Does the time of day or weekday affect screening accuracy?

Elsheikh, Tarik M.; Kirkpatrick, Joseph L.; Fischer, Dan; Herbert, Kristi D.; Renshaw, Andrew A.

doi:10.1002/cncy.20060

Cited by 31 publications

(6 citation statements)

References 15 publications

(17 reference statements)

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“…Extensive studies have explored the adverse outcome of later time of day on clinical performance in other domains, such as increasing omission errors and false positives among radiologists and decreasing abnormal cytology detection rates on gynecologic cytology samples among cytotechnologists. 18,19 Radiologists reported eyestrain and blurred vision with an increased number of images read. They hold an opinion that time day significantly impacts reading competence-related cognitive functions.…”

Section: Discussionmentioning

confidence: 99%

Assessment of the Role of Artificial Intelligence in the Association Between Time of Day and Colonoscopy Quality

Zhang

Yao

et al. 2023

JAMA Netw Open

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ImportanceTime of day was associated with a decline in adenoma detection during colonoscopy. Artificial intelligence (AI) systems are effective in improving the adenoma detection rate (ADR), but the performance of AI during different times of the day remains unknown.ObjectiveTo validate whether the assistance of an AI system could overcome the time-related decline in ADR during colonoscopy.Design, Setting, and ParticipantsThis cohort study is a secondary analysis of 2 prospective randomized controlled trials (RCT) from Renmin Hospital of Wuhan University. Consecutive patients undergoing colonoscopy were randomly assigned to either the AI-assisted group or unassisted group from June 18, 2019, to September 6, 2019, and July 1, 2020, to October 15, 2020. The ADR of early and late colonoscopy sessions per half day were compared before and after the intervention of the AI system. Data were analyzed from March to June 2022.ExposureConventional colonoscopy or AI-assisted colonoscopy.Main Outcomes and MeasuresAdenoma detection rate.ResultsA total of 1780 patients (mean [SD] age, 48.61 [13.35] years, 837 [47.02%] women) were enrolled. A total of 1041 procedures (58.48%) were performed in early sessions, with 357 randomized into the unassisted group (34.29%) and 684 into the AI group (65.71%). A total of 739 procedures (41.52%) were performed in late sessions, with 263 randomized into the unassisted group (35.59%) and 476 into the AI group (64.41%). In the unassisted group, the ADR in early sessions was significantly higher compared with that of late sessions (13.73% vs 5.70%; P = .005; OR, 2.42; 95% CI, 1.31-4.47). After the intervention of the AI system, as expected, no statistically significant difference was found (22.95% vs 22.06%, P = .78; OR, 0.96; 95% CI; 0.71-1.29). Furthermore, the AI systems showed better assistance ability on ADR in late sessions compared with early sessions (odds ratio, 3.81; 95% CI, 2.10-6.91 vs 1.60; 95% CI, 1.10-2.34).Conclusions and RelevanceIn this cohort study, AI systems showed higher assistance ability in late sessions per half day, which suggests the potential to maintain high quality and homogeneity of colonoscopies and further improve endoscopist performance in large screening programs and centers with high workloads.

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Section: Discussionmentioning

confidence: 99%

Assessment of the Role of Artificial Intelligence in the Association Between Time of Day and Colonoscopy Quality

Zhang

Yao

et al. 2023

JAMA Netw Open

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“…Although a majority of the literature illuminating the effects of cytotechnologist fatigue on the processing of cytopathology specimens is in the setting of cervical smear samples, the processing of FNA samples is similar and may hold true. [ 14 15 ] Some studies have reported cytology failure rates of as high as 31% due to cytotechnologist fatigue. [ 18 ] It is difficult to separate the endoscopist's fatigue from cytological technician's failure since the two are so intertwined in EUS-FNA.…”

Section: Discussionmentioning

confidence: 99%

“…[ 13 ] Recent reports have indicated that the time of day and the workload of the cytotechnologist impact the detection rate of abnormal cytology on gynecologic cytology samples, with more abnormal results being detected from morning samples as compared to evening samples and from samples taken later in the week when compared to those obtained earlier in the week. [ 14 15 ] Operator fatigue has not been previously examined in relation to the diagnostic accuracy of EUS-FNA. The objective in this study was to explore our institution's experience with EUS-FNA of solid pancreatic masses to elucidate if the procedure time or queue position has an impact on the overall performance characteristics.…”

