Determinants of Radiologists’ Desired Workloads

Work-Life Experience of Academic Radiologists: Food for Thought

RATIONALE AND OBJECTIVES

Work-life experience of physicians is a driver of work engagement vs. burnout. We aimed to determine individual and institutional factors affecting work-life experience of the clinical faculty at a large tertiary care academic medical center.

MATERIALS AND METHODS

The Department of Radiology clinical faculty (n = 62) were surveyed electronically in October 2022. Twenty-three questions, consisting of multiple choice, Yes/No, and Likert scale ratings were administered to obtain demographic information and data for life outside of work, life at work, and work-life integration for the prior 12 months. Work engagements in terms of clinical, research, administrative, and education; work practices including engagement in extra work and remote work; life responsibilities; and utilization of work-life balance strategies were analyzed for percentages and differences in seniority levels and genders. Ratings of faculty work engagement and life integration strategies were assessed utilizing a 1-5 Likert scale. Descriptive statistics were utilized to report mean, standard deviation, median, Q1 and Q3 for continuous measurements, while count and percentage for categories measurements. Comparisons between seniority and gender categories were conducted using independent t-test or Wilcoxon rank sum test depending on data normality assessed through histogram analysis. Chi-square test was used to make comparisons for categorical data. When encountered with small cell (category with <5 count), Fisher's exact test was used for 2 × 2 table analysis and Freeman-Halton test was used for comparisons with more than two categories. SAS 9.4 was used for the data analysis.

RESULTS

Twenty-eight faculty (M:F = 17:11) responded to the survey (survey response rate 45%). The vast majority of faculty reported working extra hours, with 40% working at least 10 hours extra per week. Total of 42.9% reported performing clinical work in the extra hours worked. Total 70.4% of faculty had caregiver responsibilities and 64.3% reported other individual stresses (e.g., financial, family/social, health-related), which required consistent demand of time and effort. A total of 35.7% of faculty reported not being able to balance competing life and work demands. A total of 21.4% respondents reported not utilizing any individual healthy lifestyle choices on a consistent basis over the prior 12 months. Protected time off work and remote work were perceived as effective strategies to provide adequate work-life balance; however, remote work engagement was relatively minor and 35.7% bought back vacation. Total 53.6% respondents reported a level 4 (out of 5) rating for work being meaningful and being positively engaged in their work.

CONCLUSION

Institutions should invest in providing the infrastructure for physician work-life balance and in facilitating healthy lifestyle choices for physicians.

Workload of diagnostic radiologists in the foreseeable future based on recent scientific advances: growth expectations and role of artificial intelligence

Objective

To determine the anticipated contribution of recently published medical imaging literature, including artificial intelligence (AI), on the workload of diagnostic radiologists.

Methods

This study included a random sample of 440 medical imaging studies published in 2019. The direct contribution of each study to patient care and its effect on the workload of diagnostic radiologists (i.e., number of examinations performed per time unit) was assessed. Separate analyses were done for an academic tertiary care center and a non-academic general teaching hospital.

Results

In the academic tertiary care center setting, 65.0% (286/440) of studies could directly contribute to patient care, of which 48.3% (138/286) would increase workload, 46.2% (132/286) would not change workload, 4.5% (13/286) would decrease workload, and 1.0% (3/286) had an unclear effect on workload. In the non-academic general teaching hospital setting, 63.0% (277/240) of studies could directly contribute to patient care, of which 48.7% (135/277) would increase workload, 46.2% (128/277) would not change workload, 4.3% (12/277) would decrease workload, and 0.7% (2/277) had an unclear effect on workload. Studies with AI as primary research area were significantly associated with an increased workload (p < 0.001), with an odds ratio (OR) of 10.64 (95% confidence interval (CI) 3.25–34.80) in the academic tertiary care center setting and an OR of 10.45 (95% CI 3.19–34.21) in the non-academic general teaching hospital setting.

