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Nogah Haramati, MD Chief of Radiology Professor, Clinical Radiology & Surgery Jack D. Weiler Hospital Albert Einstein College of Medicine Ergonomics in.

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Presentation on theme: "Nogah Haramati, MD Chief of Radiology Professor, Clinical Radiology & Surgery Jack D. Weiler Hospital Albert Einstein College of Medicine Ergonomics in."— Presentation transcript:

1 Nogah Haramati, MD Chief of Radiology Professor, Clinical Radiology & Surgery Jack D. Weiler Hospital Albert Einstein College of Medicine Ergonomics in Healthcare Radiology leads the way

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3 Surv Ophthalmol 2005; 50:253–262

4 Computer Vision Syndrome Eyestrain Eye fatigue Burning sensations Irritation Redness Blurred vision Dry eyes Surv Ophthalmol 2005; 50:253–262

5 Computer Vision Syndrome Three potential causes Ocular surface mechanisms Accommodative mechanisms Extraocular mechanisms Surv Ophthalmol 2005; 50:253–262

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8 Lighting Recommendations Incandescent lights are warmer (have more red), Incandescent lights are warmer (have more red), are easier on the eyes, and cause less glare and eyestrain Position lighting carefully to not produce glare or reflections Surv Ophthalmol 2005; 50:253–262

9 Lubricating Drops Japanese study: Majority of self-medicating eye drop users dissatisfied with the balanced salt solutions Cornea 1999; 18:408–11 Higher viscosity drops did not vary blink rates Interblink interval was normalized Ocular discomfort relieved more efficiently following VDT use. Viscous eye drops diminish overall visual acuity J Occup Med 1992; 34:1023–7

10 AJR 2005;184:681–686

11 Features of those with eye strain 36% of respondents 36% of respondents Women > Men Women > Men Longer days (> 6 hours) Longer days (> 6 hours) Take fewer breaks Take fewer breaks Report screen flicker Report screen flicker Perform CT screening Perform CT screening AJR 2005;184:681–686

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14 Fatigue Levels & Ambient Reading Room Lighting Fatigue Levels & Ambient Reading Room Lighting Siegel E, Reiner B Applied Radiology 2002; 4:11-16

15 AJR 2003;181:37–42

16 Features of affected radiologists 4 of 12 radiologists affected 4 of 12 radiologists affected Only affected had active IRB & grant proposals Only affected had active IRB & grant proposals Most academically productive of group Most academically productive of group Worked the longest hours Worked the longest hours Had 4 / 5 most demanding administrative jobs Had 4 / 5 most demanding administrative jobs 3 / 4 performed sonography 3 / 4 performed sonography AJR 2003;181:37–42

17 Work-related musculoskeletal complaints in sonologists Magnavita N et al. J Occupational & Environmental Medicine 1999; 41:981-8 Magnavita N et al. J Occupational & Environmental Medicine 1999; 41: ,041 physician sonographers 2,041 physician sonographers 18.5% neck & pack pain – reduced with proper chair and improved body positioning 18.5% neck & pack pain – reduced with proper chair and improved body positioning 5.3% hand or wrist disorder – correlated with transduscer design 5.3% hand or wrist disorder – correlated with transduscer design 80% affected at some point with musculoskeletal symptoms 80% affected at some point with musculoskeletal symptoms

18 Sites of musculoskeletal pain sites in computer users Lower back74% Lower back74% Neck73% Neck73% Wrist67% Wrist67% Finger65% Finger65% Shoulder63% Shoulder63% Technology & Health Care 2005; 13(2):125-30

19 Increasing throughput and efficiency Optimal placement of computer monitors with user-friendly PACS terminal interfaces will ensure greater acceptability and improve reporting efficiency and accuracy. British Journal of Radiology 2005; 78(931): Optimal placement of computer monitors with user-friendly PACS terminal interfaces will ensure greater acceptability and improve reporting efficiency and accuracy. British Journal of Radiology 2005; 78(931):582-6.

