Sonographers worldwide face debilitating injuries

Increasing volumes of work and demanding schedules, exacerbated by staff shortages and the pressures of working in a target-driven environment, contribute to the increased prevalence of musculoskeletal disorders among sonographers, according to leaders in the field.

"This is a worldwide problem for all those using ultrasound diagnostically," said Joan R. Baker, founder of the Society of Diagnostic Medical Sonography and president of Sound Ergonomics in Kenmore, WA. "The pressure to push more patients through encourages sonographers to take shortcuts, such as not adjusting the table or chair to the right height, not adjusting the monitor and control panel, or not having the patient move closer to the sonographer to avoid overreaching."

Nearly 85% of sonographers experience work-related pain; 90% of them have experienced work-related pain for more than half their careers. One of every five sonographers sustains a career-ending work-related injury, and the average time in the profession before a sonographer experiences pain is five years, according to a landmark study by the SDMS in 2000 with responses from 10,000 participants in the U.S. and Canada.

Robert George, president of the International Society of Radiographers and Radiological Technologists, said work-related issues caused serious breakdowns in staff relationships when some people claimed sonographers were malingering and being pandered to. It was particularly relevant when sonographers were in short supply and were frequently paid more than other staff.

When George retired a couple of years ago, he was managing a large private radiology group in Adelaide, Australia, with about 50 sonographers and 80 radiographers. Their group provided radiologists and sonographers to the Sydney 2000 Olympics and the 2006 Commonwealth games. In an e-mail to Diagnostic Imaging, he recalled sonographers who had work-related injuries requiring surgery to shoulders, elbows, and wrists. Many had to reduce their workload or stop scanning altogether. One staff member, an excellent softball pitcher, couldn't play the game anymore following a shoulder injury from scanning and subsequent surgery.

In 2003, Baker chaired a consensus conference to develop industry standards aimed at reducing work-related musculoskeletal disorders in sonography. Participants came from the U.S., the U.K., Canada, and Australia and included equipment manufacturers. Work done at this conference has led to a guidance document, Prevention of work related musculoskeletal disorders in sonography, recently released by the Society of Radiographers in the U.K.

Evaluating sonographer safety is a multidisciplinary task. In a case study example in the U.K. report, a hospital set up a team to undertake a detailed risk assessment. The team consisted of the radiology business manager, the ultrasound superintendent, a sonographer/health and safety representative, an occupational health nurse, and a back care physiotherapist.

Risk assessment involves systematically looking at the work to identify the significant risks and determine the precautions needed to eliminate or control these risks. The report recommends examining:

• work postures;

• ultrasound equipment, including adjustability of monitor and keyboard design;

• furniture, such as adjustable chairs, tables, and exam couches, for support and mobility;

• accessory equipment, such as accessibility of gel and paper roll; and

• job design, including scheduled breaks-and whether they are actually taken-workload, and case mix.

The heavy cables and transducers of some ultrasound machines cause more issues, according to George.

He suggested wireless transducers, but added that equipment manufacturers said this was technically too difficult.

Part of the problem, according to Baker, is that ergonomics have been part of equipment design for only about 10 years and most of the sonographers operating the equipment do not know how to take advantage of the ergonomic features. She added that the absence of a full-time sonographer amounts to an estimated $21,000 loss of billable revenue in just one work week.

"It is time to form a committee to look at the risk factors and the workflow and make adjustments that are cost-effective as far as equipment utilization is concerned and at the same time reduce risk of injury," she said. "

"Education is the key, and administrators, as well as sonographers and equipment manufacturers, need this education."

Ultimately, though, clinical site evaluations are the most effective way of changing sonographer behavior and reducing injury risk, and the costs incurred, she said.