1
|
Chilambe E, Muller H, du Plessis J. Novel training approach to improve a cohort of radiographers' image interpretation skills of trauma chest radiographs. J Med Imaging Radiat Sci 2024; 55:244-257. [PMID: 38429173 DOI: 10.1016/j.jmir.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 01/25/2024] [Accepted: 02/02/2024] [Indexed: 03/03/2024]
Abstract
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.
Collapse
Affiliation(s)
- Ethel Chilambe
- Imaging Department, Arthur Davison Children's Hospital, Ndola, Copperbelt, Zambia; Department of Clinical Sciences, Faculty of Health and Environmental Sciences, Central University of Technology, Bloemfontein, Free State, South Africa
| | - Henra Muller
- Department of Clinical Sciences, Faculty of Health and Environmental Sciences, Central University of Technology, Bloemfontein, Free State, South Africa.
| | - Jeanette du Plessis
- Department of Clinical Sciences, Faculty of Health and Environmental Sciences, Central University of Technology, Bloemfontein, Free State, South Africa
| |
Collapse
|
2
|
Saha A, Ganie SM, Pramanik PKD, Yadav RK, Mallik S, Zhao Z. VER-Net: a hybrid transfer learning model for lung cancer detection using CT scan images. BMC Med Imaging 2024; 24:120. [PMID: 38789925 PMCID: PMC11127393 DOI: 10.1186/s12880-024-01238-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 03/05/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Lung cancer is the second most common cancer worldwide, with over two million new cases per year. Early identification would allow healthcare practitioners to handle it more effectively. The advancement of computer-aided detection systems significantly impacted clinical analysis and decision-making on human disease. Towards this, machine learning and deep learning techniques are successfully being applied. Due to several advantages, transfer learning has become popular for disease detection based on image data. METHODS In this work, we build a novel transfer learning model (VER-Net) by stacking three different transfer learning models to detect lung cancer using lung CT scan images. The model is trained to map the CT scan images with four lung cancer classes. Various measures, such as image preprocessing, data augmentation, and hyperparameter tuning, are taken to improve the efficacy of VER-Net. All the models are trained and evaluated using multiclass classifications chest CT images. RESULTS The experimental results confirm that VER-Net outperformed the other eight transfer learning models compared with. VER-Net scored 91%, 92%, 91%, and 91.3% when tested for accuracy, precision, recall, and F1-score, respectively. Compared to the state-of-the-art, VER-Net has better accuracy. CONCLUSION VER-Net is not only effectively used for lung cancer detection but may also be useful for other diseases for which CT scan images are available.
Collapse
Affiliation(s)
- Anindita Saha
- Department of Computing Science and Engineering, IFTM University, Moradabad, Uttar Pradesh, India
| | - Shahid Mohammad Ganie
- AI Research Centre, Department of Analytics, School of Business, Woxsen University, Hyderabad, Telangana, 502345, India
| | - Pijush Kanti Dutta Pramanik
- School of Computer Applications and Technology, Galgotias University, Greater Noida, Uttar Pradesh, 203201, India.
| | - Rakesh Kumar Yadav
- Department of Computer Science & Engineering, MSOET, Maharishi University of Information Technology, Lucknow, Uttar Pradesh, India
| | - Saurav Mallik
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Zhongming Zhao
- Center for Precision Health, McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX, 77030, USA.
