Radiographic image interpretation by Australian radiographers: a systematic review

Novel training approach to improve a cohort of radiographers' image interpretation skills of trauma chest radiographs

INTRODUCTION

Zambia is experiencing a critical shortage of radiologists responsible for interpreting X-ray images. Nine radiologists serve the entire population of over 18 million people. Consequently, referring physicians can receive reports late and often receive X-ray images without radiological reports attached, which may lead to delayed diagnoses and treatment of critically injured patients. This challenge could be alleviated if radiographers could assist with interpreting X-ray images. This study was undertaken to subject a cohort of Zambian radiographers to a training intervention, however, the COVID-19 pandemic necessitated using a novel approach to the intervention by delivering the training mainly through social media but also through face-to-face lectures.

METHODS

A cohort of 27 radiographers employed at eight public hospitals in the Copperbelt Province of Zambia undertook a training intervention using face-to-face training and image discussions on the social media WhatsApp® platform. The participants underwent a pre-and post-test in which they were asked to interpret 20 adult trauma CXR images. For the training intervention, the radiographers attended a face-to-face image interpretation lecture, after which they received training images with a radiologist report weekly for eight weeks via the WhatsApp® platform. Participants were encouraged to discuss and pose questions via the platform.

RESULTS

The cohort of radiographers (n = 27) showed an improvement in their interpretation skills for trauma CXR images. The interpretation median scores ranged from approximately 82% to 93% in the pre-test and 85% to 97% in the post-test. The Wilcoxon signed-rank tests revealed significant differences in the interpretation ability skills for 12 of the 20 CXR images after the 8-week training, demonstrating the successful implementation of the program. When comparing three categories of radiographers' years of experience (1-5; >5-10; and >10 years), the Kruskal Wallis test could not identify significant differences in the CXR image interpretation skills among the different categories of experience (P = 0.1616). When comparing the interpretation skills of radiographers working at the three different hospital levels (Level 3 with a full-time radiologist and more than ten radiographers; Level 1 and 2 without a full-time radiologist; Level 2 with six to ten radiographers; and Level 1 with five or less radiographers), the Kruskal Wallis test revealed that the level of the hospital where the radiographers were employed significantly influenced their skills to interpret the CXR images (P = 0.0323).

CONCLUSION

This type of novel training intervention is urgently required in the Copperbelt Province of Zambia. The results show that the training process was implemented successfully to improve radiographers' image interpretation skills of adult trauma CXR images.

IMPLICATIONS FOR PRACTICE

Promoting radiographers' involvement in image interpretation will likely improve imaging services in Zambia, considering the critical shortage of radiologists.

See something, say something: the coroner's perspective

The communicating safely policy, publicised by the catchphrase See Something, Say Something was released by the Medical Radiation Practice Board of Australia in 2019. It was developed to support medical radiation practitioners (MRPs) upholding the obligation to communicate urgent or unexpected findings in a timely manner, when identified on medical images. Prior to this policy being part of the professional capabilities, several untimely deaths occurred-the majority of whose causal factors could have been mitigated if imaging findings were urgently communicated by MRPs. This commentary summarises three coronial inquests that involved MRPs, discusses how these coronial findings are reflected in the communicating safely policy and provides some recommendations for the profession to ensure this policy is enacted in clinical practice.

Fostering the development of research literacy and exposure to current issues in radiography: Experience of a co-designed journal club

INTRODUCTION/BACKGROUND

Journal clubs are an effective learning activity that can fulfill the continuing professional development requirements for diagnostic radiographers. For students, journal clubs can support the development of critical appraisal skills and identify opportunities to implement evidence-based practice. This educational perspective aims to describe a co-designed journal club program, which was integrated into a 9-week part-time work integrated learning on-campus placement program for diagnostic radiography students.

METHODS

The framework for the journal club program was co-designed by students and academics. The benefits and limitations of the program were analysed and discussed in relation to the collaborative aspect of the task, the nature of the program and the focus on continuing professional development.

DISCUSSION

Journal club activities provided ample opportunities for students to engage with current issues in radiography. The flexibility and practicality of the program contributed to student engagement, but were also considered a challenge to wide participation in the weekly journal club discussion. A co-designed journal club activity can facilitate reflective practice, independent learning and critical thinking. Whilst the significance of the journal club was not extensively assessed in its first implementation, it has the potential to improve student research literacy skills and critical appraisal.

