Current research on ultrasound ergonomics shows that work-related musculoskeletal disorders (WRMSDs) are a prevalent hazard among sonographers. 1-9 In particular, the neck, shoulder, and wrist appear to be injured most frequently. 1-9 Studies have associated equipment design (including console design and transducer design), duration of work, awkward body postures, and workplace culture as having the potential to increase the risk of WRMSDs. 2-4,6-9 Awareness of the issue began in the late 1990s, and much of the evidence-based research has been replicated. In 1997, Pike et al. published sentinel research revealing that >80% of sonographers scan in pain that is directly attributed to workplace tasks. 1 Since then, multiple studies have shown sonographers scanning in pain 75% to 90% of the time. 2-6 Sonographers primarily report WRMSDs as pain in the shoulder and neck. 1-6 Back pain is also frequently reported, followed by hand and wrist pain. 1,3,4,7 Other WRMSD-related symptoms include tingling or numbness of the extremities, weakness in one or both extremities, motion restriction, numbness in hands upon awakening, and clumsy fingers. 3,5 To minimize pain, a machine console height that allows for 90° elbow bend and an elbow support sling are effective tools to reduce muscle activity in the neck and trunk. 8 Muscle activity in the upper trapezius and rotator cuff muscles decreases when the need to reach for the ultrasound console is eliminated. 9 Muscle activity also decreases when arm abduction is reduced from 75° to 30° and more so when support cushions are used to support the scanning arm. 9 Studies report that approximately 80% of sonographers have access to adjustable scanning tables and heightadjustable chairs but that the tables may not have electronic controls and that the chairs may not be adequate for proper scanning postures. 4,6 Studies that report the use of a cable brace while scanning are minimal, and the overall relationship between the use of a cable brace and scanning in pain has not been evaluated. 4 Workplace culture appears 677018J DMXXX10.
Diagnostic medical sonography is viewed as a safe imaging modality. However, bioeffects research has yet to define the effects of exposure to sonography in humans. Therefore, sonographers must be aware of potential risks and practice ALARA (“as low as reasonably achievable”) routinely. This research explores sonographers’ ability to answer basic questions about the bioeffects of sonography, as well as their knowledge and use of the safety indices called the mechanical index (MI) and thermal index (TI). Members of the Society of Diagnostic Medical Sonographers, a southwestern sonographers’ society, and a sonography community on Facebook 2010 were surveyed. There is a low level of bioeffects knowledge and minimal safety practices among sonographers in this survey. No significant relationship was found between sonographer knowledge of the bioeffects of sonography, years in the profession, or whether the sonographers monitor the MI/TI.
Cerebral vascular accident, or stroke, is the second leading cause of death worldwide and a common cause of longterm disability. 1 The incidence worldwide is 258/100,000 persons with wide variations between high-and lowincome economies. 2 In the United States, the Centers for Disease Control and Prevention reports stroke affects 795,000 individuals each year, is the fifth leading cause of death, 3 and is the leading cause of long-term disability. 3,4 Between 80% and 87% of strokes are classified as ischemic with cardioembolism, large vessel atherosclerotic disease, and small vessel occlusive disease as the most common causes. 5 The category of cryptogenic stroke is used when the stroke is believed to be ischemic, but there is no identifiable cause. 6 Cryptogenic strokes are believed to be caused by emboli when they do not present as a lacunar infarct on imaging, there is a lack of extracranial atherosclerosis causing greater than 50% stenosis, and other embolic risk factors such as intracardiac thrombus, cardiac tumors, or valvular vegetations are not present. 6,7 Cryptogenic strokes are believed to comprise 25% to 40% of all embolic strokes. 8 When an embolic source for stroke cannot be clearly identified, atrial septal abnormalities such as atrial septal defects and pulmonary shunts are considered potential causes. An atrial septal defect (ASD) is a defect of the 816983J DMXXX10.1177/8756479318816983Journal of Diagnostic Medical SonographyStafford et al.
Skin cancer is the most common type of cancer in the United States, and it affects approximately 2.2 million people each year. 1 Melanoma is less common than nonmelanoma skin cancers (NMSC) but is more serious because it is the most likely to metastasize. 1 The histologic thickness or depth of invasion, called the Breslow index, determines prognosis and treatment options. 2 Preoperative evaluation of lesion depth could improve patient management and outcomes. Sonography has been used to assess lesion depth and margins prior to excision as well as to classify adjacent lymph nodes as metastatic. Adding sonography to a patient's protocol may improve management by clarifying lesion depth, identifying margins for excision, and determining lymph node involvement. MethodsA search of peer-reviewed journal databases, including CINAHL, MEDLINE, and OVID, was conducted with search terms such as sonography, ultrasound, skin cancer, and melanoma. Original research articles related to the detection and assessment of skin cancers and lymph nodes were evaluated for inclusion. Additionally, articles that focused on detecting, characterizing, and following up on skin cancer were analyzed and included. AbstractSkin cancer has become more prevalent in recent years, and finding ways to assess and characterize it prior to excision is important. Sonography can be an integral part of the preoperative and follow-up assessment of melanoma, metastatic lymph nodes, and nonmelanoma skin cancers. A review of the literature is reported, indicating that sonography appears to be effective at showing lesion thickness, defining lesion borders, and helping to identify whether lymph nodes are metastatic; however, it cannot differentiate among the types of skin cancer. Based on these findings, best practice scanning techniques are outlined for sonographers.
This research examines whether using a reference tool alters the monitoring of the mechanical index (MI) and thermal index (TI) during obstetric (OB) sonograms. A presurvey regarding users' behavior patterns of monitoring MI/TI indices was emailed to sonographers who were registered in a clinical database affiliated with an accredited sonography program. The presurvey included a reference tool which respondents were asked to print and use when performing OB sonograms. A postsurvey was sent to the same respondents to determine if behavior patterns regarding MI/TI monitoring improved after using the reference tool. There were no significant changes in how often sonographers monitored MI/TI from the pre-to the postsurvey.
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