the work of korean medical radiological technologists is divided into three areas : 
 diagnosis , treatment , and nuclear medicine1 .
the department of diagnostic radiology ( department of radiology ) is 
 in charge of general x - ray examinations , magnetic resonance imaging , ultrasonography , and 
 computerized tomography scans for conducting precise examinations of the inside of the body . 

the department of radiation oncology deals with cancer treatment , using high energy 
 radiation to kill cancer cells ; the department of nuclear medicine uses radioactive isotopes 
 with cutting - edge technologies for diagnosis and treatment of certain cancers2 . to perform these responsibilities , 
 radiological technologists are constantly required to perform physical work , such as lifting 
 adult patients who can not move adequately by themselves , pushing or pulling to move heavy 
 equipment , and continuous work with a computer keyboard or mouse3 , 4 . during these 
 activities , radiological technologists are sometimes at risk for musculoskeletal 
 disorders5 .
the acts of moving patients 
 who can not move well by themselves and pushing and pulling heavy equipment , are known to be 
 major causes of lower back pain , while the repetitive movements performed when utilizing 
 computers for functions , such as use of the picture archiving communication system ( pacs ) 
 and the order communication system ( ocs ) , are causes of upper extremity musculoskeletal 
 disorders6 . in these ways ,
the exposure 
 of radiological technologists to the risks of work - related musculoskeletal disorders can be 
 said to be increasing .
however , because awareness of occupational safety for radiological 
 technologists has been concentrated on exposure to radiation and on the necessary defense 
 against radiation exposure , the issue of safety in relation to work - related musculoskeletal 
 disorders has tended to be neglected . because the significance of work - related musculoskeletal disorders has generally come to be 
 recognized , a law was established in korea in 2005 that aims to prevention and control 
 work - related musculoskeletal disorders .
based on this legislation , physical therapists have 
 worked in different industrial fields to analyze work movements and organize educational 
 programs to prevent work - related musculoskeletal disorders .
thus , the working area of 
 physical therapists has been expanded to include this area7 .
however , data that can be utilized by physical therapists in 
 analyzing work - related musculoskeletal disorders is rarely reported , because ergonomic 
 assessment is conducted only in certain types of jobs where there is high labor intensity . 
 in general , hospitals are special workplaces in which the concept of medical personnel is 
 stronger than the concept of workers , and the concept of medical practice is stronger than 
 the concept of labor or work . however , since hospital workers are also workers who conduct 
 physical activities using their bodies , they are also exposed to the risk of work - related 
 musculoskeletal disorders . in particular ,
radiological technologists are exposed to higher 
 levels of the risks relating to musculoskeletal disorders because they are forced to use 
 inconvenient working postures due to the nature of their work , such as manually handling 
 adult patients , frequently exceeding 60  kg in weight , without any generalized mechanical 
 assistance . in these situations , they are required to adjust their own postures to 
 accommodate the positions and weights of their patients8 .
hospital workers are repeatedly exposed to the risk of work - related 
 musculoskeletal disorders , and frequently exacerbate the problem because they do not 
 recognize , or are indifferent to the problem . to prevent and effectively control 
 musculoskeletal disorders ,
the potential disorders should first be accurately diagnosed and 
 classified , and then their scales should be evaluated6 .
the aim of this study was to analyze , through ergonomic analyses , those motions most used 
 by radiological technologists that can cause musculoskeletal disorders so that the results 
 can be utilized as the basis for diagnosis , classification and prevention of occupational 
 musculoskeletal disorders in radiological technologists .
in this study , designed to assess the ergonomic risks of radiological technologists , a 
 field survey was conducted on august 1 and august 2 , 2013 , at a hospital located in 
 gangwon - do , republic of korea .
this was a university hospital in which all three areas of 
 radiological technologists work were performed .
the purpose , method , and research process of 
 the study were explained to the general manager of the department of radiology , and the 
 field survey was conducted after getting his consent .
the study s objectives and procedure 
 were explained to the study subjects , and their consent was obtained .
the study was approved 
 by the ethics committee of the kangwon national university hospital institutional review 
 board .
the work processes performed by the radiological technologists were then videotaped 
 from the left side , right side , and front so that the movements of their joints were clearly 
 visible . based on this data ,
the parts of the videotapes judged to demonstrate working 
 postures that would impose the heaviest burdens on the technologists bodies were each 
 captured and analyzed three times .
the captured working postures were assessed and analyzed using the following ergonomic 
 assessment methods : the rapid entire body assessment ( reba ) , the rapid upper limb assessment 
 ( rula ) , the national institute for occupational safety and health lifting equation ( nle ) , 
 and the strain index ( si ) .
three professors of industrial safety conducted the analysis to 
 preserve the objectivity of the study .
the professors assessed the scores through discussion 
 and analyzed the different categories of working posture .
