The importance of obstetric and gynaecologic sonographer health and safety

Abstract

In the field of obstetrics and gynaecology, sonographers are often exposed to health and safety risks that may have significant consequences: it has been reported that up to 90% of sonographers experience work‐related musculoskeletal disorders. These have the potential to be career‐ending. This topic warrants routine evaluation, which is the aim of this editorial. We intend to achieve this by presenting a summary of risks, their outcomes, and strategies to optimise health and wellness in the workplace of sonographers in obstetrics and gynaecology. We believe this discussion is of utmost importance to sonographers, their employers, and regulatory bodies.

Health and wellness in the workplace have recently become an important concept to me, a long‐time sonographer in the medical specialty of obstetrics and gynaecology. For the last 14 years, I have been exposed to the hazards of working as a sonographer in China, including but not limited to a busy workload, repetitive motion, non‐ergonomic posturing, and poor lighting conditions. As a result, I required time away from my work. This time has been used to visit Nepean Hospital in Sydney, Australia, to advance my knowledge in obstetric and gynaecologic ultrasound, but to also improve my physical and psychological condition. During this time, I spent much time reflecting on the state of safety in my line of work.

The earliest literature on the topic of work‐related health and safety in sonography appeared in 1985.1 Later in 1990, the original author further postulated that a sonographer's work environment may be potentially hazardous.2 I can certainly attest to this.

In subsequent decades, sonography as an imaging modality in modern medicine has made an immense contribution as both a diagnostic and a therapeutic tool. With increased utility comes increased demand for sonographers: greater numbers of examinations, more hours of scanning per day, and higher complexity of cases. As such, sonographers have become progressively more at risk of suffering from work‐related musculoskeletal disorders (WRMSD), defined as painful injuries affecting muscles, ligaments, tendons, and nerves.3 This is increasingly being recognised in research, with more studies focusing on work‐related health hazards, especially WRSMD in sonography. In 2016, a consensus conference on this topic was hosted by the Society of Diagnostic Medical Sonography; conference proceedings reported that up to 90% of sonographers experience WRMSDs.3 Previous conference proceedings also reported that 20% of these professionals eventually experienced a career‐ending injury.4 Furthermore, the literature demonstrates this is a significant problem in my home country as well; a recent survey in Central China showed the prevalence of WRMSD in 232 sonographers was 98.3%.5

Specifically, in the field of obstetrics and gynaecology, the past two decades have seen a rapid and broad integration of ultrasound into day‐to‐day practice. In addition to the original two‐dimensional grey‐scale ultrasound, a multitude of other techniques including intracavitary assessment, colour Doppler ultrasound, three‐dimensional (3D) visualisation, ultrasound contrast, and ultrasound‐guided interventional procedures are now widely used in obstetrics and gynaecology and their subspecialties of maternal‐fetal medicine, reproductive medicine, urogynaecology, and advanced gynaecologic endoscopic surgery.

Most of the studies on work‐related health and wellness have included cardiac sonographers. There have been few studies regarding the work‐related hazards in obstetric and gynaecologic sonography. The first editorial focused upon it was published in 1998 written by Alex Schoenfeld when he heard of a 37‐year‐old sonographer, who, after working for many years in this field, was diagnosed with scapholunate instability. Despite undergoing three orthopaedic operations, her sonographic career ended.6 Moreover, Schoenfeld went on to perform a survey of work‐related health hazards, which was published in 1999.7 It was the first assessment of the prevalence of scanning‐related disorders amongst sonographers in obstetrics and gynaecology and showed that 57% of respondents suffered from WRMSD and 47% had received orthopaedic treatment.7 Further studies have confirmed that WRMSD is a real concern with at least 50% of surveyed participants reporting injuries,8, 9 with higher reports of joint pain amongst technicians compared with physicians, females compared with males, and those who predominately perform transabdominal sonography compared with those that predominately perform transvaginal sonography.8

Contrasting ultrasound in obstetrics and gynaecology with other fields of ultrasound, there are some particularities that may play a role in WRMSD:

1. When performing transvaginal or transperineal ultrasound, the sonographer usually sits at the side of the patient, with more external rotation of their shoulder joint than when performing transabdominal sonography.

2. Obstetrical ultrasound is time‐consuming and complex, particularly detailed scanning of fetal anatomy to rule out abnormality. The average time needed to complete a morphological obstetrics examination is 45–90 min and even longer in abnormal fetuses. This translates to long periods of non‐ergonomic postures, sustained shoulder abduction, a clenched hand grip, and significant sensory demands for eyesight, attention, focus, and precise movements of the wrist and hand.10

3. The advent of 3D ultrasound brought with it a larger and heavier probe, which requires added strength and a modified grip to ensure adequate hold on the device.

4. Female employees account for the majority in obstetric and gynaecologic sonography. Literature shows that women experience WRMSD in higher numbers than men. This could be explained by differences in anthropometric measures, muscle strength, or other sex‐specific characteristics of the upper extremity between men and women.11

In general, risk factors for WRSMD include performing greater than 100 scans a month, spending an average time of 25 min or longer per scan, twisted posture, prolonged and strong handgrip, female sex, and short sonographer stature.12, 13 We believe that to ensure good health and well‐being of sonographers and others who may be scanning in the field of obstetrics and gynaecology, work‐related health hazards should be seriously considered and workplace safety should be a priority. We put forward three suggestions to assist in the prevention of work‐related health hazards:

1. Employers, departmental leadership, and regulatory bodies should emphasise education on ergonomic principles and allocate suitable workload to decrease the incidence of WRMSD and other diseases amongst healthcare employees. This should begin at the level of sonographer training. This would reduce the downstream effects of absenteeism, medical care, and disability of the employees, which may further result in averting workers compensation claims and employee attrition.14, 15 For example, sonographer safety workplace considerations have been recommended by the Sonographer Safety Initiative of South Australia.16

2. The work environment should be optimised. This should include suitable work conditions, adjustable ultrasound machines/workstations, appropriate lighting, and ergonomic chairs that are adjustable with armrests and foot support. The design of ultrasound equipment, tools, and workstations should take special consideration of the characteristics of women as they make up the majority of sonographers (approximately 89%).16

3. Sonographers should be provided with routine health screening including eyesight checks. They should be observed on a regular basis for appropriate posturing and positioning and adequate breaks between scans should be ensured. Lastly, they should be offered muscle‐strengthening exercises and/or massage therapy to prevent chronic WRMSDs.17, 18, 19

These are simply three suggestions amongst an infinite number of possible methods to improve workplace health and well‐being and prevent work‐related health hazards. Some ideas may seem like common sense, while others may be more innovative and hypothetical in nature. For example, the idea of an ultrasound‐performing robotic arm, controlled by a human at a computer station, has been thought up (Figure 1).20 This would liberate the sonographer from the twisted posture and tight handgrip. However, new work‐related hazards may arise in this environment. Ultimately, our objective was to emphasise the importance of sonographer health and well‐being, which should be a priority for all sonographers, their employers, and regulatory bodies. In the current state of sonography, we must use methods that are evidence‐based to prevent WRMSD. But, we must also continue to develop ideas and work towards an era where work‐related hazards are eliminated.

Figure 1.

Graphic Representation of a Robotically Assisted Medical Ultrasound Machine.20