CONCLUSION

A perceived benefit of the journal club activity was the collaboration within groups who were tasked to present each week. Evaluation of the level of engagement with the program as well as its ability to improve critical analytical skills and data interpretation in the future is essential.

Utilisation of radiographer comments to reduce errors in the radiology department

INTRODUCTION

Radiographer commenting is a written account of suspected abnormalities identified on medical imaging examinations by the radiographer at the time of image acquisition. Radiographer comments were originally implemented to support emergency clinicians; however, they may also have the potential to support radiologists in reducing missed findings. Therefore, the aim of this study was to investigate if a newly implemented radiographer comment system could reduce the number of errors made in radiology reports for general X-rays. Incidental findings from multisite collaborative research led to the hypothesis that in some cases radiographer comments could accurately detect abnormal X-ray appearances that were not otherwise documented in the radiologist report, thereby enabling results to be revised and errors collaboratively reduced [1].

METHODS

This study was conducted at an 800-bed hospital, where 92% of general radiographers self-selected to participate. Radiographer comments were provided to referring physicians through the electronic medical record and could be made for any emergency or inpatient general X-ray examinations. All comments made over a 12-month period were audited against the corresponding radiologist report. Radiologists were blinded to radiographer comments at the time of reporting. Where discrepancies between the radiographer comment and radiologist report arose, additional radiologist review or subsequent imaging reports were used to determine the accurate interpretation. The number of discrepant radiographer comments that were deemed true positive (TP) and provided new and correct diagnostic information compared to the radiologist report were identified. These were converted to a percentage of total radiographer comments that were therefore able to positively influence radiologist report accuracy. The number of discrepant cases where radiographer comments were deemed false positive (FP) was also measured and converted to a percentage of the total comments. Confidence intervals for both TP and FP binomial proportions were calculated using the Wilson Score Interval.

RESULTS

Over 12 months, 282 radiographer comments were made to alert clinically significant radiographic appearances on general X-ray. Of these, 32 radiographer comments were discrepant with the report. Of these 32 comments, 24 were deemed TP meaning they correctly identified a pathological imaging appearance that was not otherwise documented in the radiology report. Therefore, 8.5% of all radiographer comments added value by correctly identifying a pathology that was not otherwise documented, 95% CI (5.8% - 12.4%). This enabled results to be promptly amended and reporting errors collaboratively reduced. Conversely, eight (2.8%) radiographer comments were discrepant with the report but deemed FP and did not add value to the investigation, 95% CI (1.4% - 5.5%). The remaining 250 non-discrepant comments did not contribute to error reduction but provided real-time abnormality detection that benefitted managing teams.

CONCLUSION

These findings are consistent with previous literature proposing radiographer comments may provide a safety net for radiologists due to factors such as direct patient contact, ability to expand on clinical history, and difference in accumulated expertise. This study demonstrates that radiographer comments may be effectively used as a multidisciplinary error-reduction tool to assist radiologists in their important role and improve clinical outcomes.

ePortfolios: Enhancing confidence in student radiographers' communication of radiographic anatomy and pathology. A cross-sectional study

INTRODUCTION

In 2020, the Medical Radiation Practice Board of Australia made several revisions to its professional capabilities. To address this, medical radiation practitioners, including diagnostic radiographers, are required to escalate urgent findings in all radiographic settings. However, the confidence of radiographers in articulating descriptions of radiographic findings varies despite this requirement. This cross-sectional study explores how the implementation of eportfolio affects student self-perceived confidence in identifying and describing radiographic findings in both an academic and a clinical setting.

METHODS

A Qualtrics survey was distributed to second-year radiography students who had used eportfolios. The survey comprised of four questions using a Likert-scale and one open-ended question. Quantitative data were analysed using the Wilcoxon signed-rank test and qualitative data was thematically assessed.

RESULTS

Overall, 55 of 65 radiographic students (85%) completed the survey. Confidence (strongly agree and agree) decreased from 89% to 74% between academic and clinical environments when identifying abnormalities, and 89% to 73% when describing findings. This finding highlights the challenges students face when in the clinical environment. Wilcoxon signed rank test analysed a statistically significant relation between the two environments (P < 0.05). However, the relationship between identifying and describing skills was not statistically significant (P > 0.05). Following a review of the qualitative data, three recurring themes were identified among responses.

CONCLUSION

ePortfolios assist in improving confidence in identification and description of radiographic abnormalities, particularly in an academic setting. The clinical environment presents unique challenges which may limit student clinical performance; however, this requires further investigation.