| |
Collapse
|
3
|
Hall H, Ruparel M, Quaife SL, Dickson JL, Horst C, Tisi S, Batty J, Woznitza N, Ahmed A, Burke S, Shaw P, Soo MJ, Taylor M, Navani N, Bhowmik A, Baldwin DR, Duffy SW, Devaraj A, Nair A, Janes SM. The role of computer-assisted radiographer reporting in lung cancer screening programmes. Eur Radiol 2022; 32:6891-6899. [PMID: 35567604 PMCID: PMC9474336 DOI: 10.1007/s00330-022-08824-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/11/2022] [Accepted: 04/13/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Successful lung cancer screening delivery requires sensitive, timely reporting of low-dose computed tomography (LDCT) scans, placing a demand on radiology resources. Trained non-radiologist readers and computer-assisted detection (CADe) software may offer strategies to optimise the use of radiology resources without loss of sensitivity. This report examines the accuracy of trained reporting radiographers using CADe support to report LDCT scans performed as part of the Lung Screen Uptake Trial (LSUT). METHODS In this observational cohort study, two radiographers independently read all LDCT performed within LSUT and reported on the presence of clinically significant nodules and common incidental findings (IFs), including recommendations for management. Reports were compared against a 'reference standard' (RS) derived from nodules identified by study radiologists without CADe, plus consensus radiologist review of any additional nodules identified by the radiographers. RESULTS A total of 716 scans were included, 158 of which had one or more clinically significant pulmonary nodules as per our RS. Radiographer sensitivity against the RS was 68-73.7%, with specificity of 92.1-92.7%. Sensitivity for detection of proven cancers diagnosed from the baseline scan was 83.3-100%. The spectrum of IFs exceeded what could reasonably be covered in radiographer training. CONCLUSION Our findings highlight the complexity of LDCT reporting requirements, including the limitations of CADe and the breadth of IFs. We are unable to recommend CADe-supported radiographers as a sole reader of LDCT scans, but propose potential avenues for further research including initial triage of abnormal LDCT or reporting of follow-up surveillance scans. KEY POINTS • Successful roll-out of mass screening programmes for lung cancer depends on timely, accurate CT scan reporting, placing a demand on existing radiology resources. • This observational cohort study examines the accuracy of trained radiographers using computer-assisted detection (CADe) software to report lung cancer screening CT scans, as a potential means of supporting reporting workflows in LCS programmes. • CADe-supported radiographers were less sensitive than radiologists at identifying clinically significant pulmonary nodules, but had a low false-positive rate and good sensitivity for detection of confirmed cancers.
Collapse
Affiliation(s)
- Helen Hall
- Lungs for Living Research Centre, UCL Respiratory, Rayne Institute, University College London, 5 University Street, London, WC1E 6JF, UK
| | - Mamta Ruparel
- Lungs for Living Research Centre, UCL Respiratory, Rayne Institute, University College London, 5 University Street, London, WC1E 6JF, UK
| | - Samantha L Quaife
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jennifer L Dickson
- Lungs for Living Research Centre, UCL Respiratory, Rayne Institute, University College London, 5 University Street, London, WC1E 6JF, UK
| | - Carolyn Horst
- Lungs for Living Research Centre, UCL Respiratory, Rayne Institute, University College London, 5 University Street, London, WC1E 6JF, UK
| | - Sophie Tisi
- Lungs for Living Research Centre, UCL Respiratory, Rayne Institute, University College London, 5 University Street, London, WC1E 6JF, UK
| | - James Batty
- Department of Radiology, University College London Hospital, London, UK
| | | | - Asia Ahmed
- Department of Radiology, University College London Hospital, London, UK
| | - Stephen Burke
- Department of Radiology, Homerton University Hospital, London, UK
| | - Penny Shaw
- Department of Radiology, University College London Hospital, London, UK
| | - May Jan Soo
- Department of Radiology, Homerton University Hospital, London, UK
| | - Magali Taylor
- Department of Radiology, University College London Hospital, London, UK
| | - Neal Navani
- Lungs for Living Research Centre, UCL Respiratory, Rayne Institute, University College London, 5 University Street, London, WC1E 6JF, UK
- Department of Thoracic Medicine, University College London Hospital, London, UK
| | - Angshu Bhowmik
- Department of Thoracic Medicine, Homerton University Hospital, London, UK
| | - David R Baldwin
- Respiratory Medicine Unit, David Evans Research Centre, Nottingham University Hospitals, Nottingham, UK
| | - Stephen W Duffy
- Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Anand Devaraj
- Department of Radiology, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Arjun Nair
- Department of Radiology, University College London Hospital, London, UK
| | - Sam M Janes
- Lungs for Living Research Centre, UCL Respiratory, Rayne Institute, University College London, 5 University Street, London, WC1E 6JF, UK.
- Department of Thoracic Medicine, University College London Hospital, London, UK.
| |
Collapse
|
4
|
Toderis L, Vo A, Reychav I, Sayeed L, McHaney R, Guindy M. Development of a mobile training app to assist radiographers’ diagnostic assessments. Health Informatics J 2022; 28:14604582221083780. [DOI: 10.1177/14604582221083780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The current study reduced the time lag between performing a diagnostic assessment and identifying a critical finding in CT and MRI exams through improving radiographers’ abilities to identify those critical findings. Radiographers’ diagnostic assessments in CT and MRI exams were used to develop a mobile training application with the aim to improve radiographers’ awareness of critical findings. The current research used data analytics to examine radiographers’ interpretation of imaging studies from a privately owned medical group in Israel. During the project, the radiographers’ ability to identify critical findings improved. Implementation of the mobile training program yielded positive results where the knowledge gap was reduced and time to identify critical cases was decreased. Specifically, this study showed that radiographers can be trained in ways that enhance their involvement with radiologists to provide high quality services and improve treatment Ultimately, this gives patients higher quality of care and safer treatment.
