Ergonomics in Mammography

Muriel Anita Simmons, AS, RT(R)(M), CBPN, Joyce Goldsboro, BA, RT(R)(M), CBPN-I, and Lora D. Barke, DO


*Mammography Lead Technologist, Invision Sally Jobe Breast Centers, Greenwood Village, Colorado.
Clinical Sciences Specialist for Breast Health and Imaging, Mammography Trainer, Invision Sally Jobe Breast Centers, Parker, Colorado.
Radiologist, Medical Director, Invision Sally Jobe Breast Centers, Section Chief of Breast Imaging - Fellowship Trained in Breast Imaging, Radiology Imaging Associates, Englewood, Colorado.

Disclosures: The authors report having no significant financial or advisory relationships with corporate organizations related to this activity.

ABSTRACT

Over the years, dramatic technologic advances in mammography equipment have allowed breast imaging facilities to greatly enhance breast cancer screening. With the introduction of full-field digital mammography and the increased emphasis on preventive medicine nationwide, screening mammography has grown tremendously in need over the last 3 decades. According to the American Cancer Society, 1 in 8 women will be diagnosed with invasive breast cancer in her lifetime. Due to the high prevalence of breast cancer in women and the success of screening mammography, the data support routine annual screening mammograms starting at the age of 40 for patients with average risk. In order to produce high-quality mammographic images, mammographers must ascertain ways to protect themselves from injury as they perform their daily job functions. One of the most critical and difficult aspects of mammography is positioning the patient properly. If the breast is not positioned correctly, large volumes of breast tissue may not be imaged, thus missing breast cancers. The added skill of ergonomically correct mammography positioning will help ensure a long-lasting career with minimal joint stress and work-related injuries. The following article discusses the basics of ergonomics, recent research on its application to mammography, and the technical challenges involved. Mammographers are also provided with methods for preventing work-related injuries.

Introduction
Musculoskeletal disorders result in 70 million doctor visits per year and the cost of claims is over $50 billion.1 Carpal tunnel surgery and spine surgery are very frequent musculoskeletal procedures performed in the United States. Several factors contribute to musculoskeletal disorders including, aging workforce, sedentary lifestyles, stress, and increased diversity of workforce with increased demands.2,3 Musculoskeletal types of disorders progress slowly, so by the time the injury is noticeable there could already be moderate to severe damage. Thus proper ergonomics can reduce the incidents of these health-related injuries.

Furthermore, ergonomics has played a major role in healthcare fields that are most prone to work-related injuries among its employees. For many healthcare facilities, evaluating and creating processes for the prevention of these work-related injuries have become a top priority. As previously stated, the overall cost for worker's compensation and disability claims is estimated to be in the billions of dollars,4 with 54.6% of worker's compensation claims filed in 2012 related to musculoskeletal injury diagnoses.5 This has prompted many employers to develop a definitive plan of action to prevent or reduce these grievances. 

What is ergonomics? It is a relatively new term that literally means "the science of work."3 There are various types of ergonomics risks related to the use of body movements, equipment design, and environmental conditions. Workers who are adept at identifying the type of ergonomic risk they face on a daily basis can ultimately determine how to create processes that improve their work environment.

In most work environments such an evaluation system becomes a necessity for working staff. Employees greatly vary in shape, size, and ability. Therefore, shared workrooms or work areas should be designed to meet the needs of all workers to promote a healthy environment and decrease the potential risk of injury. Evaluation is important to determine if the work space is adequate, the equipment is placed or installed correctly, and whether the workroom or area is designed to meet the specific needs of each radiologic technologist. The work habit of each individual should be evaluated both personally and by supervising staff to ensure that tasks are being performed in an ergonomically correct manner. However, when a facility has many staff members in one area, it can be challenging to meet the physical requirements for every employee. Practical processes and procedures are critical to managing an ergonomically friendly environment.

