Radiologic technologists’ work often revolves around PACS and digital imaging, which can lead to repetitive strain injuries, many of which are exacerbated by specific features of a radiology practice. Ergonomic approaches can help to decrease the frequency and severity of repetitive strain injuries and improve productivity; however, they are complex, include all aspects of the radiology environment, and are best implemented along with proper training of imaging personnel.
Kevin D. Evans, PhD, RT(R), a professor and the division director of radiologic sciences and respiratory therapy at The Ohio State School of Health and Rehabilitation Sciences, says the term ergonomics in the rad tech space is defined as “the understanding of interactions among humans and other elements of a system.
“It means to design in order to optimize human well-being and overall system performance,” he says. “It is important to take this definition literally, as it connotes the importance of a radiographer interacting within a department and with a variety of work systems.”
Some work system examples are X-ray equipment, patient handling/care, and computer workstations. Depending on the task, the technologist’s interface may have elevated risk for injury if proper precautions are not in place. In the example of a lateral transfer of a patient from a cart to an X-ray table, patient handling devices/tools are essential to minimize the risk for injury of the technologist and the patient.
Evans’ current research is devoted to not only understanding the risk but also mitigating it. He recently conducted a survey with the help of the American Registry of Radiologic Technologists and demonstrated that 80% of responding technologists are working in pain—only elevating the risk for further injury to the employee and the patient.
“The highest frequency was low back, shoulder, and neck,” Evans says. “When you know where the area of injury is located, then you can examine the occupational interactions that might have led to these work-related musculoskeletal injuries (WRMSI). It is our job to scrutinize the workplace for ways to optimize technologists’ well-being and also increase overall system performance.”
Gordon Sze, MD, chief of neuroradiology and professor of radiology and biomedical imaging at Yale School of Medicine, says imaging personnel work under conditions that precipitate repetitive strain injuries in multiple ways. First, use of the computer mouse can result in tenosynovitis, carpal tunnel, and cubital tunnel syndromes. Second, the prolonged positions at the computer terminals can result in neck and low back pain. Third, certain specialties are associated with particular problems.
“For example, ultrasonographers, in particular, are prone to develop shoulder symptoms due to the forces exerted by pressing the ultrasound probe on the area of interest on the patient’s body with an extended arm,” he says. “Neck, elbow, and low back pain are also common.”
The new digital workplace in radiology presents many challenges, according to Sze. Although the shift away from hard copy to PACS and digital imaging has become almost universal in this country, radiology departments have lagged in realizing that these changes also create conditions that mandate changes in workplace environments. Therefore, ergonomic issues cover a broad range of concerns, including the structure of radiology suites, background lighting, chair and monitor positioning, and mouse and keyboard design and placement.
Melody Pierson, RT(R), CRA, manager of imaging services at UCHealth Greeley Hospital in Colorado, says the main workplace ergonomics issues for techs are the work/control tables and the seating. Additionally, hand/arm ergonomics are an issue due to the use of multiple pieces of equipment such as keyboards, mouse, control panels for the equipment, and touch screens, often to operate one modality and/or send images and finalize an exam. Pierson also believes there is a need for adjustable-height tables and seating, which would allow technologists to customize the height of the work table to their needs allowing them to sit/stand as they prefer.
“Work table height is an issue, as not all techs are the same height or size. If the table is too high, the shorter-stature techs are required to climb onto a standing height stool to sit, when needed, and there is a chance of falling off when getting on or getting off the stool,” she says. “When the table is too low, the tall-stature techs have to sit in a low chair and are constantly using their knees to get up and down. For the mouse, keyboard, etc, these are vendor specific and are not designed in an ergonomic way for wrist support. I’d like to see staff provided with ergonomic wrist support, etc, when available.”
From his research, Evans concluded that most X-ray equipment requires a great deal of physical manipulation of the X-ray tube and, for some smaller technologists, this means working with their arms over their head.
“Pulling an overhead C-ray tube across tracking in the ceiling is a physical stress and strain that can take a toll on the shoulders and neck,” Evans says. “Additionally, pulling patients, especially during bedside radiography, can result in significant torque on the lower back.”
Additionally, technologists are often concerned about working with the proper shielding to protect patients and themselves from unnecessary radiation, which can sometimes lead to awkward positioning.