reba was developed for the purpose 
 of analyzing the degree of exposure of the body to physical burden and the risk factors in 
 the service industries , including nursing , cleaning , and other jobs with dynamic and 
 unpredictable work postures .
different factors , including repetition , static work , working 
 postures , and duration of working hours , among others , are evaluated in relation to two 
 groups , group a ( trunk , neck , leg ) and group b ( humerus , shoulder , forearm , wrist ) , using 
 recorded video and direct observation .
reba categorizes the danger levels into 5 stages 
 using a grading system with a 15-point scale and suggests appropriate safety measures9 .
rula enables convenient and swift 
 assessment of the workload imposed by working postures by focusing on an upper limb 
 analysis , whether in assembly work , service work , meat processing , dental clinic work , or 
 video display terminal tasks , especially those involving the shoulders , wrists , neck , and 
 other upper body parts .
it divides the body parts into group a ( upper arm , lower arm , wrist ) 
 and group b ( neck , trunk , legs ) and assesses them in terms of the number of movements , the 
 static muscle work , force , and working postures as the workload parameters .
rula categorizes 
 the danger levels into 4 stages using a grading system with a 7-point scale and suggests 
 appropriate safety measures10 .
the ovako 
 working posture analysing system ( owas ) is an assessment technique developed by the ovako 
 steel company to define and assess workers working postures in relation to their 
 suitability for manual handling of heavy objects in the course of their work .
working 
 postures are considered in relation to four items : the waist , the upper extremities , the 
 lower extremities , and the weight of the object handled .
the effects of these factors on the 
 musculoskeletal system are divided into four levels , and the results are recorded11 .
the si is a method for evaluating jobs to determine whether they expose workers to 
 increased risk of developing musculoskeletal disorders of the distal upper extremity 
 ( due)12 .
the due is defined as the 
 elbow , forearm , wrist , and hand .
musculoskeletal disorders of the due include specific 
 diagnoses ( e.g. , epicondylitis , peritendinitis , tendon entrapment at the wrist or finger , 
 and carpal tunnel syndrome ) and less specific symptomatic conditions related to the 
 muscle - tendon units of the due .
the si uses six task variables to describe hand exertions : 
 intensity of exertion , duration of exertion , exertions per minute , hand / wrist posture , speed 
 of work ( how fast ) , and duration per day . among these factors
an si higher than 5 indicates the occurrence of potential 
 danger to the upper extremity .
an si below 3 indicates safety , while an si above 7 is 
 considered very dangerous .
this study was conducted to analyze the working postures of radiological technologists and 
 to utilize the results for the prevention and treatment of their musculoskeletal disorders . 
 accordingly , their postures when moving patients , when pushing or pulling an apparatus , when 
 conducting ultrasonography , and when handling a mouse for mri were analyzed .
individual 
 postures were assessed and scored according to the waist , neck , leg , shoulder , elbow , wrist , 
 wrist twisting , load , handling , and activity , and the assessment ratings were analyzed . moving a patient
was divided into a starting point and an ending point , and the postures at 
 each point were assessed . at the starting point , in both the case when the radiological 
 technologist was positioned on the right side of the patient and the case when the 
 radiological technologist was positioned on the left side of the patient , the assessment 
 rating was shown to be  improve immediately 
therefore , the work of 
 moving patients was shown to impose great burdens on the musculoskeletal system .
burdens on 
 the waist and shoulder were shown to be high , and of all the assessments , the burden on the 
 waist was shown to be the highest ( table 
 1table 1.working postures for patient liftingworking posturerisk factorrebaowasrula(rt)rebaowasrula(lt)patient lifting starting pointwaist546546neck233233leg252141shoulder ( upper arm)414414elbow ( forearm)2323wrist2222wrist twisting1201load / force233233handle33activity2121as13481248ariiiiiipatient lifting ending pointwaist546445neck233233leg252252shoulder ( upper arm)414414elbow ( forearm)2323wrist2223wrist twisting1212load / force223233handle33activity2121as13481248ariiiiiireva , rapid entire body assessment ; owas , ovako working posture analysing system ; 
 rula , rapid upper limb assessment ; as , assessment score ; ar , assessment rating ; i , 
 improve immediately ) .
reva , rapid entire body assessment ; owas , ovako working posture analysing system ; 
 rula , rapid upper limb assessment ; as , assessment score ; ar , assessment rating ; i , 
 improve immediately in assessing the posture during mouse handling for mri , the right hand and left hand were 
 assessed separately .
the assessment ratings for both the left and right hands were commonly 
 shown to be  improve soon  ( reba ) or  improve immediately  ( rula ) .
