Susan Murphey

Susan L. Murphey is the founder and president of Essential WorkWellness (www.essentialworkwellness.com), an ergonomic and practice management consulting company. Susan is a 30 year veteran of the ultrasound industry, having practiced sonography for many years before transitioning to an active role as an ergonomics expert. During the past decade, Susan has played a key role in ergonomic consulting, training and product development, mainly within ultrasound. Susan is widely published and frequently interviewed as an industry expert; she now consults on workplace ergonomics throughout the healthcare field.

How did you transition from sonography to ergonomics consulting?
It’s actually a convoluted history! I worked in physical therapy before going into ultrasound. Then, about 12 years ago, I started a company called Sound Ergonomics, and our main focus was initially ergonomic education and training for sonographers. However, it quickly became clear that folks were also looking for equipment to reduce injury risk and just didn’t have the time to research what was out there. Then we discovered that good solutions to some problems just didn’t exist, so we started down the product development path. Eventually, we became focused on equipment. Our work made a very big impact, but it was very different than what we started out as.

Why did you start your newest company?
About four years ago, I sold my interest in Sound Ergonomics and started Essential WorkWellness, to get back to my original roots in consulting, education and training. I also expanded to include all healthcare fields. This has been a really valuable experience for me, and it’s allowed me to be more effective within the supply chain. For example, the beds and stretchers that hospitals use to transport patients can be an important issue for the ultrasound department. By being involved with the facility, I can identify those kinds of issues and influence decisions made to address them. It’s expanding the knowledge of the whole group, not just the ultrasound department and increasing what I can offer clients.  

How do you approach fixing ergonomic problems in the workplace?
The way I approach fixing ergonomic problems in the workplace has changed significantly. When I started the new company, I spent time researching different types of adult education and ways to engage workers in the process. Now, when I work with sonographers, I provide them with tools to develop solutions to the problems they are encountering at work. This gives them ownership of the problem and the solution, and gives them a platform for solving new challenges. Six months after I leave, there may be a new exam or a new piece of equipment that causes problems, and this way, they’ll have the problem solving tools to address it themselves. With this approach, I’ve seen an incredible transformation within departments, to truly embracing a culture of safety.

How do workplace ergonomic policies affect sonographers?
We all work better when we’re not in pain – there’s less mental and physical fatigue, more job satisfaction and better productivity. For sonographers, the numbers of injuries are rising despite the attention this issue has gotten in the last 10-15 years. There’s a lot individuals can do to improve their comfort, but a comprehensive approach with the commitment of management and input from workers is needed. This kind of comprehensive approach develops a process for ongoing safety and positively affects job satisfaction and quality of work.

I think new, national policies are needed that require an injury avoidance policy to be in place for sonographers. It’s fabulous that bodies like ICAVL and ICAEL have instituted such rules. It gives managers leverage to make changes in the work environment.

What is your best ergonomic advice for sonographers?
The number one tip I can give sonographers is to constantly be aware of where your body is in space and what pain signals it is sending you. It sounds so elementary, but you are distracted by so many other things while scanning. It’s easy not to notice that your neck is killing you and has been killing you all day. If you can gain that awareness of what posture you’re in and what your body is telling you, then you can start to make adjustments and really transform things. Often, people just aren’t aware of what posture they’re in or they’ve been scanning that way so long that it doesn’t seem odd. This leads to masking of pain signals. If you can conquer that and recognize what needs to change, you can come up with an individualized solution.

How has the presence of ergonomics in sonography training programs changed over your career?
When I first started, students would learn ergonomic technique in the classroom, but it was often contradicted at their clinical sites. The clinical instructors would actually correct the students into more traditional postures that can cause injury over the long-term. All the ergonomics training would go out the window. That isn’t happening as much anymore because students, academic and clinical instructors and practitioners are so much more aware of the effects of poor ergonomics. 

What do you see in the near future of healthcare ergonomics?
The downturn of the economy has resulted in a big shift of focus within hospitals, and the industry has to look more carefully at fiscal responsibility. Any department with large numbers of injured employees is being pressured to correct the problem. According to recent surveys, 90% of sonographers are in pain and more than 1/3 of sonographers are over the age of 50. With those conditions, how are institutions going to fill staffing needs? I think we’ve got the perfect storm here in a lot of ways, and the time has come to address it.

Ultrasound departments are going to need to make policy and procedure shifts to address their high rates of injury. We’ve prompted a great deal of change on the individual level and in academic venues, and manufacturers have made equipment changes to promote ergonomics. It’s time to take a more global approach and really build awareness of ergonomics into the management aspect of the healthcare industry. Ergonomics should be a consideration in all aspects – from organizational planning and purchasing to individual departments. We’re at the point where we cannot ignore these issues anymore, because they are too expensive not to fix. It’s no longer a viable option not to address workplace ergonomics in healthcare.

