case. My understanding is that the quality with the dongle is slightly better.

If you are looking for a portable solution that reliably works, allows you to use them as functional headphones and attend Zoom/Teams calls—but also doesn’t isolate you from the rest of the world—the Shokz is, I think, a good solution for radiology.

A couple of very important limitations:

1. There is a slight lag when activating dictation, where you might notice degraded accuracy at the beginning of a phrase. You really need to use toggle on/off controls and not the deadman switch, and your accuracy will be way better if you just keep dictation turned on while reporting. Once dictation kicks on, transcription speed is fast and accurate. I think you will need to break the habit or toggling dictation on/off repeatedly for every discrete phrase or you will hate them.
2. Audio quality is lower when you’re actively using the microphone dictating, so if you are toggling back and forth all the time it’ll keep switching between higher and lower fidelity modes. It’s annoying. Bone conduction headphones aren’t audiophile quality anyway, but you’ve been warned. Because your ears are uncovered, if you don’t mind looking like a psychopath, you can keep AirPods in your ears while wearing the headset, which means you can have incredibly flexible audio input/output between your computer and cellphone. I wouldn’t listen to music via them while working.

I’ve been using the Shokz as an alternative to my cheap desk-clamp-to-hold-the-dictaphone method when at imaging centers, which allows for some more position flexibility (and the chance to channel your inner telemarketer.)

If you don’t need the headphones part of the headset but want something portable, you might instead try a lavalier format like the wireless Hollyland M2S.