Ergonomic considerations are very important. The majority of respondents performed ERCP in areas with poor ergonomic design. Early endoscopy literature recommended using a fluoroscopy table with an adjustable height and the ability to tilt laterally. We agree with this recommendation and also suggest that video and fluoroscopy monitors should be placed side by side at a height such that the operators’ eyes are three-quarters of the way up the screen (Figure 3) to minimize eye strain and unnecessary neck torsion. Similar recommendations have been validated by the Health and Safety Guidelines for Computer Use developed by the Massachusetts Institute of Technology. Also, ERCPs are often performed in cramped radiology facilities. Improved ergonomic design maximizes space and promotes proper posture. Finally, antifatigue matting should be used when endoscopists perform several ERCPs in succession. This floor padding reduces pressure on the spine during prolonged standing and delays the fatigue process of muscles.
Figure 3) Optimal design of endoscopic retrograde cholangiopancreatography facilities. F Fluoroscopy screen; N Nurse; O Operator; V Video screen
Among the strategies to prevent musculoskeletal injures, particularly low back injuries, ergonomic job design is considered to be the most effective means of prevention.
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We did not assess disability claims among the respondents, and presumably physicians who have been significantly injured would no longer perform ERCP. We did not assess and are unaware of any legal actions against hospitals in Canada regarding ERCPs.