The implementation of an ergonomic plan within the workplace enables staff to become more aware of their work environment. Working more efficiently lowers the overall cost of worker's compensation payouts and results in fewer instances of absenteeism and staff turnover. The end result is an overall healthier and mutually beneficial work environment for both employer and employee. The improved working conditions cause less stress to working staff and lowered costs benefits the company as a whole. When an institution demonstrates commitment to improved working conditions for their employees, employee morale is greatly increased. Mammographers can then focus less on stress-related injuries and more on the responsibility of performing high-quality mammography procedures using the latest advances in an ever-changing field.

Good ergonomics is important in all professions, but especially essential for healthcare professionals. Ergonomic principles are used to help workers ease their workload by managing body movements and physical limitations for the purpose of preventing work-related injuries.6 Improving ones overall quality of health by implementing good ergonomic techniques is vital for many physical jobs. Job satisfaction without the worry of debilitating pain and discomfort is fundamental to dedicated service and quality work from mammographers.

The demand for screening mammograms has grown over the last 30 years, increasing productivity, performance, and workload. According to the American Cancer Society (ACS), 1 in 8 women will be diagnosed with invasive breast cancer in their life time.7 Screening mammograms are a highly efficient and low cost way to successfully screen for breast cancer, and the data and recommendations from the ACS support routine annual screening mammograms starting at the age of 40 for patients with average risk.8 For this reason, it is imperative for mammographers to produce high-quality images to meet this demand. This endeavor can often be handicapped by the repetitive physical movements involved with this type of occupation. Guidelines on dexterous body mechanics and awareness on the part of the mammographer are needed to ensure proper patient positioning.

Significant technologic advances in mammography equipment have been developed over the last 3 decades. Today, dedicated mammography systems are designed with features to help prevent work-related musculoskeletal disorders. The physical appearance and functionality of mammography machines have progressively become more user-friendly. Mammography units have reduced factors thought to result in discomfort and pain for the mammographer in both lower and upper extremities. Nonetheless, despite all the technologic advances in mammography equipment, there is still no definitive way to limit the repetitive physical maneuvers involved with patient positioning.

Mammography Ergonomics Research
A study conducted in 1997 by Alastair Gale and his research team looked specifically at mammographers to see if they experienced any musculoskeletal discomfort while performing routine tasks. They investigated and determined the contributing factors were related to the design and layout of the equipment. With these facts, they offered recommendations to change equipment design to help alleviate the discomfort caused by repetitious movements.2 This laid the foundation for improving mammography machines for ease of use with motorized, lightweight units facilitating rotation with a smaller tube head, and easy accessible controls.

By 2007, the National Health Service Breast Screening Program (NHSBP) conducted another study reporting that injuries affecting the thumbs and wrists of mammographers were still of great concern. The NHSBP's 2007 updated report was called Ergonomic Assessment of Mammography Units. This report included detailed assessment of mammography units and analysis of the mammographer's tasks. Results found that many of the current systems had improved their ergonomic design. However, there were 4 physical tasks that still placed a strain on the musculoskeletal system: (1) excessive bending and twisting; (2) static working postures; (3) forceful movement; and (4) repetitive working cycles.9

Alastair Gale continued research, on this subject matter, publishing an article, Musculoskeletal Disorder in Mammography: A Guide to Tackling the Issues in the Workplace, in 2009. This article included a survey in which 62% of mammographers indicated that awkward maneuvers were used to perform their daily tasks.2 Many had already developed pain, tenderness, swelling, and loss of strength in muscles leading to conditions such as carpel tunnel syndrome, rotator cuff syndrome, tendonitis of extremities, and trigger finger or thumb. The results of this study showed severe stages of permanent disability that shortened careers and limited the services mammographers worked so hard to provide.

History of Dedicated Mammography Equipment
X-ray was discovered by Wilhelm Roentgen on November 8, 1895. This developed the pathway to visualize many body parts with radiographs. The history of mammography began in 1913, when a Berlin surgeon named Albert Salomon conducted a study with mastectomy patients. His study correlated the diagnosis of breast cancer with radiographs of breast specimens on the study of 3000 patients who underwent mastectomy.10 Many American and European radiologists contributed research detailing how breast cancer can be diagnosed using mammography radiographs. From this foundation, mammography screening was deemed as invaluable for detecting breast cancer.

