Overuse Syndromes May Be an Emerging Hazard for Radiologists

November 1, 2001

SEATTLE-Radiology practices that are converting to digital systems should be alert to the possibility of overuse syndromes, based on the experience of the radiology department at Tripler Army Medical Center, Honolulu. Lynne Ruess, MD, chief of pediatric radiology at Tripler, reported her department’s experience at the 101st Annual Meeting of the American Roentgen Ray Society (abstract 175).

SEATTLE—Radiology practices that are converting to digital systems should be alert to the possibility of overuse syndromes, based on the experience of the radiology department at Tripler Army Medical Center, Honolulu. Lynne Ruess, MD, chief of pediatric radiology at Tripler, reported her department’s experience at the 101st Annual Meeting of the American Roentgen Ray Society (abstract 175).

In a 1-year period, 4 of the 12 radiologists in the department were diagnosed with carpal tunnel syndrome, cubital tunnel syndrome, or both syndromes, Dr. Ruess said. The affected radiologists had spent a mean 31.3 months in the department, which (with the exception of mammography) has been filmless for almost 5 years.

Work in the department entails intensive use of the keyboard and mouse, telephone, and dictation equipment. Furthermore, three of the symptomatic radiologists routinely perform ultrasound exams, and all are very active academically, Dr. Ruess said. A consultation with an industrial hygienist identified several ergonomic hazards in the radiologists’ reading area and offices.

Five to 8 Hours a Day

A computer use survey revealed that the symptomatic radiologists averaged 8 hours of workday computer use, whereas the asymptomatic radiologists averaged 5 hours of workday computer use, Dr. Ruess said. This difference was not statistically significant.

There was a significant difference, however, between the symptomatic and asymptomatic radiologists in the number of products of after-hours computer use related to academic pursuits—products such as manuscripts, grant proposals, and documents related to graduate medical education.

"We put that together as being slightly more time during the day plus significantly more time at night and during weekends," Dr. Ruess said.

Tripler’s radiology department may be at the forefront of an emerging problem because of its comparatively lengthy experience with a digital system, Dr. Ruess noted. It is quite possible that other radiology practices will begin to see similar work-related injuries.

Cumulative Injuries

"We’ve been fully digital (electronic) longer than most institutions, and these are cumulative injuries," she explained. "Other practices are just now starting to install systems. I really wanted to report this to let my colleagues know that this may be coming down the pike."

In the Tripler department, radiology residents assist with many repetitive tasks, she added, suggesting that radiologists in private practice who don’t have this assistance may be at even greater risk of injury.

For More Information

For more information on ergonomics in the workplace, Dr. Ruess recommends the Cornell University ergonomics website at ergo.human.cornell.edu.

This website presents information from ergonomics research studies and class work by students and faculty in the Cornell Human Factors and Ergonomics Research Group, directed by Alan Hedge, PhD, of the Department of Design and Environmental Analysis.

Multifaceted ergonomic programs seem to help, but they are not completely effective for preventing these injuries. Individual factors likely play a role in the susceptibility to overuse syndromes. Dr. Ruess pointed out that the Tripler radiologist with the greatest number of total or cumulative computer hours was asymptomatic.

Hardware solutions, such as keyboard trays and adjustable chairs, are key components of the prevention and treatment of these syndromes, Dr. Ruess said. Voice-activated software can also provide much-needed relief from the keyboard and mouse; three of the four symptomatic radiologists at Tripler are now using this software, she said.

But any solution will also require behavioral modifications, Dr. Ruess emphasized. Specifically, radiologists need mandatory breaks and/or ergonomic exercises." The problem in a digital radiology department is that we don’t take a break from keyboard tasks. We just move from one keyboard to another," she said. Electronic filing of reports is hardly new, she noted, but in the past, this activity was interspersed with tasks that were different enough to constitute a break.

Vendors, Take Note

Dr. Ruess hopes that vendors will also take note of the Tripler experience. Radiologists are simply choosing among the products that vendors offer, when many of these products may set their users up for injury, she noted. "Hopefully, this awareness will help make the vendors aware, too, because many available workstations are not ergonomic," she said.

It is important to be preemptive and to consult professionals to avert overuse syndromes, Dr. Ruess said. "I think that part of the problem is that radiologists may set up their own departments without consulting their occupational health colleagues or industrial hygienists," she concluded. "These experts need to be involved in the planning."