Section: Introductionmentioning

confidence: 99%

Effect of the time of day and queue position in the endoscopic schedule on the performance characteristics of endoscopic ultrasound-guided fine-needle aspiration for diagnosing pancreatic malignancies

et al. 2016

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Background and Objectives:Recent reports have indicated that the time of day may impact the detection rate of abnormal cytology on gynecologic cytology samples. The aim of this study was to determine if procedure time or queue position affected the performance characteristics of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) for diagnosing solid pancreatic malignancies.Patients and Methods:We conducted a retrospective study evaluating patients with solid pancreatic lesions in whom EUS-FNA was performed. Three timing variables were evaluated as surrogate markers for endoscopist fatigue: Procedure start times, morning versus afternoon procedures, and endoscopy queue position. Statistical analyses were performed to determine whether the timing variables predicted performance characteristics of EUS-FNA.Results:We identified 609 patients (mean age: 65.8 years, 52.1% males) with solid pancreatic lesions who underwent EUS-FNA. The sensitivity of EUS-FNA was 100% for procedures that started at 7 AM while cases that started at 4 PM had a sensitivity of 81%. Using start time on a continuous scale, each elapsed hour was associated with a 1.9% decrease in EUS-FNA sensitivity (P = 0.003). Similarly, a 10% reduction in EUS-FNA sensitivity was detected between morning and afternoon procedures (92% vs. 82% respectively, P = 0.0006). A linear regression comparing the procedure start time and diagnostic accuracy revealed a decrease of approximately 1.7% in procedure accuracy for every hour later a procedure was started. A 16% reduction in EUS-FNA accuracy was detected between morning and afternoon procedures (100% vs. 84% respectively, P = 0.0009). When the queue position was assessed, a 2.4% reduction in accuracy was noted for each increase in the queue position (P = 0.013).Conclusion:Sensitivity and diagnostic accuracy of EUS-FNA for solid pancreatic lesions decline with progressively later EUS starting times and increasing numbers of procedures before a given EUS, potentially from endoscopist fatigue and cytotechnologist fatigue.

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“…The screening time for each slide (including any reviews by the supervisor) and the maximum workloads per cytologist considered in our study, based on those in the international literature [31,32,33,34,35,36,37,38], are shown in table 1. Fully automatic computer-assisted screening reduced the time of conventional cytology by 64% and of LBC by 40%.…”

Section: Resultsmentioning

confidence: 99%

Health Technology Assessment of Computer-Assisted Pap Test Screening in Italy

Palma

Moresco²,

Rossi³

2013

Acta Cytologica

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Objective: To assess the introduction of computer-assisted Pap test screening in cervical cancer screening. Various scenarios are considered: conventional and liquid-based cytology (LBC) slides, fully automatic instrumentation (Becton Dickinson FocalPoint™ Slide Profiler and Hologic ThinPrep® Imaging System), and semiautomatic scanner (Hologic Integrated Imager I-Squared). Methods: A working group was formed that included researchers from the largest centers already using instrumentation. A questionnaire on laboratory management and on social/ethical issues and annual workload was proposed. Prices for the technology were obtained directly from the producers; costs were calculated from observed and literature data. The scope of the report and final draft were submitted to a consulting committee of stakeholders. Results: The break-even point was found to be 49,000 cases/year, if conventional slides were used, while it was near the theoretical maximum capacity, 70,000 cases/year, with LBC slides. Efficiency increased with the volume of slides. Screening time decreased by two thirds for conventional slides and by less than half for LBC slides. Acceptance of the instrumentation by the users was good. Conclusions: Computer-assisted screening may increase productivity even if in most situations it will mean additional costs. Furthermore, primary screening with human papillomavirus tests will drastically reduce the need for Pap test reading.

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Does the time of day or weekday affect screening accuracy?

Cited by 31 publications

References 15 publications

Assessment of the Role of Artificial Intelligence in the Association Between Time of Day and Colonoscopy Quality

Assessment of the Role of Artificial Intelligence in the Association Between Time of Day and Colonoscopy Quality

Effect of the time of day and queue position in the endoscopic schedule on the performance characteristics of endoscopic ultrasound-guided fine-needle aspiration for diagnosing pancreatic malignancies

Health Technology Assessment of Computer-Assisted Pap Test Screening in Italy

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