Around the late 1960s, modifications of general X-ray equipment were used for mammography imaging of breast tissue using a packaged industrial film with thick emulsion. This special film had to be hand developed as it was too thick for automatic wet processing. However, it was useful for evaluating glandular tissue that was inadequately visualized with the X-ray film used at that time.  Much of the original X-ray equipment was heavy and difficult to maneuver. Patients were positioned in both the sitting and recumbent positions to obtain views of the breast. A physicist named Charles Gros was the first to develop the apparatus designed to image the soft tissue of the breast with a molybdenum anode. He developed the first upright mammography system called the Senographe in 1969.11 This was the era of the development of many different types of lightweight and motorized dedicated mammography systems used to screen for breast cancer.

Significant advances in mammography have been developed over the last 3 decades. The physical appearance and functionality of mammography equipment have become more user- friendly. Dedicated mammography units have decreased factors thought to have caused lower and upper extremity discomfort and pain by utilizing motorized gantrys, isocentric rotation, automatic release compression, easy accessible buttons on gantry, adjustable monitors, and easy exposure buttons, to name a few. Nonetheless, with all the technologic advances in mammography equipment, there is no definitive way to limit the repetitive physical maneuvers involved with positioning patients for mammograms.

Technical Challenges
Advances in full-field digital mammography have decreased procedure time from 30 minutes to approximately 10 minutes per procedure. This means an increased workload with fewer rest breaks for the average mammographer to relax between each set of repetitive movements and potentially awkward body mechanics. The mammographer may find it difficult to focus on posture while positioning mammograms, because the priority is acquiring and imaging optimal breast tissue. Positioning the patient to image the posterior deep tissues of the breast is the challenge, whereas imaging the anterior portions of the breast requires less effort. The mammographer utilizes her body strength by involving upper body, lower back, the shoulders, elbows, wrists, and hands. This constant body motion requires a degree of skill and training in the proper way to maneuver. A cooperative patient who is relaxed and pliant to the pulling and compression necessary to obtain quality imaging is always a bonus.          

It is standard practice for the mammographer to evaluate the patient's condition prior to imaging the breast. Body habitus, abnormalities, breast symptoms, and other diseases play an important role in how the breast is positioned. On occasion, special imaging positions may be necessary. Every patient is different and creates unique positioning challenges for the mammographer.12 The art of acquiring basic mammograms is 2-fold because body habitus of both the mammographer and patient require varying techniques. For mammographers who are shorter or taller than average, excessive bending or reaching can occur. Diverse body habitus in patients can include large abdomens, excessive skin, tall or short statutes, kyphotic statutes, or ambulatory limitations. Through all the challenges, mammographers are still required to produce quality images with as much breast tissue as possible. This is why basic ergonomic training is important.

There are 2 standard views required for a basic mammogram: the craniocaudal (CC) and the mediolateral (MLO) position. The CC position of the breast is used to image the medial, central, subareolar, and some lateral breast tissue. The MLO position is used to visualize the entire breast tissue including axillary tail and pectoral muscle. The breast is mobile only on the inferior and lateral aspects of the breast. It is the responsibility of the mammographer to maneuver the breast to show quality images of all breast tissue from the basic projections as well as any special views that may be requested by the radiologist.

Basic Ergonomics
There are many types of work-related activities that can result in permanent injury to workers who are carrying them out on a daily basis. These injuries can be caused by stress and motion-related repetitiveness or other factors of strain from overuse of certain body parts over an extended period of time. The following list of 9 basic steps to good ergonomics provides some common and practical ways to assist in the prevention of injury to various parts of the body. The list is general and can be supplemented in all aspects of life to improve the coordination of body movement when off duty and performing other tasks at home13,14:

