Health Services Research & Policy ■ Clinical Practice Management ■ Training & Education ■ Leadership
Health Services Research & Policy ■ Clinical Practice Management ■ Training & Education ■ Leadership
Health Services Research & Policy
■ Clinical Practice Management
■ Training & Education ■ Leadership

Oculus Drift

When it comes to fatigue in the radiology reading room, the eyes have it.

Much has been written recently about stress and burnout in radiology. Rather than focus on the impact of the modern practice of radiology on mental health, a new JACR article shines a needed light on the somatic consequences of diagnostic imaging work, particularly visual and oculomotor ones, that may occur in isolation or co-exist with (and potentially amplify) burnout.

The authors make an important distinction between fatigue (i.e., weakness or depleted energy) and the perception of tiredness (a.k.a. sleepiness). Several types of fatigue are described in the article, such as muscle fatigue due to a reduction in muscle efficiency after prolonged activity. For radiologists, the muscles most likely to fatigue are those around the eyes. Radiologist performance can be negatively affected by extended exertion in the form of image viewing even in the absence of feeling tired or reporting eye strain. In this way, fatigue may diminish radiologist concentration or focus. Working while fatigued isn't good for patient care or radiologist health and job satisfaction.

Fatigue is not necessarily an inevitable outcome of a busy workday, but it can be. Reaching or crossing your own fatigue threshold is likely multifactorial, depending on factors like the modality you are working on, how familiar you are with your clinical assignment for that day (or part of the day), the quality of the images in the study, the complexity of the disease process imaged, how quickly you are switching between interpretive and non-interpretive tasks, and the frequency and length of non-screen-based breaks or activities (such as calling back referring providers to answer their questions about recent studies).

Radiology residents and attending radiologists may have different fatigue thresholds. As the article's authors point out, eye-tracking studies have shown that residents have less efficient visual search patterns. Resident eyes wander more while looking at any given radiograph. Attendings have fewer eye movements per radiograph. So attendings can interpret a radiograph with greater speed and less effort than residents. However, the attending is likely reading more radiographs than the resident per unit time, so the cumulative effort expended — and the oculomotor fatigue that accompanies that effort — may be similar.

Radiologists should acknowledge the bodily limits of peak performance with respect to diagnostic image interpretation. By understanding the nature of task-specific fatigue, radiologists may be able to define parameters to better structure work both for optimal patient care and radiologist well-being. In the absence of the research study measures described in the JACR article, perhaps the tempo and intensity of different image interpretation tasks could serve as proxy measurements to quantify fatigue in an everyday clinical work environment. Such measures may help radiology departments create work schedules that are simultaneously fatigue-minimizing and performance-maximizing by including periods of value-adding, non-interpretive tasks.

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Wednesday, 22 May 2019

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