Long Radiology Workdays Reduce Detection and Accommodation Accuracy

Abstract

Purpose: To measure diagnostic accuracy of fracture detection, visual accommodation, reading time, and subjective ratings of fatigue and visual strain before and after a day of clinical reading. Methods:Forty attending radiologists and radiology residents viewed 60 de-identified HIPAA compliant bone examinations, half with fractures, once before any clinical reading (Early) and once after a day of clinical reading (Late). Reading time was recorded. Visual accommodation (ability to maintain focus) was measured before and after each reading session. Subjective ratings of symptoms of fatigue and oculomotor strain were collected. The study was approved by local IRBs.Results: Diagnostic accuracy was reduced significantly after a day of clinical reading, with average receiver operating characteristic (ROC) area under the curve (AUC) of 0.885 for Early reading and 0.852 for Late reading (p < 0.05). After a day of image interpretation, visual accommodation was no more variable, though error in visual accommodation was greater (p < 0.01) and subjective ratings of fatigue were higher. Conclusions:After a day of clinical reading, radiologists have reduced ability to focus, increased symptoms of fatigue and oculomotor strain, and reduced ability to detect fractures. Radiologists need to be aware of the effects of fatigue on diagnostic accuracy and take steps to mitigate these effects.

Automated Detection, Localization, and Classification of Traumatic Vertebral Body Fractures in the Thoracic and Lumbar Spine at CT

“…These classification systems are based on detailed morphologic data from patients' imaging studies; they affect treatment decisions for intervention versus conservative treatment and guide decision making for surgical approach and optimal fixation interval (4,(13)(14)(15). Classification of spine fracture patterns into these sometimes complex schemes can be a time-consuming task, resulting in additional work for the radiologist in this era of commensurately increasing workloads and study complexity (16,17). An example of a complex injury classification schema is the Magerl-AO (Arbeitsgemeinschaft für Osteosynthesefragen) system, with 53 potential categories for assignment of the detected vertebral fracture pattern (18).…”

The Insidious Problem of Fatigue in Medical Imaging Practice

“…These increasing work demands on the radiologist community have likely contributed to increased visual fatigue [29]. A number of technical factors have also been reported to contribute to visual fatigue including workstation design, monitor resolution, brightness and contrast, image refresh rates, screen flicker and glare, and working distances and angles [12].…”

Real-Time Occupational Stress and Fatigue Measurement in Medical Imaging Practice

“…After a day of image interpretation, error in visual accommodation was greater (p<0.01) and subjective fatigue ratings were higher. We concluded that after a day of clinical reading, radiologists have reduced ability to focus, increased symptoms of fatigue and oculomotor strain, and reduced ability to detect fractures [29].…”