The Impact of Fatigue on Satisfaction of Search in Chest Radiography

Elizabeth A. Krupinski, Kevin S. Berbaum, Kevin M. Schartz, Robert T. Caldwell, Mark T. Madsen

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Rationale and Objectives To assess the nature of the satisfaction of search (SOS) effect in chest radiography when observers are fatigued; determine if we could replicate recent findings that have documented the nature of the SOS effect to be due to a threshold shift rather than a change in diagnostic accuracy as in earlier film-based studies. Materials and Methods Nearing or at the end of a clinical workday, 20 radiologists read 64 chest images twice, once with and once without the addition of a simulated pulmonary nodule. Half of the images had different types of “test” abnormalities. Decision thresholds were analyzed using the center of the range of false-positive (FP) and true-positive (TP) fractions associated with each receiver operating characteristic (ROC) point for reporting test abnormalities. Detection accuracy was assessed with ROC technique and inspection time was recorded. Results The SOS effect was confirmed to be a reduction in willingness to respond (threshold shift). The center of the FP range was significantly reduced (FP = 0.10 without added nodules, FP = 0.05 with added nodules, F(1,18) = 19.85, P = 0.0003). The center of the TP range was significantly reduced (TP = 0.39 without added nodules, TP = 0.33 with added nodules, F(1,18) = 10.81, P = 0.004). Conclusions This study suggests that fatigue does not change the nature of the SOS effect, but rather may be additive with the SOS effect. SOS reduces both TP and FP responses, whereas fatigue reduces TPs more than FPs.

Original languageEnglish (US)
Pages (from-to)1058-1063
Number of pages6
JournalAcademic radiology
Issue number9
StatePublished - Sep 2017


  • Satisfaction of search
  • accuracy
  • fatigue
  • performance

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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