The Importance of Proper Form
By Keith Loria
Vol. 21 No. 6 P. 14
Poor ergonomics leads to frustration and fatigue among radiologists.
As volume and complexity of medical imaging studies have reached an all-time high, most radiologists agree that there has never been a more critical need for improved radiology reading room ergonomics. Eliot Siegel, MD, a professor of diagnostic radiology and nuclear medicine at the University of Maryland School of Medicine and chief of imaging for the VA Maryland Healthcare System in Baltimore, says there are several reasons that proper ergonomics are of paramount importance.
“Attention to ergonomics results in reduction of repetitive motion disorders, reduced mental stress and fatigue, improved productivity, and economic savings,” Siegel says.
Siegel explains that the term ergonomics comes from the Greek words ergon—work—and nomos—natural laws—and has been classified by the International Ergonomics Association into three segments—physical, cognitive, and organizational:
• The physical segment focuses on human responses to physical and physiological loads.
• The cognitive segment focuses on processes such as perception, attention, cognition, motor control, and memory storage and retrieval, as they affect interactions among humans and other elements of a system.
• The organizational segment focuses on sociotechnical systems, including their organizational structures, policies, and processes.
Omer Awan, MD, MPH, a musculoskeletal radiologist with a special interest in education and informatics who has presented on this topic at numerous RSNA meetings, says proper ergonomics is extremely important to radiologists, enabling them to function optimally throughout the day while prioritizing their health.
“The aim is to allow for the most comfortable experience for the radiologist, while eliminating common pathologic conditions such as fatigue, eye strain, back pain, and neuromuscular disorders,” Awan says.
Rebecca L. Seidel, MD, a member of the ACR human resources commission, a breast imaging radiologist, and an associate professor of radiology and imaging sciences at Emory University School of Medicine, agrees that proper ergonomics is critical to radiologists’ well-being, productivity, and performance.
“Studies have shown that 30% to 60% of radiologists report work-related musculoskeletal injuries such as back pain, carpal tunnel syndrome, eye strain, and headaches,” Seidel says. “In a study we conducted at Emory, the most commonly reported areas of discomfort among radiologists were neck, back, and right upper extremity.”
Greg Patrick, president and CEO of RedRick Technologies Inc, an organization that makes ergonomic furniture, says the sedentary nature of a radiologist’s workflow—spending a lot of time in front of a bank of monitors—causes stress that adds to the challenge. That’s why providing good ergonomic solutions that help maintain comfort is valuable.
“When someone is sore and in pain, it takes away from the professional satisfaction of the work they do,” Patrick says. “By finding good solutions and creating a properly designed ergonomic workstation, you can help avoid injuries.”
These injuries are cumulative and often go unnoticed until they reach a point where a radiologist is in too much pain to work. For this reason, it’s vital to maintain radiologists’ health so they can remain productive.
Pain in the Neck
The problems associated with poor radiology ergonomics are numerous.
“An increasing number of radiologists are complaining of repetitive motion disorders, eye strain, and neck pain that, in many cases, are impairing their work and home activities,” Siegel says. “These are likely to have a substantial impact on radiologist performance with regard to both speed and accuracy.”
For example, repetitive stress disorders such as carpal and cubital tunnel syndrome have been reported in the imaging literature, especially among mammographers. In a report Siegel wrote, “Ergonomics: Saving Your Body (and Your Mind),” he points out that after implementing digital mammography, 60% of breast imagers report suffering from repetitive stress injuries. However, only 17% utilize an ergonomic mouse, and only 13% had any sort of ergonomics training.
In any workspace that deals with keyboards and a mouse, significant hand and wrist problems can occur. For this reason, Patrick says measuring the proper height for both, with each specific user, is important.
“A lot of radiologists are also suffering from shoulder injuries and that comes from a constant use of the mouse, if they are not using it properly or the surface they have it on is not positioned appropriately for their body,” Patrick says. “They are constantly using that mouse and clicking on icons and scanning through a CT or MR study, so there is a tremendous amount of mouse work each day.”
Patrick also points out that cervical problems—especially neck injuries and discomfort—can result from incorrect ergonomics.
“There is a lot going on with the monitors, and the radiologist is constantly looking at several of them,” he says. “Everyone should be aware of the height of these monitors because that allows proper neck alignment so they are not looking too far down or up on an angle. You want to look straight ahead and maybe a few degrees down to the monitor.”
Radiologists also have a lot of focal depth issues, so managing the monitors’ positioning to allow a neutral neck posture is vital.
“The extra challenge they have is the wide landscape of monitors, which causes them to look left and right quite often,” Patrick says. “That gazing back and forth without turning the rest of their body causes them to have their necks turned in nonneutral positions, which will lead to those cervical issues.”
A Sound Plan
Awan says when optimum ergonomics is not applied, common problems that may occur include eye strain, fatigue, back pain, tendon disorders such as tendinopathy, and nerve abnormalities such as carpal tunnel syndrome. These occur for various reasons but are largely due to poor posture in the reading room and a paucity of ergonomically suitable equipment.
