The Effects of Fatigue From Overnight Shifts on Radiology Search Patterns and Diagnostic Performance

Tarek N. Hanna, Matthew E. Zygmont, Ryan Peterson, David Theriot, Haris Shekhani, Jamlik Omari Johnson, Elizabeth A. Krupinski

Research output: Contribution to journalArticlepeer-review

26 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)1709-1716
Number of pages8
JournalJournal of the American College of Radiology
Issue number12
StatePublished - Dec 1 2018


  • Fatigue
  • medical error
  • overnight
  • radiology
  • search pattern

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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