Ergonomic Evaluation The aim of the following study was to conduct an ergonomic evaluation to identify contributing factors in the development of musculoskeletal pain and discomfort in Ultrasound Sonographers involved in Obstetric and Gynecological scanning. The methodology involved a cross-sectional study of Sonographers in one hospital. The methodology included the use of the Rapid Upper Limb Assessment (RULA) to identify the exposure to postural risk, static muscle work and repetition, and the use of an adapted Musculoskeletal Questionnaire to evaluate the frequency and distribution of musculoskeletal problems,. Fourteen participants were assessed in the workplace. The RULA analysis identified that the task element with the highest risk factor within this sample was scanning patients; it was found that the participant spent between 31% and 39% of their working time doing this in a 26-hour week. The results from the questionnaire found that 64% had experiences one or more combined physical problems over the previous 12 months, with the shoulder joint (57%), cervical spine (50%) and wrist and hands (50%) identified as the most frequently reported problems. The study highlights the prevalence of self-reported symptoms among Sonographers and the postural constraints individuals have to adopt while working. Suggestions are proposed to reduce the risks via adjustable work equipment, education in using adjustable equipment, work organization changes and the use of arm supports.

Introduction

Diagnostic ultrasound (DU) was first introduced to the medical world in 1942 by Austrian Physician Dr. Karl Dussik (Levi, 2007). It was initially used to detect gall stones in 1950 by Ludwig and Stutler, but was developed for use in gynecology where there was a profound need to develop safer imaging techniques (Levi, 2007). DU was first used in the applied setting in 1958 by Professor Ian Donald from Glasgow who used ultrasound to examine gynecological patients for pelvic lesions (Levi, 2007). It was used on a more regular basis within the clinical environment during the 1960's gaining recognition by the American Medical Association in 1974 (Vanderpool, 1993).

In modern day medicine, the use of ultrasound, in both gynecology and obstetrics has become a normal part of the diagnostic and fetal assessment process. However, the increased use of ultrasound equipment has been identified as a source of workplace pain and discomfort in Sonographers. Craig (2005), surveyed 100 sonographers with 5-20 years experience. The results showed that that majority of respondents had experienced symptoms of musculoskeletal problems including wrist and shoulder problems. The study however, did not document exact figures concerning work related problems nor did it give details pertaining to the methodology or response rate of the study.

A study by Vanderpool (1993), surveyed 225 Cardiac Sonographers. A 47% response rate was achieved with 72% of respondents female. Results found that 63% of respondents had experienced wrist problems during their career and 3% had been diagnosed specifically with Carpal Tunnel Syndrome.

Wihlidal and Kumar (2008), surveyed 156 Sonographers in a postal survey in Alberta. A 61.5% (N=96) response rate was achieved and 88.5% of respondents reported work related symptoms either historically or ongoing. Clusters of symptoms included neck and intrascapular pain (54%), shoulder or upper arm pain (53%), low back pain (37.5%) and elbow pain (23.5%). Respondents were asked about absence from work and 16% reported that they had been forced to take absence due to symptoms (Wihlidal and Kumar, 2008).

In comparison with others involved radiography work, May et al. (1994) surveyed breast screening radiographers in a UK national survey of 800 participants. There were 320 respondents to the survey. This study used two control groups including clerical staff (N=400) and general radiographers not involved in screening (N=400). Preliminary results found that those involved in general radiography reported most muscular complaints (94.4%), 76% of those involved in breast screening reported pain and 70% of clerical staff reported muscular discomfort. Although only descriptive data is reported in the study, it highlights the level of complaints within general and breast screening radiography.

Habes and Baron (2000) presented a case study of ergonomic evaluation of ultrasound testing. The study highlighted the postural extremes sonographers had to adopt while using ultrasound equipment, the static loading from holding the scan heads and the biomechanical loading on the sonographers. Several recommendations from this study included the use of adjustable chairs including sit/stand seats and beds, the provision of elbow support, customizing one room for specific scanning types and a secondary monitor in the line of sight of the sonographers.

