Do You Need an Ergonomics Intervention?

In the rush to implement digital imaging technologies and PACS in the early 2000s, the ergonomics of the reading room were often overlooked. As a result, radiologists began spending eight or more hours reviewing tens of thousands of images per day, while sitting at stations not optimally designed for the task.

“PACS was implemented so rapidly, there wasn’t enough attention paid to the impact on the user,” said Mukesh Harisinghani, MD, professor of radiology at Massachusetts General Hospital (MGH), Boston. “At the same time, digital technology crept into our personal lives, so we are now scrolling, mousing and keyboarding from the time we wake until we go to sleep.”

When Dr. Harisinghani’s MGH colleagues first began complaining of wrist and elbow pain, shoulder stiffness and headaches in 2006, he sought expert advice.

“I invited an ergonomics expert to visit our reading room and give us a scorecard,” he said. “She wanted to give us a grade lower than F. . . that’s how bad it was.”

Taking matters into his own hands, Dr. Harisinghani educated himself on workplace ergonomic principles and engaged a core group to handle issues throughout the institution. In the past decade, Dr. Harisinghani has authored numerous studies on ergonomics in radiology, including in RadioGraphics.

Radiology practices and departments across the country are taking steps to better understand how reading room ergonomics contribute to repetitive stress injuries, physician wellness and burnout, and to improve the radiology workplace. For the growing number of radiologists reading from home — especially during the COVID-19 crisis — experts recommend applying the same ergonomic principles learned at work to the home workspace.

Survey Leads to New Solutions

The Department of Radiology at Northwestern University Feinberg School of Medicine in Chicago has made strides in improving ergonomics for radiology faculty and trainees who reported having minor but bothersome work-related repetitive stress injuries (RSI), according to Jeanne Horowitz, MD, associate professor of radiology. A survey of radiology faculty and trainees conducted by Dr. Horowitz revealed the following current or past injuries among 44 radiologists out of 59 respondents:

• Wrist: 60%

• Neck: 38%

• Back: 36%

• Finger: 27%

Also troubling, 40% of respondents with an RSI reported that the injury contributed to interpreting studies more slowly and 42% reported symptoms which could lead to burnout. In response, Dr. Horowitz solicited volunteers for a Northwestern Medicine Ergonomics Committee to explore and implement reading room improvements, beginning with the humble but powerful computer mouse.

“We wanted to pick the best mouse but people have different sized hands and preferences,” she said. “And we found that not everyone likes the same thing. There’s no one-size-fits-all mouse.”

After testing several models, the team equipped each PACS station with both the original wired mouse that came with the computer and a more ergonomic, wireless mouse. Dr. Horowitz and colleagues also purchased a few sophisticated gaming mice and mousepads with wrist rests as options. The PACS workstations also have sit-to-stand desks and adjustable chairs.

“The key is getting a chair that is fully adjustable, including height, seat depth, arm rest height and lumbar support,” Dr. Horowitz said.

But experts say just upgrading equipment isn’t the whole solution. At Northwestern, the hospital’s occupational health experts provided ergonomic training  sessions for the radiology department.

“The challenge lies in implementation,” said Dr. Harisinghani, who was among the faculty members consulted when the MGH radiology reading room was upgraded. “You need awareness and education and continuous documentation of feedback to make sure you’re meeting standards and updating.”

After the ergonomic interventions were implemented at Northwestern, a follow-up survey (64 respondents) revealed that the majority of previously reported RSIs either resolved or improved. Even more importantly, 83% of respondents reported that improving the ergonomic design of their workstation contributed to their well-being.

“Ergonomics is one contributor to physician wellness in a radiology practice,” Dr. Horowitz said.

Ergonomics for the Home Workspace

While the ergonomic principles are largely the same at work and home, experts offered a few suggestions to make the most of your home office.

“Many people don’t have sit-to-stand or adjustable desks at home,” she said. “If your desk feels too high, ideally a radiologist should have an adjustable chair to accommodate it. Another workaround for this situation is a footrest to raise your feet,” Dr. Horowitz said.

The researchers emphasized it isn’t necessary to spend a lot of money outfitting the home office. “A mouse that’s comfortable for the work you’re doing will give you a lot of bang for your buck,” Dr. Horowitz said. Postural and visual ergonomics can also be easily addressed.

“You can have a $10 desk, but the monitor needs to be at the right height and your chair must be well positioned,” Dr. Harisinghani added.

Omer A. Awan, MD, associate professor of diagnostic radiology and nuclear medicine at the University of Maryland, Baltimore, has researched ergonomic solutions for preserving the radiologists’ body and eyes and presented findings at recent RSNA annual meetings. 

To reduce eye strain at the computer, Dr. Awan suggests using the 20-20-20 rule: Every 20 minutes, take a 20-second break by looking 20 feet away from your monitor. To combat the sedentary nature of computer work, he suggests getting up for a walk every 30 to 60 minutes to reduce fatigue and increase the elasticity of your muscles.

“We need to make each of these habits routine,” Dr. Awan said.