Diagnostic reading session: temporal patterns and case-order effects

The authors analyzed receiver-operating-characteristic studies to determine temporal patterns and performance as a function of the elapsed time in a reading session. Nineteen radiologists each read as many as 300 chest images with use of seven different display modalities, including conventional and laser-printed film and high-resolution soft display. With a computerized reporting system, the ratio of observers' interpretation rates (time to diagnosis) were recorded for the last five and 10 compared with the first five and 10 of 30-40 cases seen in sessions lasting 45-110 minutes. Observers tended to accelerate their interpretation as the sessions progressed by an average of 15% (P < .001). The acceleration was consistent for all readers (both fast and slow) with a variety of display modes under the nonrestricted time environment.