4 key takeaways from a systematic review of fatigue in radiology

Fatigue is a real issue in radiology and affects diagnostic accuracy, according to a new systematic review of the subject published in the American Journal of Roentgenology.

For their analysis, the authors reviewed 27 different articles on the topic of radiologist fatigue. Twenty-two originated from the United States, two came from Japan and one each came from the United Kingdom, Canada and Italy. These are four key takeaways from the team's research:

1. Overnight shifts can impact accuracy and cause health problems.

“Physicians working after hours, overnight, on rotation or on call are most prone to sleep deprivation and fatigue because circadian rhythms can be skewed,” wrote lead author Pascal Tyrrell, PhD, in the department of medical imaging at the University of Toronto, and colleagues. “Although fatigue typically accumulates over several nights, radiologists can undergo phase shifting to rework their physiologic rhythms. Younger individuals were better able to cope with overnight and shift work because their circadian processes are more flexible.”

2. Over the years, researchers have suggested a variety of measures to prevent fatigue in radiology.

While some studies have highlighted potential changes to workstations that can improve fatigue, others suggested ideas such as increasing ambient lighting, taking breaks from reading exams, and so on. A 2011 study from Japan (Maeda et al.) noted that radiologists should focus on getting better sleep each night. “The researchers stated that if a radiologist has slept poorly, their vision should be considered impaired as they work,” Tyrrell and colleagues wrote.

3. Others industries have dealt with fatigue by taking direct action.

The authors noted that other professions have had to deal with fatigue. One noteworthy example is air traffic controllers, who were working unhealthy shifts until impactful changes were implemented.

“Many controllers work certain shift hours that do not allow them to adequately sleep between shifts,” the authors wrote. “It was common for a controller to work from 7 a.m. to 3 p.m. and then have their next shift from 11 p.m. that same day until 6 a.m. The FAA and the National Air Traffic Controllers Association devised an effective response against air traffic controller fatigue and implemented various changes to the industry's shift regulations.”

4. The authors closed with several recommendations for imaging leaders.

After reviewing this assortment of studies, the authors concluded their study by making several recommendations. For example, they suggested that governing bodies within radiology look at “implementing guidelines rather than policies or standards.”

“Guidelines are nonenforceable recommendations that support standards or serve as a reference for action when no standard applies,” the authors wrote. “Additionally, further research should be conducted on the effects of radiologist fatigue and ways to mitigate fatigue that could be considered in the guidelines.”

Tyrrell and colleagues also noted that double staffing can help “facilitate personal interactions” and allow radiologists to take breaks when necessary. In addition, they added, imaging leaders in charge of creating a schedule should consider a radiologist’s personal life and other obligations they may have outside of work, such as taking a child to school.

“The goal of these recommendations is to optimize alertness while minimizing detrimental physiologic effects and consequent errors,” they authors concluded. “They parallel other suggestions in the literature to prevent fatigue and include practicing appropriate viewing habits and planning breaks and session lengths. Cognitive errors, though persistent, can be avoided by using second opinions and specialists, understanding hazards of heuristics, and enlisting guidelines and support systems for clinical decisions.”