While reading that abdominal CT is critical, tending to that pain in the neck is, too.

According to a recent study of 28 radiologists conducted by Anand Prabhakar, MD, et al at Massachusetts General Hospital in Boston, a total of 75% of those questioned had seen a physician for work-related musculoskeletal symptoms and have changed their work schedule in response to those symptoms.

All the radiologists in the study employed mostly PACS and speech recognition equipment while occasionally viewing hard copy images. Half of the respondents had worked on the same system for more than 5 years, and 96% had two or three monitors at their workstations. The study revealed that 39.2% complained of lower back pain, 7.4% indicated wrist pain, 32.1% pointed to shoulder pain, while neck pain was indicated 42.8% of the time. Headache was a complaint with 32.1% of the group surveyed. Additionally, 17% of those studied never adjust their chairs, and all of those respondents complained of three or more symptoms. A reported 75% of the radiologists studied adjust their chairs sometimes (42.8%) or always (32.3%). Also, 60.7% never adjust their monitors, while 53.5% never used elbow rests and, of those, 46% had shoulder pain. Interestingly, 50% reported that they have a regular exercise program in spite of their complaints.

It’s clear that radiologists suffer from work-related ergonomic problems, but what is the remedy? “The key seems to be the adjustability of the furniture,” said Prabhakar. “What we need is a fully integrated system. That is, the phones, computer, peripherals, and monitors all need to be independently adjustable to suit each individual’s comfort level. We applaud any vendor who attempts to provide such a system.”

Yet, the issue is more complicated. With comfort come costs. “There is a cost-effectiveness concern with many facilities,” said Prabhakar. “A facility can pay more than $10,000 for a high-end desk that has not been scientifically proven to be effective in rectifying repetitive stress injuries.” Here lies the rub. According to Prabhakar, “The evidence that ergonomically designed furniture is effective is mostly anecdotal. Radiologists definitely want the options that ergonomic furniture provides, but facilities are [reluctant] to fork over the heavy expenditure without more scientific evidence that they actually work. Also, all vendors don’t provide fully integrated reading systems. We need to do more rigorous research. But although we need more testing, we don’t need scientific data to realize that ergonomically designed furniture aids productivity and musculoskeletal health.”

Vendors Leap into the Breach

Today, ergonomic furniture is available to all radiology groups. Vendors have created a wide variety of solutions. For example, AFC Industries is a leading designer and manufacturer of a complete line of high-quality medical and radiology reading room furniture. The company markets a host of ergonomically designed systems, from the new full-featured Whitestone Workstation, to a variety of carts, stands, racks, and tables, all with ergonomic features.

Nogah Haramati, MD, chief of radiology at the Montefiore Medical Center in the Bronx, NY, notes that the facility has worked directly with AFC Industries to design and develop ergonomically friendly equipment. “Through our consulting efforts with AFC on design requirements, we’ve noticed an increase in productivity in our radiology departments,” said Haramati. “Hip pain, back pain, wrist pain, all have been reduced; a result that certainly decreases downtime in the radiology department.

AFC Industries says its Whitestone Workstation features adjustment capabilities that let the user maintain a comfortable and ergonomically correct position while seated.

“The chair is the most important factor,” noted Haramati. “Do the chair first. The adjustable height of the wheels and armrest is vitally important. Also, you have to be able to lean back and lock the furniture into place. It has to be exactly the right height because a little difference goes a long way in the degree of comfort for each individual.”

Even so, your chair is just the beginning. “The tables (preferably motorized) also have to be precisely adjustable with the capability of getting the height exactly right. Monitors also have to be adjustable and stationed at an optimal distance from the eyes. It’s easy to create eye strain when the viewing angle isn’t perpendicular to the monitor,” said Haramati. “People sit in the same position for up to 8 hours, so the angle of light when reading x-rays and other exams is an important factor. Ambient light is a consideration as well. Light differences and intensity should be adjustable for those who read sitting down or standing up. A gooseneck lamp, for example, is preferable. In the end, OSHA principles are at work here.”

Haramati admits that there are no double-blind experiments that confirm the efficacy of ergonomic furniture, but he’s convinced that the design elements that Montefiore Medical Center has helped to introduce with AFC have led directly to an increase in productivity at his facility. “The evidence is anecdotal, but I can see that productivity increases with AFC equipment.” He notes that the cost of losing a young radiologist due to repetitive strain difficulties (an event he has witnessed more than once) is much more significant than the extra cost of ergonomic furniture. “The additional expense is definitely justifiable.”