Impact of Education and Experience on Radiographers' Ability to Diagnose Acute Appendicitis: A Survey in Private Malaysian Hospitals

Background

Acute appendicitis is a global surgical emergency. Radiographic modalities usually identify acute appendicitis, although radiographers' competence is questionable. This study examines how clinical radiographers' education and experience affect their ability to identify acute appendicitis using computed tomography (CT), magnetic resonance imaging (MRI) and ultrasonography (USG) characteristics. The study also aimed to determine which variable strongly influences their knowledge level.

Methods

The study surveyed radiographers with a four-part self-administered questionnaire containing demographic information and eight knowledge-based questions about the appearance of acute appendicitis in MRI, CT and USG, separately. Before distribution, the questionnaire was validated and checked the reliability.

Results

Clinical radiographers' knowledge about using MRI to diagnose acute appendicitis was strongly affected by education and experience (η2 = 0.13 and 0.14; P < 0.05), with bachelor's degree holders scoring higher regardless of experience. Radiographers with more than 5 years of experience knew more about CT and USG features to identify acute appendicitis (η2 = 0.40 and 0.27; P < 0.05). Radiographers with a bachelor's degree and greater experience had higher overall knowledge of MRI, CT and USG to diagnose acute appendicitis (η2 = 0.51 and 0.11; P < 0.05). With adjusted R2 = 54% (F [2, 44] = 27.94; P < 0.001), education and experience highly predicted the overall knowledge level.

Conclusion

The study found gaps in radiographers' knowledge of the radiographic appearance of acute appendicitis. Clinical radiographers' education level and years of experience substantially affect their knowledge level. In addition, experience is a good predictor than education level for overall knowledge level. Therefore, the study emphasises the importance of continuing education and training for radiographers to diagnose acute appendicitis quickly and accurately.

The impact of intensive training in preliminary image evaluation (PIE) for radiographers in the emergency department of a regional hospital in New Zealand - A pilot study

INTRODUCTION

New Zealand has seen an increase in the X-ray examinations in the emergency departments (ED), and the radiology report is generally unavailable immediately. This requires practitioners managing the patient to take the responsibility of detecting any abnormalities in the images and using such information for the management of the patient. There is, therefore, a need for consideration of the contribution that radiographers could make in the accurate management of the patients in ED in New Zealand. The aim of this study was to assess if an intensive preliminary image evaluation (PIE) training course improved radiographer accuracy, sensitivity, and specificity on extremity X-ray examinations in a regional ED in New Zealand.

METHOD

A pre-post-intervention design was employed for this study. Seven radiographers working at a regional base hospital in New Zealand undertook image evaluation tests to evaluate their ability to detect and describe abnormalities prior to and following a 2-day intensive PIE training course. The training concentrated on acute extremity abnormalities. Tests were then scored to determine sensitivity, specificity, and accuracy.

RESULTS

Following an intensive PIE training course, the post-intervention test mean demonstrated an improved sensitivity by an average of 3.99% (89.01-93.0), specificity improved by an average of 6.13% (79.77-85.90%), and accuracy improved by an average of 3.33% (77.55-80.87%).

CONCLUSION

This study demonstrated that an intensive training course in PIE improved the participants' sensitivity, specificity, and accuracy when evaluating acute extremity X-ray examinations in ED at the study site, however further research is required to see if these results also represent clinical ability.

IMPLICATION FOR PRACTICE

The NZ healthcare system could benefit by the introduction of a radiographers' PIE system. It is therefore recommended that when introducing PIE into an ED in New Zealand, radiographers should undertake additional training to improve image evaluation sensitivity, specificity, and accuracy prior to participation.

Real-time x-ray abnormality alerts for emergency departments using a radiographer comment model - a multisite pilot study

INTRODUCTION

The timely communication of clinically significant image appearances to Emergency Department (ED) referrers is necessary for optimum patient care. Australian reliance on verbal communication only is time-limited, open to misinterpretation and lacks transparency. A combined radiographer alert and comment model was designed to reliably communicate image abnormalities to ED referrers in real-time.

METHODS

A multidisciplinary steering group designed the model for all ED general imaging. Protocols were developed to document radiographer comments (critical, urgent and clinically significant) in patients' medical records. Critical findings were communicated directly to ED. Five NSW hospitals varying in size, complexity and population demographics piloted the model between three to twelve months during 2021-2022. Site auditors compared comments with the radiology report and designated each as True Positive (TP), False Positive (FP), indeterminate and clinically significant. Indeterminate cases were analysed by an external radiologist. Inter-observer consensus was obtained for all classifications via two independent auditors. The Positive Predictive Value (PPV), or precision of the comment, was calculated for each site.