The results of the previous studies suggest that the use of ultrasonography equipment is accompanied by physical musculoskeletal problems. The following study was carried out after an initial ergonomics evaluation of the work carried out in the radiography department of a hospital. The aim of the study was to identify the prevalence of musculoskeletal pain and discomfort, to identify postural risk factors when carrying out scanning tasks and to evaluate the workplace and equipment design.

Methodology

The participants in the...

To become familiar with the working environment and the scanning process, a period of time was spent observing Sonographers at the Neonatal unit. To further identify the principle components of the scanning process, a talk-through was carried out based on the method in Kirwan and Ainsworth (2007).
The Rapid Upper Limb Assessment (RULA), methodology developed by McAtamney and Corlett (2003) was used to identify whether the postures used when carrying out sonography tasks were high risk. The RULA analysis was carried out with 6 participants scanning obstetric patients and 6 participants scanning gynecological patients including transvaginal scanning during 90 minute observation periods.

A modified version of the standardized Musculoskeletal Questionnaire (NMQ) was used in the form of a structured interview during the initial stages of the study. The structured interview was based on the standardized and validated questionnaire developed by the Nordic Group (Kuorinka, et al., 2010).

Results

A total of 14 Sonographers took part in the study, 11 were registered Radiographers and three Medical Doctors. The age range of the participants was 35 to 52 years, with time working with ultrasound equipment ranging from 6 months to 23 years. The time spent using equipment ranged from 6 hours per week to 35 hours per week with a mean of 26 hours per week scanning patients.

The observation data identified the different types of scans carried out within the department, familiarization with the working environment and the scanning process. Two main types of scans were identified, firstly the obstetric scan and secondly the gynecological scan. Nine rooms were routinely used for scanning each fitted out with the relevant equipment including computers for record keeping. Four different types of ultrasound equipment were used within the department. Eight of the consulting rooms contained non-adjustable stools of varying heights

The talk-through process identified the task elements involved in scanning patients. Table 1., identifies the task elements from A to H. that the sonographer carries out.

Postural observations made during the RULA analysis identified that when scanning a patient, the sonographer is required to twist the neck and trunk in order to view the monitor while at the same time maintaining probe contact with the patient. The cervical spine is also held in moderate side flexion usually when the sonographer is pointing out features on the display screen. Table 1., presents the data for the RULA analysis and indicates that although the majority of tasks carried out are scored at action level 2, the scanning of patients for both types analyzed was scored at action level 3, requiring investigation and change in the near future. The degree of static loading during the scanning element was also analyzed visually and it was approximated that when carrying out an obstetric scan, the maintenance of static posture was required for 84% of the time and for a gynecological scan, 74% of the scanning time.

Table 1. Task Elements and RULA Scores of the Scanning Process

Task Element Code

Task

Obstetric Scan

Gynae. Scan Mean Grand Score

Action level

Mean Grand Score

Action Level

A

Reading the patient's notes

3

2

3

2

B

Walking

2

1

2

1

C

Computer Work

4

2

4

2

D

Setting up the patient/equipment

4

2

3

2

E

Performing the scan

5

3

6

3

F

Talking to the patient/relatives

3

2

3

2

G

Clearing the plinth

3

2

3

2

H

Communicating with colleagues

3

2

3

2

The percentage of time spent on each of the task elements was also calculated and the data is presented in Figure 1. What is highlighted from this is that the individuals surveyed, spent between 31% and 39% of their time with patients carrying out the task with the highest RULA grand score.

Figure 1. Percentage of Time on Scanning Tasks

The NMQ identified that 13 (93%) of respondents had previously or were currently experiencing at least one or more physical symptoms. Table 2., presents the summary results of the prevalence of musculoskeletal pain and discomfort. The data presented show that pain and discomfort is most commonly reported for the neck, shoulder, wrist/hands, upper and lower back. Two of the respondents felt that the symptoms they experienced did encroach upon their leisure time but none felt that their work activities had been reduced. Of those who complained of shoulder problems, 60% attributed this to sonography work including working with the arm elevated for long periods. Moving patients and heavy equipment were also implicated to a lesser degree.

Table 2. Incidence of Musculoskeletal Problems…