Stress Reduction
By Jessica Zimmer
Radiology Today
Vol. 26 No. 7 P. 10
Improving Ergonomic Setups in Radiology
Lessening the impact of certain tasks in radiology is a necessity to help professionals in the field prevent repetitive stress injuries. The first step to protecting radiologists, radiologist assistants (RAs), and technologists is recognizing what conditions strain the eyes, hands, wrists, shoulders, elbows, neck, and back. Employers and employees have the power to modify their actions, timing, and workstations, from setups and equipment to lighting and best practices.
“Prevention is the first form of treatment. It helps for physical therapists (PTs) to come in to a radiologist or radiologist assistant’s work area to look at providers’ typical body posture, such as how they hold their hands and wrists at their workstation. The PTs should also examine issues that could lead to a fall, like moisture on the floor,” says Duretti Fufa, MD, hand and upper extremity and trauma surgeon at Hospital for Special Surgery in New York City.
Eye discomfort can occur after excessive viewing of digital images and documents. Staff who lift and move patients typically suffer lower back pain. Those who use ultrasound probes, scroll through digital images and documents, or type on a computer can suffer carpal tunnel syndrome and shoulder and elbow strain. Left untreated, nonvision-related concerns may lead to nerve damage and chronic pain. Severe cases may require surgery.
Employees can learn how to avoid problems by requesting or inviting a regular review of their workstation setups and routines by PTs and occupational therapists (OTs), especially those who are in-house. Typical suggestions and corrective measures include taking regular breaks to relieve eye, hand, and wrist strain, changing the brightness display settings on a computer for viewing documents, when appropriate, and using voice recognition software with a headset instead of typing.
Radiologists can also switch from a fixed-height, seated workstation to a standing workstation or mobile desk that can move up or down. They can change how they hold or place their hands, wrists, and elbows, and use a programmable or vertical mouse to decrease pronation. This is defined as allowing the hand to remain with the back of it facing up. People who move patients can use slider sheets, slider boards, and floor or ceiling mounted lifts, aka Hoyer lifts. All of these put less strain on their muscles.
“Making it easier for radiologists and RAs to do their work improves the workplace for everyone. With the right devices, you need fewer people to move patients. You also see providers develop fewer injuries and experience less pain,” says Tobias Gilk, founder of Gilk Radiology Consultants, LLC, and senior vice president of RAD-Planning. The two companies help hospitals and clinics increase safety in radiology workspaces.
Problematic Workstations
Radiologists’ workstations and imaging suites have been a problem for decades. The issue is so well-known that the condition “tennis elbow,” meaning pain resulting from overuse of the forearm muscle and tendons, is now also known as “radiologist elbow.” The latter term was coined by Daria Manos, MD, a professor in the department of diagnostic radiology, and Kathleen MacMillan, MD, a diagnostic radiology resident, at Dalhousie University in Halifax, Nova Scotia, Canada.
The different types of actions involved in radiology positions explain why such professionals develop repetitive stress injuries. Hand, wrist, elbow, and shoulder concerns are typically caused by typing and scrolling through images or documents on computers for long periods of time, in the same position. A radiologist who uses an ultrasound probe also has to place their wrists, hands, and elbows at odd angles for prolonged periods of time.
The solution is frequent breaks and equipment that does not require as much use of the hands. A radiologist can also hold their hand differently. Further, they can use a vertical mouse that decreases pronation. Such a mouse puts the wrist and forearm into a more neutral position than a standard mouse. A vertical mouse allows the hand to grasp around the mouse. MacMillan notes the hand will still be slightly pronated when an individual uses a vertical mouse but not as much as if they use a standard mouse.
PTs, OTs, and surgeons are looking to the gaming world for solutions. Gaming mice, headsets, and split keyboards all help to reduce the number of clicks per case. Forearm supports and footrests help radiologists maintain a neutral work position. One example that MacMillan cites is a workstation that incorporated a headset in place of a handheld Dictaphone.
“This allowed both hands to remain free and eliminated the repetitive motions associated with using a handheld device,” MacMillan says. “In some instances, the headset could also be used as an alternative to the mouse and keyboard, further reducing strain.”