RESULTS

Radiographers (n = 69) provided comments for 1102 cases. The pooled average PPV for TP was 0.96; (0.947-0.971; 95% CI). The weighted mean error (FP comments) was 3.9%; (2.9% - 5.3%.; 95% CI).

CONCLUSION

The Radiographer Comment model provided consistent levels of commenting precision and reproducibility across a range of sites with a pooled average PPV (0.96). The False Positive rate or weighted mean error (FP) of 3.9% (2.9% - 5.3%.; 95% CI) was low.

IMPLICATIONS FOR FUTURE PRACTICE

A strategic, interprofessional approach in the implementation of an image alert combined with a Radiographer Comment can be adapted across a variety of hospital settings for ED and other departments.

Australian radiographer roles in the emergency department; evidence of regulatory compliance to improve patient safety - A narrative review

OBJECTIVES

Using a narrative approach, this paper aims to determine the extent of Australian radiographers' regulatory compliance to improve patient safety when performing appendicular X-ray and non-contrast brain computed tomography (CT) in the Emergency Department (ED).

KEY FINDINGS

A narrative review explored relevant literature and key regulatory policy. Ten documents were identified, three main themes were developed related to the radiographer roles in X-ray request justification, dose optimisation and preliminary image evaluation (PIE). Radiographers were equally aware of justification and optimisation pre and post the introduction of a Medical Code of Practice. The collective PIE accuracy of radiographers remained unaffected by changes in mode of PIE delivery and regulatory factors but varied based on the anatomical region.

CONCLUSION

While current Australian regulations mandate radiographer request justification, dose optimisation and PIE, the degree of compliance by Australian radiographers remains uncertain. Current literature provides evidence that radiographers can improve patient care and safety through justification, optimisation, and PIE delivery. Change in workplace practice, supported by key stakeholders including radiologists, is essential to integrate radiographers' functions into routine ED clinical practice. Further research is required to audit radiographers' regulatory compliance to improve patient safety.

IMPLICATIONS FOR PRACTICE

Patient safety in ED can be improved with timely and accurate diagnosis provided by radiographers. Radiographers have a professional obligation to adhere to the capabilities and standards for safe medical radiation practice defined by Australian regulations. Therefore, radiographers must justify the X-ray request, optimise the radiation dose where appropriate and communicate urgent or unexpected findings to the referrer.

Radiologists' perceptions of knowledge and training required by radiographers in the interpretation of radiographic images: An explorative study in KwaZulu-Natal province, South Africa

INTRODUCTION

The health sector of South Africa is burdened by the shortage of radiologists leading to the under-reporting of radiographic images and ultimately mismanagement of patients. Previous studies have recommended training of radiographers in radiographic image interpretation in order to improve the reporting. There is paucity of information regarding the knowledge and training required by radiographers to interpret radiographic images. The purpose of this study was therefore to explore the knowledge and training required by diagnostic radiographers, according to radiologists, for the interpretation of radiographs.

METHOD

A qualitative descriptive study employing criterion sampling to select qualified radiologists practicing in the eThekwini district of the KwaZulu Natal province, was conducted. One-on-one and in-depth, semi-structured interviews were used to collect data from three participants. The interviews were not carried out face to face as a result of the Covid 19 pandemic and the regulation of social distancing. This did not permit engagement with research communities. The data from the interviews were analysed using Tesch's eight steps for analysing qualitative data.

RESULTS

Findings revealed that radiologists supported the interpretation of radiographic images by radiographers in rural settings, and for the radiographer's scope of practice to be restructured to include the reporting of chest and the musculoskeletal system images. The themes that emerged from the analysis included knowledge, training, clinical competencies and medico-legal responsibilities required by radiographers in the interpretation of radiographic images.

CONCLUSION

Although the radiologists support the training of radiographers in the interpretation of radiographic images, radiologists think that the scope of practice should be limited to the interpretation of the chest and musculoskeletal systems in rural areas only.

Reporting radiographers in Norway - A qualitative interview study

INTRODUCTION

A number of Norwegian radiographers have attended an advanced programme of education and training in musculoskeletal reporting, some in the UK and some in Norway. The aim of this study was to examine how reporting radiographers, radiologists and managers experienced the education, competence, and role of reporting radiographers in Norway. To our knowledge, the role and function of reporting radiographers in Norway has not yet been explored.