Collapse
Affiliation(s)
- Liat Toderis
- Industrial Engineering & Management Department, Ariel University, Ariel, Israel
| | - Ace Vo
- Information Systems & Business Analytics, Loyola Marymount University, Los Angeles, CA, USA
| | - Iris Reychav
- Industrial Engineering & Management Department, Ariel University, Ariel, Israel
| | - Lutfus Sayeed
- Information Systems Department, San Francisco State University, San Francisco, CA, USA
| | - Roger McHaney
- Management Information Systems, Kansas State University Manhattan, Manhattan, KS, USA
| | - Michal Guindy
- Radiology, Assuta Medical Centers, BGU University, Beer Sheva, Israel
| |
Collapse
|
5
|
Feng S, Liu Q, Patel A, Bazai SU, Jin C, Kim JS, Sarrafzadeh M, Azzollini D, Yeoh J, Kim E, Gordon S, Jang‐Jaccard J, Urschler M, Barnard S, Fong A, Simmers C, Tarr GP, Wilson B. Automated pneumothorax triaging in chest X‐rays in the New Zealand population using deep‐learning algorithms. J Med Imaging Radiat Oncol 2022; 66:1035-1043. [DOI: 10.1111/1754-9485.13393] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 02/03/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Sijing Feng
- Department of Radiology Dunedin Hospital Dunedin New Zealand
| | - Qixiu Liu
- Counties Manukau Health Auckland New Zealand
| | - Aakash Patel
- Dunedin School of Medicine Dunedin Hospital Dunedin New Zealand
| | - Sibghat Ullah Bazai
- School of Natural and Computational Sciences Massey University Palmerston North New Zealand
| | | | - Ji Soo Kim
- Auckland District Health Board Auckland New Zealand
| | | | | | - Jason Yeoh
- Auckland District Health Board Auckland New Zealand
| | - Eve Kim
- Auckland District Health Board Auckland New Zealand
| | - Simon Gordon
- Waikato District Health Board Hamilton New Zealand
| | - Julian Jang‐Jaccard
- School of Natural and Computational Sciences Massey University Palmerston North New Zealand
| | - Martin Urschler
- School of Computer Science University of Auckland Auckland New Zealand
| | | | - Amy Fong
- Department of Radiology Dunedin Hospital Dunedin New Zealand
| | - Cameron Simmers
- Department of Radiology Dunedin Hospital Dunedin New Zealand
| | | | - Ben Wilson
- Department of Radiology Dunedin Hospital Dunedin New Zealand
| |
Collapse
|
6
|
Sevens T, McGivern T. Reporting radiographer academy training model; an evaluation of the impact for trainees and clinical service. Radiography (Lond) 2022; 28:798-803. [PMID: 35221214 DOI: 10.1016/j.radi.2022.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Demand on imaging services continues to increase on a background of complex issues and barriers to care. Collaborative cross organisational working through the development of imaging networks is recommended to address these issues including managing reporting workloads. Standardisation of reporting practices and collaborative cross region reporting radiographer training has been recommended to be supported by a regional reporting radiographer academy model to achieve these aims. This research explores the perceptions of trainees and their managers/mentor who undertook radiographer academy training model with a view to integrated imaging network formalisation in the region. METHODS An online questionnaire was designed to capture qualitative and quantitative data with three phases; 1) trainees perception of the academy model, 2) trainees perception of the differences in training models and 3) the perceptions of the managers/mentors related to the academy model. RESULTS There were overwhelmingly positive opinions of the academy training model from both cohorts in this study, with the two main benefits emerging being the protected study time away from clinical departments and minimal disruption to clinical services due to reduced onus on the local mentors. Peer support was also highlighted as a positive aspect of the model which would facilitate future integrated imaging network working. CONCLUSION The academy model has been well received by both cohorts in this study with positive outcomes highlighted and the model being seen as promoting and facilitating integrated imaging network working between departments. The small sample size of the study requires consideration when extrapolating the results to wider academy models, however some themes may be applicable. IMPLICATIONS FOR PRACTICE Investment in the reporting radiographer academy model is justified and provides a practical alternative to the traditional model.
