This work-in-progress is the first entry in a series of upcoming posts about radiology tools, ergonomics, and efficiency. This includes the go-to stuff I use every day to practice diagnostic radiology, (briefly) how I use them, and a few alternatives. This series has been a long time coming and is the result of a lot of research, trial and error, and input from others in the radiology community.
Unnecessary caveat: There is no real best anything. Here’s what I have idiosyncratically landed on as a stable happy set-up that balances efficiency and comfort (and an editorial selection of those favored by others).
We’ll get into more workflow details and justifications in a follow-up post. In the meantime, we can summarize my personal approach as a hands-free microphone solution, a vertical mouse with some–but not a comical number of–programmable buttons–and a left-hand device that adds additional hotkey efficiency as well as—critically!—a way to scroll with my nondominant hand in order to spread the love across multiple joints. (Okay, fine, and a foot pedal when I’m at home too.)
(When You Can Install Software):
If you have wrist pain, I highly recommend trialing a vertical mouse, which looks like a regular mouse turned partially on its side. The angle mimics a “handshake” position and eliminates the pronation that is (reportedly) a big driver of wrist discomfort. Everyone I’ve met that’s switched to one hasn’t switched back. The MX is pricey, so I actually carry it in this case when I take it to work at imaging centers (which also helps me not lose the USB dongle).
If you’re able to install the Logitech Options software on your workstation, then you’ll be able to customize the buttons on a per-application basis with the newer Logitech mice like the MX series. Very handy, but still, the MX is a wonderful daily driver and not a productivity/gaming mouse per se; it works best for radiology when paired with an off-hand device (see below). If you just want a mouse that will give you more keyboard-free PACS-control options, keep reading.
For maximum efficiency: I personally do not like the Logitech G502 (a classic choice for a few more programmable buttons) or the Logitech G600 (a wired 12-thumb-button monstrosity), but both are popular. The best of the non-MX Logitech productivity/gaming mice is probably the beloved G604 Lightspeed, which lands in the middle with a total of 15 programmable buttons. All three use Logitech’s older GHub software and have onboard memory that mostly works without the software running.
Best Mouse With Onboard Memory:
Onboard memory means the device itself contains its programming/settings. Once you set it up (i.e. at home), it’ll be plug-and-play on any workstation without needing to install drivers or other software. This is usually very helpful when working at hospitals.
On the vertical mouse front, a cheap/great-value vertical mouse option with onboard memory: The TRELC (formerly Zelotes) Vertical Gaming Mouse. It’s got a good number of buttons and a fun 4-way thumb joystick, which is a great way to engage your window settings (I have mine set to soft tissue, bone, brain, and lung).
Alternatives: If you’re looking for an inexpensive option with an insane number of buttons and don’t care about verticality, you might try the UtechSmart VenusPro (a wireless 12-thumb button mouse similar to the G600 with good onboard memory that I used for several months). I personally found it a bit challenging to get the numerous thumb options into muscle memory, particularly since I bounce between multiple PACS setups.
Again, some of the common Logitech options above (G502, G600, G604) also have onboard memory for key mapping, though the more robust (and usually less important) macro functionality will only work with the GHub software running. Of these, I would personally choose the G604 Lightspeed.
Note: To clarify, onboard memory just makes you immune to your IT department’s restrictions and makes your device plug and play on any workstation. I personally use the Zelotes every shift at the hospital (pro/con: it’s wired, so nothing to lose).
Best Mouse For Repetitive Stress When You’ve Tried Everything Else:
If you’re still having wrist/hand pain with a vertical mouse (or don’t like vertical mice) and don’t want a left-hand device (see below) to help you scroll (or when even that wasn’t enough), you might try the Contour RollerMouse. It has a unique form factor with a wide whole-hand scrolling bar that is so biomechanically different that many radiologists have used it to help recover from repetitive stress. There is a smaller/portable mobile version designed for laptop use as well. All of the RollerMouse models are quite pricey.
Also, if you like the idea of a vertical mouse but try one out and feel the angle isn’t quite right for you, Contour also makes an adjustable “Unimouse” with a hinge that goes from 35-70 degrees. Contour products are generally excellent.
Cheapest/Easiest Microphone Solution:
A desk-clamp gooseneck mount!
You really don’t need to bring your own microphone (and do the extra voice profile training it requires) in order to go hands-free when you’re at a shared workstation like the hospital reading room or an imaging center. The audio quality of the default dictaphone used for most workstations is just fine. You just need something to hold it in the general vicinity of your face.
There are a lot of brand X options on Amazon, and the listings seem to change every few months. The main considerations when choosing a gooseneck holder are its length and the type of clamping mechanism (squeeze vs twist, which mostly affects the thickness of the desk you can clamp to and how many seconds it takes to attach).
A short (super cheap and portable) holder will need to sit in the midline between your hands; a long one (like this or the upgraded this) can be clamped off to the side hovering over the keyboard, leaving your hands unimpeded (particularly helpful if you’re not a strong typist). I’ve used multiple clamps but have settled on the cheap short variety, which is easier to fit in my bag.
