Skip to main content Accessibility help
  • Print publication year: 2018
  • Online publication date: December 2018

32 - Ergonomics 2.0: Fatigue in Medical Imaging

from Part VI - Applied Perception
ACGME. (2011). Task Force on Quality Care and Professionalism. The ACGME 2011 duty hour standards: enhancing quality of care, supervision, and resident professional development. Available[1].pdf (accessed December 20, 2017).
Ackerman, P.L., Kanfer, R., Shapiro, S.W., Newton, S., Beier, M.E. (2010). Cognitive fatigue during testing: an examination of trait, time-on-task, and strategy influences. Hum Perform, 23, 381402.
Ahsberg, E. (2000). Dimensions of fatigue in different workplace populations. Scand J Psychol, 41, 231241.
Ahsberg, E, Gamberale, F, Gustafsson, K. (2000). Perceived fatigue after mental work: an experimental evaluation of a fatigue inventory. Ergonomics, 43, 252268.
Akerstedt, T., Knutsson, A., Westerholm, P., Theorell, T., Alfredsson, L., Kecklund, G. (2004). Mental fatigue, work and sleep. J Psychosom Res, 57, 427433.
Andre, J.T., Owens, D.A. (1999). Predicting optimal accommodative performance from measures of the dark focus of accommodation. Hum Fact, 41, 139145.
Ankrum, D.R. (1996). Viewing distance at computer workstations. Work Place Ergonom, September/October, 1012.
Backs, R.W., Walrath, L.C. (1992). Eye movement and pupillary response indices of mental workload during visual search of symbolic displays. Appl Ergonom, 23, 243254.
Barger, L.K., Cade, B.E., Ayas, N.T., Cronin, J.W., Rosner, B., Speizer, F.E., et al. (2005). Extended work shifts and the risk of motor vehicle crashes among interns. N Engl J Med, 352, 125314.
Bellini, L.M., Baime, M., Shea, J.A. (2002). Variation in mood and empathy during internship. JAMA, 287, 31433146.
Ben-Aroya, Z., Segal, D., Hadar, A., Hallak, M., Friger, M., Katz, M., Mazor, M. (2002). Effect of OB/GYN residents’ fatigue and training level on the accuracy of fetal weight estimation. Fetal Diagn Ther, 17, 177–181.
Berbaum, K.S., Franken, E.A., Dorfman, D.D., et al. (1990). Satisfaction of search in diagnostic radiology. Invest Radiol, 25, 133140.
Berbaum, K.S., Dorfman, D.D., Franken, E.A., et al. (2000). Proper ROC analysis and joint ROC analysis of the satisfaction of search effect in chest radiography. Acad Radiol, 7, 945958.
Berbaum, K.S., Krupinski, E.A., Schartz, K.M., et al. (2015). Satisfaction of search in chest radiography 2015. Acad Radiol, 22, 14571465.
Berbaum, K.S., Krupinski, E.A., Schartz, K.M., et al. (2016). The influence of a vocalized checklist on detection of multiple abnormalities in chest radiography. Acad Radiol, 23, 413420.
Berlin, L. (2007). Accuracy of diagnostic procedures: has it improved over the past five decades? Am J Roentgenol, 188, 11731178.
Bilimoria, K.Y., Chung, J.W., Hedges, L.V., Dahlke, A.R., Love, R., Cohen, M.E., et al. (2016). National cluster-randomized trial of duty-hour flexibility in surgical training. N Engl J Med, 374, 713727.
Boiselle, P.M., Levine, D., Horwich, P.J., et al. (2008). Repetitive stress symptoms in radiology: prevalence and response to ergonomic interventions. J Am Coll Radiol, 5, 919923.
Boksem, M.A.S., Tops, M. (2008). Mental fatigue: costs and benefits. Brain Res Rev, 59, 125139.
Boksem, M.A.S., Meijman, T.F., Lorist, M.M. (2006). Mental fatigue, motivation and action monitoring. Biol Psychol, 72, 123132.
