Sonographers Need to Practice Good Ergonomics to Avoid Injury

It’s well documented that more than half of sonographers sustain injuries on the job and some sonographers sustain career-ending injuries. Now we need to recognize that many of these injuries are preventable—and take appropriate action.

The most common injury is to the shoulder and the second most common is to the neck. Shoulder injuries are usually caused by moving the arm backward beyond midline or abducting the arm beyond 30 degrees to perform an exam. This unnatural position reduces blood flow to muscles and tendons and, over time, creates a serious injury to the joint. Neck injuries are created when sonographers repeatedly twist their head to view a monitor.

Both of these injuries can be avoided with well-designed ultrasound systems and by regularly practicing correct work postures.

An ultrasound system’s monitor needs to move freely from one side to another—ideally with height adjustment and swivel controls. The monitor also needs a handle. If a monitor requires two hands to move it, sonographers aren’t likely to make the necessary adjustments that would prevent an unnatural neck position and its resulting injuries. It’s ideal for a sonographer to be able to change transducers with one hand and for the keyboard to swivel and move from left to right to allow access to the controls on the desired side.

Imaging should be conducted on the side where the organ is located. It’s never good practice to stretch across a patient’s body to perform the scan. Sonographers also need to learn to perform exams with either hand, so they can image from either side of the patient but still have to use good work postures to avoid injury to both shoulders.

Correct positioning also applies to the ultrasound workstation where the images are processed. The keyboard should be positioned at the right height and angled in a slightly negative downward tilt, and the top of the monitor should be at eye level so the sonographer is not looking up or down.

Ironically, sonographers in the era of radiographic film had fewer injuries than they do today. Why? Because they imaged a patient, then walked to the film processor, and then walked to take the film to physicians. The walking that was required as part of the workflow provided the stretching, activity and muscle recovery the body needs.

In the digital age, sonographers need to make sure they practice good posture while imaging patients and working at workstations, and take brief breaks to stand and stretch. These activities—along with well-designed ultrasound systems and workstations—can help reduce the rate of injuries and allow sonographers to enjoy a productive career.

For more information on ergonomics and sonography, you can read and download a white paper I authored on the subject titled, “Improving the Ergonomic Workstation.”

Carolyn Coffin, Sound Ergonomics LLCCarolyn Coffin, MPH, RDMS, RVT, RDCS, Sound Ergonomics LLC. Carolyn Coffin has worked in the field of ultrasound since 1987. She has been the program coordinator for diagnostic medical sonography programs, as well as a clinical sonographer.



The USPSTF Misses Again on Breast Screening Guidelines

In a recent move that is drawing much ire from the medical and women’s health communities, the U.S. Preventive Services Task Force (USPSTF) declined to expand its recommendation on which women should receive regular mammography screening. What was offered upon this rejection was essentially the reinforcement of the conservative guidance from 2009.

The new guidance states that women in their 50s should only receive mammography screening every two years, rather than annually as is advocated by many women’s health and medical groups. Advocates for annual screening are also upset that the USPSTF did not recommend screening for women in their 40s, because of its belief that the benefits of screening in this age group do not outweigh the purported harms of screening.

To be blunt—this is questionable advice at best. The guidelines will do nothing but confuse women as again they are not emphatic, but leave decisions up to the women’s general physicians or OB-GYN.

Many women in the 40 to 49 group have dense breasts. Having regular screening mammograms can help this group be sent for further screening with adjuncts such as full breast ultrasound and MRI—helping to find earlier cancers.

Many countries, such as Sweden, Norway, Australia and Canada have adopted the approach that if you have dense breasts (or a certain amount of glandular tissue,) the woman should be screened yearly. Women with fatty breasts are screened every 2 years. This is without arbitrary age grouping.

The U.S. is getting better about dense breast notification, as 22 states have enacted laws about notifying women who possess dense tissue, and a number of other states have bills introduced about these notifications, but these new guidelines from USPTF could hinder this progress.

Breast cancer is heterogenous, i.e. ,many different types with some being much more aggressive than others. Finding cancers later may do more harm as treatments will be ineffective, more toxic and of course more expensive

Another one of the biggest pain-points in the new guidelines was that women over 70 were excluded. This is just not right. Many women in this age group are active, healthy and go on to live very long lives. Finding breast cancer in this age group can be easier due to the fact many women in this age group have fatty breast tissue, making cancer show up much easier. Small cancers can be treated and women can go on to live very productive lives.

