This cross-sectional study showed that keyboard typing and the use of handheld dictation devices were the most common methods used by radiologists to generate radiology reports; nearly 50% of the participants in this study reported using handheld dictation devices. Radiology residents and particularly those with limited years of experience were least likely to use handheld devices to generate radiology reports. We first postulated that this may be attributed to the limited availability of such handheld dictation devices within institutions and limited access to such devices for radiologists. However, we performed sensitivity analyses in the two largest hospitals within our study region, wherein all radiologists had unrestricted access to handheld dictation devices. Interestingly, the sensitivity analyses confirmed our original findings.
In our view, radiologists with limited experience are unfamiliar with the use of dictation devices for report documentation and prefer the conventional and familiar method of keyboard typing. Dictated audio files can be transcribed manually or using speech recognition technology, which involves automatic conversion of spoken voice into digital text. Traditionally, a transcriptionist listens to the voice-recorded report and transcribes the audio recording to create a text file. This preliminary document is rechecked by the radiologist to approve the final version of the report. This process often causes significant delays in delivering the final report to the referring clinician. While this manual transcription method is considered obsolete in the current practice, it is still being used in a limited number of institutions in the surveyed region.
Speech recognition technology has been used for radiology reporting since 1981 . Technological innovations in continuous speech recognition software that offers high accuracy have led to the widespread use of this technology in radiology reporting and overall medical documentation . Speech recognition technology exhibits a learning curve and its use requires training. Reports generated by experienced users need minimal editing because the error rate in such reports is lesser than that in reports generated by new/inexperienced users who require greater time and effort to edit and proofread documents . This technical difficulty could explain why radiology residents do not usually prefer this method for report generation. However, several studies have reported that speech recognition technology reduces the documentation time and cost and report turnaround time [16–18].
In our cohort, a small number of radiologists reported providing handwritten radiology reports. This finding was expected as the majority of hospitals in the surveyed region utilized electronic records almost universally for their medical services. Hence, the low rate of radiologists handwriting reports does not necessarily reflect a low preference of radiologists for this method since they are mandated to document reports electronically. The use of handwritten radiology reports is technology-independent and perceived as cost-effective, and may be more timely than other alternatives. Moreover, handwritten documentations are sometimes illegible, which can result in misdiagnosis and complications, and are susceptible to loss. Furthermore, handwritten documentations cannot be electronically analyzed, and do not facilitate efficient information sharing .
Additionally, this study demonstrated a high prevalence (70.7%) of musculoskeletal symptoms among radiologists. This observation is consistent with previous studies that reported similar findings [5 7 20]. The most commonly affected regions were the lower back and neck. Although such complaints are common among the general population and are thus not easily attributed to the occupational environment alone, they are probably related to the prolonged sitting times of radiologists . Consistent with the results of a previous study among radiologists , we found that more than half of the participants spent 7–9 hours a day working in front of computers, interpreting and reporting imaging findings. In this study, we considered the symptoms present among radiologists in the last seven days preceding the survey, as this could provide more reliable information and minimize memory recall bias.
Robertson et al. conducted an analysis of the work environment of radiologists and demonstrated that the typical work of radiologists involved complex, prolonged pointing and handheld device activities . The study also found that, in comparison to non-radiologists, radiologists spent more time using a mouse (69% vs. 42%) and less time using a keyboard (2% vs. 22%) during PACS-related activities. The researchers suggested that the use of alternative input devices and hands-free dictation systems could minimize the repetitive movements of radiologists and improve the safety of their work environment during the interpretation of radiological images in PACS. In our study, because of the limited number of radiologists who use headphone dictation, we could not evaluate the effect of hands-free dictation devices on the prevalence musculoskeletal symptoms.
It is essential for radiologists to pay careful attention to ergonomic factors of their work environment. It has been demonstrated that the use of ergonomic devices and ergonomic training can help in reducing the susceptibility to work-related musculoskeletal symptoms . Good ergonomic knowledge is of paramount importance. A previous study reported that radiologists with good ergonomic knowledge experienced significantly less lower back pain than did those with poor knowledge .
The current study is the first to investigate the association between methods used to generate radiology reports and musculoskeletal symptoms among radiologists. Moreover, our study included all hospitals in major cities of the Eastern Province, which is the largest governorate in Saudi Arabia. However, the present study has certain limitations. The musculoskeletal symptoms were self-reported. Although self-reports enable convenient and quick collection of data, they may also introduce bias such that those who experienced musculoskeletal symptoms were more likely to respond than those who did not. In addition, the present study was a cross-sectional survey; therefore, causality could not be assessed directly. Furthermore, complaints of musculoskeletal symptoms are common in the general population, and a comparison group would have enabled a more accurate evaluation of work-related musculoskeletal symptoms among radiologists. Lastly, the study did not explore the reasons for using the methods available to generate the radiology reports.