Bruno, M.A., Walker, E.A., Abujudeh, H.H. (2015). Understanding and confronting our mistakes: the epidemiology of error in radiology and strategies for error reduction. RadioGraphics, 35, 16681676.
Bultmann, U., Kant, I., Van den Brandt, P.A., Kasl, S.V. (2002a). Psychosocial work characteristics as risk factors for the onset of fatigue and psychological distress: prospective results from the Maastricht cohort study. Psychol Med, 32, 333345.
Bultmann, U., Kant, I., Kasi, S.V., Schroer, K.A.P., Swaen, G.M.H., van den Brandt, P.A. (2002b). Lifestyle factors as risk factors for fatigue and psychological distress in the working population: prospective results from the Maastricht cohort study. J Occup Environ Med, 44, 116124.
Burnside, E.S., Park, J.M., Fine, J.P., Sisney, G.A. (2005). The use of batch reading to improve the performance of screening mammography. Am J Roentgenol, 185, 790796.
Caldwell, J.A., Caldwell, J.L. (2016). Fatigue in Aviation: A Guide to Staying Awake at the Stick. New York, NY: Routledge.
Chi, C.F., Lin, F.T. (1998). A comparison of seven visual fatigue assessment techniques in three data-acquisition VDT tasks. Hum Fact, 40, 577590.
Cornell Musculoskeletal Discomfort Questionnaire for Sedentary Workers. Cornell University Ergonomics Web. Available at: (accessed April 17, 2017).
de Mello, M.T., Narciso, F.V., Tufik, S., Paiva, T., Spence, D.W., BaHammam, A.S., et al. (2013). Sleep disorders as a cause of motor vehicle collisions. Int J Prevent Med, 4, 246257.
Dillon, T.W., Emurian, H.H. (1996). Some factors affecting reports of visual fatigue resulting from use of a VDU. Comput Hum Behav, 12, 4959.
Dinnes, J., Moss, S., Melia, J., Blanks, R., Song, F., Kleijnen, J. (2001). Effectiveness and cost-effectiveness of double reading of mammograms in breast cancer screening: findings of a systematic review. Breast. 10(6), 455463.
Dorrian, J., Hussey, F., Dawson, D. (2007). Train driving efficiency and safety: examining the cost of fatigue. J Sleep Res, 16, 111.
Dreyer, K.J., Geis, J.R. (2017). When machines think: radiology’s next frontier. Radiology, 285, 713718.
Duffy, V.G., Chan, A.H.S. (2002). Effects of virtual lighting on visual performance and eye fatigue. Hum Fact Ergonom Manufact, 12, 193209.
Ebenholtz, S.M. (2001). Oculomotor Systems and Perception. New York, NY: Cambridge University Press.
European Cockpit Association. (2012). Barometer on pilt fatigue. Available at: (accessed December 20, 2017).
Fuchs, A.F., Binder, M.D. (1983). Fatigue resistance of human extraocular muscles. J Neurophysiol, 49, 2834.
Gale, A.G., Murray, D., Millar, K., Worthington, B.S. (1984). Circadian variation in radiology. Adv Psychol, 22, 313321.
Gates, D.H., Dingwell, J.B. (2008). The effects of neuromuscular fatigue on task performance during repetitive goal-directed movements. Exp Brain Res, 187, 573585.
Grantcharov, T.P., Bardram, L., Funch-Jensen, P., Rosenberg, J. (2001). Laparoscopic performance after one night on call in a surgical department: prospective study. Br Med J, 323, 12221223.
Gur, D., Bandos, A.I., Cohen, C.S., Hakim, C.M., Hardesty, L.A., Ganott, M.A., et al. (2008). The “laboratory” effect: comparing radiologists’ performance and variability during prospective clinical and laboratory mammography interpretations. Radiology, 249, 4753.
Hancock, P.A. (2013). In search of vigilance: the problem of iatrogenically created psychological phenomena. Am Psychol, 68, 97109.
Hanna, T.N., Lamoureux, C., Krupinski, E.A., Weber, S., Johnson, J.O. (2018a). Effect of shift schedule, and volume on interpretative accuracy: a retrospective analysis of 2.9 million radiologic examinations. Radiology, 287, 205212.
