The Impact of Fatigue on Complex CT Case Interpretation by Radiology Residents

      Rationale and Objectives

      To examine the effect of fatigue on diagnostic performance and interpretation of complex CT trauma studies by radiology residents.

      Materials and Methods

      Ten 2nd, 3rd, and 4th year radiology residents were given 1 hour to review as many complex CT cases as they could, once when they were fresh and once when they were fatigued (after a full day or night of diagnostic reading activity). Number of cases completed, interpretation accuracy and time per case were analyzed.


      On average readers completed 7.5 cases when fresh and 7.3 when fatigued, with 4th and 3rd year residents spending more time per case when fresh than fatigued and 2nd year residents spending more time when fatigued. The total number of true positives for major (fresh mean = 29.4 vs fatigued mean = 24.1) and minor (fresh mean = 23.30 vs fatigued mean = 18.90) findings decreased for fresh vs fatigued; and there was a significant difference as a function of year of residency (F = 4.72, p = 0.027). The 4th year residents had the most TPS in both conditions, followed by 3rd then 2nd year residents. There were more false positives when fatigued than fresh.


      Fatigue significantly impacts radiologic diagnostic efficiency and efficacy, and differs as a function of year of residency.

      Key Words


      AIS (Abbreviated Injury Scale), ANOVA (Analysis of Variance), CT (Computed Tomography), FP (False Positive), ISS (Injury Severity Score), MAIS (Maximum Abbreviated Injury Scale), NISS (New Injury Severity Score), ROC (Receiver Operating Characteristic), SD (Standard Deviation), SOFI (Swedish Occupational Fatigue Inventory), SSQ (Simulator Sickness Questionnaire), TP (True Positive)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Academic Radiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Kohn LT
        • Corrigan JM
        • Donaldson MS
        Committee on Quality of Health Care in America, Institute of Medicine. To err is human: building a safer health system.
        National Academies Press, 2000
        • Berlin L
        Radiologic errors and malpractice: a blurry distinction.
        Am J Roentgenol. 2007; 189: 517-522
        • Berlin L.
        Errors of omission.
        Am J Roentgenol. 2005; 185: 1416-1421
        • Levin DC
        • Rao VM.
        Factors that will determine future utilization trends in diagnostic imaging.
        J Am Coll Radiol. 2016; 13: 904-908
        • Flaherty S
        • Mortele KJ
        • Young GJ
        Utilization Trends in Diagnostic Imaging for a Commercially Insured Population: A Study of Massachusetts Residents 2009 to 2013.
        J Am Coll Radiol. 2018; 15: 834-841
        • Hanna TN
        • Shekhani H
        • Lamoureux C
        • et al.
        Emergency radiology practice patterns: shifts, schedules, and job satisfaction.
        J Am Coll Radiol. 2017; 14: 345-352
        • Weilburg JB
        • Sistrom CL
        • Rosenthal DI
        • et al.
        Utilization management of high-cost imaging in an outpatient setting in a large stable patient and provider cohort over 7 years.
        Radiol. 2017; 284: 766-776
        • Sokolovskaya E
        • Shinde T
        • Ruchman RB
        • et al.
        The effect of faster reporting speed for imaging studies on the number of misses and interpretation errors: a pilot study.
        J Am Coll Radiol. 2015; 12: 683-688
        • Rohatgi S
        • Hanna TN
        • Sliker CW
        • et al.
        After-hours radiology: challenges and strategies for the radiologist.
        Am J Roentgenol. 2015; 205: 956-961
        • Waite S
        • Kolla S
        • Jeudy J
        • et al.
        Tired in the reading room: the influence of fatigue in radiology.
        J Am Coll Radiol. 2017; 14: 191-197
        • Stec N
        • Arje D
        • Moody AR
        • et al.
        A systematic review of fatigue in radiology: is it a problem?.
        Am J Roentgen. 2018; 210: 799-806
        • Bechtold RE
        • Chen MY
        • Ott DJ
        • et al.
        Interpretation of abdominal CT: analysis of errors and their causes.
        J Comput Assist Tomogr. 1997; 21: 681-685
        • Krupinski EA
        • Berbaum KS
        • Caldwell RT
        • et al.
        Long radiology workdays reduce detection and accommodation accuracy.
        J Am Coll Radiol. 2010; 7: 698-704
        • Krupinski EA
        • Berbaum KS
        • Caldwell RT
        • et al.
        Do long radiology workdays affect nodule detection in dynamic CT interpretation?.
        J Am Coll Radiol. 2012; 9: 191-198
        • Hanna TN
        • Zygmont ME
        • Peterson R
        • et al.
        The effects of fatigue from overnight shifts on radiology search patterns and diagnostic performance.
        J Am Coll Radiol. 2018; 15: 1709-1716
        • Krupinski EA
        • Berbaum KS
        • Schartz KM
        • et al.
        The impact of fatigue on satisfaction of search in chest radiography.
        Acad Radiol. 2017; 24: 1058-1063
        • Krupinski EA
        • Berbaum KS.
        Measurement of visual strain in radiologists.
        Acad Radiol. 2009; 16: 947-950
        • Krupinski EA
        • Schartz KM
        • Van Tassell MS
        • et al.
        Effect of fatigue on reading computed tomography examination of the multiply injured patient.
        J Med Imag. 2017; 4035504
        • Greenspan L
        • McLellan BA
        • Greig H
        Abbreviated Injury Scale and Injury Severity SCale: a scoring chart.
        J Trauma. 1985; 25: 60-64
        • Baker SP
        • O'Neill B
        • Haddon W
        The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care.
        J Trauma. 1974; 14: 187-196
        • Osler T
        • Baker SP
        • Long W
        A modification of the injury severity score that both improves accuracy and simplifies scoring.
        J Trauma. 1997; 43: 922-925
        • Schartz K
        • Berbaum K
        • Caldwell B
        • et al.
        Software to facilitate medical image perception and technology evaluation research.
        in: Paper presented at MIPS XII, Iowa City, Iowa. October 17-202007
        • Ahsberg E.
        Dimensions of fatigue in different workplace populations.
        Scandinavian J Psych. 2000; 41: 231-241
        • Ahsberg E
        • Gamberale F
        • Gustafsson K
        Perceived fatigue after mental work: an experimental evaluation of a fatigue inventory.
        Ergonomics. 2000; 43: 252-268
        • Kennedy RS
        • Lane NE
        • Berbaum KS
        • et al.
        Simulator Sickness Questionnaire: an enhanced method for quantifying simulator sickness.
        Intl J Aviation Psych. 1993; 3: 203-220
        • Kennedy RS
        • Lane NE
        • Lilienthal MG
        • et al.
        Profile analysis of simulator sickness symptoms: application to virtual environment systems.
        Presence. 1992; 1: 295-301
        • Krupinski EA
        • Graham AR
        • Weinstein RS
        Characterizing the development of visual search expertise in pathology residents viewing whole slide images.
        Hum Path. 2013; 44: 357-364
        • Bertram R
        • Kaakinen J
        • Bensch F
        • et al.
        Eye movements of radiologists reflect expertise in CT study interpretation: a potential tool to measure resident development.
        Radiol. 2016; 281: 805-815