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


Prevent Repetitive Stress Injury in RadiologyWe’re discussing the challenges of RSI in a two-part interview with Dr. Jay W. Patti, a radiologist from Mecklenburg Radiology Associates in Charlotte, NC.

In Part One of this Q&A, Dr. Patti outlined some of the obstacles that radiologists face regarding their physical workplaces. Those challenges include rotating to different facilities so there’s a lack of ownership of a workstation, not wanting to seem “high maintenance,” and having different individuals with different ergonomic needs working at the same workstation. Now, back to the discussion:

Allan: That is a long list of obstacles. Is the situation solvable?

Dr. Patti: The obstacles I’ve talked about should not discourage one from addressing these problems because finding solutions to the problems are in the interest of the institution, the radiologist and the patient. Institutions should not be under the impression that these are problems “for the radiologist to figure out” as the solutions are often specifically defined as being a financial obligation of the entity that receives the technical component of the billable service.

The institutional goals to provide excellent patient care are akin to a professional baseball team’s desire to win games. To accomplish this goal the league or professional organizations need to set standards of play. Team owners need to create an environment and supply equipment to the players, so that the athletes can practice their profession at the highest level, avoiding injuries which limit their performance.

Likewise, in hospitals, ignoring ergonomics and opting for the cheapest solution has downstream negative consequences to care that can be provided by a physician. It would be unthinkable for a healthcare institution to only provide one size of gloves to its surgeons and a surgeon would not readily agree to operate on an OR table which is not height adjustable. The same considerations should be given to radiologists in their practice environment as the stakes are just as high when considering the key role that radiologists play in the modern healthcare institution.

As the US healthcare market moves toward demanding more value from its providers, radiologists and institutions should borrow successful systems from other industries such as the LEAN principles known to the manufacturing industry. Central to the core LEAN philosophy is the concept of eliminating waste and optimizing conditions to achieve success. Creating an ergonomically flexible work environment which can be adapted to different users will help assure that these goals are met.

In 2012 the ACR, AAPM, and SIIM created a technical standard for the electronic practice of medical imaging which should serve as a guide for institutions to implement ergonomically optimal work conditions for radiologists. The technical standard describes a specific series of physical requirement (III,D,1,f) which should be implemented by imaging service providers. Yearly capital or operational expenses should be budgeted to maintain these workspaces. Adjustable tables, display arms and chairs should be maintained or replaced when they cease to function properly.

Additionally, PACS vendors should continue the pursuit to minimize wasted time and wasted mouse clicks to perform common actions. They should be guided by good heuristic user interface design and recognize the unique characteristics of their user base of radiologists, such as the cost involved in requiring a radiologist to divert their eyes from the medical images to complete a task. Considerations should be made to create “click count standards” for common tasks in PACS applications and compare across PACS vendors.

Allan: Are there specific steps the radiologists can take on their own?

Dr. Patti: Yes. In addition to advocating for ergonomically improved workspaces, radiologists can take steps to reduce repetitive stress injuries, which are simple and cheap. Rolling up one’s sleeves can reduce the focal pressure on the median nerve while using a mouse. The use of a dead man switch for dictation or on-off toggle can be set to reduce stress on the first CMC joint. Anti-reflective high index prescription glasses can be used to reduce eye strain. Workstation cases can be placed in a location other than directly under a desk.

Lastly, radiologists can adopt the ACR principles of Imaging 3.0 by getting out of the “cockpit” and leaving the reading room more frequently to interact with patients and referring physicians. Similarly, when a radiologist is consulted by a referring physician to review a study, if the radiologist has the appropriate tools, they can raise the height of the monitors and stand with the referring physician to review the case. This provides a better viewing angle for the referring physician and at the same time offers a greater level of respect to the interaction with the consulting physician, fostering a better professional relationship.

Many of the simple solutions at the control of the radiologist are mere common sense, but can only accomplish a certain level of improved ergonomics. To affect greater change radiologists need to convey the importance of these issues to facility administration, and facility administrators need to listen to the needs of the radiologist without discarding the request as being “high maintenance.” These problems are real and affect the quality of care that is provided to patients. Institutional administration and radiologists are on the same team if the goal of the team is to allow radiologists to practice their profession at the highest level and in doing so provide the best care to their patients.

Discover how Dr. Patti’s practice collaborates with other radiology groups in the region to provide top-notch service with PACS support.

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