the mouse work required 
 for mri was shown to impose large burdens on the neck , the shoulder , and the wrist ( table 2table 2.mouse handling work postureworking posturesrisk factorright handleft handrebarularebarulamouse handlingwaist3434neck3535leg1111shoulder ( upper arm)4444elbow ( forearm)2323wrist2334wrist twisting1212load / force0000handle11activity2121as108108arsisireva , rapid entire body assessment ; owas , ovako working posture analysing system ; 
 rula , rapid upper limb assessment ; as , assessment score ; ar , assessment rating ; i , 
 improve immediately ; s , improve soon . ) .
the sis indicated that continuously handling a mouse with the right hand 
 placed the hand in a little in danger and that the level of risk for the left hand was 
 uncertain . in the case of the left hand ,
work done with severe flexion of the wrist and 
 without any support was shown to be particularly problematic ( table 3table 3.mouse handling work posture strain indexworking posturehand sideintensity ofexertionduration ofexertion ( % of cycle)effortsper minutehand / wristposturespeed of workduration of taskper day ( hours)si scoremouse handlingright3.00.51.51.51.51.05.06 a little dangerousleft3.00.51.02.01.01.03.00 uncertain ) .
ultrasonography work postures were assessed after dividing them into three 
 levels , from cases in which the distance between the radiology technologist and patient was 
 the shortest to cases in which the distance was the longest .
the assessment ratings for reba 
 were shown to be  should be improved  and  improve soon  and that for rula was shown to be 
  improve immediately  .
the results showed that when the distance between the radiology 
 technologist and the patient was longer , the burden on the neck and shoulder was greater 
 ( table 4table 4.ultrasonography work postureworking posturesrisk factorposture 1posture 2posture 3rebarularebarularebarulaposture 1 ( close to the patient)waist212133neck242436leg313531shoulder ( upper arm)333133posture 2 ( middle)elbow ( forearm)121223wrist122223wrist twisting121212load / force000000posture 3 ( patients with distant)handle1 - 1 - 1-activity111111as6898108arshould be improved4 .
ireva , rapid entire body assessment ; owas , ovako working posture analysing system ; 
 rula , rapid upper limb assessment ; as , assessment score ; ar , assessment rating ; i , 
 improve immediately ; s , improve soon . ) .
the apparatus pushing work posture assessed was the radiological 
 technologist s posture when pushing a heavy portable radiation apparatus to move it .
the 
 reba showed an assessment rating of  should be improved  and the rula showed an assessment 
 rating of  improve immediately  .
the load / force burdens were shown to be high ( table 5table 5.apparatus pushing working postureworking posturerisk factorrebarulapushing apparatuswaist22neck11leg22shoulder ( upper arm)22elbow ( forearm)22wrist11wrist twisting01load / force23handle0-activity11assessment score78assessment ratingshould be improvedimprove immediately ) .
reva , rapid entire body assessment ; owas , ovako working posture analysing system ; 
 rula , rapid upper limb assessment ; as , assessment score ; ar , assessment rating ; i , 
 improve immediately ; s , improve soon .
reva , rapid entire body assessment ; owas , ovako working posture analysing system ; 
 rula , rapid upper limb assessment ; as , assessment score ; ar , assessment rating ; i , 
 improve immediately ; s , improve soon .
this study was conducted to analyze the working postures of radiological technologists so 
 that the results can be utilized for the prevention and treatment of musculoskeletal 
 disorders . in this study ,
burdens on radiological technologists waists were shown to be 
 high when they were moving patients for a ct scan .
this result is supported by studies 
 indicating that the lower back pain of radiological technologists is closely related to the 
 frequency with which they assist in moving patients13 .
the table for a ct scanner is just wide enough for a patient to 
 lie on and is positioned at a height that is close to the hip joints of the radiological 
 technologists .
therefore , when moving patients , they use force after bending substantially 
 at their waists and stretching their arms out far . as the trunk is bent forward , the load on 
 the lumbar region increases markedly14 . 

in addition , since the movements are made in the limited space of the ct scan room and the 
 height of the table is fixed , the radiological technologist can not take up a position that 
 would distribute his or her weight to the lower extremities .
therefore , these movements can 
 be understood to impose large burdens on the waist . as a measure to prevent the 
 musculoskeletal disorders that can occur when moving patients , making the height of the 
 table that the patient lies on adjustable so that the radiological technologists can also 
 use their lower extremities when moving heavy patients and thereby distribute the force to 
 their lower extremities
although there are diverse causes of lower back 
 pain , manual transporting work , such as pushing , pulling , transporting , loading , and 
 unloading , is an important cause15 . 

