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Background
Since the advent of PACS, diagnostic radiology has become highly reliant on the digital workstation. While technological advancements have improved efficiency with regard to patient care, usage of computer workstations has increased the rate of work-related injuries. Optimizing use of computer software and peripheral devices can therefore improve patient care and reduce risk of injury to radiologists.

Educational Goals / Teaching Points
Understand how macros, Autohotkey (AHK), and programmable peripherals can increase radiologist efficiency and reduce risk of work-related injury.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
A repetitive stress injury (RSI) is a syndrome resulting from repetitive or sustained movements. In radiology, these involve the use of peripheral devices such as mice, keyboards, and dictation microphones to perform worklist navigation, image manipulation, and other tasks. The most common RSI in radiology is carpal tunnel syndrome, typically attributed to excessive mouse and keyboard usage with the wrist in dorsiflexion. Cubital tunnel syndrome can result from elbow flexion related to use of handheld dictaphones. Other radiology-associated RSIs include so-called “computer back” and “mouse shoulder.” A macro is a user-defined keystroke that automates a complex task on a computer. Macros enhance efficiency by streamlining commonly performed tasks, freeing up time for the radiologist to perform image interpretation. Macros work synergistically with AHK, a specialized programming tool that enables radiologists to perform, with a single keystroke, complex actions that would normally require a handheld dictaphone or multiple mouse clicks. Within reporting software, AHK scripts can perform dictation toggling, cycle through template fields, and sign reports. Within PACS, a “click lock” function simulates holding of the left-click mouse button and is helpful for scrolling through cross-sectional studies with minimal effort. Other tasks AHK can simplify include searching the web for highlighted text, retrieving specific information from EMR, and auto-filling webforms used to page other clinicians. “Hotstrings” can replace short key combinations with longer text strings. Use of macros and AHK is optimized when combined with ergonomic and programmable mice and keyboards. Ideal features for mice include programmable buttons with on-board memory to allow mobility across workstations, swappable profiles to have site- or modality-specific configurations, and hyperscroll to scroll through reports and websites with ease. Vertically oriented mice place the wrist in a more natural position. Gaming mousepads decrease friction and further decrease wrist strain. Mechanical keyboards are popular for their distinct feel and audible feedback, reducing typing errors and fatigue. Backlit keys are helpful for low light setups common in radiology. Special tenkeyless (TKL) configurations can provide similar functionality in a smaller form factor, ideal when desktop space is limited.

Conclusion
Macros, AHK, and programmable peripherals can greatly increase efficiency and reduce work-related injuries to radiologists.