Taking Steps to Improve Well-Being
New radiology-specific research finds musculoskeletal strain is widespread, but minor adjustments can make a big difference.
We’ve all seen the dramatic headlines: “Sitting Is the New Smoking!” “Sitting is Killing You!” And, indeed, sedentary lifestyles have been shown to compromise cardiac and metabolic health, as well as negatively impact quality of life. Prolonged sedentary time is also associated with increased rates of burnout and fatigue and decreased ability to concentrate. Radiologists are at an increased risk of being sedentary at work compared with other medical specialties. This risk has been magnified in recent years with an increasing volume of cases, pressure for fast reporting, and emphasis on relative value units.1 The current digital environment and PACS workstations have also contributed to the development of musculoskeletal injuries in radiologists. Long hours sitting at workstations and failure to take breaks likely contribute to low back pain, neck pain, and repetitive stress injuries in radiologists.2
How can radiologists mitigate job-related risks in order to stay healthier? The good news is that enhancing well-being doesn’t require a wholesale change in lifestyle. Small steps add up.
If so, that’s pretty much the problem, says Rebecca L. Seidel, MD, assistant professor of radiology and imaging sciences at Emory University School of Medicine. Seidel and her colleague Elizabeth A. Krupinski, PhD, an experimental psychologist and professor, conducted research on the extent and severity of musculoskeletal disorders (MSDs) among radiologists.3
While prior studies have suggested an occupational link to neck and back pain, eye strain, and other issues, Seidel says hers is the first to use a standardized tool — the Cornell Musculoskeletal Discomfort Questionnaire — to assess MSDs in radiologists. Of the 99 radiologists who completed the electronic survey, Seidel and Krupinski found that 80 percent spent seven or more hours per day at a computer workstation, and 87 percent reported discomfort in at least one body part once or more in the week before the survey. Pain was most frequently reported in the neck, back, and right upper extremity. In addition, 53 percent of those with neck pain reported symptoms that slightly or substantially interfered with their ability to work.
Seidel and Krupinski’s findings also point to statistically significant gender differences. Female radiologists noted more discomfort in the shoulders and left forearm than male counterparts, and they more often reported distracting discomfort in the neck, lower back, and hip/buttocks.
Seidel believes equipment may be a factor. “Perhaps the equipment — desks, chairs, microphones — is better suited for a male body habitus than a female body habitus. This requires further investigation.” She speculates that the right shoulder discomfort could be related to the use of dictation controls by primarily right-handed radiologists of both genders.
Even as she plans additional research, Seidel points to adjustments that can help now:
- If a workstation has adjustable equipment, make modifications before starting work to optimize ergonomics. It is desirable to maintain a neutral wrist position, sufficient distance between eyes and screen, and an upright posture.1
- Get up and move around. Radiologists should fight the urge to power through a large volume of work in favor of regular, short breaks that can have a positive effect on productivity and comfort.
- Prevent eye strain and fatigue by following Cornell University’s Design and Environmental Analysis Professor Alan Hedge’s 20-20-20 rule. Every 20 minutes, look 20 feet away for 20 seconds.4
- Alternate sitting and standing. Even in environments where sit/stand desks are provided, radiologists tend to mostly sit. It is thought that cycling between sitting, standing, and moving may be more desirable.
Habits away from work can help reduce job-related risk as well, according to A. Nina Watson, MD, assistant professor of radiology and imaging sciences at Emory University School of Medicine. Watson, a proponent of preventive medicine and an expert in wellness, health, and nutrition, believes that the increased volume of work is taking a toll on radiologists’ health and well-being as evidenced by increased rates of burnout being reported.5
“Like many physicians, some radiologists tend to put their own health on the back burner as they prioritize caring for others,” says Watson. “Because they were able to get away with it during medical school and residency, many tend to continue.” Among countermeasures, Watson recommends the following:
- Build 30 minutes or more of exercise into the day. Think outside the gym, consider a dance class, martial arts practice, or running.
- Consider a fitness vacation like a hiking or cycling tour.
- Wake up 30 minutes earlier a few days each week. If you can do this three times a week, it means you get 90 minutes that can be dedicated to working out.
- Integrate exercise into your family activities. Instead of watching your kids ride their bikes, you can ride with them.
- Incorporate physical activity into your social life. Try to meet up with friends for a Zumba or Pilates class.
Recent research indicates that risks associated with sedentary behavior are not abated simply by tacking on physical activity. Physical activity incorporated both inside and outside of the work environment has been shown to decrease stress and increase productivity.6 According to Seidel, greater sedentary time is associated with increased risk for cardiovascular disease, cancer incidence and mortality, and type 2 diabetes. “Too much sitting is independently associated with these poor outcomes regardless of physical activity,” says Seidel. “Going to the gym before or after work, although beneficial in other ways, does not reverse the poor health outcomes associated with many hours of sitting.”
Seidel and Watson believe that bite-size changes can have a big impact. Watson suggests incorporating small breaks in one’s day to devote to being more active. “You can take a brisk walk around your office or building or a quick run up and down the stairs,” she says. “While at your desk you can take breaks to do stretching exercises, lift small hand weights, or do squats. Instead of calling a colleague or member of your staff, you can walk to their office. You can make a conscious choice to take the stairs as often as possible, rather than the elevator. When our schedules allow limited opportunities for exercise, we want to look for opportunities to be more active.”
Seidel agrees. “Radiologists must start prioritizing their physical and emotional well-being to ensure a long, productive and fulfilling career,” she says.
- Eckstein DA, Park HJ, Hanhan SB. Creating a Curriculum of Health and Wellness for Radiologists. J Am Coll Radiol. 2018:15(4):681–683. Available at bit.ly/JACR_Wellness.
- Parikh JR, Bender C, Bluth E. Musculoskeletal Injuries Affecting Radiologists According to the 2017 ACR Human Resources Commission Workforce Survey. J Am Coll Radiol. 2018:15(5):803–808. Available at bit.ly/MSKInjuries.
- Seidel RL, Krupinski EA. The Agony of It All: Musculoskeletal Discomfort in the Reading Room. J Am Coll Radiol. 2017:14(12):1620–1625. Available at bit.ly/ReadingRoom_MSD.
- Hedge, A, Ray, EJ. (2004) Effects of an electronic height-adjustable worksurface on self-assessed musculoskeletal discomfort and productivity among computer workers, Proceedings of the Human Factors and Ergonomics Society 48th Annual Meeting, New Orleans, Sept. 20–24, HFES, Santa Monica, 1091–1095. Available at bit.ly/Ergo_Study.
- Harolds JA, Parikh JR, Bluth EI, Dutton SC, Recht MP. Burnout of radiologists: frequency, risk factors, and remedies: a report of the ACR Commission on Human Resources. J Am Coll Radiol. 2016;13(4):411–6. Available at bit.ly/2016_JACRSurvey.
- Richardson ML. Wellness in the radiology reading room: making your workstation a work out station. Am J Roentgenol. 2014;20(3):627–629. Available at bit.ly/Workstation_Workout.
By Evelyn Sacks, freelance writer, ACR Press