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Content Reviewed 09/30/2008

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In the day-to-day operations of a sonography lab, there is always pressure to increase the number of procedures performed. To reduce the risk of potentially career-ending musculoskeletal disorders, management should ensure that the need to perform a high number of procedures does not compromise management commitment to implementing proper ergonomic measures for sonographers.

Costs to an institution can include excessive sick leave absences, reduced production, loss of workforce, costs related to temporary staff and all other costs associated with recruiting and training for a hard-to-fill position.

On average, today's sonographers have been scanning for more than 10 years; their training did not include instruction on occupational injury and how to avoid it. Recognition of the problems and possible interventions can help sonographers protect themselves by identifying and avoiding hazardous situations.

Problem Recognition and Intervention

Many sonographers operate with relative independence. It is necessary that they remain informed about the possible hazards associated with the procedures they are performing. They should use all controls available to minimize the intensity and time they are exposed to stressful procedures.

Possible Solutions

Employers should ensure that sonographers receive appropriate training and follow best practices in order to reduce the risk of developing musculoskeletal disorders. These best practices include:

  • Taking time to adjust all available equipment to minimize periods of sustained bending, twisting, reaching, lifting, contact pressure and awkward postures; alternating between sitting and standing positions; and varying scanning techniques and transducer grips.
  • Reducing arm abduction (spread) and forward and backward reach by using measures such as:
    • Requesting the patient move to a position which is advantageous from a posture standpoint, usually as close to you as possible.
    • Adjusting the exam table and chair.
    • Using arm supports.
  • Lowering the light level in the room to eliminate glare on the monitor and to increase contrast on the monitor so the image can be seen comfortably and without strain.
  • Using correct body mechanics when moving patients, wheelchairs, beds, stretchers and ultrasound equipment.
    • Causes for concern include lifting more than 50 pounds, moving an adult patient who cannot assist, moving a patient who is obese, or pushing equipment that weights over 600 pounds across a threshold or up and down ramps.
  • Relaxing muscles periodically throughout the day:
    • Stretch hand, shoulder, and back muscles.
    • Take mini breaks during the procedure.
    • Refocus eyes onto distant objects.
    • Vary procedures and tasks as much as reasonably possible.
    • Take meal breaks away from work-related tasks.
  • Stopping about every 8 minutes for mini breaks to perform activities such as:
    • Opening and closing your fist.
    • Rolling your shoulders.
    • Turning your head from side to side.
    • Focusing your eyes on a distant spot on the wall.
  • Maintaining a high level of physical fitness and range of motion in order to perform the demanding work tasks that are required. Spend a few minutes warming up muscles prior to undertaking tasks.
  • Reporting and documenting any persistent pain experience to their employer and seek competent medical advice.
  • Employers, with the input from sonographers, should implement staffing solutions that allow periods of  time away from high-risk tasks and provide as much variety as possible in the daily schedule. Intersperse easier procedures throughout the day if possible.
  • Staying informed about the health care facilities policies and procedures, including file incident reports. Seek assistance from employee health or risk management personnel when pain or discomfort is experienced.

Employers should ensure that sonographers participate in education and training to reduce the risk of developing musculoskeletal disorders. This education and training could include:

  • Attending employer sponsored in-services.
  • Attending seminars, lectures, workshops or conferences offered by professional organizations or manufacturers.
  • Accessing journals, textbooks or online resources.
  • Attending a formal sonography program that includes education on musculoskeletal disorders (MSDs) prevention in the curriculum.


Engineering Controls, Work Practices and Scheduling

Potential Hazards

Examples of other factors that may increase the force, posture, or repetition of a task which may result in injuries.

  • Locating equipment in a room that is too small to allow for proper arrangement and alignment of the machine, bed, chair and sonographer.
  • Inadequate ventilation.
  • Lighting that is too bright and unable to be controlled..
  • Poor orientation of diagnostic suites in relation to other critical areas requiring excessive frequency and distance of equipment or patient transfer.
  • Lack of time to properly adjust equipment or patients for optimal procedure performance.
  • Lack of knowledge about how to design, setup and equip the diagnostic suite for a particular procedure.
  • Lack of knowledge concerning basic body biomechanics to minimize stress to the body.
  • Improper staffing for the procedures performed.

Possible Solutions

  • Provide adequate space in the examination area for the maneuverability of equipment around the exam table and easy access from all sides.
  • Provide adjustable room lighting with easily accessible dimmer controls and/or window shades or curtains.
  • Provide adequate ventilation and temperature control to ensure the comfort of sonographer and patient while enabling the equipment to operate at a functional temperature.
  • New equipment should always be assessed for its suitability in the physical space in which it will be used.
    • Casters or wheels should be suitable for the flooring surface.
    • Equipment size and weight should be evaluated to ensure that it is suitable for the procedures and physical space in which it will be placed.
    • Equipment should be compatible with other items that will be used during the exam.
  • Sonographers should be informed about improved patient positioning options that may assist in reducing scan time: 
    • Arm extensions support the patient's limb(s) during vascular studies.
    • Central locking casters make it easier and quicker to lock the table in place.
  • Provide adequate rest breaks between examinations, particularly for challenging procedures which are comprised of similar postural and muscular force requirements.
  • Encourage task rotation in the workplace as much as possible. Scan different types of procedures whenever possible. In multi-specialty labs, avoid doing the same type of scans back to back; intersperse time scanning with time performing other laboratory tasks and paper work.
  • Collaborate with employees on staffing solutions that allow sufficient time away from work for rest and recuperation.
  • Establish maximum transducer use time per hour, if possible. Research to determine maximum safe transducer time is encouraged.
  • Provide annual training to all employees on the risk and prevention of musculoskeletal disorders.
  • Perform risk assessments in consultation with the sonographers on a regular basis to identify musculoskeletal disorders and formulate and implement controls for the prevention and/or reduction of these disorders.
  • Solicit sonographer input on establishing protocols on examination scheduling.
  • Develop best practice documents with input from the sonographers/sonologists. Review and update regularly. Ensure that new sonographers are educated and familiar with the best practices of the institution.
  • When planning to purchase new equipment, the employer should seek the input of technical staff to assess the risks and suitability of the equipment. For example, at least some tables should be able to accommodate bariatric (obese) patients weighing up to 600 pounds.
  • Ensure that maintenance schedules and plans are implemented and enforced.
    • Sonographers should know when and to whom defective equipment should be reported.
    • Maintenance employees should know which equipment is to be serviced and on what schedule.

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