3 ways radiologists can fend off repetitive stress injury

Radiologists reading digital imaging exams move their mouses much more and tap their keypads far less than computer-bound nonradiologist workers, and that’s just one of several factors contributing to the rise of repetitive stress injuries (RSIs) in radiologists.

The American College of Radiology’s Commission on Human Resources breaks down the problem and recommends ways rads can avoid some nagging RSIs to which they’re especially susceptible—carpal tunnel syndrome, back strain, shoulder trouble and more—in an article published online Aug. 18 in JACR.

“The digital workplace in radiology presents many ergonomic challenges,” write Gordon Sze, MD, of Yale and colleagues. “Although the shift away from hard copies to PACS and digital imaging has become almost universal in the United States, radiology departments have lagged in realizing that these changes create conditions that mandate changes in the work environment.”

Here are three suggestions the ACR-backed authors emphasize.

1. Rearrange your reading room.

Setups that worked fine in film-based reading environments doesn’t work well in digital settings, not only because of the changes in how radiologists view images but also because of the ways they now work. Sze and colleagues recommend reducing space set aside for face-to-face clinician consultations, for example, since most of these interactions today are phone-based.

“Factors needing consideration include architectural planning, room layout, workstation design and general environmental concerns,” they write, citing research to back that up.

Another study the authors reference showed that an open environment—one allowing “easy interaction with other radiologists, with soundproof walls and sound-absorbing clouds above, as well as individually controlled lighting”—won high marks from radiologists who’d used it.

2. Keep things muted, comfortable and quiet.

Noting that work conditions agreeable to a group can vary based on members’ personal preferences and even age, Sze and co-authors recommend mild ambient lighting, emanating indirectly from overhead, to avoid glare. “At the same time, individualized lighting control in the immediate individual reading space is also required when written materials or notes on paper must be read,” they point out.

Meanwhile temperature and ventilation affect the well-being of sensitive electronic devices as well as people, the authors note. And few radiologists work well in aurally overactive quarters, so consider that ambient noise has multiple feeder sources.

“Noise from human sources”—including other radiologists on the phone and patients in nearby areas—“has been found to be more distracting than mechanical noise and should be minimized to the extent possible,” Sze and team write. They add that today’s speech-recognition software is more sensitive to unwanted sounds than yesterday’s Dictaphones—“which is another reason to reduce noise in the reading room.”

3. Ergonomically optimize your monitors, keyboards and mice.

“The ideal number of monitors is controversial, but a three-monitor approach is popular, with one low-resolution monitor to view worklists and hospital electronic medical records and two high-resolution monitors to review imaging examinations,” Sze and colleagues write. “The use of three monitors also reduces the need for body movements compared with setups in which more monitors are used.”

As for distance to the screen, they cite a study showing that 50 to 75 centimeters from eyes to screen, with a 5-millimeter font, may be best. The risk here is not just RSI but also computer visual syndrome, with which all computer-based workers live in the form of eye strain, headaches and blurred vision.

As for avoiding carpal tunnel syndrome and similar conditions affecting the hands and wrists, the authors recommend situating the keyboard and mouse “in a convenient location and at a comfortable height, with plenty of desk space available around them and few obstructions, to allow fluid movements. Ideally, these devices should be thin and flat to reduce wrist extension. The mouse should be configured to minimize long and repetitive movements down the screen.”

Additionally, Sze et al. encourage radiologists to raise awareness of the RSI risk within the profession. Plus they suggest seeking out workplace-specific ergonomics training.

“[I]ndividualizing the workplace is crucial,” they write, citing a study that showed radiologists “experienced a significant decrease in workplace injuries after ergonomic training. Even more successful is participatory ergonomics, in which radiologists themselves develop personalized ergonomic measures.”

Commenting on radiologists who have already been stricken with an RSI, the authors urge action.

“Although the vast majority of cases of RSI in radiologists are self-limited,” they write, “it is important to acknowledge and treat these injuries because progression to chronicity, even to the point of requiring surgery, can occur.”