On a personal note, two of my aunts had small cancers found when they were over 75. One lived to be 93, being cancer-free for almost 20 years, and the other lived to be 103!

As a woman, I am lucky I have had the opportunity to have advisors and the education to know what to do. There are many out there who are not so lucky. Much has been done to educate women on the importance of screening, and what the USPSTF is doing by confusing them will not help.

For an addition helpful viewpoint on this issue, please read Dr. Daniel Kopans opinion that was published on AuntMinnie.

Anne Richards, CarestreamAnne Richards, Clinical Development Manager, Women’s Healthcare, Carestream



Diagnostic Reading #25: Five Must Read Articles from the Past Week

Carestream LogoIt’s Friday, which means it is time for a new edition of Diagnostic Reading. This week’s articles include a study on radiology and patient care, the benefit of clinical decision support, breast cancer screening recommendations, the importance of telemedicine and an update about the future of Medicare without SGR.

1) ARRS: Patient Consults Improve Care, Raise Radiology Profile – AuntMinnie

A study presented at the annual American Roentgen Ray Society meeting in Toronto revealed that patients value the ability to meet with a radiologist to discuss diagnostic images. The study found that patients that met with a radiologist were likely to want to review exam results with a radiologist again. Furthermore, connecting with patients adds to the value of care provided by radiologists.

2) Clinical Decision Support can Cut Inappropriate Imaging – AuntMinnie

According to a report in Tuesday’s edition of Annals of Internal Medicine, clinical decision-support (CDS) can have a beneficial effect on imaging appropriateness. Hard-stop features could cut inappropriate imaging even more. These features disallow imaging procedures without the approval of another person, if the software considers the study to be inappropriate.

3) Speak Now About USPSTF Breast Cancer Screening Recommendations – Diagnostic Imaging

The United States Preventive Services Task Force has released recommendations for mammography. These recommendations discuss the issues of breast density and aging as some of the risk factors for breast cancer. USPSTF is asking for public comments on these recommendations until May 18, 2015.

4) Telemedicine a High 2015 Priority for Healthcare Executives – FierceHealthIT

A survey of 233 healthcare professionals conducted by REACH Health has indicated that telemedicine has taken a position of precedence among healthcare executives. About 60 percent of respondents considered telemedicine to be a high priority this year. These professionals see telemedicine as an important way to improve care. The author notes that patients are interested in telemedicine and aware of its benefits.

5) The SGR is history. Now what? – Health Imaging

With legislation to repeal SGR last week, it is time to look towards the future of healthcare. This article explains what the SGR repeal means and how it will affect healthcare legislation. The author discusses the importance of the new value-based healthcare model that will be put into place called the Merit-Based Incentive Payment System.



Video: Meaningful Use and Clinical Decision Support Dominated HIMSS15

Dave Fornell, editor for Imaging Technology News (ITN) and Diagnostic and Interventional Cardiology (DAIC) Magazine, stopped by the Carestream booth at HIMSS15 to discuss the biggest trends he saw at the conference.

Meaningful Use (MU) was the biggest trend Fornell saw, and he noted the different stages being focused on by vendors and hospitals. VNA, PACS, and EMR vendors he spoke with are focused on complying with Stage 3, but they are seeing that the hospitals are focused on consolidation.

Fornell also touched on clinical decision support, and how its part of Stage 2, but a much more important part of Stage 3 MU. As imaging exams are ordered, patient history is going to be ask for, and used as an integral component of the process.

The complete interview from HIMSS15 can be veiwed below.

Video: Discussion on Healthcare Data Storage & Interoperability Guidelines

Marianne Matthews, chief editor, Axis, and Cristine Kao, global marketing director, Healthcare Information Solutions, Carestream, discuss the challenges in today’s healthcare IT environment, particularly the high volumes of data and what facilities must do to manage it.

Matthews and Kao had this discussion at HIMSS15, and expanded on the role that healthcare providers play in the management of data, as well as how they are working with vendors to address data storage needs.

The ONC Interoperability Guidelines were also discussed. Particularly, the advantages of these guidelines becoming more widespread, the benefits of having DICOM medical images continue to be a standard, and the role radiology can play in the digitization of healthcare moving forward.