Conclusions

Recently published medical imaging studies often add value to radiological patient care. However, they likely increase the overall workload of diagnostic radiologists, and this particularly applies to AI studies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13244-021-01031-4.

Analysis of dominant factors affecting fatigue caused by soft-copy reading

RATIONALE AND OBJECTIVES

The aim of this study was to analyze the dominant factors affecting fatigue caused by soft-copy reading to identify a method for decreasing fatigue in clinical practice.

MATERIALS AND METHODS

Two types of fatigue-fatigue in the central nervous system and subjective visual fatigue-were evaluated using a critical fusion frequency test and a questionnaire administered to 17 male radiologists before and after soft-copy reading. Reading-induced fatigue was assumed to be affected by 20 hypothetical factors associated with personal characteristics, time required for reading, content or amount of reading, and the reading environment. We used multiple linear regression analysis with a variable selection method to detect the best combination of factors capable of expressing variations in each of the measured fatigue values. The effects of the detected (dominant) factors on fatigue were also examined based on coefficients of the dominant factors in multiple regression models.

RESULTS

Fatigue in the central nervous system decreased with a higher corrected visual acuity and a higher ambient illuminance in the reading room and was also affected by the type of monitor used. Visual fatigue was relieved when there was a larger difference in the brightness of the monitor and the surfaces surrounding the monitor and tended to be more severe when glasses rather than contact lenses were worn.

CONCLUSIONS

Increasing the ambient illuminance, using an appropriate type of monitor, improving the corrected visual acuity, and using contact lenses rather than eyeglasses could help decrease reading-induced fatigue in male radiologists.

Medical imaging displays and their use in image interpretation

The adequate and repeatable performance of the image display system is a key element of information technology platforms in a modern radiology department. However, despite the wide availability of high-end computing platforms and advanced color and gray-scale monitors, the quality and properties of the final displayed medical image may often be inadequate for diagnostic purposes if the displays are not configured and maintained properly. In this article-an expanded version of the Radiological Society of North America educational module "Image Display"-the authors discuss fundamentals of image display hardware, quality control and quality assurance processes for optimal image interpretation settings, and parameters of the viewing environment that influence reader performance. Radiologists, medical physicists, and other allied professionals should strive to understand the role of display technology and proper usage for a quality radiology practice. The display settings and display quality control and quality assurance processes described in this article can help ensure high standards of perceived image quality and image interpretation accuracy.

Do long radiology workdays affect nodule detection in dynamic CT interpretation?

PURPOSE

A previous study demonstrated decreased diagnostic accuracy for finding fractures and decreased ability to focus on skeletal radiographs after a long working day. Skeletal radiographic examinations commonly have images that are displayed statically. The aim of this study was to investigate whether diagnostic accuracy for detecting pulmonary nodules on CT of the chest displayed dynamically would be similarly affected by fatigue.

METHODS

Twenty-two radiologists and 22 residents were given 2 tests searching CT chest sequences for a solitary pulmonary nodule before and after a day of clinical reading. To measure search time, 10 lung CT sequences, each containing 20 consecutive sections and a single nodule, were inspected using free search and navigation. To measure diagnostic accuracy, 100 CT sequences, each with 20 sections and half with nodules, were displayed at preset scrolling speed and duration. Accuracy was measured using receiver operating characteristic curve analysis. Visual strain was measured via dark vergence, an indicator of the ability to keep the eyes focused on the display.

RESULTS

Diagnostic accuracy was reduced after a day of clinical reading (P = .0246), but search time was not affected (P > .05). After a day of reading, dark vergence was significantly larger and more variable (P = .0098), reflecting higher levels of visual strain, and subjective ratings of fatigue were also higher.

CONCLUSIONS

After their usual workday, radiologists experience increased fatigue and decreased diagnostic accuracy for detecting pulmonary nodules on CT. Effects of fatigue may be mitigated by active interaction with the display.

