Abstract
Professor Benzie's comments are interesting and absolutely right.
The repetitive strain injuries (RSI) problem is a serious and worldwide one, now being exacerbated by increasingly demanding applications such as nuchal translucency scanning and measurement, and doubtless there will be more.
I have been struck by the invidious comparison between the massive technological development that has taken place in recent years at the equipment end of the flexible transducer cable, and the absolutely primitive situation at the other. The transducer – the ‘sensory organ’ for collecting the diagnostic information – is just hand-held by the sonographer, who has to carry out these increasingly fine and demanding actions with it. There is absolutely no ‘instrumental’ link, or assistance provided between it and the rest of this sophisticated equipment package. Not only that, but the sonographers are prevented from seeing what they are doing with the transducer, because they have to look in another direction altogether to watch the screen, and have to rely too heavily on proprioception. (As an aside, I have come to suspect that it is diversity in proprioceptive ability between sonographers that may explain in part why some suffer more from RSI than others, and why some fortunate ones do not seem to suffer at all.)
So I share with Professor Benzie the view that some form of robotic assistance to the sonographer is highly desirable to tackle the RSI problem. When I first became aware of how serious the problem had become, when I returned to medical ultrasound after an absence of more than 20 years, my immediate reaction was that perhaps we had been too hasty in abandoning mechanical scanning in the early 1960s when we had a fully automatic scanning machine working for six years for Ian Donald, during which time several thousand patients were successfully scanned by it. It is hardly practicable just to put the clock back 50 years, but it did make me explore the feasibility of designing an arm and manipulator ‘hand’ to assist the sonographer, in line with Professor Benzie's suggestion. Advice from friends in the defence industry was that the existing ‘mechatronic’ technology is already well up to the task.
However that would take time to make happen, even if one could, and the RSI problem is an acute and present one. So when Mrs Pat Ward and I began the Kinghorn project, we decided to attempt to ‘pick the low-hanging fruit first’ and attempt to draw attention to the ergonomic deficiencies – one might even say absurdities – of the ‘tower-type’ ultrasound machines that have become the norm over the last 30 years, ever since the emergence of realtime scanning. It was these, and what might be done, relatively inexpensively about them, that I tried to bring out in my letter last August.
Minor ergonomic improvements to control panels, different shapes of transducer handles, etc., are all very well, and welcome, but the real problem is to do with sonographers being forced by the layout of the their equipment, to face parallel to the patient and couch, and so have their scanning arms extended unnaturally sideways. This could be remedied by manufacturers making the necessary lo-tech equipment changes to couches, displays and control panels, so that sonographers can face more naturally across the patient, and so have their work in front of them, like almost everyone else in this world.