The Effects of Fatigue From Overnight Shifts on Radiology Search Patterns and Diagnostic Performance
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Purpose The aim of this study was to assess the effect of overnight shifts (ONS) on radiologist fatigue, visual search pattern, and diagnostic performance.Methods This experimental study was approved by the institutional review board. Twelve radiologists (five faculty members and seven residents) each completed two sessions: one during a normal workday ("not fatigued") and another in the morning after an ONS ("fatigued"). Each radiologist completed the Swedish Occupational Fatigue Inventory. During each session, radiologists viewed 20 bone radiographs consisting of normal and abnormal findings. Viewing time, diagnostic confidence, and eye-tracking data were recorded.Results Swedish Occupational Fatigue Inventory results demonstrated worsening in all five variables (lack of energy, physical exertion, physical discomfort, lack of motivation, and sleepiness) after ONS (P < .01). Overall, participants demonstrated worse diagnostic performance in the fatigued versus not fatigued state (P < .05). Total viewing time per case was longer when fatigued (35.9 ± 25.8 seconds) than not fatigued (24.8 ± 16.3 seconds) (P < .0001). Total viewing time per case was longer for residents (P < .05). Mean total fixations generated during the search increased by 60% during fatigued sessions (P < .0001). Mean time to first fixate on the fracture increased by 34% during fatigued sessions (P < .0001) and was longer for residents (P < .01). Dwell times associated with true- and false-positive decisions increased, whereas those with false negatives decreased.Conclusions After ONS, radiologists were more fatigued with worse diagnostic performance, a 45% increase in view time per case, a 60% increase in total gaze fixations, and a 34% increase in time to fixate on the fracture. The effects of fatigue were more pronounced in residents.
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Fatigue from overnight hospital shifts resulted in worse diagnostic performance among radiologists, and the mean time to first fixate on a fracture increased by 34% among the fatigued physicians.
“Fatigue from overnight hospital shifts resulted in worse diagnostic performance among radiologists, and the mean time to first fixate on a fracture increased by 34% among the fatigued physicians [19].”
From Vitamins and Minerals for Energy, Fatigue and Cognition: A Narrative Review of the Biochemical and Clinical Evidence (2020) · cites this paper as [19]
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References 38 · Cited by 97
- Authors
- Hanna, T. N., Zygmont, M. E., Peterson, R., Theriot, D., Shekhani, H., Johnson, J.-O., & Krupinski, E. A.
- Affiliations
- Emory University (US)
- Corresponding author
- Hanna, Tarek N.
- ORCID
- Venue
- Journal of the American College of Radiology
- Publisher
- Elsevier BV
- Published
- 2018-12
- Volume
- 15
- Issue
- 12
- Pages
- 1709-1716
- ISSN
- 1546-1440 (ISSN-L)
- PMC
- PMC6054573
- OpenAlex
- W2784963350
- Cited by
- 97
- References
- 38
- Citations by year
- 2026: 17 · 2025: 19 · 2024: 9 · 2023: 11 · 2022: 12 · 2021: 10 · 2020: 6 · 2019: 11 · 2018: 2
- FWCI
- 5.01
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American College of Radiology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Biomedical Imaging and Bioengineering (5R01EB004987-09)
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Radiology practices and education
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and Work-Related Fatigue
- Health Sciences › Medicine › Emergency Medicine › Hospital Admissions and Outcomes
- Keywords
- diagnostic performance, visual search patterns, eye tracking, bone radiographs, fracture detection, radiology residents, diagnostic confidence, dwell time, viewing time, occupational fatigue
- MeSH terms
- Radiologists, Adult, Clinical Competence, Diagnostic Errors, Eye Movements, Fatigue, Female, Humans, Internship and Residency, Male, Sweden, Visual Perception, Workload
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