Repetitive Stress Injuries in the Ultrasound Laboratory

click here for audio/video version  *requires RealPlayer - free download

Martin Necas, RDMS, RVT: "I’m Martin, and I’m the Ultrasound Section Coordinator for OBGYN.net. I’m here at the 44^th Annual Convention of the AIUM in San Francisco, and sitting down with me is Paula Woletz, she is an Assistant Professor at the University of Medicine and Dentistry of New Jersey, and she’s also the Chairperson of the Sonographer section of AIUM. Now Paula, repetitive strain injuries in sonographers or sonologists are a very popular topic and it has been studied extensively in recent years. I know you have given a presentation here at AIUM, can you tell us a little bit about the work that you have done and what has come out of this?"

Paula Woletz: "Of course, a lot of the work that’s done has been yours and we did some of our own but it’s not a new topic. The first sign that I could get of anything in print regarding it was back in 1985 when there had been enough anecdotal evidence of problems that Marveen Craig did a survey of about 100 experienced sonographers and uncovered a lot of injuries. That was followed-up again in 1990 and repeatedly true then. You’ve done some major work and Joan Baker has done some major work, most of the work till now has been based on questionnaires. I work in a relatively large department; we have eleven sonographers, ten physicians and a number of people had complained about injuries. It was enough that we really felt we needed to look into it. What we did was we got two physicians to come in and separately one physician interviewed and got questionnaires on each of the individuals in the department, and the other one did a physical exam and then they were able to correlate the information they got. They were able to document a surprising number of injuries just among the total of twelve people they examined, and this was concrete physical signs and manifestations that they were able to document. From there we took it a little further and we invited NIOSH - the National Institute of Occupational Safety and Health - to come in and do an ergonomics study and see just why people were getting the injuries they did. They were great, they came in, they also did questionnaires, asked people to show what they did and how, and then they spent several days actually video taping us doing exams."

Martin Necas, RDMS, RVT: "That is fantastic, what was the outcome?"

Paula Woletz: "The outcome was two-fold, internally they sent us a video tape which they had narrated for us showing us where problems were going on and the contributory factors. They also ended up putting out a publication which is available for free from the government that looked into the ergonomic factors that lead to injuries among sonographers, and they came up with some recommendations how to minimize the incidence of these occurring."

Martin Necas, RDMS, RVT: "I see, Paula, tell me once the sonographers could see the type of movements or the type of station design that they were working on and they could correlate it with the physical symptoms, did they become more aware and try to prevent adverse physical habits from occurring?"

Paula Woletz: "They did, first of all they did modify their own work habits somewhat. The biggest change they made was that we have some workstations that are much more conducive for a short sonographer and others that are more comfortable for taller ones, and we assign people to rooms for a week at a time. We started seeing tall and short sonographers swapping rooms and that was probably the biggest single change. We also got people more aware so they started showing up at employee health so that there was documented evidence of their injuries that was work related and now that’s covered by worker’s comp."

Martin Necas, RDMS, RVT: "Yes, would you make any recommendations for those sonographers who are currently working in the field and are interested in preventing repetitive strain injury as far as what resources are available? How do we learn about prevention of repetitive strain injury, and are there any exercise programs that perhaps sonographers should engage in? How do we go about this?"

Paula Woletz: "The first thing I would do is look up the government document. There have also been a number of publications that discuss it and go into the various references of what has been done so far. I don’t know of any really well focused exercise program and I think it is going to be necessary, it was mentioned by the people from NIOSH. I haven’t seen one formulated as yet. Some of the recommendations they did make are very easy to implement and some of them cost, and of course, money is always an issue. The expensive ones are equipment modification, if a monitor has a fixed height and you need to have it appropriate for your eye level, then a tall sonographer is going to have to have a lower chair and a short sonographer is going to have to have a taller one. If you’re changing the height of the chair then you also need to change the height of the examining table so that it’s at an appropriate level. One of the things that the folks from NIOSH showed us was that a lot of our scanning, and I do only obstetrics so we have a lot of very big patients, a lot of its like this. They said that for the amount of force that’s needed to do a good sonogram that’s the absolute worst position. Ideally, you want your arm at about a 40 degree angle that gives you the most strength, you don’t want to do a lot of reaching or a lot of twisting, and of course, we do all of that."

Martin Necas, RDMS, RVT: "That’s right."

Paula Woletz: "So that was a big thing, get those all to be adjustable. Another thing that their advising which doesn’t sound expensive but ultimately could be is they said people need rests. If you have 90 seconds of muscle exertion, then you need to have 90 seconds of resting the muscles. If you’re doing an exam for 30 or 40 minutes then you need to take a 30 or 40 minute break to recover. It doesn’t mean you’re not working, there are other responsibilities that you could be fulfilling but you shouldn’t be standing uninterrupted for long periods of the day. And the reason I say that’s expensive is that many practices rely on their sonographers working straight through without a break and to change that means hiring more people."

Martin Necas, RDMS, RVT: "Yes, absolutely. You have certainly done some very interesting work, and I’m particularly pleased that you have managed to involve the government so that now there is more awareness perhaps. And we’ll try to look this document up on the Internet and provide a link along OBGYN.net if at all possible. Before we go, could you tell us a little bit about what the future holds? Are there plans for more studies, and where should we take it from here?"

Paula Woletz: "There are plans for more studies, and we’re applying for some grants to pursue them ourselves. We’d like them to go further, we really want to be able to document not only that injuries occur - that much we can prove - but we want to be able to show that interventions can decrease the incidence of these happening in the future, that’s our goal."

Martin Necas, RDMS, RVT: "Thank you very much. It’s been a pleasure to have you here, and thank you again for talking to us."

Paula Woletz: "Thank you."