Hanna, T., Zygmont, M., Peterson, R., Shekhani, H., Theriot, D., Johnson, J.O., Krupinski, E.A. (2018b). The effects of fatigue from overnight shifts on radiology search patterns and diagnostic performance. J Am Coll Radiol, pii: S1546-1440(17)31661-7.
Hardy, G.E., Shapiro, D.A., Borrill, C.S. (1997). Fatigue in the workforce of National Health Service trusts: levels of symptomatology and links with minor psychiatric disorder, demographic, occupational and work role factors. J Psychosom Res, 43, 8392.
Harris, J.D., Staheli, G., LeClere, L., Andersone, D., McCormick, F. (2015). What effects have resident work-hour changes had on education, quality of life, and safety? A systematic review. Clin Orthop Rel Res, 473, 16001608.
Hasebe, S., Graf, E.W., Schor, C. (2001). Fatigue reduces tonic accommodation. Ophthalmic Physiol Opt, 21, 151160.
Heron, G., Charman, W.N., Gray, L.S. (1999). Accommodation responses and ageing. Invest Ophthalmol Visual Sci, 40, 28722883.
Ho, J.C., Lee, M.B., Chen, R.Y., Chen, C.J., Chang, W.P., Yeh, C.Y., et al. (2013). Work-related fatigue among medical personnel in Taiwan. J Formos Med Assoc, 112, 608615.
Hoffmann, J.C., Mittal, S., Hoffmann, C.H., Fadl, A., Baadh, A., Katz, D.S., Flug, J. (2016). Combating the health risks of sedentary behavior in the contemporary radiology reading room. Am J Roentgenol, 206, 11351140.
Horowitz, T.S., Cade, B.E., Wolfe, J.M., Czeisler, C.A. (2003). Searching night and day: a dissociation of effects of circadian phase and time awake on visual selective attention and vigilance. Psychol Sci, 14, 549557.
Howard, S.K., Gaba, D.M., Smith, B.E., Weinger, M.B., Herndon, C., Keshavacharya, S., Rosekind, M.R. (2003). Simulation of rested versus sleep-deprived anesthesiologists. Anesthesiology, 98, 13451355.
Jaschinski-Kruza, W. (1988). Visual strain during VDU work: the effect of viewing distance and dark focus. Ergonomics, 31, 14491465.
Kahn, C.E. (2017). From images to actions: opportunities for artificial intelligence in radiology. Radiology, 285, 719720.
Khan, F.A., Bhalla, S., Jost, G. (2002). Results of the 2001 survey of the American Association of Academic chief residents in radiology. Acad Radiol, 9, 8997.
Kohli, M., Prevedello, L.M., Filice, R.W., Geis, J.R. (2017). Implementing machine learning in radiology practice and research. Am J Roentgenol, 208, 754760.
Komiushina, T.A. (2000). Physiological mechanisms of the etiology of visual fatigue during work involving visual stress. Vestnik Oftalmologii, 116, 3336.
Krupinski, E.A., Berbaum, K.S. (2009). Measurement of visual strain in radiologists. Acad Radiol, 16, 947950.
Krupinski, E., Reiner, B.I. (2012). Real-time occupational stress and fatigue measurement in medical imaging practice. J Digit Imag, 25, 319324.
Krupinski, E.A., Berbaum, K.S., Caldwell, R.T., Schartz, K.M., Kim, J. (2010). Long radiology workdays reduce detection and accommodation accuracy. J Am Coll Radiol, 7, 698704.
Krupinski, E.A., Berbaum, K.S., Caldwell, R.T., Schartz, K.M., Madsen, M.T., Kramer, D.J. (2012). Do long radiology workdays affect nodule detection in dynamic CT interpretation? J Am Coll Radiol, 9, 191198.
Krupinski, E.A., Berbaum, K.S., Schartz, K.M., Caldwell, R.T., Madsen, M.T. (2017a). The impact of fatigue on satisfaction of search in chest radiography. Acad Radiol, 24, 10581063.