20 Factors having positive predictive value for near future development of upper extremity tendonitis Age > 40 Age > 40 BMI over 30 BMI over 30 Shoulder or neck discomfort at baseline Shoulder or neck discomfort at baseline History of CTS History of CTS Journal of Occupational Rehabilitation 2005; 15(1):37-46

21 Keyboard platform device with continuous passive motion (CPM) Stevenson suggests use of CPM may be used to treat, as well as prevent, carpal tunnel-like symptoms in those who keyboard. Stevenson suggests use of CPM may be used to treat, as well as prevent, carpal tunnel-like symptoms in those who keyboard. Work 2005; 24(2): Work 2005; 24(2):145-55

22 The United States MEPS (musculoskeletal-- eyestrain--psychosocial--stress) study The United States MEPS (musculoskeletal-- eyestrain--psychosocial--stress) study International Journal of Occupational Safety & Ergonomics. 2005; 11(1):49-63, 2005 workstation redesign workstation redesign ergonomic chairs ergonomic chairs motorized adj. WS motorized adj. WS Adj. keyboards Adj. keyboards Adj. footrests Adj. footrests Monitor support Monitor support Ergonomics training Ergonomics training Corrective lenses Corrective lenses Improved: neck and shoulder mobility Improved: neck and shoulder mobility Improved intensity and frequency of musculoskeletal pain Improved intensity and frequency of musculoskeletal pain Improved measured postural angles of head and trunk Improved measured postural angles of head and trunk Trapezius load improved as assessed by EMG Trapezius load improved as assessed by EMG

23 Increasing the understanding in how to adjust the work stand and chair may have been contributing factors to reducing the pain level Aaras A, et al. International Journal of Occupational Safety & Ergonomics 2005; 11(1):25-47

24 Participative training in workstation ergonomics can improve work postures, work practices, risk factor exposure, and pain Greene BL, et al. Work 2005; 24(1):41-52

25 Strain & Motion Sensing Fabrics Lorussi F., et al. Lorussi F., et al. Studies in Health Technology & Informatics. 2004; 108: Studies in Health Technology & Informatics. 2004; 108:266-70

26 Important factors in the design of future computer workstations Work pauses Work pauses Reduction of glare or reflection Reduction of glare or reflection Screen height Screen height Juul-Kristensen B, et al. Scandinavian Journal of Work, Environment & Health. 2004; 30(5):390-8

27 Since previous symptoms was a significant predictor of recurrent symptoms in all three regions under study, it can be concluded that musculoskeletal symptoms are persistent Juul-Kristensen B, et al. Scandinavian Journal of Work, Environment & Health. 2004; 30(5):390-8

28 Prospective study Prospective study Factors of computer work that predict musculoskeletal symptoms in the shoulder, elbow, and low-back regions Factors of computer work that predict musculoskeletal symptoms in the shoulder, elbow, and low-back regions symptoms more often in the elbow (10%), shoulder (18%), and low back (23%) symptoms more often in the elbow (10%), shoulder (18%), and low back (23%) Women were more likely to be afflicted than men in all regions Women were more likely to be afflicted than men in all regions Previous symptoms was a significant predictor for symptoms in all regions Previous symptoms was a significant predictor for symptoms in all regions

29 Work-related musculoskeletal disorders College students report high rates of computer use-associated upper extremity musculoskeletal symptoms and symptom-related functional limitation. Work 2004; 23(2):85-93 College students report high rates of computer use-associated upper extremity musculoskeletal symptoms and symptom-related functional limitation. Work 2004; 23(2):85-93 Work-related musculoskeletal disorders in the neck-shoulder area and upper extremities are common among computer users, especially women Work-related musculoskeletal disorders in the neck-shoulder area and upper extremities are common among computer users, especially women Certain individuals who work with incorrectly adjusted office equipment may be at greater risk of developing work-related musculoskeletal disorders Certain individuals who work with incorrectly adjusted office equipment may be at greater risk of developing work-related musculoskeletal disorders Zennaro D., et al. Human Factors. 2004; 46(2): Zennaro D., et al. Human Factors. 2004; 46(2):252-66