“Eye strain that decreases visual acuity is a simple problem related to reading many studies throughout the day,” Awan says. “Taking frequent breaks—ideally every 20 minutes, looking 20 feet away for 20 seconds—as well as using indirect blue lighting can go a long way in alleviating eye strain and convergence issues.”
Siegel notes that improper lighting, where the monitor brightness does not match room brightness, especially when monitor brightness is much lower than room brightness, has been shown in studies to affect reading times and reduce accuracy in diagnosis.
“Another specific challenge is related to sound distractions in the reading room,” Siegel says. “Most are due to other radiologists dictating or discussing cases with clinicians or talking on the phone.”
Other sound-related challenges include outside noises. For example, Siegel’s reading room is adjacent to the MRI scanner and, during some scans, the background noise can be upwards of 85 to 90 decibels.
“We are also adjacent to the main lobby, which can be noisy as well,” he says. “Our ergonomics solution was to purchase a ‘sound masking’ system, which was relatively inexpensive, for our room. This has had a major impact on reducing perceived noise distractions and has probably been the best ‘bang for the buck’ of all of our ergonomic modifications.”
Additionally, the University of Maryland utilized acoustic carpeting and ceiling tile in the reading room, with strategically placed sound baffles to minimize internal noise—eg, other radiologists talking on the phone.
At many practices, radiologists share chairs and workstations, but, as Seidel notes, one size does not fit all. In her 2017 study, the majority of radiologists reported spending more than seven hours a day seated at a computer workstation. She explains that prolonged sedentary time has been shown to be a risk factor for poor health outcomes, such as all-cause mortality, heart disease, and type 2 diabetes. Accordingly, a sit/stand workstation allows radiologists to alter position through the workday, potentially reducing sedentary time, repetitive strain, and fatigue.
“Investing in a good ergonomic workstation allows each radiologist to make necessary adjustments to optimize ergonomics for their height and body habits,” Seidel says. “This includes adjusting the height and tilt of the table and the monitor height, depth, and tilt. Same with a chair; the radiologist’s chair should have head and lumbar support and adjustable height, seat pan, arm rests, and recline.”
In addition to an improved mouse/track ball to reduce repetitive stress injuries, Siegel recommends many equipment and furniture solutions that can improve ergonomics for radiologists. These include a sound masking system to reduce the distractions associated with noises inside and outside the room, a workstation with ventilation to produce sustained airflow—as one might want in a car driving to or from work—and task lighting, rather than overhead lighting, to reduce glare and provide radiologists with greater control.
LED lighting, rather than incandescent, can make a difference as well, Siegel says. “And blue lighting for the wall behind the workstation can improve visual acuity, reduce stress, and provide stimulation during the day for reading.” There is one caveat, however: “This blue lighting is not advised at night because it can disrupt sleep if used just before going to sleep.”
Another recommendation is adjusting seat height so the radiologist is looking slightly down at the midpoint of the monitor, rather than looking up.
“All of these reduce physical and mental stress, improve productivity, improve sense of well-being, and result in higher diagnostic accuracy and reduction of errors,” Siegel says.
Awan says investment in equipment such as desks that are adjustable by height, as well as chairs that provide adequate back support, can go a long way in reducing mechanical pressure on the back while performing diagnostic interpretation.
“In addition, adjustable desks allow users to optimize ground support, if one chooses to read standing, which can have additional cardiovascular benefits, per various studies on ergonomics,” he says.
Making a Difference
By following simple measures such as taking frequent breaks, using dimmable LED lights, and optimizing furniture, radiologists can preserve their health, decrease fatigue and eye strain, and, ultimately, enjoy a healthier, more sustainable experience.
Patrick notes that treating ergonomic investment as a service contract for radiologists is an acknowledged perspective, aligning with the belief that radiology reading rooms are the operating rooms of radiology, and therefore deserve commensurate resources to support the delivery of high-quality care at the lowest cost.
Seidel adds that quality ergonomic intervention must include elucidation.
“Radiologists need to be educated about optimization of ergonomics, in order to maximize the benefits of ergonomic solutions,” she says.
Over time, poor ergonomics can contribute to fatigue, musculoskeletal discomfort, eye strain, and disability, which can result in decreased productivity and increased medical errors. By investing in quality ergonomic reading room solutions, practice leaders demonstrate their commitment to the well-being of the radiologist.
According to Siegel, room redesign may be the wisest investment one can make, not only in health but also productivity. Blue Cross Blue Shield found that, after implementing ergonomic designs in employee workstations, there was a 4.4% improvement in productivity, resulting in a significant cost-saving opportunity in radiology. Similarly, a comprehensive ergonomics program at Johns Hopkins Hospital resulted in an 80% reduction in musculoskeletal disorders over a six-year period. By making changes to better serve the needs of radiologists, hospitals and imaging centers can anticipate an uptick in performance.
“Employees notice when the department is putting forth their best efforts to ensure their health and safety,” Siegel says. “That will lead to a reduction of turnover, a decrease in absenteeism, improved morale, and an increase in employee involvement.”
— Keith Loria is a freelance writer based in Oakton, Virginia. He is a frequent contributor to Radiology Today.