He also points out an interesting aspect to the issues of ergonomic furniture—the area of software design. Haramati implicates the high number of mouse clicks required to achieve a given function as a factor in repetitive stress injuries. “When people do this 8 hours a day, the number of mouse clicks and additional scrolling necessarily accumulates. This means a lot more repetitive movement and that leads to stress injuries and discomfort.” According to Haramati, computer software efficiencies are one of the keys to ergonomic efficiency, and, as he categorically states, “Ergonomic efficiency is everything.”

David Hirschorn, MD, director of radiology informatics at Staten Island University Hospital, and also a user of AFC Industries equipment, generally agrees. “Adjustability is the key. The ability to raise and lower screens and adjust them to a person’s height is important. If the table is too high, one tends to get neck strain,” said Hirschorn. “Mobility is also a significant feature. It should be easy to move the equipment around the room to suit different circumstances.”

Hirschorn also admits there is no scientific evidence to indicate that ergonomic furniture actually works. “I can’t say ergonomic furniture actually raises productivity. The evidence is mostly anecdotal,” said Hirschorn. “But I’m convinced the equipment is effective. I can see that productivity is better than before, so my feeling is that ergonomic furniture is absolutely necessary—especially when radiologists perform their reading duties all day long.”

Adjustability, Adjustability, Adjustability

According to manufacturer Anthro Corporation, Carl’s Table, Model CT08, is designed with a tilting surface that supports the forearm and shoulders, decreasing the risk of musculoskeletal disorders.

The Anthro Corporation, an Oregon-based manufacturer of ergonomic radiology furniture, is most noted for its Carl’s Table models. It markets its equipment around the world (in Europe it is known as the AW-170 table) to all radiology markets, including hospitals, clinics, imaging centers, as well as the veterinary and dental markets. Anthro’s latest table model is the CT08, an advanced multidimensional table with many innovative features. As with AFC, the Anthro Corporation works with radiology departments around the country to improve and optimize ergonomic reading room equipment.

Henry Krebs, MD, medical director for radiology at St Joseph’s Hospital in Atlanta, has employed Carl’s Table for almost 5 years. “We’ve looked at a lot of radiology tables and continue to do so on a regular basis, but we think Carl’s Table is ergonomically the best,” said Krebs. “It has excellent table management features, including ready access to phones, monitors, and other radiology equipment. It also has a built-in lighting system, which provides the proper (and adjustable) light intensity to avoid eye strain.”

Once again, the pervasive requirement for ergonomic comfort is for adjustability under a variety of circumstances, as all of the experts point out. “We like the adaptability of Carl’s Tables. For example, it’s easy to change the monitor configurations and all our radiologists appreciate that feature,” said Krebs.

Krebs says his team takes ergonomic issues very seriously because addressing problems produces maximum efficiency. “The point is that every radiologist is built differently. The length of their arms is different, the length of their torsos is different, and they are anchored to their workstations for 6 to 8 hours per day,” said Krebs. “For example, we employ a number of radiologists with musculoskeletal neck issues. Carl’s Table is a lifesaver for these people because they can read standing up and be as productive as those who prefer to sit down. That’s one of the advantages that Carl’s Table gives us.

“It is true that ergonomically designed radiology tables are very expensive, and there is a cost/efficiency evaluation to be made,” noted Krebs. “But we interview our radiologists to determine the efficacy of our ergonomic furniture, and we are convinced that the furniture increases the comfort level of our people.”

The state of ergonomic art has developed significantly in the past few years. Top of the line workstations now feature motorized tilting work surfaces that accommodate both standing and sitting positions, automatic lighting control for glare-free back lighting, air circulation and warm/cool environmental management systems, noise reduction partitions, digital readouts of surface and monitor height, position memory settings, sophisticated orthopedic support chairs, plus a multitude of customizable options to make the workstation as ergonomically friendly as possible.

As Krebs puts it, “In the end, in spite of high cost, ergonomic furniture is well worth the investment. As I like to say, a happy radiologist is a productive radiologist.”

James Markland is a contributing writer for Axis Imaging News.