METHODS

The study had a qualitative design and was based on eleven individual interviews of reporting radiographers, radiologists, and managers. The participants represented five different imaging departments from four hospital trusts in Norway. The interviews were analyzed using inductive content analysis.

RESULTS

The analysis identified two main categories: "Education and training", and "The reporting radiographer". The subcategories were: "Education", "Training", "Competence", and "The new role". The study found the program to be demanding, challenging, and time-consuming. However, the reporting radiographers described it as motivating because they gained new competence. The competence of reporting radiographers was regarded as adequate. The participants found that reporting radiographers had a unique competence in both image acquisition and reporting, and they were described as a missing link between radiographers and radiologists.

CONCLUSION

Reporting radiographers are experienced as an asset for the department. Reporting radiographers not only contribute to musculoskeletal imaging reports but are also important for collaboration, training, and professional development in imaging, and in collaborating with orthopedics. This was seen to increase the quality of musculoskeletal imaging.

IMPLICATIONS FOR PRACTICE

Reporting radiographers are a valuable resource in image departments, especially in smaller hospitals where the shortage of radiologists is noticeable.

Reducing diagnostic errors in the emergency department at the time of patient treatment

OBJECTIVE

The purpose of the present study was to compare and combine the radiographic interpretation accuracy of emergency clinicians and radiographers in clinical practice.

METHODS

A total of 838 radiographic examinations were included for analysis from 1 August to 24 August 2020. The range of examinations reviewed included the appendicular and axial skeleton, chest and abdomen. Both paediatric and adult examinations were reviewed. The emergency clinician's and radiographer's interpretations for each examination were compared to the radiologist's report. This allowed mean sensitivity, specificity and diagnostic accuracy to be calculated.

RESULTS

The radiographer's interpretation demonstrated a mean sensitivity, specificity and accuracy of 80%, 98% and 92%, respectively. The emergency clinician's interpretation demonstrated a mean sensitivity, specificity and accuracy of 82%, 95% and 89%, respectively. When the radiographer's and emergency clinician's interpretations were combined, it yielded a mean sensitivity, specificity and accuracy of 90%, 93% and 92%, respectively.

CONCLUSIONS

This is the first study to directly compare and combine the accuracy of an emergency clinician's radiographic interpretation with a radiographer's interpretation within clinical practice. The present study demonstrated that with the addition of a radiographer's interpretation, an emergency clinician's interpretation can be more accurate than the emergency clinician's interpretation in isolation. This highlights the value of a radiographer's interpretation that can complement an emergency clinician's interpretation when a radiologist's report is unavailable.

The changing concept of radiographer's role in UAE: An analysis of radiologists' opinions and acceptance

INTRODUCTION

The role of radiographers in the United Arab Emirates (UAE) is currently focused on image acquisition. However, many advances have been made in different countries in recent years whereby radiographers who receive appropriate education and training, can provide image interpretation/reports. When implemented, this role development has enabled a more cost effective and efficient service delivery whilst relieving the burden off radiologists, allowing them to concentrate on more complex imaging examinations. This role development is commonplace in many countries but not in the UAE.

AIM

This study aims to investigate the radiologists' opinions, perceptions, and willingness to accept the advanced practice role of reporting radiographers in the UAE and determine their level of support for implementing these roles.

METHODS

Data was collected utilizing a mixed-methods study design that included a survey and focus group discussions (FGD). Study participants included radiologists who currently work in UAE public and private health organizations. The survey link was emailed directly to the radiologists, together with a covering letter and participants' information sheet outlining the study's aim. Participants indicated on the survey if they wanted to participate in FGD. Two online FGD were conducted using Zoom software (Zoom Video Communications Inc., San Jose, California, United States) and aimed to explore possible reasons for participant's opinions. Ethical approval was obtained from the Ministry of Health, and all methods were performed as per study protocol.

RESULTS

A total of 69 radiologists participated in the survey, 48 males and 21 females aged between 41 and 60 years and with between 11 and 16 years of experience. Most participants (n = 54, 78.2%) believe that radiographers should only perform advanced tasks in image interpretation after obtaining adequate training and under the supervision of a radiologist. According to 55% of radiologists, the development of the radiographer role could draw more UAE nationals to the field. Six participants were recruited to FGD and declared mixed opinions that emphasized the need to improve the radiographers knowledge and experience to enable role development.