Krupinski, E.A., Schartz, K.M., van Tassell, M.S., Madsen, M.T., Caldwell, R.T., Berbaum, K.S. (2017b). Effect of fatigue on reading computed tomography examination of the multiple injured patient. J Med Imag, 4, 035504.
Landrigan, C.P., Rothschild, J.M., Cronin, J.W., Kaushal, R., Burdick, E., Katz, J.T., et al. (2004). Effect of reducing interns’ work hours on serious medical errors in intensive care units. N Engl J Med, 351, 18381848.
Lavine, R.A., Sibert, J.L., Gokturk, M., Dickens, B. (2002). Eye-tracking measures and human performance in a vigilance task. Aviat Space Environ Med, 73, 367372.
Lee, J.G., Jun, S., Cho, Y.W., Lee, H., et al. (2017). Deep learning in medical imaging: general overview. Korean J Radiol, 18, 570584.
Levine, A.C., Adusumilli, J., Landrigan, C.P. (2010). Effects of reducing or eliminating resident work shifts over 16 hours: a systematic review. Sleep, 33, 10431053.
Lockley, S.W., Barger, L.K., Ayas, N.T., Rothschild, J.M., Czeisler, C.A., Landrigan, C.P. (2007). Effects of health care provider work hours and sleep deprivation on safety and performance. Jt Comm J Qual Patient Saf, 33(11 Suppl), 718.
Lorist, M.M., Kernell, D., Meijman, T.F., Zijdewind, I. (2002). Motor fatigue and cognitive task performance in humans. J Physiol, 545, 313319.
Mann, F.A., Danz, P.L. (1993). The night stalker effect: quality improvements with a dedicated night-call rotation. Invest Radiol, 28, 9296.
Megaw, E.D. (1995). The definition and measurement of visual fatigue. In: Wilson, J.R., Corlett, E.N. (eds.) Evaluation of Human Work: a Practical Ergonomics Methodology. Philadelphia, PA: Taylor & Francis. pp. 840863.
Mehta, R.K., Agnew, M.J. (2012). Influence of mental workload on muscle endurance, fatigue, and recovery during intermittent static work. Eur J Appl Physiol, 112, 28912902.
Mockel, T., Beste, C., Wascher, E. (2015). The effects of time on task in response selection – an ERP study of mental fatigue. Sci Rep, 5, 10113.
Moonesinghe, S.R., Lowery, J., Shahi, N., Millen, A., Beard, J.D. (2011). Impact of reduction in working hours for doctors in training on postgraduate medical education and patients’ outcomes: systematic review. Br Med J, 342, d1580.
Murata, A., Uetake, A., Otsuka, M., Takasaw, Y. (2001). Proposal of an index to evaluate visual fatigue induced during visual display terminal tasks. Int J Hum-Comput Interact, 13, 305321.
Mutti, D.O., Zadnik, K. (1996). Is computer use a risk factor for myopia? J Am Optom Assn, 67, 521530.
Owens, J.A. (2001). Sleep loss and fatigue in medical training. Curr Opin Pulm Med, 7, 411418.
Patterson, P.D., Suffoletto, B.P., Kupas, D.F., Weaver, M.D., Hostler, D. (2010). Sleep quality and fatigue among prehospital providers. Prehosp Emerg Care, 14, 187193.
Patterson, P.D., Weaver, M.D., Frank, R.C., Warner, C.W., Martin-Gill, C., Guyette, F.X., et al. (2012). Association between poor sleep, fatigue, and safety outcomes in emergency medical services providers. Prehosp Emerg Care, 6, 8697.
Pigeon, W.R., Sateia, M.J., Ferguson, R.J. (2003). Distinguishing between excessive daytime sleepiness and fatigue – toward improved detection and treatment. J Psychosom Res, 54, 6169.
Pronovost, P., Needham, D., Berenholtz, S., Sinopoli, D., Chu, H., Cosgrove, S., et al. (2006). An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med, 355, 27252732.
Reuss, L., O’Connor, S.C., Cho, K.H., et al. (2003). Carpal tunnel syndrome and cubital tunnel syndrome: work-related musculoskeletal disorders in four symptomatic radiologists. Am J Roentgenol, 181, 3742.
