Kevin D. Evans

Objective: Ideally, schedules should provide sufficient time for quality patient examinations, sufficient time for other examination-related activities, and recovery time for sonographers. One difficulty with examination times and scheduling is the variability among examinations due to a myriad of factors. The objective of this work was an improved understanding of these factors and their relation to sonographer workload, potentially leading to better-informed scheduling in the future. Materials and Methods: A collaborative approach was used to (1) develop a list of potential workload-contributing factors, (2) document factor occurrence during examinations, and (3) explore associations between workload factors and perceived workload. Results: Notable differences were seen in workload between examinations. The association between total number of workload factors and perceived workload was stronger than between workload variables and examination duration. Conclusion: This supports the concept that more dynamic, flexible scheduling that accounts for situation-level workload experiences may aid in providing more appropriate and sustainable workloads for sonographers.

Objective: Supporting sonographers’ health and well-being requires targeting the workplace factors they identify as most influential. This study examined sonographers’ perspectives to guide priorities for resource allocation and solution development. Materials and Methods: An online survey of 1276 U.S. and Canadian sonographers asked participants to rate 30 workplace factors across four categories—workflow, equipment/physical environment, administrative/organizational environment, and training/health practices—on their perception of impact on well-being and importance for understanding and improving. Respondents selected up to five factors as the highest priorities for immediate action and resource allocation. Results: Five factors ranked among the top 10 across specialties and were rated as significantly impactful and important by more than two-thirds of respondents: productivity requirements (76.9% impact, 74.3% importance), staff scheduling policies (73.2%, 74.4%), supervisor support (72.1%, 71.2%), exam room furniture (73.1%, 68.0%), and ultrasound machine design (69.3%, 75.6%). Exam scheduling was the top priority across all practice areas and the only factor identified in the top five by a majority of all respondents. Conclusion: While specialty area differences exist, sonographers consistently identified administrative and organizational factors as the most impactful, important, and of highest priority for immediate action. Addressing these concerns requires contextualized solutions developed with direct practitioner input.

A virtual participatory workshop was held to address the issue of prioritizing image quality over the risk of work-related musculoskeletal injury (WRMSI) and burnout. The data that were collected from the session was analyzed qualitatively to discover the possible factors that could negatively affect the quality of sonographic examinations, without blaming the sonographer. The capture of rich discussion centered on the need to strike a proper balance between a high-quality sonogram without contributing to negative effects to a sonographers’ health and safety. As a sonographer’s health declines, the physical abilities and cognitive focus required to perform one’s best also declines, resulting in lower overall quality and a downward spiral of declining health and quality. Identifying solutions to maintain a proper balance between image quality and sonographer health and safety is paramount. To successfully implement and maintain workplace solutions, sonographers, clinic staff, and administrators must work together to determine which solutions can be trialed in the workplace. Further practical research is needed to quantitatively measure some of the key themes from the workshop: the need for structural change to reinforce the necessity of WRMSI risk reduction, ongoing prioritization of quality over WRMSI risk reduction, and an urgent need to teach students WRMSI risk reduction.

Objective: The aim of these analyses was to determine the potential development of increased carotid intima-media thickness (cIMT) and spectral Doppler velocity in a cohort of children who were eligible for federal nutrition support services. Materials and Methods: A secondary data analysis was conducted based on data collected during a larger randomized clinical trial. Data were pulled on 108 children, ages 8 to 11 years, who had both cIMT measures, as well as spectral Doppler data, at the level of measured intimae. Additional data such as vessel geometry, body mass index (BMI), and blood pressure (BP) were added to the analysis to provide additional descriptive data. Results: The posterior cIMT data provided the best visualization and measurements to assess the presence of early risk for atherosclerosis. In this cohort of 8- to 11-year-olds, the median spectral Doppler values did not exceed the published values for these ages, nor did their systolic blood pressure. In this group, 77 (71%) were classified as having a healthy BMI. However, the posterior cIMT data were compared to published measures of pediatric cIMT values and 60 children (55%) exceeded the expected mean thickness of 0.38 mm + 0.04 on the right and 58 (53%) on the left. Conclusion: The use of spectral Doppler to assess the risk of developing atherosclerosis may not be the best diagnostic tool, based on this cohort. The measurement of cIMT has the most promise to proper classify healthy appearing 8- to 11-year-olds, for early signs of diminished cardiovascular health.

