Pain Prevention: Strategies to Reduce Repetitive Stress Injuries Amongst Radiologists – Part One

2014-10-30
 

Prevent Repetitive Stress Injury in RadiologyThis blog is in the form of an interview with Dr. Jay W. Patti, a radiologist from Mecklenburg Radiology Associates in Charlotte, NC. The interview is on a topic of interest to both of us (and hopefully you out there in Internet-land): using ergonomics to reduce repetitive stress injury (RSI) amongst radiologists.

Allan: Why do you think radiologists are still struggling with workstation ergonomics? And is it still important?

Dr. Patti: While improving workstation ergonomics is of great concern to radiologists, it is a topic of conversation which often remains behind the closed doors of the reading room, between radiologists. The combination of declining reimbursement for the technical component of radiology services and shifting relationships between facility administration and radiologists leads to an environment where radiologists fear that advocating for improved ergonomics makes them appear out of touch or high maintenance.

Unfortunately, if radiologists neglect to advocate for adequately ergonomic workspaces, they will run the risk of developing repetitive stress injuries, providing a less-than-optimal work product to the institution in which they work, and ultimately negatively impacting the care they provide to their patients.

Allan: Why do you feel ergonomics is a challenge? How have things changed from the old days of film?

Dr. Patti: Over the last 15 years, there has been a drastic change in the way that radiologists physically practice their profession. The PACS viewer has materially changed the way that radiologists interact with medical images. What was once a more mechanically diverse set of tasks such as standing/bending/walking in front of an alternator, using a magnifying glass to get a closer look, and adjusting a hot light to change the image brightness, has now been abdicated to two buttons controlled by two fingers.

At the same time, decreased professional reimbursement has resulted in demands for efficient radiologist workflows and the elimination of extraneous movements and actions. Together these changes have resulted in radiologists sitting in chairs with a narrow scope of physical tasks for long periods of time, sometimes 5 to 10 hours in a row with little, if any, breaks.

Theoretically, to maximize efficiency in a fee-for-service model, a radiologist should be physically positioned directly in front of the PACS display with eyes focused on the images and given few other tasks. The images should move in front of them, limiting even eye movements. While this is true, a similar argument could be made for maximizing the water consumed from a fire hose. In reality, there are ergonomic nuances to both maximizing radiologist efficiency and drinking from a fire hose.

Complicating the pursuit for these solutions is that all radiologists are built differently and a one-size-fits-all solution actually never fits any one radiologist optimally. For example, radiologists with common ailments such as back pain might have trouble sitting for extended stretches of time, while others may have trouble standing for extended periods of time. Radiologists who have a low threshold for vertigo symptoms in a dark room might be inclined to move their head laterally rather than rotating at the neck (a motion which can evoke vertiginous symptoms).

The tools are constantly physically changing as well. The advent of curved monitors in the consumer space may eventually move into the PACS display space changing the way that radiologists need to rotate or move laterally while viewing images.

Allan: Are there other limitations on achieving an ergonomic environment?

Dr. Patti: Yes. Often the physical limitations of a workspace limit the opportunities for improvement. For example, the positioning of a door behind the radiologist in a small room might necessitate that the door be closed while reviewing images to minimize ambient or reflected light, but the addition of a 3D image server, EMR access workstation, or a second institution’s PACS unit creates additional heat which quickly increases the temperature of the room with the door closed. Problems like this are most challenging because major trade-offs are necessary and the physical constraints of the environment are the limiting factor.

Other limitations are based on what is available for purchase in the market at a reasonable cost. Most radiologists’ equipment, with the exception of the PACS displays and a vendor-designed VR microphone, was not originally designed for radiologists but rather adapted to the radiologist workflow from other use cases. For example, most business and consumer-level computer users do not work in the dark. Because of this, the reflected light from a white keyboard does not materially change the ambient light of the workspace. Until black keyboards were commonly commercially available, this presented a unique problem for radiologists who work in the dark. Luckily the high level requirements on input controls and demands on graphics cards by radiologists are mirrored by computer gamers. This shared need has provided many common solutions such as the mouse designed for gamers but used in many PACS installations as well.

Furthermore, the manner in which many radiologists share workstations with other radiologists has led to an apathetic attitude toward workspace ergonomics. It is common for radiologists to be subspecialized and radiology groups to offer a wide range of subspecialized services. Some of these services require the physical presence of a radiologist with specific skills such as an interventional radiologist to do procedures such as biopsies and angiograms. To assure that patients within a geographic region have adequate access to these specialized services, radiologists with different skills rotate to different locations daily.

The consequence of this is that in many settings, the reading room is used by a different radiologist each day, on a 10- to 20-day cycle. Because of this lack of “ownership” of a poorly designed, uncomfortable and possibly harmful work environment, many radiologists believe that the inconvenience of advocating for a better environment is not justified by the perceived personal reward. This is unfortunate, because it is exactly these situations, due to frequent user rotation, where advocacy for a flexible ergonomic solution would have the greatest impact on the user base as a whole.

Read the remainder of this Q&A with Dr. Patti.

What types of preventative measures are being taken at your facility to prevent RSI? Comment below and join the conversation.

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