Are Radiologists’ Work Patterns Safe? Learning from the Aviation Industry
As the volume and complexity of imaging in the UK continues to rise, there is pressure on radiologists to spend increasing amounts of time reporting to cope with the growing workload. Although average annual growth in the total number of cross-sectional studies (CT and MR) has been over 10%, the workforce of Consultant Radiologists is growing at only 3% annually.
It is known that radiologists’ behaviours change over the course of a reporting session, and that at the end of the working day, radiologists’ visual performance and ability to detect pathology is lower than at the start of the day. It follows that longer reporting sessions may lead to higher error rate and burn out.
Yet there is no established consensus on the optimum duration and structure of reporting sessions, despite the Royal College of Radiologists stating in its guide to job planning that “adequate time should be provided in job plans to deliver the workload expected safely and without compromise on quality”.
There is also considerable variability in the practice of individual radiologists in this regard. A recent survey conducted on behalf of the British Society of Neuroradiologists and published in 2018 revealed that some radiologists report for up to 12 hours a day and for 4 hours without taking a break. Mean break duration was 15 minutes, but with computer-based activities replacing reporting for about half of respondents.
For many years, medicine has been learning from the aviation industry. There are clear parallels between the work of radiologists and air traffic controllers (ATCs): both forms of work require periods of intense concentration and the analysis of visual information from computer monitors, and any factors that impair perception or ability to concentrate can have a potentially serious effect on the performance of both groups.
ATCs’ working hours are standardised across the UK by the Civil Aviation Authority “to ensure that controller fatigue does not endanger aircraft and thereby to assist controllers to provide a safe and effective service”. It is stipulated that no operational duty should exceed two hours without a break of at least 30 minutes; that rest activities should exclude computer-based tasks; and that daytime shifts should not exceed 8 hours. The working conditions of many radiologists compare badly with the controls applied to ATC work.
A critical concept from cognitive psychology in understanding how long concentrated attention can be sustained is vigilance. It is well established that there is a vigilance decrement with prolonged periods of cognitive tasking, with declines commencing after as little as 20 minutes. It may be that radiologists need to take regular breaks – potentially every hour – to sustain reporting performance over the course of a day.
As radiological investigations become increasingly complex, there is an additional risk of cognitive overload. As radiologists work closer to their maximum cognitive capacity, the avoidance of fatigue-related performance decrements is all the more important. It is therefore essential that radiologists consider the importance of limiting the duration of reporting sessions and of taking regular, adequate breaks. Employers and managers must adjust their expectations of reporting output accordingly, so that radiologists can minimise reporting errors and keep patients safe.
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