workers who are to engage in handling heavy objects should be adequately educated and 
 trained in correct methods for lifting heavy objects , methods for lowering , methods for 
 moving , methods for loading , working postures , exercises to prevent lower back pain , and 
 other working methods before they are assigned to work in order to prevent lower back 
 pain16 .
this education and training 
 should also be provided to radiological technologists to prevent lower back pain in them . in 
 addition , habituation to the use of movement assistance systems , such as the easy - trans used 
 when moving from sitting postures on a wheelchair or chair to a bed or when moving from a 
 bed to a wheelchair , can also be a good way to reduce the burden on the waist and lower 
 back .
the assessment of postures during mouse handling for an mri scan showed that large burdens 
 were imposed on the neck , shoulder , and wrist .
repetitive keyboard entries , continuous 
 movements in fixed postures ( static posture ) , inappropriate working postures , and prolonged 
 periods of work cause pain in the neck , shoulder , elbow , wrist , and fingers , together with 
 health hazards , such as numbness and tingling . among hospital workers , radiological 
 technologists show a high incidence of vdt syndrome , thereby supporting this study result
. 
 therefore , to prevent not only vdt syndrome2 but also musculoskeletal disorders , a mouse pad with a wrist rest 
 should be used for the right hand , and a support should be prepared for the left arm . in the case of ultrasonography working postures , larger burdens on the leg and neck were 
 found when the patient s examination sites were located further away and the radiological 
 technologist s upper extremities and arms were stretched further out . while maintaining a 
 constant pressure , the radiological technologist is required to stretch his upper 
 extremities out far while watching the computer monitor of the ultrasonography equipment . 
 due to this position , when the patient s examination sites are located further away , the 
 neck and trunk must be twisted further , thereby increasing the burden on the neck . 

therefore , the location of both the ultrasonography equipment and the patient should be 
 arranged appropriately , and the computer monitor for the ultrasonography equipment should be 
 situated at an appropriate level .
the assessment of working postures when pushing a portable 
 radiation apparatus showed that burdens on the musculoskeletal system increased as the 
 weight of the apparatus being pushed by the radiological technologist increased .
therefore , 
 measures to reduce the weight of portable radiation apparatuses should be sought . among the 
 radiological technologists in the department of diagnostic radiology
the largest number of them reported pain in the lower extremity , followed by pain in the 
 shoulder , hand , wrist , waist , neck , and elbow in order of precedence , and a higher ratio of 
 females reported symptoms compared with males17 . in a study conducted by lee jin et al .
, symptoms appeared most 
 frequently in the shoulder , followed by the waist , neck , and leg / foot in order of 
 precedence , and a slightly higher degree of fatigue was shown .
the present study also showed 
 that risks to the shoulder and waist were high , while the risks to the wrist and leg 
 appeared to be highest , as was shown in the study of lee13 .
although some differences were shown between the present study and 
 a study conducted by kim , the differences are considered attributable to the fact that the 
 study conducted by kim was limited to radiological technologists .
radiological technologists are stressed due to the high tension of their work , and the 
 muscles , blood vessels , and nerve tissues in their necks , shoulders , arms , hands , waists , 
 legs , and knees are damaged or affected by their hard physical work , such as standing for 
 most of their working hours , repetitive movements including waist flexion , and helping 
 patients to move , together with static motions4 .
although the musculoskeletal disorders of radiological 
 technologists occur in various regions of their bodies , they occur most frequently in the 
 shoulder and the lumbar region
. however , as the issue of occupational safety of radiological 
 technologists has been focused on possible exposure to radiation and defense against 
 radiation exposure , the issue of safety in relation to work - related musculoskeletal 
 disorders has been neglected , and education and interest regarding the prevention of 
 musculoskeletal disorders has been insufficient .
therefore , hospitals need to be educated 
 regarding the concept of musculoskeletal disorders , and this needs to followed by education 
 regarding prevention through use of correct working postures , exercise methods for 
 radiological technologists .
 [ purpose ] the aim of this study was to analyze , through ergonomic analyses , those motions 
 most used by radiological technologists that can cause musculoskeletal disorders . 
 [ subjects and methods ] the subjects were 7 radiological technologists with work experience 
 in hospitals for more than 5  years . for the analysis of working postures , we simulated the 
 work posture of radiological technologists when moving patients , when pushing or pulling 
 an apparatus , when conducting ultrasonography , and when handling a mouse for mri were 
 analyzed . 
 [ results ] in this study , the burdens on the radiological technologists waists 
 were shown to be high when they were moving patients for a ct scan . during mouse handling 
 for an mri scan , 
 large burdens were imposed on the neck . in the case of ultrasonography 
 working postures , larger burdens on the leg and neck were found when the patient s 
 examination sites were located further away . 
 the assessment of working postures when 
 pushing a portable radiation apparatus showed that burdens on the musculoskeletal system 
 increased as the weight of the apparatus increased . 
 [ conclusion ] the musculoskeletal 
 disorders of radiological technologists occur in various regions of their bodies but occur 
 most frequently in the shoulder and the lumbar region . 
 therefore , hospitals need to be 
 educated regarding the concept of musculoskeletal disorders . 