  1. Maintain the natural curve of the spine: Basic work ergonomics includes good work posture in the neutral S curve of the back, whether you are sitting or standing. Your posture is the best place to start ergonomically, and a natural and neutral position is always recommended.
  2. Keep the neck aligned: Strive to keep the S curve in the upper neck in a neutral position, with the neck properly aligned (or stacked) with the head and shoulders.
  3. Keep elbows at your side: Keep shoulders relaxed and elbows by your side, close to the body, at a 90° angle.
  4. Keep wrist in neutral position: Keep the wrist in the same plane as the forearm.
  5. Reduce excessive force: It is important to keep to a minimum movements involving pulling, forceful motion, or handling weighty objects. This can cause undue fatigue and joint stress.
  6. Keep objects within easy reach: Always keep reachable objects and patients within a semicircle. Get close to heavy objects before lifting or moving. Keep objects close to your body to avoid pressure on the lower back.
  7. Work at proper heights: Perform work at elbow height, whether sitting or standing.
  8. Use proper lifting and bending techniques: Spread your feet apart to help use your body as a base. Stay close to your object or patient. Bend at your knees, not at your waist.
  9. Maintain good health, fitness, and flexibility: It is important to perform warm-up exercises and stretching techniques several times throughout the day to maintain joint flexibility.

Once a technologist has learned these 9 basic steps to good ergonomics, a self-evaluation can be made to determine if there are needed areas of improvement in their daily processes. Because routine habits are often hard to break, referring to these 9 basics steps periodically as a standard refresher will help reduce any tendency to revert back to old forms and methods. Healthy habits will soon evolve and ultimately improve the quality of any task being performed, whether it involves the simple use of a computer workstation or the art of positioning patients.

Basic Ergonomics for Mammography Positioning  
To successfully apply the 9 basics of ergonomics outlined above, the mammographer needs to review and practice these steps until they feel comfortable with them. Positioning the breast for examinations requires the mammographer to stay in neutral postures as much as possible. To avoid bending at the waist, mammographers should incorporate micro-pauses by bending with the knees only and returning to a neutral position quickly. To avoid reaching, mammographers should stand close to the patient while positioning. These basic techniques can be the start of establishing good habits to protect joints and overall health.

Dedication to mammography ergonomics will reduce the stress of a repetitive job. No 2 mammographers position patients exactly the same, so implementing basic techniques within the department can be a good guideline. Mammography patients can be difficult, some will have limitations, and every situation is different. Despite the variety, mammographers must learn to prevent injury while acquiring accurate positioning crucial to detecting breast cancer. Proper positioning depends on the mammographer and patient.

Mammography Positioning
The mammographer spends much of her day positioning patients of all shapes and sizes. Since a variety of patients report for mammography, each time another patient is positioned, the mammographer needs to evaluate how they are going to approach the positioning of this patient. The patient may be tall and thin to short and stout and anywhere in between. All these qualifying factors produce a new challenge for mammographers with each patient, lending to a variety of ways to position the breast each time.

Positioning the CC and MLO views of the breast can be quite challenging depending on the body habitus of the patient and whether the patient can stand or sit for the examination. Wheelchair patients also require awkward positioning techniques from the mammographer as well. However, regardless of the level of difficulty involved with the positioning of a patient, the mammographer must always be aware of maintaining good posture with limited movement of the extremities. The mammographer should remember to keep movement of the extremities close to the center core of her body as well as using her entire body for positioning of the patient. Keeping these simple techniques in mind, mammographers will be able to achieve the images they are striving for without added strain on their bodies.

It is also important to note that some mammographers may have physical limitations of their own and, therefore, may not always be able to perform some basic body movements. In this situation, the mammographer should be allowed to perform mammography positioning in a manner which will not cause more personal harm or injury. For example, the mammographer could have an existing neck, spine, or hip injury. Certain body mechanics related to ergonomic correctness may not be possible in such instances. Other mammographers may have extreme statures that vary from very tall to very short. These mammographers may need to adjust their positioning technique according to their height and girth. When physical limitations that result in stress to certain physical areas are recognized, the employee should inform employers of the limitation. An ergonomic evaluation may be necessary to prevent any future injury to the employee.

