Abstract
How can work-related musculoskeletal injuries (WRMSI) be addressed? Perhaps through a multipronged approach that addresses components such as administration, the individual worker, and the design of the work environment. Much like a stool, all three legs of the stool must be balanced for it to stand up. Without one of the legs on the stool, it will tip over. If the administrative “stool leg” is missing, there is no support for injury reporting, controlling workloads, or supporting the use of ergonomic equipment in the department. If the individual worker “stool leg” is missing, work postures are not modified to be more comfortable, and ergonomic features of the workstation are not properly utilized. This can result in injury risks that are not reported to administration. If the work environment “stool leg” is missing, there are few ergonomic features built into the work station equipment, the examination room is not properly designed for the job, and the computer workstation is poorly designed.
Sonographers have been surveyed many times since 1993. All surveys, both within the United States and in many other countries outside, have demonstrated a work-related injury rate of at least 80% among diagnostic medical sonographers (DMS). Physicians in other countries and maternal-fetal medicine in the United States have also demonstrated similar incidence rates. 1 These WRMSI rates appear to be consistently high, regardless of the specialty. However, some sonography examinations are more likely to cause injury, such as venous reflux imaging, transvaginal sonography, bedside scanning, and especially echocardiograms. In many countries, sonograms are performed by physicians or midwives. More and more physicians are using sonography as a part of their practice, which may eventually lead to handheld ultrasound devices becoming an extension of the stethoscope. A DMS, by definition, is a medical professional who makes a graph or image using ultrasound.
Those who have studied occupational injury, among DMSs, believe it is not the number of patient examinations but rather the way the examination is done that makes a difference. It is also important how the workstation is ergonomically designed; however, consumers continue to look for someone else to solve the problem. All the surveys that have been completed to date were based on self-reporting. Many of these surveys have been based on small numbers of respondents. However, two large surveys were completed in 2009 and 2013. Both indicated an increase in the incidence of WRMSI2–9 (see Table 1).
Selected Published Studies on the Incidence of Work-Related Musculoskeletal Injury Among Sonographers and Vascular Technologists.
The most frequently asked question is, “How many patients are safe to scan in a clinical day?” This is certainly an easy question to ask, but it is very difficult to answer. The time has come to find a way to answer this question. However, the number of patients may not be as important as being able to provide a daily metric that can be used to possibly reduce the patient load. The frequency with which this question is asked would seem to indicate that the number of patients and examinations performed may be a limitation to a healthy workforce.
We need a registry (national database) to collect data that can be accessed and researched by those who could provide evidence of those work behaviors and equipment designs that are contributory to the current rate of WRMSI. By collecting data from as many sonologists and sonographers as possible, the national database could be queried as to the most important issues or factors related to WRMSI. The data collected could lead to evidence that points to the number of cases per day that could safely reduce the risk for WRMSI.
Once data and empirical evidence are provided, implementing these changes may be more easily done through the process of laboratory accreditation.
A 2017 publication detailing the National Institute of Occupational Safety and Health’s funding of research grants was very disappointing. It showed that only one new research grant was funded out of 196 submissions. 10 The overall success rate of 1% for research grant proposals was at the agency’s lowest since 2007. 10 This would indicate that the sonography profession should address these issues rather than wait for funding to support the needed research. A cadre of researchers is ready and capable of generating the empirical evidence needed; therefore, it is important to turn to other sources to support them financially.
A well-designed national database would produce other information that would be very valuable in understanding the causes of WRMSI as well as other workplace-related risks. No other occupation is allowed to risk the injury of their workforce as the sonography professional has done. This may mean we have to change the way we scan. Allowing a long-standing 90% injury rate to continue without solutions is totally unacceptable. This situation is very frustrating for those who have been working on this issue for many years trying to sort out the multifaceted nature of the problem. This is nothing to say of those many sonographers who have been injured and have had their career ended.