Certain embodiments of the present invention provide a system, method and computer instructions for assessing alertness of an operator of an image review system. In an embodiment, such a system includes: an input module configured to allow alertness data to be input; an alertness assessment module configured to evaluate alertness based on the alertness data; and an output module configured to output information based on the evaluation made by the alertness assessment module. In certain embodiments, the input module may input alertness data from: a three-dimensional coordinate tracking system; a brain wave monitoring device; an eye movement monitoring device; a video recording device; and/or an eye closure monitoring device, for example. In certain embodiments, the alertness assessment module may evaluate alertness data using: a Psychomotor Vigilance Performance Task; the Karolinska Sleepiness Scale; and/or a Visual Analogue Sleepiness Scale, for example.