CONCLUSION

Radiologists' worries about radiographer engagement in image interpretation may be alleviated if they participate in education and training for new responsibilities. In addition, this could boost the confidence of radiologists and improve trust in radiographer competency and training.

IMPLICATIONS FOR PRACTICE

Guidelines and work standards must be developed jointly by radiologists and radiographers to ensure the governance and acceptability of new radiographer reporting roles. Some radiologists perceive that radiographer reporting is possible in UAE when radiographers are trained to set guidelines and with supervision from radiologists. Change is taking place, and many radiologists express optimism for the future, though the rate of change will be determined by a willingness to change attitudes and perceptions.

Optimizing integrated imaging service delivery by tier in low-resource health systems

Access to imaging diagnostics has been shown to result in accurate treatment, management, and optimal outcomes. Particularly in low-income and low-middle-income countries (LICs, LMICs), access is limited due to a lack of adequate resources. To achieve Sustainable Development Goal (SDG) 3, access to imaging services is critical at every tier of the health system. Optimizing imaging services in low-resource settings is best accomplished by prescriptive, integrated, and coordinated tiered service delivery that takes contextual factors into consideration. To our knowledge, this is the first recommendation for optimized, specific imaging care delivery by tier. A model for tier-based essential imaging services informs and guides policymakers as they set priorities and make budgetary decisions. In this paper, we recommend a framework for tiered imaging services essential to reduce the global burden of disease and attain universal health coverage (UHC). A lack of access to basic imaging services, even at the lowest tier of the health system, can no longer be justified by cost. Worldwide, affordable modalities of modern ultrasound and X-ray are becoming an accessible mainstay for the investigation of common conditions such as pregnancy, pneumonia, and fractures, and are safely performed and interpreted by qualified professionals. Finally, given the vast gap in access to imaging resources between LMICs and high-income countries (HICs), a scale-up of tiered imaging services in low-resource settings has the potential to reduce health disparities between, and within countries. As the access to appropriately integrated imaging services improves, UHC may be achieved.

An analysis of radiographer preliminary image evaluation - A focus on common false negatives

INTRODUCTION

Preliminary image evaluation (PIE) is a mechanism whereby radiographers provide a preliminary evaluation of whether pathology is present in their radiographs, typically acquired within the emergency department (ED). PIE provides referrers with a timely communication of pathology prior to the availability of a radiology report. The purpose of this study was to determine the most common radiographer PIE false-negative interpretations.

METHODS

Each month over a two-year period, 100 PIEs of adult and paediatric patients were randomly reviewed in a metropolitan hospital ED. The radiographer's PIE was compared with the radiologist's report and categorised into basic quality indicators; true positive, true negative, false positive and false negative. The anatomical regions which most commonly indicated a false-negative interpretation were further analysed.

RESULTS

2402 cases were reviewed which resulted in an overall PIE accuracy of 88.7%. Wrists, hands, phalanges (upper), ankles, feet and phalanges (lower) reporting the highest false-negative or false-negative/true-positive interpretations (60/116). Of the 60 false-negative PIEs, 68 pathologies were identified. 41.1% (28/68) of the pathology not identified were in the phalanges. Within these regions, examinations with multiple injuries commonly reported false negatives (17/60).

CONCLUSIONS

This study demonstrated the most common false-negative radiographer PIEs were within the upper and lower distal extremities. Specifically, the phalanges and examinations demonstrating multiple injuries reported high levels of misinterpretation. The misinterpretation in multi-injury examinations could be attributed to 'Subsequent Search Miss (SSM)' error. These results provide valuable insights into areas of emphasis when providing image interpretation education.

Writing your first paper: An informal guide for medical radiation sciences professionals

Writing and submitting a paper can be a daunting prospect, especially the first time. One of the more challenging aspects is knowing how to begin. Countless projects in the workplace never make it past local dissemination or conference presentation. This informal guide will help you take that next step and begin the peer-reviewed publication journey.

Performance and educational training of radiographers in lung nodule or mass detection: Retrospective comparison with different deep learning algorithms

The aim of this investigation was to compare the diagnostic performance of radiographers and deep learning algorithms in pulmonary nodule/mass detection on chest radiograph.A test set of 100 chest radiographs containing 53 cases with no pathology (normal) and 47 abnormal cases (pulmonary nodules/masses) independently interpreted by 6 trained radiographers and deep learning algorithems in a random order. The diagnostic performances of both deep learning algorithms and trained radiographers for pulmonary nodules/masses detection were compared.QUIBIM Chest X-ray Classifier, a deep learning through mass algorithm that performs superiorly to practicing radiographers in the detection of pulmonary nodules/masses (AUCMass: 0.916 vs AUCTrained radiographer: 0.778, P < .001). In addition, heat-map algorithm could automatically detect and localize pulmonary nodules/masses in chest radiographs with high specificity.In conclusion, the deep-learning based computer-aided diagnosis system through 4 algorithms could potentially assist trained radiographers by increasing the confidence and access to chest radiograph interpretation in the age of digital age with the growing demand of medical imaging usage and radiologist burnout.

