1. A system comprising: a diagnostic image review system configured to display a plurality of images such that each displayed image can be reviewed by an operator for diagnostic purposes; an input module operably connected to the diagnostic image review system, the input module configured to input alertness data regarding alertness of the operator while the operator reviews each displayed image, the input module and diagnostic image review system configured such that each of the displayed images is associated with alertness data that was input while the image was being displayed by the diagnostic image review system; an alertness assessment module operably connected to the input module and configured to evaluate said alertness data to identify one or more images that were displayed by the diagnostic image review system while the operator was not sufficiently alert; and an output module operably connected to the alertness assessment module and configured to output information based on the evaluation made by the alertness assessment module.