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How to Reduce Radiology Fatigue

Radiologists face increased workloads and shorter turnaround times to examine and interpret complex images. Doing more with less has its consequences, like radiology fatigue.

Fatigue or that feeling of extreme weariness that comes with low energy and impacts everyday activities are prevalent in radiology and can impact diagnostic testing accuracy, according to the American Journal of Roentgenology (AJR).1

The pressure to increase productivity has moved forward without the full acknowledgment of the perceptual, cognitive, and physical limitations of interpreting radiologists, despite evidence that higher workloads and fatigue can lead to visual tiredness, cognitive overload, and decision fatigue.2

Fatigue is a multi-layered condition with physical and mental effects. As radiologists work to boost productivity, it is essential to consider the potential impacts fatigue may have on patient outcomes.3

The differences between fatigue and sleepiness

Many mistakenly use the words “sleepiness” and “fatigue” interchangeably.4 Sleepiness is described as drowsiness and decreased alertness, while fatigue is a feeling of weakness or depleted energy.

Though both often exist together, a person can be fatigued without actually feeling the need to sleep. For example, insomniacs often feel weary and weak but not sleepy. Nevertheless, both conditions can negatively impact how they perform daily activities.4

Causes of fatigue

According to the National Safety Council (NSC),9 there are many causes of fatigue, including:

  • The time of day the person works, especially those who work longer shifts or overnight
  • Sleep deprivation
  • The time spent on a single task
  • Personal factors, such as medication use, age, physical and mental health conditions

Work factors also may contribute to fatigue in the workplace, including:

  • Task-related factors, such as the physical and mental demands of a job
  • Environmental factors, such as working in noisy quarters or poor air quality
  • Organizational factors, such as leadership commitment and safety culture

A closer look at the AJR study

According to the AJR study,1 the researchers conducted a systematic review of 27 quantitative and qualitative studies that focused on radiologist fatigue and mistakes caused by extreme tiredness. Typical outcome measures included:

  • Self-reports
  • Reaction time
  • Tests to measure visual strain 

Visual fatigue3 is a significant concern in radiologists because medical imaging depends heavily on optical input. Humans view and analyze their environments with rapid eye movements. When fatigue sets in, it reduces the speed of rapid eye movements.

Researchers found that the reduction in rapid eye movements may be an excellent way to measure fatigue in radiologists. Furthermore, it found that the effects of visual oculomotor fatigue, as well as overall physical and mental fatigue, should be considered since their ability to see is necessary for lesion detection in imaging interpretation.3

Other evidence of radiology fatigue impacting detection

A study that investigated the effect of fatigue in the detection of “easy”- and “hard”-to-detect bone fractures found that detection accuracy was lower for those who read the images later than those who read them earlier in the day.6

It further showed that the readers were more nearsighted, more subjectively fatigued, and experienced increased visual strain after a day of diagnostic interpretation compared to those who read the same images the prior morning.6

Another study showed that radiologists presented an increased number of dramatically different clinical interpretations during the last two hours of a consecutive 12-hour overnight shift than those offered by attending physicians the next day.

Though the residents’ fatigue levels were not ascertained during the study, the researchers concluded that fatigue or circadian desynchronization was the most reasonable reason for the drop off in performance.

Desynchronization of the circadian,8 often referred to as the body’s internal clock, impacts the body’s sleep patterns and other bodily processes, like body temperature and alertness. When this occurs, people have difficulty performing daily functions.7

Addressing radiology fatigue

According to the AJR,1 various groups from the reviewed studies suggested ways to address radiologist fatigue, including examining:

  • The number of hours they worked
  • Ergonomic interventions, like improving the environment of the workplace or workstations
  • Implementing tools to measure and standardize fatigue and optimize workflow
  • Offering education in appropriate viewing habits and encouraging breaks throughout a shift

Ways individuals can reduce fatigue in the workplace

According to the NSC, signs of fatigue may be challenging to identify, and radiologists may not know when it is time to break.9

To avoid fatigue, individuals should:

  • Provide for adequate rest between physically or cognitively demanding activities
  • Align their natural body clocks with their work schedules
  • Maintain consistent sleep schedules, make up for losses on days off

Evidence shows that radiology fatigue exists and that can negatively impact testing accuracy. Taking measures to fight fatigue in the workplace will help diminish the impact it has on patients and the quality of care the medical community provides.

References:

  1. Stec, N., et al. A Systematic Review of Fatigue in Radiology: Is It a Problem? AJR Am J Roentgenology. 2018 https://www.ncbi.nlm.nih.gov/pubmed/29446673 Web. March 22, 2019.
  2. Reiner, B.I. and Krupinski, E. The insidious problem of fatigue in medical imaging practice. J Digit Imaging. 2012. https://www.researchgate.net/publication/51854506. Web. March 22, 2019.
  3. Waite, S., et al. Tired in the Reading Room: The Influence of Fatigue in Radiology. Journal of the American College of Radiology. 2017. https://www.jacr.org/article/S1546-1440(16)31076-6/fulltext Web. March 21, 2019.
  4. Shahid, A., Shen., J., and Shapiro, C. Measurements of sleepiness and fatigue. J Psychosom Res. 2010. https://www.ncbi.nlm.nih.gov/pubmed/20630266 Web. March 22, 2019.
  5. Pigeon, W.R., Sateia, M.J., and Ferguson, R.J. Distinguishing between excessive daytime sleepiness and fatigue: toward improved detection and treatment. J Psychosom Res. 2003. https://www.ncbi.nlm.nih.gov/pubmed/12505556 Web. March 22, 2019.
  6. Krupinski, E., et al. Long radiology workdays reduce detection and accommodation accuracy. J Am Coll Radiol. 2010. https://www.jacr.org/article/S1546-1440(10)00134-1/fulltext Web. March 22, 2019
  7. Ruutiainen, T., et al. Increased error rates in preliminary reports issued by radiology residents working more than 10 consecutive hours overnight. Acad Radiol. 2013. https://www.academicradiology.org/article/S1076-6332(12)00538-7/fulltext Web. March 22, 2019.
  8. Granada, A., et al. Circadian desynchronization. Interface Focus. 2011. 10.1098/rsfs.2010.0002. Web. March 22, 2019.
  9. National Security Council. Safety: What You Can Do. https://www.nsc.org/work-safety/safety-topics/fatigue/what-you-can-do. Web. March 22, 2019.