Computed tomography technologist notes in PACS to radiologists: what are they telling us and how does it increase value?

PURPOSE

In the clinical workflow of radiology services, a critical connection exists between technologists and radiologists, yet there is often limited communication between this key link in the chain of patient imaging. Our aim was to quantify and detail the communication between CT technologists and radiologists in our tertiary oncology practice.

METHODS

Using the note function in our EMR, as standard operating procedure, CT technologists are instructed to place pertinent notes for the radiologist relevant to any portion of the patient encounter. Note categories pertain to quality and/or safety: patient limitations (e.g., patient unable to raise arm), protocol confirmation (e.g., rectal contrast given), critical finding communication, scan range considerations, IV issues, reduction in eGFR, oral contrast issues, allergy information, general feedback, equipment malfunction, and radiologist approval information. The percentage of notes within each category were recorded upon review of contiguous abdominal CT scans in July 2018 with the primary outcome measure of overall note volume compared to baseline in July 2016 after which time technologists were educated on the importance of notes and were requested to increase use of this tool. Notes were regularly reviewed to identify practice improvement opportunities.

RESULTS

Compared to baseline 2 years earlier (8860 CT scans, 812 technologist notes), there was a 32% increase in technologist note volume (10,948 CT scans, 1330 technologist notes), representing an increase of notes from 9.2% of exams to 12.1% of exams (p < .001) and there were 14 related practice improvements.

CONCLUSION

After communicating the importance of CT technologist notes and requesting increased notation frequency, technologist note volume significantly increased and 14 specific case examples of related practice improvement demonstrate the electronic medical record note function to be a robust tool in the management of patient imaging.

Understanding diagnostic test accuracy studies and systematic reviews: A primer for medical radiation technologists

Diagnostic test accuracy studies are performed in order to determine the value of a diagnostic test. Primary studies of diagnostic accuracy describe the accuracy of a test calculated using the number of true and false positive and negative cases of a given diagnosis of interest. Systematic reviews of diagnostic test accuracy are performed to identify accuracy of a test but also to investigate where the test might sit in a diagnostic pathway or determine how different tests compare against each other. This introductory discussion paper aims to give the reader an overview of the various features in primary and secondary diagnostic test accuracy study designs for medical imaging professionals.

The effect of a digital training tool to aid chest image interpretation: Hybridising eye tracking technology and a decision support tool

INTRODUCTION

Eye tracking technology, checklists and search strategies have been demonstrated as useful aids in image interpretation. A training tool was developed, by the research team, which included these features. This study aimed to evaluate the effect of the training tool on participant image interpretation performance.

METHODS

The study was carried out with reporting radiographers who had either commenced training in chest image interpretation (n = 12) or were trained in musculoskeletal image interpretation (n = 23) (total n = 35). Participants were allocated to a control or intervention group. Participants completed an initial assessment at recruitment and re-attended nine months later for a follow-up assessment. The intervention group were given unlimited access to a digital training tool. During assessments participants interpreted 20 chest images whilst using eye tracking technology (total of 1400 images were interpreted). A confidence level was obtained from participants on their diagnosis and a questionnaire, to obtain demographic data, was completed following the assessment.

RESULTS

Improvements were seen in the confidence of intervention group participants (p < 0.05). False Positive (FP) scores decreased for both the control and intervention group (p < 0.05), this decrease was from 4.20 to 3.20 for the control group and from 5.87 to 3.27 for the intervention group. True Negative (TN) scores increased, from 5.13 to 6.73 for the intervention group (p < 0.05). Mean decision time decreased for both the control and intervention group.

CONCLUSION

The tool led to positive effects on participant performance and could be a useful aid in chest image interpretation learning.

IMPLICATIONS FOR PRACTICE

Improvements in performance were observed with a digital tool. The tool could improve image interpretation methods and training.