Collapse
Affiliation(s)
- T Sevens
- South Yorkshire & Bassetlaw Integrated Care System, United Kingdom.
| | - T McGivern
- South Yorkshire & Bassetlaw Integrated Care System, United Kingdom.
| |
Collapse
|
7
|
Hunter R, Wilkinson E, Snaith B. A single-centre experience of implementing a rapid CXR reporting and CT access pathway for suspected lung cancer: Initial outcomes. Radiography (Lond) 2022; 28:304-311. [DOI: 10.1016/j.radi.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 12/10/2021] [Accepted: 12/13/2021] [Indexed: 11/29/2022]
|
8
|
Wood K. How is the reporting radiographer role portrayed in published studies? A scoping review. Radiography (Lond) 2021; 28:215-221. [PMID: 34404577 DOI: 10.1016/j.radi.2021.07.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/23/2021] [Accepted: 07/27/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Radiographers have been undertaking reporting tasks since the 1980's with a wealth of evidence published to support this practice. Radiographers have since developed skills in reporting all body systems, from all referral sources across a range of modalities. Radiographer reporting is now considered established and demand for radiographers in this role is rising to meet service demand. Reporting radiographers work as part of multi-professional image reporting teams, it is unclear how the radiographer role is perceived as part of this model. The aim was to review peer-reviewed literature to evaluate how the role of the reporting radiographer is portrayed and how the relationship between the two imaging professions has developed. KEY FINDINGS Language used to discuss the role of the reporting radiographer has changed over time. There is progress demonstrated from the practice of radiographer reporting being considered contentious or opposed to accepted and established. Recent publications focus on the importance utilising the skills of all multi-disciplinary team members in workforce structure. This features prominently when discussing future workforce design, such as with the Cancer workforce strategy and the development of the national standards for musculoskeletal reporting. CONCLUSION Published literature has highlighted a move towards acceptance of the reporting radiographer role. Multi-disciplinary team working, utilising the skills of all imaging team members, is essential to the success and sustainability of the imaging workforce moving forwards. IMPLICATIONS FOR PRACTICE Reporting by radiographers is established and will be prominent in the reporting workforce as part of long-term workforce planning, considering skills mix to form effective and sustainable multidisciplinary reporting teams.
Collapse
Affiliation(s)
- K Wood
- College of Health, Psychology and Social Care, University of Derby, UK.
| |
Collapse
|
9
|
Evans C, Poku B, Pearce R, Eldridge J, Hendrick P, Knaggs R, Blake H, Yogeswaran G, McLuskey J, Tomczak P, Thow R, Harris P, Conway J, Collier R. Characterising the outcomes, impacts and implementation challenges of advanced clinical practice roles in the UK: a scoping review. BMJ Open 2021; 11:e048171. [PMID: 34353799 PMCID: PMC8344309 DOI: 10.1136/bmjopen-2020-048171] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 06/23/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES In response to demographic and health system pressures, the development of non-medical advanced clinical practice (ACP) roles is a key component of National Health Service workforce transformation policy in the UK. This review was undertaken to establish a baseline of evidence on ACP roles and their outcomes, impacts and implementation challenges across the UK. DESIGN A scoping review was undertaken following JBI methodological guidance. METHODS 13 online databases (Medline, CINAHL, ASSIA, Embase, HMIC, AMED, Amber, OT seeker, PsycINFO, PEDro, SportDiscus, Osteopathic Research and PenNutrition) and grey literature sources were searched from 2005 to 2020. Data extraction, charting and summary was guided by the PEPPA-Plus framework. The review was undertaken by a multi-professional team that included an expert lay representative. RESULTS 191 papers met the inclusion criteria (any type of UK evidence, any sector/setting and any profession meeting the Health Education England definition of ACP). Most papers were small-scale descriptive studies, service evaluations or audits. The papers reported mainly on clinical aspects of the ACP role. Most papers related to nursing, pharmacy, physiotherapy and radiography roles and these were referred to by a plethora of different titles. ACP roles were reported to be achieving beneficial impacts across a range of clinical and health system outcomes. They were highly acceptable to patients and staff. No significant adverse events were reported. There was a lack of cost-effectiveness evidence. Implementation challenges included a lack of role clarity and an ambivalent role identity, lack of mentorship, lack of continuing professional development and an unclear career pathway. CONCLUSION This review suggests a need for educational and role standardisation and a supported career pathway for advanced clinical practitioners (ACPs) in the UK. Future research should: (i) adopt more robust study designs, (ii) investigate the full scope of the ACP role and (iii) include a wider range of professions and sectors.