This workstation featured a gaming mouse with programmable buttons that allowed a radiology resident to switch between PACS by pressing numbered buttons. The resident did not have to navigate manually with a standard mouse or rely on a single key or set of keys to carry out an action. The setup reduced the number of movements on a mouse, compared with switching windows with a standard mouse. It also streamlined workflow.
“I have found that live education tends to be the most effective,” Mac- Millan says. “When an expert is present to demonstrate and help set up workstations, it gives radiologists the confidence that their environment is optimized. It reduces the burden of trying to figure it out alone. Seeing different equipment setups firsthand can also reinforce best practices.”
Need a Lift?
For employees who have to move patients, concerns arise when radiology examination rooms are too small. “More space in a room helps radiologists and RAs position patients better,” Gilk says. “The problem is that hospitals and clinics were not built that way decades ago.”
Slide boards are thick, smooth plastic boards onto which an employee can slide a patient and transport them to another location. These are one way to alleviate back strain when lifting a patient from a stretcher to a CT or MRI machine. The best boards are those with multiple handles or hand holes on each side. This allows multiple people to assist with a patient transfer. Hover- Matts, inflatable air mattresses placed underneath patients, are similar to slide boards. They facilitate horizontal transfers. Slide sheets are relatively thin plastic sheets that allow an employee to move a patient on a surface without friction. Mounted and floor lifts use machine power to lift a patient in a plastic sling. These devices also make it easier for employees to move patients.
“Lifting is especially hard when assisting larger and heavier patients,” Gilk says. “This is an issue because the weight of American adults has increased over time.”
The US VA has been a testing ground for improving radiology workplaces. “They’re the preeminent entity in codifying and promulgating ways to help patients receive treatment, as well as in making spaces accessible,” Gilk says.
Tracy Eisner, a CT technologist at Dartmouth–Hitchcock Medical Center in Lebanon, New Hampshire, says the presence of patient transfer devices in radiology stations are a result of people speaking up and hospitals and clinics responding with solutions.
“Staff members can get injured if they are trying to get something done quickly and do not look at the tools that are available,” Eisner says. “It’s worth it to take a couple extra seconds rather than just go for it.”
Gripping Narrative
Today, a CT scan can contain up to 2,000 images, including reconstructions and postprocessed series. In decades past, a single study typically contained between 25 and 30 images. As a result, radiologists now spend much more time examining and scrolling through images, increasing the risk of repetitive stress injury.
Radiologists should be educated early on in their careers about the benefits of prioritizing ergonomic setups, says Judy Rowe, MD, a practicing radiologist at the QEII Health Sciences Centre and an assistant professor in the department of diagnostic radiology at Dalhousie University, in Halifax, Nova Scotia.
“We are working to embed ergonomics topics into our quality and informatics curriculum for trainees. This focuses on residents, but we have also had dedicated speakers for our departmentwide Grand Rounds sessions,” Rowe says.
Nick Maroldi, DPT, orthopaedic clinical specialist, certified hand therapist, and PT at Hospital for Special Surgery, thinks ergonomics and body mechanics should be taught as early as medical school. “I have treated radiologists and RAs for repetitive stress injuries,” Maroldi says. “These injuries are typically from years of overuse, faulty mechanics, or repetitive motions and can be avoided. Trying to fix the problems and relieve the pain can take a long time.”
Maroldi sees such work as a challenge to radiologists and RAs who remain on the job. He explains that it is difficult to relearn how to do a job that one has done for years. “It takes conscious time and effort,” he says.
Maroldi says providers in training should take particular care in learning how to position patients and capture images of nonmobile patients who have difficulty moving themselves. “Whenever possible, repetitive or resisted motion should come from movement of the elbow or shoulder, rather than the wrist. It is best practice to maintain a neutral wrist position as often as possible, especially when gripping something like an ultrasound probe. Prolonged or repetitive gripping with a flexed wrist can cause strain on the tendons,” he says.
A user can have the perfect setup with all the right equipment but still put prolonged strain on their soft tissues, if they perform the same set of tasks for multiple hours per day. “You need to take short breaks when possible or change your position often throughout the day,” Maroldi says.
Radiologists and RAs who push their hands to practice repetitive gripping can incur more problems. Maroldi sees it as more helpful for radiology professionals with hand and wrist strains to develop endurance.