Rodrigues, J.C., Morgan, S., Augustine, K., et al. (2014). Musculoskeletal symptoms amongst clinical radiologists and the implications of reporting environment ergonomics- a multicentre questionnaire study. J Digit Imag, 27, 255261.
Rogers, A.E. (2008). The effects of fatigue and sleepiness on nurse performance and patient safety. In: Hughes, R.G. (ed.). Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville, MD: Agency for Healthcare Research and Quality.
Rogers, A.E., Hwang, W.T., Scott, L.D., Aiken, L.H., Dinges, D.F. (2004). The working hours of hospital staff nurses and patient safety. Health Aff (Millwood), 23, 202212.
Rohatgi, S., Hanna, T.N., Sliker, C.W., Abbott, R.M., Nicola, R. (2015). After-hours radiology: challenges and strategies for the radiologist. Am J Roentgenol, 205, 956961.
Rosen, I.M., Shea, J.A., Bellini, L.M. (2003). Residents’ work hours. N Engl J Med, 348, 664666.
Rozenshtein, A., Bauman-Fishkin, O., Fishkin, I., Homel, P. (2003). Radiology residency call in the Northeastern United States: comparison of difficulty and frequency in programs of different sizes. Acad Radiol, 10, 559564.
Rutter, C.M., Taplin, S. (2000). Assessing mammographers’ accuracy. A comparison of clinical and test performance. J Clin Epidemiol, 53, 443450.
Ruutiainen, A.T., Durand, D.J., Scanlon, M.H., Itri, J.N. (2013). Increased error rates in preliminary reports issued by radiology residents working more than 10 consecutive hours overnight. Acad Radiol, 20, 305311.
Sanchez-Roman, F.R., Perez-Lucio, C., Juarez-Ruiz, C., Velez-Zamora, N.M., Jimenez-Villarruel, M. (1996). Risk factors for asthenopia among computer terminal operators. Salud Publ Mex, 38, 189196.
Scott, J.N., Romano, C.C. (2003). On-call services provided by radiology residents in a university hospital environment. Can Assn Radiol J, 54, 104108.
Scott, H., Evan, A., Gale, A., Murphy, A., Reed, J. (2009). The relationship between real life breast screening and an annual self-assessment scheme. Proc SPIE Med Imag, 7263, 72631E-1–72631E-7.
Seidel, R.L., Krupinski, E.A. (2017). The agony of it all: musculoskeletal discomfort in the reading room. J Am Coll Radiol, 14, 16201625.
Siegel, E.L., Reiner, B. (2002). Image workflow. In: Dreyer, K.J., Mehta, A., Thrall, J.H. (eds.) PACS: A Guide to the Digital Revolution. New York, NY: Springer-Verlag, pp. 161190.
Sirevaag, E.J., Stern, J.A. (2000). Ocular measures of fatigue and cognitive factors. In: Backs, R.W., Boucsein, W. (eds.) Engineering Psychophysiology: Issues and Applications. Maywah, NJ: Lawrence Erlbaum, pp. 269287.
Sommerich, C.M., Joines, S.M.B., Psihogios, J.P. (2001). Effects of computer monitor viewing angle and related factors on strain, performance, and preference outcomes. Hum Fact, 43, 3955.
Stern, J.A., Boyer, D., Schroeder, D., Touchstone, M. (1994). Blinks, saccades, and fixation pauses during vigilance task performance. I. Time on task. FAA Off Aviat Med Rep, FAA-AM-94- 26, 144.
Stinton, C., Jenkinson, D., Adekanmbi, V., Clarke, A., Taylor-Phillips, S. (2017). Does time of day influence cancer detection and recall rates in mammography? Proc SPIE Med Imag, 10136, 10136B.
Stone, M.D., Doyle, J., Bosch, R.J., Bothe, A., Steele, G. (2000). Effect of resident call system on ABSITE performance. Surgery, 28, 465471.