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31 Rumreich LL, et al Journal of Digital Imaging 2003; 16(3):262-9 Survey of 90 Indiana University radiology faculty radiologists, fellows & residents Survey of 90 Indiana University radiology faculty radiologists, fellows & residents 46% rating themselves as "very dissatisfied" or "dissatisfied” with the soft-copy environment 46% rating themselves as "very dissatisfied" or "dissatisfied” with the soft-copy environment Least satisfied regarding work space ergonomics, room layout, amount of work space & lighting Least satisfied regarding work space ergonomics, room layout, amount of work space & lighting 98% indicated that an "ideal" soft-copy environment would have a positive effect on their efficiency 98% indicated that an "ideal" soft-copy environment would have a positive effect on their efficiency

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33 Amick BC 3rd, et al. Spine 2003; 28(24): Workers who received a highly adjustable chair and office ergonomics training had reduced back pain symptom growth over the workday Workers who received a highly adjustable chair and office ergonomics training had reduced back pain symptom growth over the workday

34 Helander M. Forget about ergonomics in chair design? Focus on aesthetics and comfort!. Ergonomics 2003; 46: Poor proprioceptive feedback from ligaments, joints and the spine Poor proprioceptive feedback from ligaments, joints and the spine The joints are relatively insensitive to small changes in angle The joints are relatively insensitive to small changes in angle the spine cannot sense differences in pressure due to different body postures the spine cannot sense differences in pressure due to different body postures

35 Helander M. Forget about ergonomics in chair design? Focus on aesthetics and comfort!. Ergonomics 2003; 46: Many ergonomics features that are supposed to relieve discomfort in sitting are indistinguishable because they cannot be perceived Many ergonomics features that are supposed to relieve discomfort in sitting are indistinguishable because they cannot be perceived A study of ergonomics chairs verified that users could distinguish between parameters that relate to aesthetics and comfort, but had difficulty in distinguishing between ergonomics features A study of ergonomics chairs verified that users could distinguish between parameters that relate to aesthetics and comfort, but had difficulty in distinguishing between ergonomics features

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39 Sillanpaa J, et al. Occupational Medicine (Oxford) 2003; 53(7): Musculoskeletal symptoms common Musculoskeletal symptoms common Duration of daily keyboard and mouse use had no connection with musculoskeletal symptoms Duration of daily keyboard and mouse use had no connection with musculoskeletal symptoms More consideration should be paid to the ergonomics of workstations, the placing of the mouse, the postures of the upper extremities and the handling of the mouse More consideration should be paid to the ergonomics of workstations, the placing of the mouse, the postures of the upper extremities and the handling of the mouse

40 Kryger AI, et al. Occupational & Environmental Med. 2003; 60 :e14, 2003 Intensive use of a mouse device, and to a lesser extent keyboard usage, were the main risk factors for forearm pain Intensive use of a mouse device, and to a lesser extent keyboard usage, were the main risk factors for forearm pain The occurrence of clinical disorders was low, suggesting that computer use is not commonly associated with any severe occupational hazard to the forearm The occurrence of clinical disorders was low, suggesting that computer use is not commonly associated with any severe occupational hazard to the forearm

41 Keir PJ. Wells RP. The effect of typing posture on wrist extensor muscle loading Human Factors 2002; 44(3): Greater than 25% of maximal exertion required of the wrist extensors when the wrist is extended Greater than 25% of maximal exertion required of the wrist extensors when the wrist is extended With wrist extension, passive forces of extrinsic finger flexor muscles was the most responsible With wrist extension, passive forces of extrinsic finger flexor muscles was the most responsible Findings in relative agreement with previous EMG studies Findings in relative agreement with previous EMG studies May indicate a mechanism for forearm extensor pain in office workers May indicate a mechanism for forearm extensor pain in office workers