Collapse
Affiliation(s)
- Catrin Evans
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Brenda Poku
- School of Sociology and Social Policy, University of Nottingham, Nottingham, UK
| | - Ruth Pearce
- School of Education, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jeanette Eldridge
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Paul Hendrick
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Roger Knaggs
- School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Holly Blake
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Gowsika Yogeswaran
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - John McLuskey
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Philippa Tomczak
- School of Sociology and Social Policy, University of Nottingham, Nottingham, UK
| | - Ruaridh Thow
- Emergency Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Peter Harris
- Health Education England East Midlands, Leicester, UK
| | - Joy Conway
- College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, UK
| | - Richard Collier
- Centre for Advancing Practice, Health Education England, Leeds, UK
| |
Collapse
|
10
|
Dwyer-Hemmings L, Fairhead C. The diagnostic performance of chest radiographs for lung malignancy in symptomatic primary-care populations: A systematic review and meta-analysis. BJR Open 2021; 3:20210005. [PMID: 34381948 PMCID: PMC8327929 DOI: 10.1259/bjro.20210005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 06/17/2021] [Accepted: 07/07/2021] [Indexed: 11/24/2022] Open
Abstract
Objectives: To synthesise existing evidence for the diagnostic accuracy of chest radiographs to detect lung malignancy in symptomatic patients presenting to primary care. Methods: A systematic review was performed and reported in accordance with the PRISMA framework, using a protocol prospectively registered with the PROSPERO database (CRD42020212450). Nine databases were searched for relevant studies. Data were extracted and chest radiograph sensitivity and specificity calculated where possible. Risk of bias was assessed using a validated tool. Random effects meta-analysis was performed. Results: Ten studies were included. Sensitivity meta-analysis was performed in five studies which were not the high risk of bias, with summary sensitivity of 81% (95% CI: 74–87%). Specificity could be calculated in five studies, with summary specificity of 68% (95% CI: 49–87%). Conclusions: The sensitivity of chest radiographs for detecting lung malignancy in primary care is relatively low. Physicians and policymakers must consider strategies to attenuate the possibility of false reassurance with a negative chest radiograph for this significant pathology. Options include widening access to cross-sectional imaging in primary care; however, any intervention would need to take into account the medical and financial costs of possible over-investigation. Prospective trials with long-term follow-up are required to further evaluate the risks and benefits of this strategy. Advances in knowledge: The chest radiograph has a sensitivity of 81% and specificity of 68% for lung malignancy in a symptomatic primary-care population. A negative chest radiograph does not exclude lung cancer, and physicians should maintain a low threshold to consider specialist referral or cross-sectional imaging.
Collapse
Affiliation(s)
- Louis Dwyer-Hemmings
- Institute of Medical and Biomedical Education, St George's University, London, United Kingdom
| | | |
Collapse
|
11
|
Ooi JWL, Er ATW, Lee WC, Chee HC. The 12-hour shift: radiographers' perspectives and its applicability during a pandemic. Radiography (Lond) 2020; 27:512-518. [PMID: 33243565 PMCID: PMC7685134 DOI: 10.1016/j.radi.2020.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/08/2020] [Accepted: 11/09/2020] [Indexed: 12/15/2022]
Abstract
Introduction Traditionally, shift work for radiographers at our institution comprised of three shift patterns – morning (8am-2pm), afternoon (2pm–9pm) and night (9pm-8am). However, when COVID-19 was first detected in Singapore in January 2020, the 12-h shift was introduced for better team segregation and deployment to meet the service needs of the Emergency Department. The 12-h shift consisted of the day (9am-9pm) and night (9pm-9am) shifts. While the 12-h shift is common to nursing practices, it is new to the radiography profession within the study centre. This study explores the radiographers' perspectives of the new shift and the impact of shift patterns on radiographers' wellness and work performance compared to the original three shift patterns. Methods A mixed-methods design study was adopted for this single-centre evaluation. An anonymous online questionnaire was administered to radiographers who had experienced both shift types. Additionally, the number of radiographers who had taken sick leave, and images rejected and accepted from the X-ray consoles were retrospectively collected to measure the impact of the new shift. Results Radiographers experienced fatigue and appreciated the longer rest days associated with the 12-h shift. Additionally, the sick leave rates and image reject counts were more favourable with the 12-h shift pattern. Conclusion The findings indicate that the extended shift hours are effective during a pandemic but may result in radiographer burnout during a prolonged outbreak. Implications for practice Studying these variables will provide an effective starting point in understanding the efficacy and applicability of a 12-h shift system during pandemic periods.
