Elizabeth Anne Krupinski PhD, Presenter: Nothing to Disclose

Kevin Staley Berbaum PhD, Abstract Co-Author: Nothing to Disclose

Robert Caldwell, Abstract Co-Author: Nothing to Disclose

Kevin M. Schartz PhD, Abstract Co-Author: Nothing to Disclose

David Kramer BA, Abstract Co-Author: Nothing to Disclose

Radiologists are reading more cases with more images per case, especially in CT and MRI. Shortages in radiologists compound this, especially for specialty radiologists in rural and medically underserved areas. Thus, radiologists are working longer hours than ever before and there have been concerns raised regarding fatigue and whether it impacts diagnostic accuracy. The goal of this study was to measure the impact of reader of reader visual fatigue by assessing symptoms, the ability to keep the eye focused on the display and diagnostic accuracy.

Twenty radiologists and 20 radiology residents were given two diagnostic performance tests. IN both they searched CT chest sequences for a solitary pulmonary nodule before (rested) and after (tired) a day of clinical reading. 10 cases used free search and navigation, and 100 used preset scrolling speed and duration. Dark vergence was used to measure visual strain, and subjects filled out the Swedish Occupational Fatigue Inventory (SOFI) and the oculomotor strain subscale of the Simulator Sickness Questionnaire (SSQ) before each session. Accuracy was measured using ROC techniques.

Results to date suggest that there is a decrease in vergence measures from before a day clinical reading (rested) to after a day (tired) of clinical reading. ROC analyses indicate a decrease in accuracy as well. Using Swensson’s technique yields an ROC area = 0.86 rested vs. 0.83 tired, p (one-tailed) = 0.09. Using Swensson’s LROC technique yields an area = 0.73 rested vs. 0.66 tired, p (one-tailed) = 0.09. Using Swensson’s Loc Accuracy technique yields an area = 0.77 rested vs. 0.72 tired, p (one-tailed) = 0.13).

To date, the results confirm our findings with static images and detection of bone fractures. Radiologists at the end of a long work day experience greater levels of measurable visual fatigue or strain, contributing to a decrease in diagnostic accuracy.

Radiologists are experiencing visual strain. It impacts diagnostic accuracy. We need to a) increase awareness of this, and b) develop ways to reduce visual strain and fatigue in the reading room.

Krupinski, E, Berbaum, K, Caldwell, R, Schartz, K, Kramer, D, CT Interpretation: The Impact of Long Workdays on Interpretation Accuracy and Visual Strain.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11006283.html