This study aimed to investigate the effect on reading performance of how long radiologists have been awake (“time awake”) and the number of hours they slept at night (“hours slept at night”) before a reading session. Data from 133 mammographic reading assessments were extracted from the Breast Screen Reader Assessment Strategy database. Analysis of covariance was performed to determine whether sensitivity, specificity, lesion sensitivity, ROC, and JAFROC were influenced by the time awake and the hours slept at night. The results showed that less experienced radiologists’ performance varied significantly according to the time awake: lesion sensitivity was significantly lower among radiologists who performed readings after being awake for less than 2 h (44.6%) than among those who had been awake for 8 to <10 h (71.03%; p = 0.013); likewise, the same metric was significantly lower among those who had been awake for 4 to <6 h (47.7%) than among those who had been awake for 8 to <10 h (71.03%; p = 0.002) and for 10 to <12 h (63.46%; p = 0.026). The ROC values of the less experienced radiologists also seemed to depend on the hours slept at night: values for those who had slept ≤6 h (0.72) were significantly lower than for those who had slept >6 h (0.77) (p = 0.029). The results indicate that inexperienced radiologists’ performance may be affected by the time awake and hours slept the night before a reading session.
Numerous factors contribute to radiologist image reading discrepancy and interpretive errors. However, a factor often overlooked is how interpretations might be impacted by the time of day when the image reading takes place—a factor that other disciplines have shown to be a determinant of competency. This study therefore seeks to investigate whether radiologists’ reading performances vary according to the time of the day at which the readings take place. We evaluated 197 mammographic reading assessments collected from the BreastScreen Reader Assessment Strategy (BREAST) database, which included reading timestamps and radiologists’ demographic data, and conducted an analysis of covariance to determine whether time of day influenced the radiologists’ specificity, lesion sensitivity, and jackknife alternative free-response receiver operating characteristic (JAFROC). After adjusting for radiologist experience and fellowship, we found a significant effect of the time of day of the readings on specificity but none on lesion sensitivity or JAFROC. Radiologist specificity was significantly lower in the late morning (10 am–12 pm) and late afternoon (4 pm–6 pm) than in the early morning (8 am–10 am) or early afternoon (2 pm–4 pm), indicating a higher rate of false-positive interpretations in the late morning and late afternoon. Thus, the time of day mammographic image readings take place may influence radiologists’ performances, specifically their ability to identify normal images correctly. These findings present significant implications for radiologic clinicians.
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