Collapse
Affiliation(s)
- J W L Ooi
- Changi General Hospital, 2 Simei Street 3, 529889, Singapore.
| | - A T W Er
- Changi General Hospital, 2 Simei Street 3, 529889, Singapore.
| | - W C Lee
- Changi General Hospital, 2 Simei Street 3, 529889, Singapore.
| | - H C Chee
- Changi General Hospital, 2 Simei Street 3, 529889, Singapore.
| |
Collapse
|
12
|
Kidney function testing prior to contrast-enhanced CT: a comparative cost analysis of a personalised risk-stratified pathway versus a test all approach. Clin Radiol 2020; 76:202-212. [PMID: 33109348 DOI: 10.1016/j.crad.2020.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 09/17/2020] [Indexed: 12/18/2022]
Abstract
AIM To map current contrast-enhanced computed tomography (CT) pathways, develop a risk-stratified pathway, and model associated costs and resource use. MATERIALS AND METHODS Phase 1 comprised multicentre mapping of current practice and development of an alternative pathway, replacing pre-assessment of estimated glomerular filtration rate (eGFR) with a scan-day screening questionnaire for risk stratification and point of care (PoC) creatinine. Phase 2 measured resource use and analysis of routinely collected data, used to populate a model comparing the costs of current and risk-stratified pathways in Phase 3. RESULTS Site variation across a range of processes within the clinical care pathway was identified. Data from a single centre suggested that 78% (n=347/447) could have avoided their pre-scan laboratory test as they did not have post-contrast acute kidney injury (AKI) risk factors. Only 24% of outpatients who underwent computed tomography (CT) would have identified risk factors, which would have prompted a scan-day PoC test. There was a 94% probability that the risk-stratified pathway was cost-saving, with an estimated 5-year potential cost saving of £69,620 (95% CI: -£13,295-£154,603). Although the cost of a laboratory serum creatinine test is cheaper than the PoC equivalent (£5.29 versus £5.96), the screening questionnaire ruled out the need for a large majority of the eGFR measurements specifically for the CT examination. CONCLUSION The present study proposes an alternative pathway, which has the potential to improve the efficiency of the current CT pathway. A multicentre appraisal is required to demonstrate the impact of embedding this new pathway on a wider NHS level, particularly in light of new diagnostic guidance (DG37) published by NICE.
Collapse
|
13
|
Wuni AR, Courtier N, Kelly D. Developing a policy framework to support role extension in diagnostic radiography in Ghana. J Med Imaging Radiat Sci 2020; 52:112-120. [PMID: 33082122 DOI: 10.1016/j.jmir.2020.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/23/2020] [Accepted: 09/28/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION A global shortage of radiologists is affecting the timely provision of imaging reports and thus healthcare delivery. This situation has been the main driving factor behind successful role extension by radiographers into areas that traditionally were within the scope of radiologists, including image interpretation and reporting. The shortage of radiologists is even worse in developing countries like Ghana. There is a need for policy to guide the introduction and implementation of role extension in Ghana. METHODS A qualitative, single case study with multiple sites across the country was used. A sample of 16 participants, including 8 radiographers, 3 radiologists, 3 medical officers, a senior official each from the Ministry of Health and the Allied Health Professions Council, were interviewed about role extension. RESULTS The findings indicate the need for a guiding policy of role extension to be spear headed by the Ministry of Health to gain the needed credibility. The findings suggest the policy should be made to meet the local needs of the country. It also established the policy should regulate education and training and the scope of practice. CONCLUSION The study established the need for policy to guide the introduction and practice of role extension in diagnostic radiography in Ghana. The study also established the need for a broad consultation of all key stakeholders based on an internationally accepted consensus building model.
Collapse
Affiliation(s)
| | | | - Daniel Kelly
- School of Healthcare Sciences, Cardiff University, UK
| |
Collapse
|
14
|
Woznitza N, Steele R, Groombridge H, Compton E, Gower S, Hussain A, Norman H, O'Brien A, Robertson K. Clinical reporting of radiographs by radiographers: Policy and practice guidance for regional imaging networks. Radiography (Lond) 2020; 27:645-649. [PMID: 32814647 DOI: 10.1016/j.radi.2020.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 07/31/2020] [Accepted: 08/03/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Radiographer reporting is an essential component of imaging across the United Kingdom. Since the previous policy and practice guidance in 2004 the role and contribution of reporting radiographers has changed significantly. The move to imaging networks further reinforces the need for consistency in scope of practice and clinical governance for radiographer reporting. KEY FINDINGS This guidance provides a consistent, evidence-based template for planning a reporting service, resourcing, clinical governance, preceptorship, volume and frequency of reporting, a peer learning framework and expected standards. CONCLUSION Developed for North Central and East London, this framework and standards will help reduce unwarranted variation. IMPLICATIONS FOR PRACTICE Consistency in practice could help maximise the contribution of radiographer reporting.
