Activity simulation in Radiology: Chest X-Ray in bed-ridden patients

Abstract

Work-related musculoskeletal disorders (WRMSDs) symptoms are frequent in healthcare workers. In Radiology Departments, demanding postures assumed by radiographers frequently occurred. Chest plain radiography to bed-ridden patients is one of the most demanding ones. To evaluate postural strain in radiographers’, professional activity was simulated during bedside chest plain radiography performance.Bed-ridden chest X-ray examinations are generally performed by two radiographers. The simulations scenarios were recorded using photogrammetry methods, assessing postural variations of the main body segments (head/neck, upper arm, and trunk) (Kapitaniak et al. method, 2001). The main body angles of observed body segments were measured with dedicated software (Kinovea, version 0.8.15). The postures were classified into three categories according to European Standards (EN 1005-4:2005 + A1:2008): “acceptable”, “conditionally acceptable”, and “not acceptable” (British Standard, 2018).Results show demanding postures assumed by radiographers occurred during the X-ray tube manipulation requiring arm flexion, being more evident for radiographers that were shorter. Regarding patient handling, upper arm flexion was “not acceptable” when holding and pushing the patient by the shoulders. This arm posture may increase the risk of injuries especially since it is associated with high exertion of force and is repeated during the examination. In contrast, by supporting patients by scapula passing under the axilla, the constraint in the upper arm was reduced and the trunk flexion, even a bit more important, remain “acceptable”. This observation indicates that the need to train radiographers in manual patient handling. Unacceptable neck extensions can also be observed in the medium and smallest radiographers while handling the patient to probably have an overview (Cernean et al., 2017; Giger et al., 2008) and/or maintain a certain physical distance from the patient.Since bedside chest radiography is one of the most performed examinations requiring repeated movements and awkward posture, particular attention should be paid to biomechanical load. One strategy to reduce this physical constraint is the collaboration of both radiographers to lift the patient. Another one is changing the bedside radiography procedure, for instance raising the upper side of the bed to 45º, which will reduce the main risk factors doing the X-ray.Most of the radiographers self-associated conventional radiography practice with low back complaints, which is in line with previous studies in X-ray radiographers (Lorusso et al., 2007). This result was not surprising, even though the trunk posture was never classified as “not acceptable”, because the repetitive truck flexion with exertion of force to lift the patient may increase the risk of WRMSDs symptoms. Further research is needed to identify the demanding tasks responsible for symptoms.There is a lack of literature on the impact of anthropometric characteristics of radiographers performing X-rays, but mammography related studies showed that not adjustable radiological equipment to anthropometrics characteristics, is a physical risk factor, requiring radiographers to assume awkward postures possibly leading to WRMSDs symptoms (Cernean et al., 2017; Costa et al., 2014a). We dare to say there is a need to improve communication between users, equipment manufacturers, and designers to fit the needs of a wider range of radiographers' anthropometrics characteristics.