Diagnostic Reading #24: Five Must Read Articles from the Past Week

Carestream LogoIt’s finally Friday and that means it’s time for another Diagnostic Reading. This week’s articles include big news about the SGR repeal legislation, an update from HIMSS 2015 about patient engagement, information about reducing hospital readmissions, issues with modern American healthcare, and information on what to do if an ultrasound is necessary but there is no sonographer on duty. Enjoy!

1) Congress Passes SGR Repeal Legislation, Ushers in New Era in MD Value-Based Payment – Healthcare Informatics

The Sustainable Growth Rate (SGR) formula has been a topic of tension with physicians for quite some time. This week, Senate voted with an overwhelming majority to repeal SGR. The formula was set to cut Medicare reimbursements by 21% only three hours before the legislation passed. This legal action will encourage the pay-for-value model that healthcare leaders have emphasized as the most realistic way to distribute Medicare reimbursements.

2) HIMSS15: Patient Engagement among Top Priorities for Providers – FierceHealthIT

A survey of hospital IT executives conducted by HIMSS has found that 72% of respondents said patient engagement would make up a large part of their organizational strategy over the next couple of years. A hospital executive, Bill Feaster, from Children’s Hospital of Orange County, said, “We’re not going to improve the health of our population unless we get patients engaged in their own care.”

3) A Hybrid Approach to Avoiding Readmissions – Hospitals & Health Networks

Hospital readmissions are costly. A nurse practitioner and a social worker have teamed up in order to address the issue of hospital readmissions, particularly for senior citizens. This article discusses a different approach to reducing readmissions. The author says that in order for this hybrid system to work, it is important to keep up-to-date with elderly patients. Physicians can educate patients while they are in the hospital, and with the support of an electronic health record, they can make sure patients are educated and adhering to everyday medical needs.

4) Four Healthcare Issues the Government Must Tackle – Fierce Healthcare

Healthcare expert, Paul Keckley, PhD, gives advice on how the United States can catch some of the world leaders in providing quality healthcare while using a smaller percentage of GDP. Keckley’s ideas include adjusting the structure, incentives, employer-based insurance and developing a transparent pricing model.

5) Teleradiology Prompts Shift in Use of After-Hours Ultrasound – AuntMinnie

The use of ultrasound is growing in healthcare facilities around the world. Unlike other forms of medical imaging, ultrasound is dependent on operator techniques. Many facilities are using teleradiology in order for after hours CT or MRI images (6 p.m. – 8 a.m.). This means many facilities might share one radiologist. A study in France wanted to find whether or not ultrasound images could be taken using other modalities or postponed until a trained sonographer was on hand. The study found that most ultrasound requests can be postponed until working hours or replaced with a different mode of imaging.

Clinical Collaboration Platform Grown from the Enterprise VNA

We have discussed the evolution of the vendor-neutral archive at length on Everything Rad, and that conversation will not dissipate any time soon.

Healthcare facilities are dealing with petabytes upon exabytes of data, and not only do they need technological resources to store this data, but they also need a system that can properly categorize the data, and provide access to it across different -ologies.

The animation below shows how VNA owners can build upon their systems to create the Clinical Collaboration Platform. The platform is able to capture data from various sources without changing departmental workflow.

A patient-centric repository is created that stores all of the medical imaging data whatever the format or modality, and distributes the images via the appropriate clinical viewer.

Infographic: The Evolution of the DRX-Evolution

The DRX-Evolution was designed for the future. Since its introduction, the CARESTREAM DRX-Evolution has set a benchmark for imaging performance in hospitals around the world. Today, it still offers the power of the X-Factor, with a wireless DRX Plus Detector that works across virtually all of your imaging systems. It still features modular design, to fit your individual space, workflow and budget. And it still protects you from technology obsolescence with its future-proof design.

The Plus system offers LED lighting for enhanced functionality and aesthetics, greater flexibility with an extended tube column, a high performance Carestream generator, an optional table to accommodate patients up to 705 lbs (320 kg), and a forward-looking design to accommodate advanced imaging applications in the future.

The infographic below shows how we arrived to where the DRX-Evolution is today from its initial launch in 2009. We believe the “evolution of the Evolution” demonstrates our dedication to not only providing a high-quality product, but to make sure we continuously enhance it to meet the needs of today’s professional. Learn more about the DRX-Evolution!