Collapse
Affiliation(s)
- N Woznitza
- Radiology Department, Homerton University Hospital, UK; School of Allied and Public Health Professions, Canterbury Christ Church University, UK; North Central and East London Cancer Alliance, UK; Health Education England, London, UK.
| | - R Steele
- North Central and East London Cancer Alliance, UK; Radiology Department, University College London Hospitals, UK
| | - H Groombridge
- Radiology Department, University College London Hospitals, UK
| | - E Compton
- Radiology Department, Guys & St Thomas' Hospitals, UK
| | - S Gower
- Radiology Department, Kings College Hospitals, UK
| | - A Hussain
- North Central and East London Cancer Alliance, UK
| | - H Norman
- North Central and East London Cancer Alliance, UK
| | - A O'Brien
- Radiology Department, Kings College Hospitals, UK
| | - K Robertson
- NHS England and Improvement, London, UK; South East London Cancer Alliance, UK
| |
Collapse
|
15
|
Qamar SR, Evans D, Gibney B, Redmond CE, Nasir MU, Wong K, Nicolaou S. Emergent Comprehensive Imaging of the Major Trauma Patient: A New Paradigm for Improved Clinical Decision-Making. Can Assoc Radiol J 2020; 72:293-310. [PMID: 32268772 DOI: 10.1177/0846537120914247] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Modern advances in the medical imaging layered onto sophisticated trauma resuscitation strategies in highly organized regionalized trauma systems have created a paradigm shift in the management of severely injured patients. Although immediate exploratory surgery to identify and control life-threatening injuries still has its place, accelerated image acquisition and interpretation procedures now make it rare for trauma surgeons in major centers to venture into damage control surgery unaided by computed tomography (CT) or other imaging, particularly in cases of blunt trauma. Indeed, because of the high incidence of clinically occult injuries associated with major mechanism trauma, and even lower energy trauma in frail or elderly patients, CT imaging has become as invaluable as physical examination, if not more so, in critical decision-making in support of optimal outcomes. In particular, whole-body computed tomography (WBCT) completed promptly after initial assessment of a major trauma provides a quick, comprehensive survey of injuries that enables better surgical planning, obviates the need for multiple subsequent studies, and permits specialized reconstructions when needed. For those at risk for problematic occult injury after modest trauma, WBCT facilitates safer discharge planning and simplified follow-up. Through standardized guidelines, streamlined protocols, synoptic reporting, accessible web-based platforms, and active collaboration with clinicians, radiologists dedicated to trauma and emergency imaging enable clearer understanding of complex injuries in high-risk patients which leads to superior clinical decision-making. Whereas dated dogma has long warned that the CT scanner is the last place to take a challenging trauma patient, modern practice suggests that, more often than not, early comprehensive imaging can be done safely and efficiently and is in the patient's best interest. This article outlines how the role of diagnostic imaging for major trauma has evolved considerably in recent years.
Collapse
Affiliation(s)
- Sadia Raheez Qamar
- Department of Emergency and Trauma Radiology, Vancouver General Hospital, 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - David Evans
- Department of Surgery, 8167Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian Gibney
- Department of Emergency and Trauma Radiology, Vancouver General Hospital, 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - Ciaran E Redmond
- Department of Emergency and Trauma Radiology, Vancouver General Hospital, 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - Muhammad Umer Nasir
- Department of Emergency and Trauma Radiology, Vancouver General Hospital, 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - Kenneth Wong
- Department of Radiology, 71511Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Savvas Nicolaou
- Department of Emergency and Trauma Radiology, Vancouver General Hospital, 8166University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
16
|
Lockwood P. An evaluation of CT head reporting radiographers' scope of practice within the United Kingdom. Radiography (Lond) 2020; 26:102-109. [PMID: 32052789 DOI: 10.1016/j.radi.2019.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/03/2019] [Accepted: 09/08/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION This study investigated the scope of practice of CT head reporting radiographers in the UK, and to compare adherence to professional body standards. METHODS An online questionnaire was utilized applying both multiple-choice and response (closed questions), and qualitative open question free-text responses. The 30 questions covered four key areas of demographics, the scope of practice, referrals, and ongoing competence, as described in professional body national guidance standards. The questionnaire was disseminated (convenience sampling) via Twitter and email to the National CT Head Reporting Special Interest Group. Responses were transcribed and coded; the results applied descriptive statistics to summarise observations of the study sample. RESULTS The sample of participant response data analysed was n = 54. Most respondents were from England, with a postgraduate certificate award in clinical reporting, and a mean length of 8.3 years of reporting experience. The accepted referral pathway included a wide range of medical and surgical specialities, including both in and outpatients and acute and chronic pathways. Furthermore, 96.2% of the sample had a scope of practice that authorised referral recommendations to a broad and inclusive group of medical and surgical teams, and if required further or repeat diagnostic imaging. To maintain quality and evidence of ongoing competency, all radiographers were involved in audit cycles. CONCLUSION The data collected confirmed the reporting practice within this sample group aligns to national recommended guidance. The data provided key information on the range and variation of individuals scope of practice within age restrictions of patients, examination types, referral teams, and ongoing competency practices. IMPLICATIONS FOR PRACTICE This paper details the scope of practice of CT head reporting by radiographers and the contribution made to the healthcare sector.