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43 Ortiz-Hernandez L, et al Archives of Medical Research 2003; 34(4): PC use increased risk of work-related musculoskeletal disorders of the hand & upper extremity PC use increased risk of work-related musculoskeletal disorders of the hand & upper extremity Increase mediated by ergonomic factors such as mouse use, remaining seated for prolonged periods, adoption of inadequate or uncomfortable postures, performing certain PC tasks, and psychosocial factors. Increase mediated by ergonomic factors such as mouse use, remaining seated for prolonged periods, adoption of inadequate or uncomfortable postures, performing certain PC tasks, and psychosocial factors.

44 Reiland J. Justifying the cost of height-adjustable office work surfaces Occupational Health & Safety. 2003; 72(6):117-9, The question shouldn't be How are we going to pay for an improved office environment? The question shouldn't be How are we going to pay for an improved office environment? The better questions are, Can we identify the ways that we already pay for a poor office environment? and Can we afford to keep paying? The better questions are, Can we identify the ways that we already pay for a poor office environment? and Can we afford to keep paying?

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46 Balci R, Aghazadeh F. Ergonomics 2003; 46(5): minute work/5-minute rest, and 15- minute work/micro breaks 30-minute work/5-minute rest, and 15- minute work/micro breaks Lowest eyestrain and blurred vision Lowest eyestrain and blurred vision Discomfort in the elbow and arm was the lowest with the 15/micro schedule for the mental arithmetic task Discomfort in the elbow and arm was the lowest with the 15/micro schedule for the mental arithmetic task The 15/micro schedule resulted in the highest speed, accuracy, and performance The 15/micro schedule resulted in the highest speed, accuracy, and performance

47 Hsu WH, Wang MJ. AIHA Journal: a Journal for the Science of Occupational & Environmental Health & Safety 2003; 64(2): Full-time VDT users had significantly higher rates of physical discomfort (66%) than part-time VDT users (41%) Full-time VDT users had significantly higher rates of physical discomfort (66%) than part-time VDT users (41%) Physical/ergonomic variables were found more dominant than psychosocial factors for visual and upper extremity discomforts Physical/ergonomic variables were found more dominant than psychosocial factors for visual and upper extremity discomforts Psychosocial variables were the dominant for back and lower extremity discomfort Psychosocial variables were the dominant for back and lower extremity discomfort

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49 Monitor Position: Up or Down? Pain in computer users is diminished when gazing downwards at angles of 14 degrees or more Boletin - Asociacion Medica de Puerto Rico. 2004; 96(2): Pain in computer users is diminished when gazing downwards at angles of 14 degrees or more Boletin - Asociacion Medica de Puerto Rico. 2004; 96(2): Screen below eye height was a significant predictor for elbow symptoms Scandinavian Journal of Work, Environment & Health. 2004; 30(5):390-8 Screen below eye height was a significant predictor for elbow symptoms Scandinavian Journal of Work, Environment & Health. 2004; 30(5):390-8

50 Bonney RA. Corlett EN. Head posture and loading of the cervical spine Applied Ergonomics 2002; 33(5):415-7 Studied horizontal gaze along with 20 & 40 gaze angles below the horizontal Studied horizontal gaze along with 20 & 40 gaze angles below the horizontal Increased spinal loading demonstrated by the increase in spinal shrinkage calls into question the recommendations for angle of gaze recommended in textbooks Increased spinal loading demonstrated by the increase in spinal shrinkage calls into question the recommendations for angle of gaze recommended in textbooks

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52 Fries SH et al. The influence of the viewing angle on neck- load during work with video display units. Journal of Rehabilitation Medicine. 2001; 33(3):133-6, 2001 Loading moment on the neck was significantly lower at viewing angle 3 degrees above the horizontal than at 20 degrees below the horizontal Loading moment on the neck was significantly lower at viewing angle 3 degrees above the horizontal than at 20 degrees below the horizontal

53 Szeto GP. Lee R. An ergonomic evaluation comparing desktop, notebook, and subnotebook computers. Archives of Physical Medicine & Rehabilitation 2002; 83(4): Computer users need to consider the posture of the spine and potential risk of developing musculoskeletal discomfort in choosing computers. Computer users need to consider the posture of the spine and potential risk of developing musculoskeletal discomfort in choosing computers.