With a microphone holder, you are guaranteed that your microphone solution will work since you’re still using the same microphone that’s supported by your IT department that was plugged in when you got there!
Best Home Microphone Solution:
Tons of viable options, but I like a shotgun microphone such as the Rode NTG.
When you are watching a video of someone talking and you don’t see a microphone in the frame, it’s either a lapel mic hidden under their clothing or more often a shotgun mic boomed just out of frame.
Shotgun mics are directional, can be relatively far from your mouth, and have excellent noise rejection outside of the target. They’re a great option for ergonomics, flexibility, and reducing clutter.
I actually clamp the Rode NTG to the top of one of my monitors using this C-clamp and thread adapter and point it at my face, which allows me to hold my head in any particular position–lean back, lean forward, slouch–and still capture audio. A side benefit of this particular microphone is that’s great for video calls, and you can use it when you start your YouTube side hustle.
Mic Alternative: Headsets
Headsets work, and I previously used one for quite a while, but I think it’s ultimately less comfortable over time. When using a corded headset, you’re tethered to your desk. Cheap wireless headsets tend to be laggy, and the audio drops enough that dictation accuracy suffers for most of the sub-$100 headsets I’ve tried.
If a wireless headset is your dream form factor (or you enjoy gaming online), try the Razer BlackShark V2 Pro Wireless. Want active noise canceling? Consider the Bang & Olufsen Beoplay Portal. If you want to go the telemarketer route and can use Bluetooth (I can’t except at home), try the Plantronics’ Poly Voyager 5200 (which you can pair to two sources simultaneously). Desperately want a neckband? Apparently, the Sony SRS-NB10 works.
Most headsets also cover your ears. For a full day’s work, I’ve found it’s easier to shed the weight of a headset and utilize separate headphones like the AirPods Pro 2, which allow you to take calls from clinicians effortlessly, play music from your phone, and offer excellent noise canceling for an earbud form factor; they do a great job suppressing the noise from the MRI (or washing machine & dryer!) in the next room.
Mic Alternative: Condenser or Dynamic USB Microphones
Most conventional USB mics usually take up desk real estate (and condenser microphones, which are usually multi-purpose and cheaper, also tend to pick up a lot of room noise), but in practice, any decent USB microphone should work.
I’ve seen people dictate with things as cheap as a $40 Blue Snowball. Another common choice in the ~$100 range would be something like the Blue Yeti. Upgrades would be the higher-end USB dynamic vocal mics like the Rode Podcaster or Shure MV7, which are just generally excellent microphones for any voicework.
If you have the desk real estate and are planning on splurging for a serious setup that’s also useful for videoconferencing, interviews, podcasts, etc, you might pair your new microphone with a boom arm like the one from Blue that has built-in cord management. It’ll get the mic off your desk, get it close to your mouth when you need it, and get it out of your way when you don’t.
Optional Dictation Control: Foot Pedal
Once your microphone is hands-free, you need to control dictation (on/off, previous field, next field) in some other way. Without some help from AutoHotkey, the default keyboard controls for PowerScribe only work when the app is the active window (which still really isn’t so bad). The only solution that works completely out of the box without any software solution to replicate the PowerMic functionality is the foot pedal. The Infinity is plug-and-play with PowerScribe and has a big button in the middle for toggling dictation and smaller left/right buttons for previous/next field. Note: It’s big enough and heavy enough that it feels pretty dorky to carry around.
If you do the extra steps of utilizing AutoHotkey to replicate its functionality, then I’ll admit the pedal is largely superfluous. I still use one at home because I have it, but I’d probably skip it if starting from scratch since I am very happy with my AHK scripts. Still, the more interaction methods I use, the more flexible I am and the more distinct postures I can dictate from.
Best Offhand Device:
I love the Contour Shuttle Pro V2 and using it completely changed my workflow. There are other options that have similar (or even more robust) hotkey options, but the Shuttle has a fantastic wheel feature in the middle that has become my primary scrolling method. For the combination of ergonomics and efficiency, I think it is ultimately the best option.
The only real downside to Contour products is that there is no onboard memory, so you’ll need to install (or have your IT department) install the configuration software on every single computer you need to use it on (also, that software isn’t super great.) The hassle is worth it.
The build quality of the device itself is excellent. There is a cheaper Shuttle Express option with five buttons (instead of 16). It’s good, but the build quality of the Pro is much better, and I promise you’ll eventually find a good use for the extra buttons in the end. Just get the Pro. I’ll cover how I have mine set up in another post.
Alternatives: Razer Tartarus V2 and Elgato Stream Deck (both overall excellent products, but neither gives you the amazing spinning wheel of the Shuttle; for me, reducing repetitive stress is equally if not more important than hotkey/macro functionality.) The Tartarus does have a mouse-like scroll wheel and a thumb joystick, so it does definitely offer some scrolling flexibility.