“They can practice by developing long hold times when lifting light weights, such as dumbbells, or doing exercises such as kettlebell carries,” Maroldi says. “These activities encourage neutral wrist positioning and functional gripping. That has useful carryover to work related tasks.”
Maroldi advises that radiologists and RAs stay physically active in general and make modifications to avoid excessive strain on the wrists. Ideas include performing planks on forearms rather than palms and using handles or dumbbells to perform push-ups. The latter emphasizes neutral wrist position and protects against excessive tension and loading.
Needs Adjustment
Many hospitals and clinics support ergonomic setups and tools because the aids increase wellness and efficiency. Yet, in other workplaces, radiologists and RAs are pressured to work continuously.
“The volume of work assigned to a radiologist in a day is generally high,” Rowe says. “Staff often eat lunch at their reporting stations. It would be unusual to take a scheduled break.”
Rowe says radiologists are expected to complete assigned work in a timely manner. A radiologist’s day is often extended if they take regular breaks.
“Even those who are mindful of the protective nature of breaks with respect to repetitive strain often will not take them. In many practices, coverage for breaks is not part of the scheduled workflow,” she says.
A reporting station checklist with reminders about neutral posture, eyelevel monitors, and the importance of breaks can serve as a reminder to staff. If an employer fails to recognize the need for breaks, radiologists and RAs should consult their labor union or an employment law attorney who has represented medical professionals.
Certain other elements of a workstation can also help radiologists prevent repetitive stress injuries. “A generic chair in most office environments is designed for the average male. [It’s] not ideal for those of smaller stature,” Rowe says. “In our work environment, we have added a couple of different sized chairs, to ensure comfort for all.”
Adjustment is also helpful. In many facilities, workspaces are shared. They are not optimized to the stature and preferences of a single user. Employees should talk about which adjustments are quick and relatively easy. Employees who work from home should talk to a consultant from their workplace or an outside entity about the ergonomics of their home setup. Rowe adds that a quiet work environment and the positioning of a workstation within the room can be critical.
“If the workstation is arranged in a way that requires the radiologist to repeatedly turn their head to interact with colleagues or respond to interruptions, it can lead to chronic neck strain,” MacMillan says. “Optimizing room layout—with improved sightlines and minimal need for head or body rotation— can help mitigate this risk.”
Communication Is Key
After a radiologist has incurred an injury, they should see a provider to ask about appropriate hand, wrist, and arm braces. “Radiologists frequently see physiotherapists (aka physical therapists) on a regular basis, once they have an established injury. These injuries can be exacerbated by times of high-volume reporting, ie, a long call weekend,” Rowe says.
When a repetitive stress injury is severe, Fufa recommends ice and elevation, topical anti-inflammatory medications, oral anti-inflammatory medications, and cortisone shots.
“After you’ve incurred an injury, you can modify or lessen your work routines as you progress through recovery,” Fufa says. “It’s not a good idea to work through pain, especially when performing a procedure on a patient.”
Eisner, who has worked as a CT technologist for approximately 30 years, says, increasingly, hospitals are listening to technologists and RAs about how to improve radiology workplaces.
“Yet it’s also about the individual having the right mindset and a team mentality,” she says. “If a technologist sees a colleague taking a risk, it helps to say, ‘You only have one back.’”
In some cases, Eisner says, technologists and RAs who have suffered a repetitive stress injury should share the extent to which that injury affected their job and everyday life. “If you strain your lower back, that affects your ability to sit, sleep, and walk, let alone work. Even when staffing is short everywhere, it’s a good idea to cultivate a work culture of ‘We’ll all pitch in and help one another,’” she says.
Eisner adds that good work relationships, clear statements about expectations, and in-person demonstrations of how to engage in procedures correctly can be preventive measures. “Communication with patients goes a long way,” she says. “When you tell a patient, ‘Keep your hands on your belly, we’re sliding you from one table to the other,’ the patient knows what’s coming. They’re less likely to get scared and move unpredictably. Statements of assurance make them feel more secure.”
— Jessica Zimmer is a freelance writer living in northern California. She specializes in covering AI and legal matters.