Objective: The aim of this product evaluation was to investigate the workflow and occupational health benefits of implementing augmented reality (AR) technology (MediView XR Inc, Cleveland, OH) paired with a portable ultrasound equipment system. Materials and Methods: A diverse sample of sonography users was consented and ranged in experience levels. They were asked to complete a video training session, a hands-on demonstration, and remote instruction while using the augmented reality ultrasound (AR US) system. The duration of participants’ tasks was assessed during the use of both AR US and the 2-dimensional ultrasound (2D US) system. Participants’ postures and positions were evaluated using the Rapid Upper Limb Assessment (RULA), which assessed ergonomic risk factors, linked to body position and muscle usage. Participants also completed the System Usability Scale (SUS). Finally, participants were invited to complete a qualitative interview session, regarding the use of the AR US system. Results: A total of 20 participants provided data after using both the AR US and 2D US systems. The assessment data revealed positive SUS scores, which reflected favorably on both the product, education, and the training provided. The time spent on simulated work (20 minutes), with both imaging systems, remained consistent. The Rapid Upper Limb Assessment tool (RULA) scores for the cohort indicated a lower (better) median upper body score when using the AR US system. The cohort also had a statistically significant lower median subscore for the neck, trunk, and legs, compared with 2D US ( p < 0.00). Conclusion: Although larger studies are necessary to validate these findings, this cohort identified several opportunities for integrating the AR US system. Preliminary evidence suggests that an AR US system may offer occupational health benefits, as part of the imaging workflow.

Objective: This study was designed to assess the severity of lung tissue changes due to COVID-19 in a pediatric cohort that still complained of post-COVID-19 symptoms. Materials and Methods: Parents and adolescents, 13 to 22 years old and have had a confirmatory positive polymerase chain reaction (+PCR) and/or rapid antigen test for COVID-19, consented to have a series of diagnostic tests to determine the level of lung tissue changes due to COVID-19. Sixteen adolescents completed the intake form and lung sonography. The lung sonogram was completed using the bedside lung ultrasound in emergency (BLUE) point method and a GE Logiq I laptop ultrasound system, as well as a linear 7.5-MHz or 3.0-MHz convex-array transducers. Thirteen adolescents completed a chest magnetic resonance imaging (MRI) examination on a 0.55T Siemens MAGNETOM Free.Max scanner. The examination included the heart and lungs of each participant and took about 90 minutes. A radiologist, sonographer, and computed tomography (CT) technologist reviewed and scored the images. Those positive lung sonogram scores were matched anatomically to the same slice within the chest MRI examination. Results: Based on the 13 participants, the acoustic mapping process demonstrated no diagnostic matches for positively scored sonograms at the pleural line or pulmonary parenchyma with the corresponding MRI image slices. There were diagnostic matches for negatively scored sonograms at the pleural line or pulmonary parenchyma with the corresponding MRI image slices. Conclusion: With lingering post-COVID-19 symptomology, this adolescent cohort demonstrated that acoustic mapping of their lung sonograms and chest MRI images had important combined diagnostic value. Lung sonography demonstrated diagnostic effectiveness for evaluating the periphery of the lung tissue, in this cohort but limited in viewing deeper structures. Conversely, MRI provided definitive views of the entire chest cavity and lung tissue, which is important for properly evaluating deeper pulmonary parenchyma.

Workplace violence is considered the act or threat of violence, exemplified by verbal threats and or physical threats perpetrated to an employee in the workplace. As part of the ongoing survey research being conducted, workplace violence events (WVEs), specific to sonographers and vascular technologists, were explored. These threats were further categorized based on the four types of WVE proposed by the Injury Prevention Research Center in 2001. Qualitative analysis of this survey data and voluntary comments, provided by study participants, were identified as condescending behavior, and being bullied as major workplace concerns. Further qualitative assessment of the comments resulted in identifying the added risk of Customer/client (Type 2) and Worker-on-worker (Type 3) WVEs, which are considered forms of verbal abuse. This information needs to be considered by each sonographer and vascular technologist and whether it is an issue in their workplace. In addition, a comprehensive workplace violence prevention program is advocated to address workplace incivility and promote worker health, safety, and well-being. Providing annual training is not enough, as workers need to have policies and resources readily available to address WVEs when they occur. These policies and resources should specifically address WVEs perpetrated by patients and co-workers.

