An Even Keel

As imaging becomes increasinlgy complex, and the radiology work environment more stressful, it is more important than ever for radiologists to maintain their focus.evenkeel

There are arguably more stressors confronting radiologists today than at any point in the specialty’s history.

The tension between quality patient care and the demands of ever faster turnaround times, a sluggish economic recovery that has made it difficult to enter or exit the field, and other factors present great challenges to the field of radiology. Given the upheaval surrounding them, radiologists may find it challenging to stay focused and keep their concentration on delivering the best care to patients.

Stress on the Rise

A recent study on diagnostic accuracy and fatigue found that accuracy is significantly reduced after a day of reading images. Indeed, the authors note, “radiologists experience induced myopia after a long day or night of reading.” As the article’s lead author, Elizabeth A. Krupinski, PhD, professor of medical imaging at the University of Arizona, explains, “Our society has invested much in imaging technology and our physicians who interpret images. Radiologists now read more studies, containing more images, incurring greater demands.”

These demands are multivariate and on the rise, triggering an “epidemic of physician stress and burnout,” according to Peter S. Moskowitz, MD, executive director of the Center for Professional & Personal Renewal in Palo Alto, Calif. He says that the top reasons radiology has become an increasingly challenging profession include changing reimbursement models resulting in pressure to work harder to maintain income, increasing turf battles to control medical imaging, and the culture of American medicine, in which physicians are not comfortable asking for help or admitting they need support until they are in the midst of a crisis.

Many radiologists feel forced to meet these escalating demands by working longer hours, or even by working extra from home. James M. Busch, MD, president of Diagnostic Radiology Consultants in Chattanooga, Tenn., says that taking work home is easy for radiologists at his practice because of the technological capabilities available to them. “Everyone in my practice has a workstation at their home. We all have a lot of bandwidth; I personally have a gigabyte going into my house that allows me to read images just as quickly as if I were at work. Image review from home is no longer a rate-limiting step,” he says. But for all of the flexibility this allows Busch and his colleagues, there is a downside. “Radiology has become a 24/7/365 business,” he says. "You have to set strong boundaries between your work life and home life, or else you open yourself up to fatigue."

Setting Boundaries

One way radiologists can inoculate themselves against burnout and make themselves more alert and efficient is by walking away from their workstation at a reasonable time. Moskowitz, a career and life coach for health care professionals, touts the importance of understanding that work-life balance is a “path and not a destination.” He notes, “My 15 years of coaching physicians has taught me that the goal of healthy balance is attainable. However, it is never perfect and is in need of frequent updating and re-evaluation. That said, learning to say no at appropriate times is crucial to the goal of reaching reasonable work-life balance.”

"Learning to say no at appropriate times is crucial to the goal of reaching a reasonable work-life balance." — Peter S. Moskowitz, MD

However, the ability to say no can present difficulties for radiologists who have no outside interests compelling them to go home at the end of regular business hours. For Busch, playing organized soccer and jogging five to six days a week is enough of an inducement for him to walk away at the end of a busy day. But adhering to outside interests is only possible when those around you support the endeavor. Though Krupinski acknowledges that building this infrastructure is not always easy, she says, “Having support and understanding on both the private and professional side is critical, especially when compromises need to be made. Rather than thinking of boundaries and absolutes, people should help create environments where there is open communication and mutual respect for finding balances that work for everyone.”

Practical Solutions

Although some situations require a revamping of one’s entire lifestyle, others necessitate smaller-scale course corrections. To regain focus during a busy day, Moskowitz recommends taking a break every 60 to 90 minutes to engage in activities such as deep-breathing exercises, meditation, listening to music, or other relaxation techniques. Krupinski suggests radiologists make liberal use of the "20/20/20" technique throughout the work day: "Every 20 minutes look at something about 20 feet away from your workstation display for about 20 seconds,” she says. “This gives your eyes and eye muscles a chance to recover a bit from the intense close-up viewing that reading from a computer display entails.”

Krupinski also endorses a range of technologies that can take some of the strain off of radiologists, such as computeraided detection (CAD) software and other automated image analysis schemes such as those that help automatically quantify imaging parameters or segment out regions of interest. “When CAD and other tools are available, they can help the radiologist detect abnormalities more readily. If they can do this with high enough sensitivity and specificity, it seems likely that one consequence is to reduce the time it takes to interpret a case, thereby making it easier to get through more cases in a given amount of time,” she says. In addition, Busch’s practice has taken pains to ensure that identical work stations were installed both in the practice and at the hospital with which they contract. “That way,” he explains, “our radiologists can make use of the same comfortable, predictable user interface no matter where they show up for work.”

Busch also notes that his practice has tailored staff responsibilities based on each person’s strengths. “One person might be in the bunker reading room to minimize distractions and optimize image interpretation. Another person acts as the point person when it comes to interacting with referring physicians and hospital administrators, fielding potential distractions from the interpreting radiologists,” he says. In addition, his practice is staffed such that radiologists with fellowships in certain subspecialties can read to their strengths, allowing for faster turnaround times. Busch attests that defined roles are key to a teamwork approach in order to achieve both quality and quantity during image interpretation.

Burnout is a risk every radiologist will face if they do not take steps to prevent it. Establishing a healthy balance between one’s professional and personal lives, employing relaxation techniques, and harnessing technology can all aid in removing some of the pressures radiologists face every day. And knowing when to take a step back can even translate into improved patient care.

By Chris Hobson



1. Krupinski EA, et al. “Do Long Radiology Workdays Affect Nodule Detection in Dynamic CT Interpretation?” JACR 2012;9(3):191–98. Available at Accessed Nov. 5, 2013.


Other Suggested Resources
JACR® article “Culture Shift: An Imperative for Future Survival”:
ACR Bulletin article “Rise and Shine”:
ACR’s Imaging 3.0TM website:

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