Diagnostic Reading #23: Five Must Read Articles from the Past Week

Carestream LogoSince HIMSS 2015 kicks off on Sunday in Chicago, we thought it would be best to focus on healthcare IT articles in this week’s and next week’s issues of Diagnostic Reading. This week’s articles focus on the interoperability roadmap, an infographic showing one doctor’s computer clicks in one day, the importance of patient-generated data, turning healthcare data into useful information, and how patient portals and tracking devices are driving engagement.

1) Patient-Generated Data: One Cardiac Surgeon Explains its Increasing Impact Healthcare Informatics

In an interview with Healthcare Informatics, Sunil Malhotra, M.D., explains how he has been collaborating with vendors to ensure patient data is collected and provided as part of the record of a patient’s health. Dr. Malhotra said that he plans to monitor patients using applications that allow patients to enter data manually or through devices. Through a platform, a care team dashboard will give Dr. Malhotra and his team information that can be monitored.

2) Infographic: One Doc’s Clicks Per DayHealthcare IT News

The aim of the infographic is to show how IT interactions impact patient wait times, provider efficiency and documentation. The image show the daily technilogy interaction of a physician and her staff: 24 patients over 16 hours for a total of 2,541 clicks.

3) Turning Health Data into Useful InformationHealth Data Management

The Robert Wood Johnson Foundation has issued four recommendations on how health data can be collected, shared, protected, and translated in ways that are useful to consumers, organizations, and communities nationwide.

4) Patient Portals and Tracking Devices Driving EngagementEHR Intelligence

A Harris Poll surveyed 2,000 adults across the U.S. and found that 84% of respondents have access to patient portal through their physician’s practice. An additional finding is that adults older than 55 years of age are more likely to access their medical records through these tools than adults between 18-54.

5) Hospitals, CIOs Call for Increased Patient Identifier Action in Interoperability RoadmapFierceHealthIT

The College of Healthcare Information Management Executives (CHIME) and the Association of Medical Directors of Information Systems  call patient identification vital to the formation of interoperable Learning Health System, and stressed this last week to the Office of the National Coordinator for Health IT in regard to its draft roadmap.

Combating Mobile Health Skeptics by Highlighting the Benefits

There are two camps in the mobile health (mHealth) issue: those who find the technologies to be beneficial and embrace adoption, and those who remain skeptical and refuse to adopt, or are slower to.

If anything, current market statistics are siding with the first camp—the global mHealth market is expected to be worth $49.1 billion by 2020, up from $1.2 billion in 2012; an estimated 500 million smartphone users worldwide will be using mHealth apps this year, and those users will have more than 100,000 mHealth apps available via the iOS and Android platforms.

With all signs pointing to the mHealth explosion, challenges still exist. The most common ones being clinician adoption, lack of apps specific for medical use, improvement of medical apps that already exist, an authoritative collection of medical apps, security/privacy protection, and inability for healthcare organizations to handle Bring Your Own Device (BYOD) policies.

These are challenges most can agree on but the skeptics still hold out on mHealth technologies until the benefits in efficiency and cost outweigh the disruption and expense of adoption. Those specific benefits include:

mHealth Benefits

How Providers Currently Use Mobile DevicesContrary to the skeptics’ beliefs, as the chart to the right indicates, mHealth is already intertwined into the healthcare space. Providers are using smartphones and tablets to share information with patients, look up reference material, learn about new treatments and clinical research, or even help to diagnose patients. mHealth is proving to be beneficial for the providers and the patients receiving the care.

While there is still a high population of physicians who do not believe in the benefits of mHealth, they will not be able to ignore their patients. Millions of people are using mobile apps and wearable technology to track calorie intake, sleep patterns, miles jogged, and other health habits. As they become more in-tune with their own health they will expect that their physicians will do the same, using similar devices.

For more details about the mHealth phenomenon and what providers can do to move adoption in the right direction, you can view and download the eBook, “The Healthcare March to Mobility.”

The eBook includes commentary from myself and Dr. Woojin Kim, MD, Perelman School of Medicine at the University of Pennsylvania Health System and Montage Healthcare Solutions, that explains the needs, challenges, and benefits of mHealth.

Ben Wilson, IntelBen Wilson is the Director of Mobile Health at Intel Corporation. He is responsible for development and execution of mobile health strategies and programs at Intel. Ben is also Co-Chair of the Accountable Care Community of Practice, a consortium of healthcare IT leaders committed to collaboration in the development of Accountable Care healthcare organizations. A Stanford graduate, Ben’s MBA and MPH in Health Management were earned at UC Berkeley.