Use and Orientation of Equipment
The layout of the examination room may have an impact on the sonographer by making equipment hard to maneuver and position.
- Doorways that are too narrow may require frequent turning and repositioning to get patients and equipment into the exam room. More force is required when starting, stopping or turning during transport
- Inappropriate flooring material (e.g., thick carpet) or elevated or pronounced transitions between rooms and halls make movement of patients and equipment more difficult and may require the use of
- Examination rooms that are too small make it difficult to properly arrange the patient and equipment for a variety of procedures.
- Examination rooms that are arranged for only one configuration force sonographers to repeatedly use the same body posture or motions for prolonged periods of time. This increases the risk of injury to
the shoulders, elbows, wrists, and hands.
- Lighting that does not include dimmer switches or controls, makes monitors difficult to read. This may lead to eye strain and back and neck discomfort as sonographers lean forward to detect items on the
In the next tab, we will take a closer look at the potential hazards and possible solutions in an examination room.
Examination Rooms (Continued)
Examination rooms should:
- Provide adequate space for maneuvering and orienting people and equipment around the exam table, allowing access from all sides.
- Have doorways that allow easy access for wheelchairs, beds and ultrasound equipment, minimizing the amount of turning and repositioning.
- Have hard surface flooring which allows easy movement of equipment. Anti-fatigue mats or pads can be placed around the exam area if sonographers must stand for prolonged periods.
- Provide easy access to imaging supplies, such as having supplies available in a number of locations.
- Have equipment such as thermal printers or recording devices in an area that reduces reach but allows the equipment to be accessed. Placing equipment or supplies on carts or stands may increase
mobility and accessibility
- Have controllable environmental conditions, especially light levels. Switches, curtain or blind mechanisms should be placed in convenient locations.
- Provide adequate ventilation and temperature controls to ensure the comfort of the sonographer and patient while allowing the equipment to function properly.
Positioning and Adjusting the Exam Table
The position of the table in the exam room is critical. It should be positioned in an area where there is access to all sides of the patient, as well as to other tools and devices needed for the scan.
You should be aware of and use ergonomic principles when moving heavy items, such as exam tables or consoles.
- Unlock wheels before attempting to move items.
- Push rather than pull unless the item moves easily.
- Try to push with the hands at about chest height.
- Enlist the assistance of others if the object is difficult to move.
Positioning the Ultrasound Equipment
Using ultrasound equipment including the console, keyboard and transducer may present a significant risk of (MSDs) to the sonographer if not properly arranged. Due to the high cost of ultrasound equipment,
older equipment may stay in use for some time. Older equipment often has the monitor, console and keyboard bundled into a single unit, allowing for few adjustments.
In addition, the transducer is generally designed based on diagnostic performance and not necessarily for ease of use. Newer equipment is much more adjustable. When replacing this ultrasound equipment,
models with maximum adjustability may help to prevent work-related MSDs.
Using the Transducer and Imaging Supplies
The transducer is the part of the ultrasound equipment that comes in contact with the patient's skin. It is almost always handheld and, depending on the application, it may be small or large.
Generally, the transducer is made from a hard, smooth material to ensure it can be adequately cleaned. Many procedures require the sonographer to exert force when pressing the head of the transducer
toward the area of interest. To get the best picture of the affected area, the sound wave emitted from the transducer needs to be redirected during the process, often requiring the use of highly
In addition to the transducer, other items such as gloves and coupling agents may be necessary to improve the scans and provide sanitary conditions. Use and placement of these items may
create additional hazards.
In the next two tabs, we will take a closer look at potential hazards and possible solutions when using the transducer and imaging supplies.
Using the Transducer and Imaging Supplies (Continued)
- Using highly repetitive motions and prolonged forceful hand exertions often in bent wrist postures when using the transducer can be a hazard. This increases the risk of injury to the hand, wrist and elbow.
- Exerting force while the forearm is rotated, especially if the wrist is bent inward (flexed) can increase the risk of injuries to the elbow.
- Supporting or moving heavy cables repeatedly or for prolonged periods of time increases the risk of injury to the shoulder, arm and wrist.
- Repeatedly dragging or pulling the transducer cable during scanning motions creates resistance to transducer movement causing torque. Torque increases the amount of force the muscles of the forearms
must exert, increasing the risk of injury to the hand, wrist, and elbow.
The user’s wrist is bent and the arm is unsupported. The cord of the transducer creates drag on the transducer and increases the finger force which must be exerted.
Operator has wrist and forearm supported, hand comfortably draped around the transducer and cable brace in use, reducing torque on wrist.
Using the Transducer and Imaging Supplies (Continued)
- Use arm rests or cushions to support the arm during scans. This reduces the muscle force needed to hold the arm and any devices held in the hand.
- Transducer cables should be supported during the exam. A cable brace may be used to position cables overhead or along the arm. Using a cable brace to manage transducer cable to minimize the amount of force exerted by muscles.
- Always scan while maintaining the arm in front of the body and spread less than about 30 degrees.
- Position yourself as close to the patient as possible to minimize reach distances.
- Move around the table rather than reaching over the patient.
- Keep the elbows close to the torso and the forearm approximately parallel with the floor.
- Store all imaging supplies within easy access in the examination area.
Ultrasound and Monitor Placement
The keyboard and the monitor are the principle interface points between the sonographer and the ultrasound equipment.
- Repeated reaching to the keyboard while performing ultrasound exams can stress the upper arm and shoulder.
- Repeated toggling and keystrokes with the wrist in an extended posture can stress the wrist and hand.
- Provide adjustable chairs and exam tables so the posture of the sonographer can be properly adjusted in relation to the patient and ultrasound equipment.
- Place the ultrasound equipment as close to the exam table as possible to minimize the awkward postures, such as reaching and turning of the head. Ideally, sonographers should be able to
access all equipment and materials while keeping the elbows close to the body.
Positioning the Monitor
The monitor is a critical part of the exam ultrasound equipment. Sonographers must view the monitor while operating the transducer to ensure they are obtaining the proper visual scan.
Older ultrasound equipment often provides little adjustment possibility, especially for the monitor which is often attached directly to the console.
This monitor is independently adjustable from the console, allowing it to be ideally positioned.
- Repeated use of awkward postures due to inappropriately placed monitors.
- Eye strain, blurred vision, double vision, dry eyes and headache resulting from prolonged concentration to view images that are unclear or washed out on the monitor.
- Provide a fully adjustable monitor on a monitor arm which is detached from the main console. It should be easily positioned for both sitting and standing postures and for a variety of procedures.
- Have a monitor on each side of the bed. These should be easily repositionable. LCD or plasma monitors are preferable in high light areas.
- Do not share the monitor with patients if this compromises proper placement of the monitor for the sonographer. Provide an additional monitor for patients if they need to view the procedure.
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