Most mammographers devote very little conscious thought to each approach of positioning a patient for a mammogram. The majority of mammographers have performed this task over and over for a number of years and have become very rote at this particular function. However, it is highly important for each mammographer to do a quick mental review of basic ergonomic techniques in order to improve their own body mechanics and performance with each procedure that is carried out. The following are some examples of ergonomic basics that the mammographer should review and consider when positioning for mammography.

Ergonomics Basics the Mammographer Must Remember
Apply good posture technique by standing straight without slouching or bending from side to side, at the same time standing close to the side of your patient. It is important to maintain balance by bending the knees slightly and keeping the feet somewhat apart. On occasion, the mammographer will find they need to slouch, bend, or place their body into awkward positions for more difficult patients. When this occurs, the mammographer needs to remember that all movements should occur with their center core in mind. The entire body should be utilized to manipulate through those difficult positions, with the goal of returning to a neutral position as soon as possible.

Always keep the shoulders relaxed and pulled back while bending the arms slightly. Elbows should be kept close to the body at a 90° angle. Again, the arms slightly bent should stay close to the core of the body. This can be accomplished by standing close to the patient during the mammography procedure, regardless of the position.

Avoid any extra stretching or turning movements that could potentially strain the muscles and tendons of the musculoskeletal system.

Avoid staying in awkward positions for any length of time. On occasion, the mammographer may have a patient who is wheelchair bound and unable to stand. The mammographer has no choice but to bend over the patient and equipment in contorted positions. It is important for the mammographer to remember to relax as much as possible and not hold those strenuous positions for any length of time.

 Utilize securely locked stools or chairs whenever possible. Secure the patient on these pieces of furniture so they are seated firmly in the center portion of the chair and not on the edge. The mammographer must be mindful of stools or chairs with wheels by making sure they are locked or secured before placing a patient. By using a stool or chair, the mammographer does not always have to steady or hold the patient in position. The more the mammographer has to hold and steady the patient, the greater the chance of injury or joint strain.

Foot Pedals
Keep foot pedals close to avoid excessive reaching (Figure 1). The mammographic systems of today have 2 sets of foot pedals to aid in the positioning of the gantry and movement of the compression paddle. The foot pedals must be kept out of range of the patient's feet, wheelchair, or chair. At the same time, the pedals should be positioned in close proximity to the mammographer's feet for easy use.

 Always check the position of the foot pedals before beginning the patient procedure to ensure they are in proximate location for easy use.

Always use the foot pedal with small tapping compressions while compressing. Only use the knob for the final compression when needed. (Compression with the knobs can cause tendonitis.)

Avoid placing the foot pedals at such a distance that the mammographer must stretch her leg to make contact with the pedal (Figure 2). The leg should be a comfortable distance from the pedal and slightly bent to maintain balance while using the foot pedal.

Additional Tips for Positioning the Crainiocaudal View
Use 2 hands to position (Figure 3). Try to keep elbows and wrist in the same plane. Firmly hold the breast with fingers spread wide until the compression paddle comes into place (Figure 4). Once again, standing close to the patient while positioning allows the mammographer to use firm strength without excessive force. The light field will help you check correct positioning.

 

 

Additional Tips for Positioning the Mediolateral View
Stand close to the patient while pulling the posterolateral breast tissue. Keep your wrist and forearm in same plane (Figure 5). At the same time place the other hand behind the shoulder and have the patient lift her shoulder and arm and reach across the top of the image receptor. If this is challenging, have the patient reach her arm across and stand behind the detector to check correct placement into axilla. You can guide the arm into correct position by using 2 hands (to help reduce stress), keeping your wrist and forearm in the same plane.

 Stand close to patient near the ipsilateral breast and re-position by pulling posterolateral breast tissue. If the tube and face shield get in the way, the face shield can be removed. You may have to bend slightly forward at the knees to obtain more lateral breast tissue or check for folds.  

After the pulling and placement of the breast tissue, hold the breast tissue up and out until compression is in place. This can require some extension and angling of the wrist (Figure 5). Slightly bending at the knees will help relieve some wrist pressure. Hold the breast firmly until the paddle replaces your hand. (Please note: it can be a challenge to use a foot pedal while slightly bending at the knees.) After the paddle replaces your hand, stand up close to the patient and complete the final compression.