Evans has seen policies put in place that require technologists to work in pairs to do bedside radiography, which allows a person to have assistance with patient handling and also with manipulation of the X-ray tube.
“I also think that some departments have invested in engineering controls—tools that have reduced the risk for worker injury,” he says. “Some examples are slide boards, hoyer lifts, and inflatable lift mats. These devices allow for the weight of patients to be reduced and to easily slide them onto the X-ray table, with minimal physical [radiologic technologist] effort.”
Ergotron adjustable workstations for technologists are also safety measures, as they allow for height adjustments for reporting and billing.
“All these improvements need to work synergistically to reduce the risk of WRMSI and prevent an injury that removes a worker,” Evans says. “When an injured worker leaves the department, those left behind have to pick up the slack, and this immediately raises their risk for WRMSI.”
With respect to prevention, Sze notes that ergonomic training and devices are widely known to substantially decrease the incidence and prevalence of repetitive strain injuries. However, their implementation in radiology departments is still incomplete, despite formal guidelines from the offices of the Occupational Health and Safety Administration and the American National Standards Institute. Studies have also shown that ergonomic improvements can not only decrease repetitive strain injuries but also result in a myriad of other benefits, including improved efficiency.
Just as the American Society of Radiologic Technologists (ASRT) works to ensure the safety of patients, the organization is also engaged in finding safeguards for the radiologic technologists who provide diagnostic imaging and radiation therapy procedures. And it starts as part of the basic education of every rad tech. The ASRT Radiography Curriculum, first written in 1952, outlines a common body of knowledge that is essential for all entry-level radiographers. Curriculum guidelines ensure that all radiographers are educated about ergonomic principles and arranging a work environment that reduces the risk of work-related injuries while increasing staff productivity and job satisfaction. The curriculum includes help with body mechanics, proper body alignment, proper movement, and rules for safe patient transfer, among other points of emphasis.
According to Stefan Schultz, a physical therapist and innovation manager for Briotix Health in Centennial, Colorado, because rad techs are increasingly exposed to many hours of sustained sitting in front of multiple screens performing visually intensive work, awkward sustained postures of the upper extremities are also primary drivers of ergonomic risk for some of the radiology subspecialty disciplines such as sonography.
“New imaging techniques have moved more and more of a rad tech’s work to seated computer workstations that are not typically properly designed for comfort,” Schultz says. “The work demands are also often so intense that they make tissue recovery and microbreaks very challenging during the workday.”
The issue of lighting as a driver of ergonomic risk among rad techs has increasingly garnered attention as well. Schultz notes eye fatigue is common in environments with fluorescent lighting, driving awkward sustained postures that eventually can lead to tissue fatigue.
“Individual ambient lighting can address this issue. In addition, the ability to adjust the workstation to introduce movement, promote neutral posture, and facilitate tissue recovery is a recommended feature for all rad tech workstations,” he says. “The challenge is, upfront costs of an ergonomically designed workstation are often seen as cost prohibitive.”
Challenges for Change
Change isn’t always easy, whether it comes down to financial limitations or the unwillingness of a rad tech to change his or her ways. Evans notes that all remedies are decisions, and costs must be approved by managers and directors within the radiology department. Interventions also have to be multipronged; a team approach—including administration—is needed.
“We refer to this as macroergonomic support, which begins by making managers and directors aware of the risk of WRMSI that exists among technologists,” Evans says. “The literature has very few published articles on this problem and those that do exist were conducted outside the USA. We have to do a better job assuring employees that using the resources afforded by occupational health are a benefit and not used to jeopardize their employment.”
Pierson says it’s also important to safeguard staff health by equipping them with an on-demand personal dosimeter to monitor and quickly check for any accidental dose exposure that could occur through awkward positioning; body positioning and angle of the dosimeter to the radiation source are important for accurate measurements.
“The primary challenge is fiscal,” she says. “None of [these interventions are] cheap, and we are all tasked with managing our funds. However, it really comes down to the knowledge of what it costs a department or facility when there is an employee injury.”
Just as important as optimization of the work environment is raising awareness among imaging personnel of best ergonomic practices. Training with respect to potential ergonomic adjustments and personalization of the reading area is also helpful in reducing work-related injuries.