an important role in
imaging to help
diagnose patients with injuries or
illnesses. However, the repetitive
actions needed to scan patients
manually with an ultrasound probe
often lead to chronic joint injuries
in the radiographer’s shoulder, neck
and wrist, as well as back pain.
Take Ms Kho Ying Ying (below), Senior
Principal Radiographer, Singapore
General Hospital (SGH), for
example. Ms Kho uses a range of
ultrasound probes and different
manoeuvres to obtain images of
diagnostic quality to aid in patients’
diagnosis. Some ultrasound
examinations can be challenging
— for instance, portable scans,
transvaginal scans and scanning
patients with high body mass index
(BMI) — where she has to assume
awkward postures during the scan,
stretching her arm to ensure that
patients and the equipment are in
the right position, thereby
putting herself at risk of
The main causes of WRMSDs
include awkward postures or improper positioning during
scanning, repetitive scanning
motions using force, and long
durations of gripping.
“After performing a series of
technically challenging cases, my
arm is stretched out, and I can
feel the strain on my shoulder
and arm,” said Ms Kho.
To minimise such injuries, a
team of physiotherapists and
radiographers from SGH and
Sengkang General Hospital (SKH)
have utilised a robotic arm, which
acts as the radiographer’s ‘arm’
to hold and move the ultrasound
probe when scanning patients.
Known as ROBUST (Robotic
Assisted Ultrasonography System),
this technology was developed
with the help of robotic
“ROBUST can lessen the strain
on radiographers who previously
had to hold the probe and stretch
over the patients when doing the
scans,” said Professor Celia Tan (below),
Senior Director (Special Projects),
SingHealth, and the Principal
Investigator of the project team.
“A sonographer or radiographer
performing ultrasound scans would
have to see about 15 patients a day. The repetitive movements
throughout the day can cause
muscle injuries or WRMSDs. With
ROBUST, the scan can now be
done using a robotic arm holding
the ultrasound probe instead,”
said Prof Tan.
For ultrasound radiographers
like Ms Kho, her work can be
less strenuous with ROBUST, as
she manipulates the mouse to
move the robotic arm to perform
ultrasound scans for the liver,
gall bladder, kidneys, spleen
and pancreas over the patient’s
By leveraging robotic
technology, the team believes
that they have found a modern
innovative solution to the age-old
problem of WRMSDs.
“The robot arm is already
available commercially. It is
used in other manufacturing
industries for physically laborious
work, such as packing and car
assembly. However, this is the
first time it is used in a healthcare
setting,” Prof Tan said.
A physiotherapist by training,
Prof Tan said that the hospitals have seen an increase in the number
of ultrasound scans performed in the
last few years, which puts ultrasound
radiographers at a higher risk of
over-exertion and injury.
In 2019, there were an average
of 695 and 194 ultrasound scans
performed in SGH and SKH
respectively per week. This has
increased by 53 and 32 scans
respectively per week in 2020.
Prof Tan said that they
received many positive feedback
from radiographers and patients
following a recent trial on the use
of ROBUST at SGH and SKH.
“With ROBUST, the efficiency
of capturing diagnostic quality
images is not compromised in
comparison to conventional scans.
The radiographers also felt it was
less strenuous on them to use the
mouse, compared to physically
stretching over the patient to hold
the probe,” she added.
Patients who had participated
in the trial felt that the pressure
exerted by the robotic arm was
acceptable and they did not feel
Although some shared that the
use of the robotic arm seemed
intimidating at first, they were
reassured as the radiographer was
seated next to them throughout
the scanning process, ensuring that
the procedure is executed safely.
“Some patients still prefer the
human touch when undergoing
a scan, but most of them are
accepting of the robotic arm,”
said Ms Kho. “Those who have
undergone the scan with the
robotic arm are willing to repeat
the experience in future scans.”
In addition, ROBUST can also
reduce the risk of any infection
exposure by ensuring safe distance
between the radiographer and
The future of ROBUST
The ROBUST study was awarded
more than $1.3 million in 2017
from the MOH Ageless Workplaces
Innovation Grant under the
National Innovation Challenge on
Active and Confident Ageing.
The project team is currently
in discussions with a local
robotic solutions company
to commercialise the system,
and plans to roll it out in other
SingHealth institutions and
hospitals from 2023 onwards.
More projects are being
explored to programme the
robot arm to scan autonomously in
the future. Such devices can lower
the risk of work injuries or fatigue,
and even allow senior staff to
continue in this area of work.
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