Takahashi, K., Sasaki, T., Hosokawa, T., Kurasaki, M., Saito, K. (2001). Combined effects of working environmental conditions in VDT work. Ergonomics, 44, 562570.
Taylor, P., Potts, H.W.W. (2008). Computer aids and human second reading as interventions in screening mammography: two systematic reviews to compare effects on cancer detection and recall rate. Eur J Cancer, 44, 798807.
Taylor-Phillips, S., Clarke, A., Wallis, M., Wheaton, M, Duncan, A, Gale, A.G. (2001). The time course of cancer detection performance. Proc SPIE Med Imag, 7966, 796605-1–796605-8.
Taylor-Phillips, S., Wallis, M.G., Jenkinson, D., Adekanmbi, V., Parsons, H., Dunn, J., et al. (2016). Effect of using the same vs different order for second readings of screening mammograms on rates of breast cancer detection: a randomized clinical trial. JAMA, 315, 19561965.
Thompson, A.C., Kremer Prill, M.J., Biswal, S., et al. (2014). Factors associated with repetitive strain, and strategies to reduce injury among breast-imaging radiologists. J Am Coll Radiol, 11, 10741079.
Townsend, R.R., Manco-Johnson, M.L. (1995). Night call in US radiology residency programs. Acad Radiol, 2, 810815.
Trinkoff, A.M., Le, R., Geiger-Brown, J., Lipscomb, J. (2007). Work schedule, needle use, and needlestick injuries among registered nurses. Infect Control Hosp Epidemiol, 28, 156164.
Turville, K.L., Psihogios, J.P., Ulmer, T.R., Mirka, G.A. (1998). The effects of video display terminal height on the operator: a comparison of the 15” and 40” recommendation. Appl Ergonom, 9, 239246.
Tyrrell, R.A., Leibowitz, H.W. (1990). The relation of vergence effort to reports of visual fatigue following prolonged near work. Hum Fact, 32, 341357.
Van Cutsem, J., Marcora, S., De Pauw, K., Bailey, S., Meeusen, R., Roelands, B. (2017). The effects of mental fatigue on physical performance: a systematic review. Sports Med, 47, 15691588.
Van Orden, K.F., Jung, T.P., Makeig, S. (2000). Combined eye activity measures accurately estimate changes in sustained visual task performance. Biol Psychol, 52, 221240.
Veasey, S., Rosen, R., Barzansky, B., Rosen, I., Owens, J. (2002). Sleep loss and fatigue in residency training: a reappraisal. JAMA, 288, 11161124.
Waite, S., Kolla, S., Jeudy, J., Legasto, A., Macknik, S.L., Martinez-Condo, S., Krupinski, E.A., Reede, D.L. (2017). Tired in the reading room: the influence of fatigue in radiology. J Am Coll Radiol, 14, 191197.
Wascher, E., Getzmann, S. (2014). Rapid mental fatigue amplifies age-related attentional deficits. J Psychophys, 28, 215224.
Watanabe, Y. (2007). Preface and mini-review: fatigue science for human health. In: Watanabe, Y., Evengård, B., Natelson, B., Jason, L., Kuratsune, H. (eds.) Fatigue Science for Human Health. New York, NY: Springer, pp. 511.
Watten, R.G., Lie, I. (1992). Time factors in VDT-induced myopia and visual fatigue: an experimental study. J Hum Ergol, 21, 1320.
Watten, R.G., Lie, I., Birketvedt, O. (1994). The influence of long-term visual near-work on accommodation and vergence: a field study. J Hum Ergol, 23, 2739.
Whetsell, J.F. (2003). Changing the law, challenging the culture: rethinking the “sleepy resident” problem. Ann Health Law, 12, 2373.
Wolska, A., Switula, M. (1999). Luminance of the surround and visual fatigue of VDT operators. Int J Occup Saf Ergonom, 5, 553581.
Yunfang, L., Wenjing, W., Bingshuang, H., Changji, L., Chenglie, Z. (2000). Visual strain and working capacity in computer operators. Homeostasis Health Dis, 40, 2729.
Ziefle, M. (1998). Effects of display resolution on visual performance. Hum Fact, 40, 554568.