The Impact of Fatigue on Satisfaction of Search in Chest Radiography

Abstract

Purpose To assess the nature of the satisfaction of search (SOS) effect in chest radiography when observers are fatigued; determine if we could replicate recent findings that have documented the nature of the SOS effect to be due to a threshold shift rather than a change in diagnostic accuracy as in earlier film-based studies. Materials and Methods Nearing or at the end of a clinical workday, 20 radiologists read 64 chest images twice, once with and once without the addition of a simulated pulmonary nodule. Half of the images had different types of “test” abnormalities. Decision thresholds were analyzed using the center of the range of false positive (FP) and true positive (TP) fractions associated with each Receiver Operating Characteristic (ROC) point for reporting test abnormalities. Detection accuracy was assessed with ROC technique and inspection time was recorded. Results The SOS effect was confirmed to be a reduction in willingness to respond (threshold shift). The center of the FP range was significantly reduced (FP = 0.10 without added nodules, FP = 0.05 with added nodules, F(1,18) = 19.85, p = 0.0003). The center of the TP range was significantly reduced (TP = 0.39 without added nodules, TP = 0.33 with added nodules, F(1,18) = 10.81, p = 0.004). Conclusion This study suggests that fatigue does not change the nature of the SOS effect, but rather may be additive with the SOS effect. SOS reduces both true and false positive responses, whereas fatigue reduces true positives more than false positives.

Effect of fatigue on reading computed tomography examination of the multiply injured patient

“…5,6 The first study investigating the effects of fatigue on interpretation involving multiple abnormalities was recently published. 7 This study, however, was limited to plain film chest radiography thus the results may not generalize to more advanced imaging techniques, such as CT. In fact, earlier studies [that did not include satisfaction of search (SOS)] demonstrated that the impact of fatigue may indeed differ for plain film and chest CT so there is a reason to believe that the same may hold true with SOS.…”

“…2 The effects of an extended workday have been investigated in laboratory studies using a number of tasks that simulate clinical interpretation. [5][6][7] Studies using single lesion detection tasks [fractures in bone images and nodules in computed radiography (CR) and computed tomography (CT) chest] generally demonstrated a statistically significant average decrease in diagnostic accuracy of ∼4%. 5,6 The first study investigating the effects of fatigue on interpretation involving multiple abnormalities was recently published.…”

“…Recent studies 9,10 examining the SOS effect in chest radiography with modern imaging techniques indicate a threshold shift [reduction in both true positive (TP) and false positive (FP)], reflecting a reluctance to report native lesions in the presence of nodules. Using the same computed radiography examinations, Krupinski et al 7 were the first to study performance in detecting multiple abnormalities under conditions of fatigue.…”

Full-body CT scan in Polytrauma Diagnosis. Analysis of Ten Years’ Experience

“…Необходимо иметь в виду, что сбор анамнеза у таких пациентов не всегда возможен и показатели клинического обследования в 20-50 % случаев с тупыми травмами бывают недостоверными [3,4]. Было высказано предположение о том, что после нахождения первой травмы той или иной анатомической области врач довольствуется полученным результатом поиска и прекращает искать иные потенциальные повреждения в других анатомических областях, в связи с чем феномен получил название «насыщения поиска» [5]. При наличии травмы головы c нарушением сознания достоверность обследования при выявлении травмы живота падает до 16 % [6,7].…”

Effect of Invisible Exertions on Computed Tomography Radiologists in Saudi Hospitals

“…Although a radiology work environment is categorized as shift work, disturbances in daily sleeping cycles are associated with physiological and behavioral effects as well as a loss of the rhythm entrainment [2]. Considerable fatigue and human error affect radiology practices with recent literature covering how diagnostic accuracy is compromised after long working hours [4] [5] [6][3] [7]. Under financial pressure, radiologists' practices are adopting a faster and more agile productivity style to accommodate larger workloads.…”