In a new study published in Radiology, researchers have found that fatigue and professional experience have an impact on the likelihood that radiologists recommend additional imaging for female patients undergoing breast cancer screening (2022; doi: 10.1148/radiol.210318).
Underscoring how fatigue affects radiologists differently depending on their experience level, the research determined that, when reading digital breast tomosynthesis (DBT) images later in the day, less-experienced radiologists would be more likely to recommend additional imaging for women being screened for breast cancer. The study also found that recalls and false-positive results for breast imaging patients were much more likely when less-experienced radiologists who had worked more hours that particular day were interpreting the images.
Previous studies have demonstrated the adverse effects that fatigue can have on radiologist performance. For example, a 2018 literature search examined radiologist fatigue and radiologic error stemming from fatigue, using outcome measures such as subjective self-reports and tests to measure eyestrain (AJR Am J Roentgenol 2018; doi: 10.2214/AJR.17.18613). Reaction time was also recorded. The review included 27 articles, and found that fatigue was present in radiology and it affects diagnostic accuracy.
But, as this study's authors have noted, we know less about how fatigue impacts DBT interpretation. The link between fatigue and radiologists' ability to interpret DBT images is noteworthy, as DBT is likely to replace digital mammography as the gold standard for breast cancer screening in the U.S., as DBT offers improved cancer detection and lower recall rates.
With these factors in mind, researchers from Brown University sought to determine whether recall and false-positive rates would vary by time of day of interpretation for screening mammography for breast cancer performed with digital mammography and DBT.
In a retrospective review, researchers identified 97,671 screening mammograms. A group of 18 radiologists at one of 12 community sites read the images between January 2018 and December 2019. The researchers analyzed the results by type of image, either standard digital mammography or the "more complex digital breast tomosynthesis," according to the authors, who separated radiologists into two groups: those with at least 5 post-training years of experience and those with less than 5 post-training years of experience. A total of nine radiologists fell into each category.
The overall recall rates for digital mammography (10.2%) and DBT (9.0%) were different, as was the false positive rate. For digital mammography, the false positive rate stood at 9.8 percent; that number for DBT was 8.6 percent.
Among radiologists with five or fewer post-training years of experience, odds of recall increased by 11.5 percent for every hour when using DBT, but this was not found with digital mammography. For radiologists with more than 5 post-training years of experience, no evidence of increase in recall was observed for DBT, and there was no evidence that these were different. Overall, the authors found that patients were more likely to be recalled when their screening DBT images were interpreted later in the day by less experienced radiologists.
"Less experienced radiologists were more likely to recommend additional imaging if digital breast tomosynthesis was interpreted later in the day," noted Ana Lourenco, MD, Professor of Diagnostic Imaging at Brown University, and the study's lead author.
She said this finding may be due to differences in System 1 and System 2 processing for less experienced versus more experienced radiologists, adding that the radiology team can take steps to moderate the time-of-day effects (Acad Radiol 2017; https://doi.org/10.1016/j.acra.2016.08.012). For example, these effects "could potentially be mitigated by scheduling breaks in the clinical workday, though this certainly needs further study," Lourenco noted.
Mark McGraw is a contributing writer.