There are also some macro one-hand keyboards that have onboard memory, are reasonably priced, and can get the job done efficiency-wise, but most have some limitations and none have the ergonomic/scroll benefits. The ELSRA Smart is quite good, and both it and the Shuttle both have transparent keycaps that you can add labels under for ease of use/memory, which is handy. If you need a solution that doesn’t require software, give that one a go.
Note: If you go the Razer route, you’ll need to have the Razer Synapse software running, in which case you might use a Razer gaming mouse like the Naga V2 HyperSpeed Wireless to go with it if you want a ludicrous number of programmable buttons.
For actual monitors, what you need will largely depend on who you work for, their contractual requirements, and if you do any breast imaging. Medical-grade diagnostic monitors like those from Barco, Eizo, and LG Medical are very pricey, so hopefully someone will provide them if you need them. Note that they remain non-negotiable for mammography.
The performance gap between magic monitors and consumer panels has narrowed considerably over the past decade (especially for displaying the Super Nintendo/N64 range images from CT, MRI, and US), and the reality is that many radiologists are now using consumer monitors at home (and many imaging centers are too). Some variety of Dell is by far the most common option, but I’ve even seen people rocking one of these massive ultrawide curved monitors as a standalone solution (though the vertical height is probably a bit constrained compared to what you’d be used to). The Dell 49″ ultrawide is big enough to simulate a 4-monitor setup and even includes a built-in KVM that allows you toggle or share the display between two computers (#screengoals).
If you’re planning on using consumer monitors–and please note that I, of course, am not advocating that you do so–be aware that ultra-high-resolution 5k+ monitors can even be too much to display some PACS comfortably at their native resolution. 4k is just fine. A good/typical workhorse option would be the Dell UltraSharp U2723QE. Some people like to use the larger 31.5-inch version, particularly for their side display to be able to fit more dictation/worklist/clinical info in one place. Note that the included stands do allow for portrait orientation.
When it comes to monitors for a home radiology set-up, the one thing that really matters is height. They should be at eye level to prevent neck strain, so you’ll probably need either decent height-adjustable stands, some thick textbooks, or–my preferred solution–monitor arms.
Monitor arms are a great way to get monitors at the perfect height and viewing angle while clearing up desk real estate. I personally have four monitors that I have mounted with two of these double-monitor arms. They are super stable for the price and include handy USB ports. If you’re sticking to three monitors, you can simplify with one triple arm. You’ll need something good if you’re using something heavy like diagnostic monitors or one of those gigantic curved ones (though a single ultrawide can do just fine real-estate-wise just sitting on its included base).
Lastly, consider adding bias lighting to help reduce eye strain. There’s the very popular (and auto-dimming) BenQ lightbar and tons of lightstrip options including several that allow for RGB color customization. But, for example, the cheap dimmable option I use for some soft white backlighting will only set you back about $10.
Okay, this is purely personal preference. There are lots of great ergonomic chairs available for your home office, but my luxury splurge when I revamped my attending set-up was the Embody by Herman Miller. You can really get in the weeds with this, and there is definitely no best. Testing out things in person is a good idea if you have the opportunity, even if you decide to buy online.
Alternatives: I prefer the Embody over the classic and extremely popular perennial classic Aeron because it accommodates a wider variety of seating positions, has adjustable lumbar tension/support, and has adjustable seat length, which means that it accommodates people of different heights (like my wife). The Aeron comes in three discrete size options. Note: you can often find used/refurbished Aerons at a significant discount.
Offerings from Steelcase (particularly the Gesture) and other manufacturers are also very popular. If you’re looking for something less high-backed/imposing and not an Aeron, you might like the Herman Miller Sayl or Steelcase Series 1. You certainly don’t need to splurge just to have something better than the average offering at Office Depot or Ikea.
There are lots of options for standing desks. I won’t pretend to have tried them all. Common favorites are the desks by Uplift, of which there are sizes, shapes (rectangle!, L!, curved corner!), and surfaces for everyone. The Uplift V2 was chosen as the favorite by the Wirecutter. Uplift often puts their extra stock on Amazon, so sometimes you can find great deals on their Amazon store.
Alternatives: The Fully Jarvis, which can go a bit lower and is therefore good for those shorter than 5’4″. Also note that if you have a desk you don’t want to part with, you could consider a desk converter like the Uplift E7 (but it’s just as expensive, not the most elegant, and you’ll be a little more constrained on monitor placement).
While you’re standing, maybe you’re one of those people who can dictate while walking and get a desk treadmill to go under it? (I don’t know how people do this.)
Full disclosure: I don’t have a fun standing desk. The data behind standing desks is also pretty overhyped (what you really need is to be active more and sedentary less), but I’ll still get one eventually when I need to update the office furniture. If you’re not a standing/treadmill person, maybe you’ll opt for an under-desk cycle or elliptical instead (I haven’t, so let me know if you do!).
At some point in this journey, you may become a person that needs to carry a backpack to work.