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55 Aaras A et al. Applied Ergonomics 2001; 32(6): year prospective study and follow-up 6 year prospective study and follow-up VDU workers received new lighting system, new workplaces and optometric examination and corrections if needed VDU workers received new lighting system, new workplaces and optometric examination and corrections if needed significant reduction in visual discomfort significant reduction in visual discomfort Supporting the forearm yielded significant reduction of shoulder and neck pain Supporting the forearm yielded significant reduction of shoulder and neck pain Shoulder & back pain also reduced Shoulder & back pain also reduced

56 Bendix T, et al. What does a backrest actually do to the lumbar spine? Ergonomics 1996; 39(4): Traditional conception that a backrest facilitates lordosis is apparently not true Traditional conception that a backrest facilitates lordosis is apparently not true Backrests actually facilitate the opportunity for the user to stabilize their lumbar spines by providing their lower backs with support, resulting in relative kyphotic increases Backrests actually facilitate the opportunity for the user to stabilize their lumbar spines by providing their lower backs with support, resulting in relative kyphotic increases Traditional concepts in backrest ergonomy should be re-considered Traditional concepts in backrest ergonomy should be re-considered

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59 Our Purpose To design an ergonomic radiologist softcopy reading environment that is suitable for the entire spectrum of height, weight, visual acuity, presbyopia, myopia and existing spine, shoulder, wrist and forearm pathology

60 Chair selection must be based on comfort & adjustability Cost & Cleansing capability are also important

61 Critical Chair Adjustments Seat height Seat height Lumbar support height Lumbar support height Armrest height Armrest height Armrest long enough to support forearm & rotatable Armrest long enough to support forearm & rotatable Width between armrests Width between armrests Seat forward/back position Seat forward/back position Seat lean & lock Seat lean & lock Chair must roll Chair must roll

62 Too Low Too HighJust Right All chair adjustments must be set for the individual’s maximal comfort

63 The Ergonomic Table

64 Critical Features Keyboard on table not in central keyboard tray Keyboard on table not in central keyboard tray Entire table surface is granulated mouse surface Entire table surface is granulated mouse surface All devices and controls within arms reach All devices and controls within arms reach

65 Critical Features Foot rest at ergonomic height Foot rest at ergonomic height Table surface height adjustable Table surface height adjustable Monitor height adjustable independently of table surface Monitor height adjustable independently of table surface Monitor distance adjustable Monitor distance adjustable

66 The Foot Rest Critical to Relief of Low Back Strain

67 Adjusting the Table and Monitor Heights Table height is matched to comfortable armrest height Table height is matched to comfortable armrest height Monitor height is adjusted to user comfort. Monitor height is adjusted to user comfort. Presbyopia, use of progressive lenses and other factors require these adjustments to be tailored to each individual Presbyopia, use of progressive lenses and other factors require these adjustments to be tailored to each individual

68 Ability to read while standing up Relief of low back pain Relief of low back pain User preference for some User preference for some Those suffering from spinal stenosis are more comfortable standing Those suffering from spinal stenosis are more comfortable standing

69 All Height Controls within Easy Reach Adjustments to table height and to monitor height need to be easy, quick and silent Adjustments to table height and to monitor height need to be easy, quick and silent Memory for preference settings is nice but not critical Memory for preference settings is nice but not critical

70 Monitor-Eye distance Must be adjustable Focal distance is very individual

71 Flexible environment

72 Lighting

73 Acoustic Partitions Corkboard covered by acoustic material Smoked glass at upper part of partition

74 Ergonomics = Comfort The devil is in the details

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