Current perspectives in medical image perception

Medical images constitute a core portion of the information a physician utilizes to render diagnostic and treatment decisions. At a fundamental level, this diagnostic process involves two basic processes: visually inspecting the image (visual perception) and rendering an interpretation (cognition). The likelihood of error in the interpretation of medical images is, unfortunately, not negligible. Errors do occur, and patients' lives are impacted, underscoring our need to understand how physicians interact with the information in an image during the interpretation process. With improved understanding, we can develop ways to further improve decision making and, thus, to improve patient care. The science of medical image perception is dedicated to understanding and improving the clinical interpretation process.

Long radiology workdays reduce detection and accommodation accuracy

PURPOSE

The aim of this study was to measure the diagnostic accuracy of fracture detection, visual accommodation, reading time, and subjective ratings of fatigue and visual strain before and after a day of clinical reading.

METHODS

Forty attending radiologists and radiology residents viewed 60 deidentified, HIPAA-compliant bone examinations, half with fractures, once before any clinical reading (early) and once after a day of clinical reading (late). Reading time was recorded. Visual accommodation (the ability to maintain focus) was measured before and after each reading session. Subjective ratings of symptoms of fatigue and oculomotor strain were collected. The study was approved by local institutional review boards.

RESULTS

Diagnostic accuracy was reduced significantly after a day of clinical reading, with average areas under the receiver operating characteristic curves of 0.885 for early reading and 0.852 for late reading (P < .05). After a day of image interpretation, visual accommodation was no more variable, though error in visual accommodation was greater (P < .01), and subjective ratings of fatigue were higher.

CONCLUSIONS

After a day of clinical reading, radiologists have reduced ability to focus, increased symptoms of fatigue and oculomotor strain, and reduced ability to detect fractures. Radiologists need to be aware of the effects of fatigue on diagnostic accuracy and take steps to mitigate these effects.

Radiologists' clinical practice of neuroimaging

PURPOSE

Because of the importance of neuroimaging as a radiology subspecialty, the aim of this study was to provide a detailed portrait of the demographics, clinical activities, and practices of radiologists heavily involved in neuroimaging.

METHODS

The authors analyzed data from the ACR's 2003 Survey of Radiologists, a large, stratified random-sample survey in which respondents were guaranteed confidentiality. The survey achieved a 63% response rate, and responses were weighted to make them representative of all radiologists in the United States.

RESULTS

Three-fourths of US radiologists reported doing neuroradiology; 9% reported that neuroradiology was their main subspecialty, and 9% reported spending more than 50% of their clinical work time doing neuroradiology. Of these latter two categories, more than about 75% had certificates of added qualification (CAQs) in neuroradiology, and more than 80% had done neuroradiology fellowships. However, of those spending more than 50% of their clinical work time doing neuroradiology, 7% neither had CAQs nor had done fellowships in the field. One-fourth of radiologists with CAQs or who had done neuroradiology fellowships spent less than 30% of their clinical work time doing neuroradiology. One-third to one-half of neuroimaging was performed by radiologists not heavily involved in the field. Only 6% to 8% of radiologists heavily involved in the field were women, compared with 22% in other subspecialties.

CONCLUSIONS

Neuroimaging has the great strength of being a relatively well-integrated subspecialty in that a very large majority of those heavily involved in its practice have CAQs and did fellowships in the field. Among possible concerns are the relatively few women in the field and the apparent waste of expertise resulting from one-fourth of those with neuroradiology subspecialty training or certification being relatively little immersed in its practice.

Radiology report turnaround: expectations and solutions

The ultimate work product of a radiology department is a finalized radiology report. Radiology stakeholders are now demanding faster report turnaround times (RTAT) and anything that delays delivery of the finalized report will undermine the value of a radiology department. Traditional reporting methods are inherently inefficient and the desire to deliver fast RTAT will always be challenged. It is only through the adoption of an integrated radiology information system (RIS)/picture archiving and communication system (PACS) and voice recognition (VR) system that RTAT can consistently meet stakeholder expectations. VR systems also offer the opportunity to create standardized, higher quality reports.