An audit of radiographers’ practice of left-right image annotation in film-screen radiography and after installation of computed radiography in a tertiary hospital in Africa

Background

Errors in radiographic image annotation by radiographers could potentially lead to misdiagnoses by radiologists and wrong side surgery by surgeons. Such medical negligence has dire medico-legal consequences. It was hypothesized that newer technology of computed radiography (CR) and direct digital radiography (DDR) image annotation would potentially lead to a change in practice with subsequent reduction in annotation errors. Following installation of computed radiography, a modality with electronic, post-processing image annotation, the hypothesis was investigated in our study centre.

Results

A total of 72,602 and 126,482 images were documented for film-screen radiography (FSR) and computed radiography (CR), respectively in the department. From these, a sample size of 9452 made up of 4726 each for FSR and CR was drawn. Anatomical side marker errors were common in every anatomy imaged, with more errors seen in FSR (4.6%) than CR (0.6%). Collectively, an error rate of 3.0% was observed. Errors noticed were as a result of marker burnout due to over-exposure as well as marker cone off due to tight beam collimation.

Conclusion

Error rates were considerably reduced following a change from film-screen radiography (FSR) to computed radiography (CR) at the study centre. This change was, however, influenced more by a team of quality control radiographers stationed at CR workstation than by actual practice in x-ray imaging suite. Presence of anthropomorphic phantom in the teaching laboratories in the universities for demonstrations will significantly inculcate the skill needed to completely eliminate anatomical side marker (ASM) error in practice.

Strategies for Inclusive Medical Imaging Environments for Sexual and Gender Minority Patients and Radiographers: An Integrative Literature Review

BACKGROUND

Sexual and gender minority patients, and radiographers, experience several challenges that hinder realisation of their rights to equality and to a standard of living which is adequate for their well-being and health, in clinical environments. To this extent, a person-centred care approach is advocated for the medical radiation science professions so that a more inclusive medical imaging environment for patients and radiographers is provided. There is no summation of the body of knowledge available to promote all-encompassing environments for sexual and gender minority groups in medical imaging.

PURPOSE

The purpose of this study was to establish the current evidence available on strategies that can be and are used to foster inclusive medical imaging environments for sexual and gender minority patient groups and radiographers.

KEY FINDINGS

Four articles, predominantly written from a global north perspective and within the last three years, formed part of this review. The strategies that emerged from the analysed articles were categorised into three themes, namely, using inclusive language, educating radiographers, and creating affirming health care environments.

CONCLUSION

Limited evidence exists on the strategies used to promote more inclusive medical imaging environments for sexual and gender minority patients and radiographers. Hence, more work in this area is needed from a diagnostic radiography perspective. Recommendations for possible future research are provided.

Accuracy of radiographer comment following a two-month experiential and blended learning in appendicular skeleton X-ray interpretation: The Singapore experience

INTRODUCTION

The value of combined blended and experiential learning on radiographer diagnostic comment has not been explored. This study aims to examine the accuracy of image interpretation comment of radiographers who received a period of blended and experiential learning in Radiographer Abnormality Detection Systems (RADS).

METHODS

We evaluated the diagnostic opinions of 13 radiographers who received a blended training and experiential learning (a process of self-learning and reflection) in RADS. Radiographers' opinions on 16,483 images were examined using the final radiologists' report as a reference standard. For each radiographer, we recorded the number of true positive, true negative, false positive and false negative opinions and MedCal® was used to calculate diagnostic performance and error rates. A t-test was used to assess whether the number of images read was associated with performance and whether the radiographers retained performance over time.

RESULTS

Sensitivity ranged from 87.4 (84.0-90.2) to 98.9 (97.5-99.7) with a mean of 94.3 (93.6-94.8). Specificity varied from 96.4 (94.8-97.5) to 99.9 (99.41-100.0) with a mean of 98.2 (97.9-98.4). Diagnostic accuracy ranged from 93.1 (91.5-94.4) to 99.5 (98.9-99.8) with a mean of 96.9 (96.6-97.1). The mean false positive rate was 0.018 (range: 0.010-0.031) with a false negative rate of 0.057 (range: 0.026-0.11). There were no differences in performance between the first and latter nine months of providing opinions and the number of images reviewed was not associated with performance.

CONCLUSION

Radiographers who received blended and experiential learning in RADS provide accurate diagnostic comments on plain emergency appendicular skeleton radiographs.

IMPLICATION FOR PRACTICE

A combined blended and experiential learning can equip radiographers to provide diagnostic opinion on plain appendicular skeleton radiographs.