Musculoskeletal Disorders in Radiation Therapists

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Musculoskeletal disorders are the second most common workplace-related illness. Approximately 477,000 workers each year in the UK suffer from a musculoskeletal disorder due to their work responsibilities, equating to 7.3 million working days lost.

Musculoskeletal disorders (MSD) are injuries to the muscles, tendons, ligaments, joints, cartilage, nerves, and spinal discs. They can affect almost any region of the body, but most commonly to the back and upper limbs or neck. Symptoms of these injuries include localized or widespread pain which is worsened with movement, stiffness, fatigue and sleep disturbances, twitching muscles, and a burning sensation in the muscle, all of which can reduce the quality of life affecting mental health as well as physical health.

According to the Health and Safety Executive, the primary causes of musculoskeletal injuries are fixed or constrained body positions, the continual repetition of movements, force concentrated on small parts of the body such as the hand or wrists, and a pace of work that does not allow sufficient recovery between movements.

These recognised causes are commonplace within the radiotherapy setting where the working environment is very demanding. Radiographers often work entire shifts on the Linear Accelerator (LINAC) treating 40-50 patients with short appointment times for each. Radiographers are required to maneuver patient immobilization devices on and off the treatment couch and assist patients onto the treatment couch into a supine position. Radiographers will move patients until they are in the correct treatment position, carry out the treatment, and then assist the patient in disembarking the treatment bed.

Manual handling training is mandatory for all therapeutic radiographers under the Manual Handling Regulations of 1992. However, despite staff shortages, high-pressure working environments and high patient throughput expectations often lead to radiographers continuing to carry out work, which applies pressure and strain on their bodies to meet this demand.

Let's explore further the particular stresses on a radiographer’s body as they assist their patients on a typical working day. Taehyng and Hyolyun (2014)examined the physical burden on radiographers when positioning patients on their imaging couch which mirrors that of a radiotherapy couch in dimensions and height. Their study indicated that the lower back pain of radiological technologists was closely related to the frequency with which they assist patients in movement. They noted that the table for a CT scanner is just wide enough for a patient to lie on and is positioned at a height that is close to the hip joints of the radiological technologists. This means that while moving patients, they use force after bending substantially at their waists and stretching their arms out. As the trunk is bent forward, the load on the lumbar region increases markedly. In addition, since the movements are made in the limited space of the CT scan room and the height of the table is fixed, the radiological technologist cannot take up a position that would distribute his or her weight to the lower extremities. Therefore, these movements can be understood to impose large burdens on the waist.

In 2012 The Society of Radiographers published the results of a survey they conducted on musculoskeletal disorders in Therapeutic Radiographers. Of the 352 respondents, 56.6% acknowledged that they currently suffer from aches and pains. 49.6% of respondents felt that they had not been given sufficient training and information to prevent an MSD, and 76.7% acknowledged that they had to twist or bend their bodies during a typical working day in a way that could lead to a tear or strain. 80.2% of radiographers felt that their health influenced their work performance which, in turn, impacts patient safety and work productivity.

Leo Cancer Care has prided itself in always putting patient comfort and a positive treatment experience first when developing its upright patient positioning system. By keeping patients upright for treatment, they can position themselves more easily in and out of the system much like they would a chair at home. When helping a patient exit the system, the electronically driven adjustable height means we can put the patient in a perched position only a few degrees off standing before they step forward and exit to the side. This negates the need for the radiographer to twist, bend and apply force with the arms extended in order to assist the patient out of a supine position, into a seated one and then upright before they can walk away from the treatment couch.

Please note: The Leo Cancer Care products are not commercially available and will not treat patients until regulatory approval has been achieved.

Above is a video that demonstrates how a radiographer will assist a patient in and out of the upright patient positioning system.

A study by Radiotherapist, Sophie Boisbouvier directly compared patient comfort when in the supine treatment position and when in the upright patient positioning system, 94% said the upright system was easy to get out of compared to 60% who said the same about the supine treatment position.

Research carried out at Centre Leon Berard suggests that reproducibility in this system is higher than in supine treatments due to the 5 points of immobilization used for each patient at the feet, the shins, the knees, the pelvis, the back, and for some patients, at the head. Having a highly reproducible treatment position means there is less need for prolonged patient setups and re-set ups after imaging, reducing chances for radiographers to acquire a MSD.

According to Leo Cancer Care, upright is the more natural position for us as Humans. Certainly patients getting in and out of a chair is something they do multiple times a day compared to lying down and returning to standing. Patients are better equipped physically to do this task, reducing the burden of assisting patients for radiographers. Where patients do need additional assistance, this can be carried out using all the normal manual handling devices that are utilised in the clinical setting.

Upright radiotherapy could be the solution to increased patient throughput with a system that is easier for patients to enter and exit. Greater reproducibility reduces the need for patient repositioning and most importantly, it could allow radiographers to deliver treatment in a system that reduces the risk of injury to them, allowing them to have a prolonged career in the clinical setting free from injury.

References

Health and Safety Executive. Musculoskeletal disorders. Available at: https://www.hse.gov.uk/msd/

Society of Radiographers. Musculoskeletal Disorders in Therapeutic Radiographers. 2012. Available at: https://www.sor.org/learning/document-library/musculoskeletal-disorders-therapeutic-radiographers

Taehyung, K., Hyolyun, R (2014) Analysis of risk factors for work-related musculoskeletal disorders in radiological technologists. Journal of Physical Therapy Science. 26: pp 1423-1428

Udoh, BE., et al (2019) Musculo-skeletal symptoms and its severity among radiographers and sonographers in southern Nigeria. Journal of Advances in medicine and medical research. 29(12): pp 1-7

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BlogsKate Yip25 July 2023