Abstract
Foreword by Kevin D. Evans
This issue is dedicated to the topic of work-related musculoskeletal disorders (WRMSDs) in sonography. The topic of WRMSDs has been discussed extensively and also generated the need for a consensus conference to gather leaders from professional organizations, stakeholders, and commercial vendors. The first consensus conference was held in 2003 and was chaired by Joan P. Baker, a founder of the Society of Diagnostic Medical Sonography (SDMS) and the American Registry of Diagnostic Medical Sonographers (ARDMS). 1 Ms Baker’s influence on this topic is significant, and for this reason it seemed important to have her reflect on the history of WRMSDs. Ms Baker’s own research into this topic continues to be the most cited Journal of Diagnostic Medical Sonography (JDMS) article and underscores that 90% of sonographers and vascular technologist are working in pain.2,3 Joan’s additional participation in a second consensus conference adds to her perspective on what has transpired with regard to the increasing risk of occupational injuries among sonographers and vascular technologists. The following are her thoughts on the history and outcome of WRMSDs among sonographers.
History by Joan P. Baker
The realization that sonographers were at risk for occupational injury was not obvious until the mid-1990s when the first large survey was undertaken by Canadian sonographers in British Columbia.
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The sonographer’s shoulder was the focus of most of the discussion among sonographers, in the early days of working with an articulated arm on the B-scanner. Marveen Craig
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established this concern for sonographer injury when she published a JDMS article titled Sonography: An Occupational Health Hazard?
Not long after this seminal publication, Heidi Vanderpool and colleagues 6 published a landmark article about the prevalence of carpal tunnel syndrome among cardiac sonographers, and this became a study that really highlighted the upper extremity risks that sonographers were experiencing.
In 1995, because of continued reporting of occupational injuries among Canadian sonographers, the Health Care Benefit Trust of Vancouver British Columbia (HCBT) formed a task force to study this issue to determine the prevalence of WRMSDs and to recommend workload changes and equipment redesign. The SDMS joined in this effort, and approximately 1000 sonographers randomly selected from the ARDMS database for the United States and Canada responded to a survey. Details of this survey were published in 1995 by Dr Ian Pike and colleagues. 7 Pike et al’s work documented an astounding self-reported rate of WRMSDs of 84%. This task force had only two sonographers serving on it: Vicky Lessoway, representing Canada, and Joan Baker, representing the United States. Other members of the task force included a statistician and a variety of HCBT administrators.
I was asked to give a talk at the SDMS annual conference in Palm Springs, California, in 1993. The title was Stress in the Workplace. I received a phone call asking me what I was going to talk about, and it became apparent that there were many sonographers wanting me to talk about scanning in pain rather than the traditional meaning of stress at work. This led to the discovery that many sonographers were suffering and were under the belief that they were the only ones who were working in pain and discomfort. Most sonographers had not connected their discomfort with their occupation. This reporting, in 1994, prompted the SDMS to join the Canadian effort in British Columbia. The Canadian and US research results motivated the SDMS to hold an international consensus conference in 2003 involving four countries—Australia, England, Canada, and the United States—to set standards to reduce the risk of injury to our profession. 1
Since that original consensus conference, improvement in the number of people who experience discomfort when scanning has still not yet been realized. This may be the result of increased awareness on the part of professionals, which has spurred higher reporting rates. One of the most alarming facts that came from the 2008 survey was the chronological age of the respondents. The survey showed that the age has shifted from 8.3% of sonographers being older than 50 years in 1997 compared to 30% today. This implies that injury
Sonographers also have to realize that when they feel that they have been injured, they need to go to occupational health and fill out the necessary incident report forms to formally document their injury. They should seek medical advice outside of their employer’s facility to avoid placing the employer in a conflict of interest position. It would be easy to assume that the department in your employer’s facility that delivers the diagnostic imaging would be the best place to seek a diagnosis and possible treatment. However, staying within that facility may create a situation where the sonographer does not receive an unbiased assessment.
In the early years of the profession, some sonography equipment manufacturers shielded themselves behind the lack of identified risk clearly associated with the equipment. They cited the need for accessory equipment such as height-adjustable tables and better patient scheduling. Since this approach did not, in itself, reduce the incidence of WRMSDs, many manufacturers started to redesign their equipment. This meant that they had to make the equipment easier to move and to address issues with the control panels, software packages, and monitors.
Administrators sought changes and administrative controls that essentially had a zero budget impact. The drive to increase patient throughput to offset reduced reimbursement negated most of the efforts to adjust the schedule. Many administrators continued to deny the existence of the problem altogether. Time allowed per study was reduced whereas the breadth of the study increased to encompass more views. Patient weight limits for magnetic resonance imaging and computed tomography tables drove more obese patients to be studied with sonography. Manpower shortages increased the patient volume burden on fewer sonographers. The introduction of Picture Archival Computer systems allowed for greater throughput of imaging examinations for physician interpretation. Data from the SDMS Sonographer Benchmark Study demonstrated a 55.5% increase in the number of sonograms per sonographer per year in the 8-year period from 1992 to 2000. 8
Data have also been collected from countries such as Australia, United Kingdom, Canada, and Italy. All of these global studies have demonstrated a significant incidence of occupational injury in sonography. In fact, all had an incidence of 80% or higher.9–12 The scanning technique and conditions under which these sonographers or sonologists work are vastly different. The one thing they have in common is the type of equipment they used and the length of time they had been practicing sonography.
The SDMS believed that the time had come to hold a second consensus conference to address these issues that are still having an impact on manpower and threatening the profession of sonography. The result of the second consensus conference was the revised Industry Standards for the Prevention of Work-Related Musculoskeletal Disorders in Sonography. There is a human toll that is being experienced from work-related injuries all over the world.
Developing lasting solutions to lower the risk of occupational injury among sonographers will require a combined effort by the equipment manufacturers, employers, and sonographers. Since WRMSDs are caused by multiple factors, injury prevention requires solutions from equally varied resources. By taking a multidisciplinary approach, significant impact can be made on reducing the risk of work-related injuries for sonographers and vascular technologists.