title: Long radiology workdays reduce detection and accommodation accuracy.
abstract: OBJECTIVE
  The aim of this study was to measure the diagnostic accuracy of fracture detection, visual accommodation, reading time, and subjective ratings of fatigue and visual strain before and after a day of clinical reading.
  
  
  METHODS
  Forty attending radiologists and radiology residents viewed 60 deidentified, HIPAA-compliant bone examinations, half with fractures, once before any clinical reading (early) and once after a day of clinical reading (late). Reading time was recorded. Visual accommodation (the ability to maintain focus) was measured before and after each reading session. Subjective ratings of symptoms of fatigue and oculomotor strain were collected. The study was approved by local institutional review boards.
  
  
  RESULTS
  Diagnostic accuracy was reduced significantly after a day of clinical reading, with average areas under the receiver operating characteristic curves of 0.885 for early reading and 0.852 for late reading (P < .05). After a day of image interpretation, visual accommodation was no more variable, though error in visual accommodation was greater (P < .01), and subjective ratings of fatigue were higher.
  
  
  CONCLUSIONS
  After a day of clinical reading, radiologists have reduced ability to focus, increased symptoms of fatigue and oculomotor strain, and reduced ability to detect fractures. Radiologists need to be aware of the effects of fatigue on diagnostic accuracy and take steps to mitigate these effects.
authors.affiliation: Department of Radiology, University of Arizona, 1609 N Warren, Tucson, AZ 85724, USA. krupinski@radiology.arizona.edu
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Krupinski
authors.forename: Kevin S
authors.initials: KS
authors.lastname: Berbaum
authors.forename: Robert T
authors.initials: RT
authors.lastname: Caldwell
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Schartz
authors.forename: John
authors.initials: J
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000377:Agnosia / Q000209:etiology; D001364:Awareness; D001842:Bone and Bones / Q000000981:diagnostic imaging; D019937:Diagnostic Techniques and Procedures / Q000592:standards; D004650:Employee Performance Appraisal / Q000379:methods*; D005221:Fatigue / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography / Q000592:standards*; D012890:Sleep; D013679:Technology, Radiologic / Q000706:statistics & numerical data*; D014792:Visual Acuity; D016526:Workload / Q000706:statistics & numerical data*
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