Occupational injuries account for up to 60% of all workplace illness. Work-related musculoskeletal disorders (WRMSD) are becoming more and more apparant in sonographers. This article looks at this subject in further detail.
Ms. Baker
,
Ms. Coffin
, and
Ms. Murphey
are Ergonomic Consultants with Sound Ergonomics, LLC, Kenmore WA.
Ms. Baker is a member of the Ultrasound Program at Bellevue
Community College, Bellevue, WA. Ms. Coffin is the Ultrasound
Program Director at Dona Ana Community College, Las Cruces,
NM.
Occupational injuries account for up to 60% of all workplace
illnesses, according to the United States Department of Labor,
costing businesses $20 billion per year.
1,2
Work-related musculoskeletal disorders (WRMSD), injuries caused by
or aggravated by workplace activities, have been described in a
number of professions over the years. They have only recently been
identified in sonographers, and studies indicate the incidence of
sonographer WRMSDs are increasing. The areas most often involved
are: the shoulder (76%), neck (74%), and wrist (59%).
3
Knowing this information, it is important
to consider ultrasound equipment design features in addressing the
risk factors for WRMSD. Surveys among sonographers in America,
Canada, Australia, and the United Kingdom have shown that more than
80% are scanning in pain and 20% have been forced to give up their
profession as a result of their injury.
3,5
Symptoms
Symptoms of WRMSD can occur after months or years of overuse and
have been staged according to symptom reversibility and outcome.
Stage 1 includes aching and tiredness that subside with overnight
rest and do not cause any reduction in work performance. Stage 2
entails recurrent aching and tiredness that do not subside with
overnight rest. Symptoms occur earlier in the workday than Stage 1
symptoms and affect performance at work. Finally, Stage 3 symptoms
include aching, fatigue, and weakness that result in reduced
performance in work and leisure activities. Pain occurs with
nonrepetitive movements. These symptoms disturb sleep and may last
years.
4
Injury Prevention
Since WRMSD is caused by multiple factors, injury prevention
requires solutions from many sources. The solutions for
musculoskeletal injury can be broken down into three categories:
engineering controls, administrative controls, and sonographer
solutions.
Engineering Controls
Engineering controls eliminate the presence of risk factors in
the workplace through design changes in the equipment. Ancillary
equipment is just as important as the rest of the materials in the
design of an ergonomic workstation for sonography. Examination
tables should be height-adjustable and should have features to
address the types of studies being performed, such as stirrups for
obstetrical and gynecological work or dropout sections for cardiac
scanning. A ceiling- or wall-mounted monitor should be provided for
patient viewing. It is not possible for the sonographer to share
his/her monitor with the patient and maintain neutral positioning
of the neck. Picture archiving and communication systems (PACS) and
other computer workstations should also utilize ergonomic
guidelines. The computer tower should not hinder access to the
keyboard in order to minimize reach requirements.
Adaptive equipment for sonographers includes cushions that
support the forearm while scanning to reduce the workload of the
neck and shoulder muscles. Prolonged abduction of the arm during
scanning is extremely fatiguing and can lead to muscular overload
and injury. Transducer cable holders are also available, which
reduce torque on the wrist caused by transducer and cable
weight.
Administrative Controls
Administrative controls reduce the worker's exposure to risk
factors through changes in schedule and workload. Many sonographers
do not get any breaks during the day, not even lunch. Sonographers
need time for their muscles and tendons to recover between
patients. Rotating sonographers' job and task assignments reduces
the employee's contact with job hazards. Workload distribution is
also important. The same sonographer should not be assigned to
bedside studies for the day or assigned to rooms that do specific
studies, especially those that are injury producing, such as
endovaginal exams. A variety of work and equipment is necessary to
allow for the utilization of different muscle groups, hence
providing relief.
A reasonable flow of patients with sufficient time to complete
the study and its associated paperwork is the most efficient
system, and it reduces the risk of injury. Lighting should not be
overlooked, as improper light levels and glare lead to poor
postural alignment. Dimmer controls in scanning rooms should be
easily accessible. Additionally, bedside studies can cause problems
for lighting since most patient rooms are not dark enough to
prevent glare on the monitor.
Sonographer Solutions
Sonographers can learn how to reduce their exposure to risk
factors and to injury-producing actions through ergonomic education
and training. The best equipment, if used poorly, will not create
an ergonomically designed workstation. Sonographers must learn the
risk factors, understand the importance of good postural alignment
and examination techniques, and modify their work behaviors
accordingly. Certain engineering controls can also be implemented
with technique modifications on the part of the sonographer.
The Economics of Ergonomics
The cost of occupational injury to both the employer and the
employee is phenomenal. The losses to the employer encompass not
only the medical costs of an injury, but also the cost of
replacement staff, Worker's Compensation, and loss of revenue. The
loss of experienced professionals and a skilled, stable workforce
affects productivity. The cost to the worker includes not only
monetary hardship, but also the possibility of permanent injury,
chronic pain, and loss of their professional career. Table 1 lists
the costs of WRMSD and Table 2 lists the costs of investments in
ergonomic protection in sonography. However, these costs cannot
account for the value of the continuing productivity of a healthy,
competent sonographer.
Ergonomics Considerations
There are a variety of ergonomic design elements included in
many of the current ultrasound imaging systems on the market. Small
platform footprints make it possible to optimize the position of
the ultrasound equipment in relationship to the examination table,
even in small exam rooms. Ultrasound systems are becoming
lightweight and offer height-adjustable consoles, making it easier
to obtain the best postural alignment to accommodate sitting or
standing positions. Additionally, space under the console allows
sonographers to position themselves close to the equipment,
minimizing reach. Keyboard layouts providing a "home-based" design
position the most commonly used controls in the center of the
console to minimize hand motion. Control panels have also been
designed with a wrist rest to support the carpal tunnel area.
Transducer ports are being placed within a natural reach zone of
the sonographer when sitting or standing, decreasing the reaching
and bending required in changing transducers. Additionally,
transducers and their cables are more flexible and lightweight,
which is very important in reducing hand and wrist strain. Some
systems also offer multiple options for foot support, which helps
to reduce the risk of Achilles tendon problems.
Conclusion
It is now critical to consider ergonomics when designing
workstations and purchasing equipment since dollars spent on
improving the ergonomic design of the workstation have an excellent
return on investment. This investment leads to improved performance
of sonographers and improved employee well-being. Additionally,
retaining well-trained staff maximizes the efficiency of the
department workflow, accuracy, and utilization of interpreting
physicians. Ergonomics provides the foundation for effective
management and well-trained workers to perform at their best, thus
increasing productivity and profits. *