When checking the inframammary fold, some bending may be required. Bend at the knees and move forward in a fluid motion to check, then return quickly to a neutral position and apply final compression with foot paddle.

Control Panel/Workstation Ergonomics
The functional work space of the control panel/workstation in the mammography procedure room should be set up so that the keyboard and mouse are at a level where the mammographer does not have to reach, raise, or extend her arm and shoulders at any great length. The position of the keyboard should be slightly tilt with the mouse directly to the side for ease of movement. The elbow should not be hyperextended, but slightly bent for ease of movement.

The center of the monitor should be set at eye level. This limits the need for the mammographer to raise or tilt the head while viewing images, thereby avoiding unnecessary neck and shoulder strain.

When it comes to a functional workstation, adjustability is the key. Arm rests, chair and desk height, lighting, and additional equipment should all be adjustable to ensure the ergonomic comfort of each individual staff member that utilizes the workspace.

Clothing and Shoes
Wearing comfortable clothing and shoes is considered to be as important as the posture and stance of the body. Loose fitting clothing will allow for any body movement necessary to position the patient. Comfortable and good fitting footwear is also important. The amount of time standing and walking while positioning and performing mammography can place added stress on the leg muscles as well as the feet.

Recognizing the Risk
The field of mammography involves a unique machine configuration for the purpose of detecting breast cancer using dedicated mammography units. One constant variable in this profession are the many different sizes and body types of both mammographers and patients. Breast imaging centers are designed to provide for a steady flow of patients daily, resulting in a high volume of productivity. Many mammography units and computer workstations are considered shared workplaces, never dedicated to one primary worker.

One of the greatest changes in the last decade has been the use of digital technology. The task of writing extensive reports has been replaced by efficient computer applications. Dedicated full-field digital mammography units have eliminated the need to use cassettes after every exposure. Darkrooms with heavy containers of chemicals are almost obsolete. Digital images can be accessed with the click of a mouse, as opposed to hanging films on view boxes. With these changes, some aspects of the physical nature of this occupation have diminished.

Nonetheless, mammographers should still be concerned about the debilitating problems associated with such a physically repetitive job. Healthcare workers are still presented with greater ergonomic challenges and increasing pressure to work more efficiently and productively. Recognizing the risks begins with a mammographer's awareness of her own body. The majority of injuries usually develop over a period of time as a result of repeated stress on a particular body part. It may be difficult to notice the stress until it becomes chronic and permanent.

Conditions common among many mammographers are cumulative trauma disorders and other repetitive motion injuries. High production demands do not allow for much time and rest to recover from the physical task of positioning a mammogram every 10 minutes. The most common musculoskeletal work-related injury is carpal tunnel syndrome. This involves injury to the median nerve located in the wrist while being entrapped from the buildup of pressure caused by repeatedly flexing the wrist.15 This condition can be very painful and disabling, causing loss of hand and wrist strength. Most symptoms include weakness, clumsiness, numbness, tingling, and swelling. If carpal tunnel syndrome is diagnosed early, further damage could be prevented.

Other cumulative trauma disorders include trigger fingers or thumbs and tendonitis of the wrist or the elbow. The lower back is another common problem area due to repetitive twisting and potential strains. Be aware of pain and discomfort while performing certain maneuvers. If symptoms persist, seek medical attention to prevent further injuries. Diagnosis of work-related injuries includes identifying the affected body part, determining the extent of injury, and determining the cause of the injury. Mammographers can avoid all these potential hazards by learning to apply the basics of ergonomics to every assigned procedure.

Workplace Ergonomic: Process and Resources
Ergonomics involves a collaborative effort on the part of both employers and employees to develop a plan of efficiency that allows mammographers to work smarter and better. This joint effort promotes good health in a safe environment. There is less overall stress for both the mammographer and the healthcare facility if work-related injuries are kept to a minimum. The morale of a department flourishes if everyone's welfare is considered when making the work environment safe. Productivity increases when there are content and happy employees who feel good about their organized, ergonomic workrooms or areas. Less stress is placed on associate co-workers when the staff is healthy and following the basics of good ergonomics.