As the world tackled the COVID-19 pandemic, nearly all research institutions underwent significant change, shifting from an in-person to an online landscape, resulting in several benefits and drawbacks to their research laboratories. The pandemic shut down most research efforts, and methods such as online Zoom meetings were required to keep most elements of the research and training going. In the post-COVID period, anxieties about health and safety resulted in difficulty in recruiting participants for clinical studies, and the emphasis on following health standards and guidelines (e.g., social distancing, personal protective equipment) required flexibility in research training processes. This symposium incorporates satisfaction rates and anecdotal evidence from individuals experiencing in-person and virtual research training throughout the pandemic to examine the changes and effects COVID-19 had on laboratory research. Nine traits of a high-quality research training environment (RTE), proposed in a study by Gelso et al, provide context for the subjective claims made and assist in categorizing certain traits. Both modes of research training carry benefits and drawbacks. The increase in collaboration and communication in an online space promoted several of the nine traits of an RTE. However, qualitative feedback from students suggests that the lack of training incorporating the direct operation of equipment, holding a transducer, and direct interaction was detrimental to new laboratory members and their research training. Flexibility and a combination of in-person and online training are likely necessary for an effective research environment in a post-COVID world.

Objective: Work-related injuries have a major effect on worker health and well-being. This is particularly true in sonography, where work-related musculoskeletal disorders (WRMSDs) are common. In response to the current challenge of understanding strategy implementation across social and organizational dimensions, this research captured sonographers’, echocardiographers’, and vascular technologists’ perceptions of critical administrative, organizational, and general health and training challenges, and potential solutions for improving worker health and well-being. Materials and Methods: A survey invitation was sent to the WRMSD Grand Challenge longitudinal study registry participants. Open-ended questions on the online questionnaire allowed respondents to share comments, ideas, or potential solutions to improve worker health and well-being regarding the administrative and organizational environment or through training and general health interventions. There were 377 free-text responses that were qualitatively analyzed using a grounded theory approach to generate overarching themes and identify emerging theory, supported by initial coding, focused coding, and reflexive memoing. A member check was conducted by interviewing four participants to refine and confirm the findings. Results: Five themes were identified: “Limits and Guidelines,” “Injury Education,” “Ergonomics Training Constraints,” “Resources and Equipment,” and “Individual Habits.” Participant suggestions within these themes were categorized and mapped onto a sociotechnical systems model that was developed previously to study the healthcare system(s) in which sonography users work. This conceptual mapping revealed how these solutions were situated to impact different levels of the work environment. The themes and mapping supported an emerging grounded theory: Risk Reduction Relies on Proper Employee Representation . Conclusion: These qualitative findings align with contemporary guidelines and recommendations for mitigating injuries in sonographers, illuminating challenges and solutions targeting levels of influence beyond the staff sonographers’ scope. The need for representation of sonographers at higher-level administrative levels has not heretofore been addressed by WRMSD guidelines.

Objective: This work aimed to explore how the COVID-19 pandemic affected the work of sonographers and vascular technologists. Materials and Methods: A follow-up questionnaire was sent to an established registry of ultrasonography users who opted into a longitudinal research study examining worker health and wellbeing. Multiple questions related to the general impacts of COVID-19 on sonography work practices, workload, and considerations of remaining or leaving their current job were included; responses to these questions were descriptively tabulated. Participants indicated specific changes that occurred and provided general comments related to COVID-19 impacts in two free-text questions. These comments were qualitatively analyzed by two sonographers who used an interpretive grounded theory approach to formatively code and memo the comments. Four summative interviews were conducted with participants who represented varied practice areas to gain deeper insights into the experiences expressed by the total respondent pool. Qualitative coding of the free-text responses and interview transcripts was completed independently by the two sonographers using the Sonography Work Systems (SWS) framework, and the full research team contributed to the interpretation of the findings. Results: A total of 1389 ultrasonography users completed the questionnaire. The pandemic changed the ways in which examinations were performed for approximately half of the respondents. A higher or somewhat higher workload was noted by 48% of the sample, while only 10% experienced a lower or somewhat lower workload. Components of the work system were a major concern for respondents, and a lack of support from supervisors and hospital administration was a key finding. Participants felt limited in their ability to provide care, experienced posttraumatic stress, and reported a lack of reciprocity, which were all underscored as undesirable outcomes. Conclusion: Sonographers and vascular technologists suffered negative consequences during the COVID-19 pandemic. The most marked outcome was the undesirable effects on the work system, which resulted in the need for these workers to engage in herculean efforts over a sustained period. Findings suggest that these health care heroes may have experienced physical and mental harm while trying to provide health care services, despite numerous institutional challenges.