Terry DuBose

Terry J. DuBose, MS, RDMS, FSDMS, FAIUM, has recently retired from his post as Director of the Diagnostic Medical Sonography Division at the University of Arkansas for Medical Sciences (UAMS). He has relocated from Little Rock, Arkansas, to Austin, Texas.

How did you become interested in the field of sonography?

I had a BS in Business Administration, and after I came back from Vietnam, I spent two years protesting the Vietnam War fulltime. When I decided I wanted to get into health services, I went to a career counselor at the Texas Hospital Association. He looked at my background, which included photography and silk screening, and recommended radiography. I entered school, and then went to work at Seton Hospital. I heard about ultrasound (sonography now) from some colleagues who had been at the University of California and started requesting the hospital buy a machine. When the first sonographic machine in Austin showed up, I was on the loading dock. They basically put me in a cubicle in ICU and told me to figure it out. I got a text book, Sample and Sarti, and started scanning myself until I could duplicate the liver and gallbladder in the book. I was doing special procedures at the time, and I began doing more and more sonography. 1979 was the last time I took an X-ray.

What are the most significant technological advances you’ve seen over the course of your career?

I think there were really three that were the greatest sonographic advances. The first is real-time, and the second is color Doppler and spectral Doppler integration, and the third is 3D.

What do you expect to see over the next 10 years?

I think that image fusion, integrating sonography with CT and MRI, and the use of 3D will continue to develop. 3D imaging is an interesting case of a solution in search of a problem.  3D images of a baby’s face help a lot when communicating a diagnosis to parents, especially in case of something like a cleft palate. But diagnostically, we can see that with 2D. Volumetric studies will lead to great advances in estimating fetal cranial volume and age. Also, the fetal liver volume will tell us more about maternal diabetes and fetal responses. Luis Gonçalves has done fetal heart reconstruction using power Doppler with 3D acquisition and then inversion, so you only see the blood flow of the fetal heart and great vessels, and you’re able to rotate in real time while viewing the beating. Refined, this will gives us incredible views of the fetal heart. We’re doing things we couldn’t do before, and sonography  is better for the fetus than MRI and CT.

What has been your most rewarding or memorable experience in sonography?

Getting the Kenneth Gottesfeld Award for published research in 1985 from the Journal of Diagnostic Medical Sonography gives me the most satisfaction. Frank Hadlock and Larry Waldroup were the peer reviewers on that article. However, it is also one of the most frustrating experiences, because we are still not using 3D imaging to get measurements of the fetal cranium to calculate fetal age.

Do you have any advice for new sonographers?

Definitely go to an accredited program for your education because you will get the proper clinical education. Realize that this will be a lifelong learning situation, because the sonographic instrumentation is advancing rapidly, and you will always be learning something new.

What do you plan to do with your retirement?

UAMS made me an Associate Professor Emeritus, so I’ll still teach one course a semester online – at least until they decide they’re tired of me! I have relocated back to Austin, Texas and will play with my grandchildren.

Dr. Thierry de Baere, MD

Thierry de Baere, MD, is head of the Department of Interventional Radiology at the Institut Gustave Roussy in Villejuif, France. Dr. de Baere has practiced interventional radiology for 19 years, with a focus in oncology. His main interests are tumor ablation, portal vein embolization, intra-arterial therapies and digestive tract intervention. In addition, he is a reviewer for JVIR, CVIR, Radiology and European Radiology.

When and how did you become interested in the field of interventional radiology and radiofrequency treatment?

About 19 years ago, in 1990, I became interested in interventional radiology, and in 1997, we started treating with radiofrequency.  This is really the only treatment for small tumors outside of surgery, and with radiofrequency, we can treat patients who are poor surgical risks. Patients with poor lung function or poor kidney function can be treated and cured, and they might not have been eligible for surgery.

What do you consider the most rewarding aspects of your career?

We are able to cure patients with minimal side effects — patients are cured without scars, without going through chemotherapy.

What has been the most challenging part of your career?

Dealing with cancer every day, in a cancer center, makes it common place for you, but it’s a unique and difficult situation for every patient that you treat. It can make it a bit strange, because it is common to you but uncommon to your patients.

What do you find significant about radiofrequency ablation as compared to other types of treatments?

The side effects of radiofrequency ablation are much less difficult to deal with than other treatments, and it requires less time on the patient’s part — you can go in one day and go out the next. The tumor is completely ablated in one treatment, and there is no other treatment like that. With surgery, you will be in the hospital for days and recovering at home after that; chemo and radiation both require multiple courses.

What technological changes do you expect in the field over the course of the next 10 years?

First, I expect continued improvement in image-guidance. Over the last 15 years, we’ve seen faster image acquisition and better quality plus image fusion. The quality is boosted every year. Second, we’ll see improvement in the tools we’re using for ablation and new drugs dedicated to local delivery.