Ultrasound News: Rethinking Sonography — Form and Function in the Ultrasound Suite
By Susan Murphey, BS, RDMS, RDCS, CECD
Radiology Today
Vol. 21 No. 6 P. 8

Imagine getting into a rental car that has just been returned by someone much taller than you. What is the first thing you would do? If you are like most people, you would adjust the seat and mirrors to a position that allows you to drive safely and comfortably. But what if you didn’t know how to adjust the seat, or the mirrors were not adjustable?

Using an ultrasound machine is not so different. Sonographers need to be able to adjust the system before beginning a scan, in order to use it effectively, comfortably, and safely. That means the equipment needs to be readily adjustable, and the sonographer needs to know how to adjust it to maintain correct posture.

The design of an ultrasound system determines the posture needed to interact with it. Without the ability to properly adjust the workstation, sonographers can be exposed to risk factors for work-related musculoskeletal disorders (WRMSDs). Posture is determined by one of the following three factors:

• the need to see—eg, looking up/down, rotating neck, twisting trunk;
• the need to reach—eg, extending arm, bending/twisting trunk; and
• the need for support—eg, leaning/shifting weight to offset postural fatigue.

If these needs are not well met by the design of the equipment, ergonomic hazards result. Because the work of a sonographer relies on continual interaction with the ultrasound system, equipment design influences posture and movements. The human-machine interface is where information is exchanged through cognitive and physical interactions.

The ideal human-machine interface creates an intuitive interaction that improves comfort, efficiency, accuracy, and productivity. It is the basis of good ergonomics and can reduce the risk for WRMSDs through reducing or eliminating the risks for injury such as repetitive motion, awkward postures, or excess force. A poorly designed human-machine interface negatively influences physical behaviors, increasing the risk for WRMSDs as a result of risk factors that are introduced by the need to interact with the equipment.

A number of studies have shown a positive correlation between scanning activities and an increased risk for WRMSDs among sonographers and other ultrasound users. The latest reports indicate that up to 90% of ultrasound practitioners are affected by some degree of musculoskeletal disorder, with shoulder pain being the most common. Risk factors such as excess force—including grip force, applied force, and push-pull force—along with awkward postures are the leading causes of pain among sonography practitioners.1 The duration of exposure is a significant portion of their work day.

Repeated exposure to risk factors can result in chronic pain and quicker onset of fatigue. Physical pain disrupts the focus of the sonographer from the diagnostic emphasis of the exam. Reducing or eliminating risk factors for WRMSDs allows workers to operate at their best, improving accuracy, reproducibility, and productivity, benefiting the sonographer, the patient, and the employer.

Keys to Addressing WRMSD Risk
As a registered diagnostic medical sonographer and certified ergonomic compliance director, I am frequently called on to evaluate ultrasound systems prior to the launch of a new product. What I often find is a disconnect between the product design team and the end user.

Most often, the deficits I find relate to usability. The design team may be limited in their understanding of the work the sonographer/user is tasked with in their interaction with the system. Understandably, much of the product development focus has been on image quality and diagnostic capability, for without those there is not much benefit to the machine. But in reality, without sonographers, there is no market for the machines. With a 90% injury rate among sonography practitioners, it is time for every stakeholder in the practice to get involved.

Traditionally, sonographer comfort has been seen as the responsibility of clinical sites. It was not until the Industry Standards for the Prevention of WRMSD in Sonography were published by the Society of Diagnostic Medical Sonography that the role of the manufacturer in the prevention of injury become apparent. The document was the first to outline the responsibilities of manufacturers, employers, sonographers, and educators to do their part to address the factors leading to sonographer injury.2 The following are several ways in which stakeholders in the field of sonography can help alleviate painful and costly injuries.

Manufacturers Improving the Human-Machine Interface
The ultimate achievement in design is to create a product that intuitively influences a user to operate safely. As both a sonographer and an ergonomics specialist, I have had the opportunity to evaluate many ultrasound machines and experience ergonomic developments that are redefining ultrasound. Design elements that reduce or eliminate risk factors are going to be most successful in reducing symptoms of musculoskeletal disorder. Recent additions to the market interrupt the traditional, risk-provoking user interface by engineering an intuitive interaction with the system. In this way, sonographer safety is not dependent on the user learning something new, being trained how to do it, or having the time to do it; there is simply no other way to do it but safely.

Sonographer Education
While it is important for machines to be designed with sonographers in mind, it is also important that sonographers be properly trained on the best practices for the reduction of risk. While some devices are being created with intuitive interfaces that guide users into the correct scanning position, others require sonographer knowledge of how to set up the machine to optimize positioning, in order to prevent WRMSDs. Moreover, academic education programs should teach postural alignment for the reduction of injury to sonographers, alongside imaging techniques. In the long run, learning proper posture to prevent WRMSDs is just as important as technical scanning knowledge in sonography.

Employer Responsibility
Even if machines are ergonomically designed and sonographers know how to use them properly, WRMSDs can still occur if practice managers are not involved with worker safety. It is vital to sonographer and patient well-being that suitable workstation equipment be available and that schedules allow for muscle recovery and sufficient time to optimize scanning practices. Morale is improved when there is a corporate culture that demonstrates an active interest in worker health and well-being. Happy staff equals happy patients. Retaining a stable, skilled workforce benefits everyone.

Changing Sonography Practice
In short, WRMSDs are a significant problem in sonography practice. The good news is that industry experts are working together to create ultrasound devices that optimize ergonomics through engineering that mitigates risks. Ergonomics needs to be part of clinical management, just as much as productivity and patient satisfaction. Ultimately, all stakeholders in the field of sonography benefit from reducing WRMSDs, so it is important for all involved—equipment designers, manufacturers, sonographers, and employers—to work on solutions to the problem. It’s time to change the practice of sonography, freeing sonographers to focus on providing the best possible patient care instead of worrying about injuries.

— Susan Murphey, BS, RDMS, RDCS, CECD, is the president of Essential WorkWellness.

1. Evans K, Roll S, Baker J. Work-related musculoskeletal disorders (WRMSD) among registered diagnostic medical sonographers and vascular technologists: a representative sample. J Diagn Med Sonogr. 2009;25(6):287-299.

2. Work related musculoskeletal disorders and sonography. Society of Diagnostic Medical Sonography website. https://www.sdms.org/resources/careers/work-related-musculoskeletal-disorders