The important mission of Occupational Safety and Health Administration (OSHA) and Centers for Disease Control and Prevention is to assist with ensuring a safe and healthful work environment nationwide. These programs provide a foundation of preventive programs and processes that can serve to help reduce stress and eliminate injuries in the workplace. Per OSHA guidelines, some of the most important elements of an ergonomic process developed by various industries across the board are:

  1. Management Support:  A strong commitment by management to ensure the success of an ergonomic process which should include clearly defined goals and objectives.
  2. Worker Involvement: Feedback from workers identifying workplace hazards and allowing workers to voice both concerns and suggestions for change.
  3. Training: Ongoing training on ergonomics and its benefits, ergonomic concerns specific to the industry and workplace, and the importance of reporting early symptoms of musculoskeletal disorders.
  4. Problem Identification: Identifying and assessing ergonomic problems specific to the industry and workplace.
  5. Implementing Solutions: Applying techniques and implementing processes to reduce, control, or eliminate workplace musculoskeletal disorders.
  6. Evaluating Progress: Establishing periodic evaluations and corrective action procedures to assess the effectiveness of ergonomic processes and improve upon them as needed.

Employees who have concerns about ongoing unsafe conditions and hazards in their workplace can contact OSHA confidentially at 1-800-321-OSHA (6742).16

Conclusions
In conclusion, there is no downside to establishing a good ergonomic plan. Everyone benefits from following basic ergonomic practices at work or at home. Less injury to the entire body will always promote good health, fitness, and flexibility. When a difficult or physically challenging situation arises, the mammographer should be better equipped with the tools and stamina to manage that situation without causing potential injury to patients or other staff. When basic ergonomic rules are disregarded, an increased risk of injury is likely to occur. The price to the employer and employee can be very costly from medical bills to time missed from work.

Mammographers spend the majority of their time in the mammography room positioning patients in a repetitive manner every 10 to 15 minutes. Doing the same task over and over can be detrimental to the body if certain techniques are not followed. Mammographers must be cognizant of how they stand, relax, stretch, and bend during each and every single procedure. They must remain aware of the correct and incorrect ways to keep the body inclined to avoid any injury or stress associated with repetitive motions. Most importantly, any injury to the body needs to be reported to the management staff immediately.

The overall cost of disorders and injuries caused by not practicing good ergonomics must be reduced, especially in a time when healthcare costs are on the rise. It is vital for everyone-owners, management, and staff-to take an active role in identifying and implementing a plan of action to establish the basics of good ergonomics within each workplace. Preventive programs are very important in all of healthcare today. Some imaging facilities have even hired certified public ergonomists to make a detailed and specialized onsite assessment of the work environment for the benefit of radiologists and their supporting mammographers.

Mammography positioning is a very physical and demanding job for the mammographer. The acquisition of skillful positioning techniques enables the mammographer to become better at producing optimal mammographic images by giving special attention to ergonomics.  

References
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13. McLeod D. Ten principles of ergonomics. Available at: http://www.danmacleod.com/ErgoForYou/10_principles_of_ergonomics.htm. Accessed November 5, 2013.

14. Ghosh M. The basic of ergonomics. EzineArticles. Available at: http://ezinearticles.com/?The-Basics-of-%20%20%20%20%20%20%20Ergonomics&id=7486120. Accessed November 5, 2013.

15. National Institute of Neurological Disorders and Stroke. Carpal tunnel syndrome fact sheet. Available at: http://www.ninds.nih.gov/disorders/carpal_tunnel/detail_carpal_tunnel.htm#236433049. Accessed November 5, 2013.

16. Occupational Safety and Health Administration Ergonomics Program Management Guidelines. Prevention of musculoskeletal disorders in the workplace. Available at: https://www.osha.gov/SLTC/ergonomics/index.html. Accessed November 5, 2013.


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