Collapse
Affiliation(s)
- P Lockwood
- Clinical and Medical Sciences Research Hub, School of Allied Health Professions, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent, UK.
| |
Collapse
|
17
|
Murphy A, Ekpo E, Steffens T, Neep MJ. Radiographic image interpretation by Australian radiographers: a systematic review. J Med Radiat Sci 2019; 66:269-283. [PMID: 31545009 PMCID: PMC6920699 DOI: 10.1002/jmrs.356] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 08/25/2019] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Radiographer image evaluation methods such as the preliminary image evaluation (PIE), a formal comment describing radiographers' findings in radiological images, are embedded in the contemporary radiographer role within Australia. However, perceptions surrounding both the capacity for Australian radiographers to adopt PIE and the barriers to its implementation are highly variable and seldom evidence-based. This paper systematically reviews the literature to examine radiographic image interpretation by Australian radiographers and the barriers to implementation. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses were used to systematically review articles via Scopus, Ovid MEDLINE, PubMed, ScienceDirect and Informit. Articles were deemed eligible for inclusion if they were English language, peer-reviewed and explored radiographic image interpretation by radiographers in the context of the Australian healthcare system. Letters to the editor, opinion pieces, reviews and reports were excluded. RESULTS A total of 926 studies were screened for relevance, 19 articles met the inclusion criteria. The 19 articles consisted of 11 cohort studies, seven cross-sectional surveys and one randomised control trial. Studies exploring radiographers' image interpretation performance utilised a variety of methodological designs with accuracy, sensitivity and specificity values ranging from 57 to 98%, 45 to 98% and 68 to 98%, respectively. Primary barriers to radiographic image evaluation by radiographers included lack of accessible educational resources and support from both radiologists and radiographers. CONCLUSION Australian radiographers can undertake PIE; however, educational and clinical support barriers limit implementation. Access to targeted education and a clear definition of radiographers' image evaluation role may drive a wider acceptance of radiographer image evaluation in Australia.
Collapse
Affiliation(s)
- Andrew Murphy
- Department of Medical ImagingSt Paul's HospitalVancouverBCCanada
- Department of Medical ImagingBritish Columbia Children's HospitalVancouverBCCanada
- Faculty of Health SciencesDiscipline of Medical Imaging ScienceThe University of SydneyLidcombeNSWAustralia
| | - Ernest Ekpo
- Faculty of Health SciencesDiscipline of Medical Imaging ScienceThe University of SydneyLidcombeNSWAustralia
| | - Thomas Steffens
- Department of Medical ImagingPrincess Alexandra HospitalBrisbaneQldAustralia
| | - Michael J. Neep
- Department of Medical ImagingLogan HospitalMeadowbrookQldAustralia
- School of Clinical SciencesFaculty of HealthQueensland University of TechnologyBrisbaneQldAustralia
| |
Collapse
|
18
|
Stevens B. A survey assessment of reporting radiographers' scope of practice in the West Midlands region of the United Kingdom. Radiography (Lond) 2019; 25:214-219. [DOI: 10.1016/j.radi.2019.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 01/14/2019] [Accepted: 01/20/2019] [Indexed: 10/27/2022]
|
19
|
Culpan G, Culpan AM, Docherty P, Denton E. Radiographer reporting: A literature review to support cancer workforce planning in England. Radiography (Lond) 2019; 25:155-163. [DOI: 10.1016/j.radi.2019.02.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 02/12/2019] [Accepted: 02/17/2019] [Indexed: 10/27/2022]
|
20
|
Woznitza N, Steele R, Piper K, Burke S, Rowe S, Bhowmik A, Maughn S, Springett K. Increasing radiology capacity within the lung cancer pathway: centralised work-based support for trainee chest X-ray reporting radiographers. J Med Radiat Sci 2018; 65:200-208. [PMID: 29806102 PMCID: PMC6119729 DOI: 10.1002/jmrs.285] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 05/01/2018] [Accepted: 05/04/2018] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Diagnostic capacity and time to diagnosis are frequently identified as a barrier to improving cancer patient outcomes. Maximising the contribution of the medical imaging workforce, including reporting radiographers, is one way to improve service delivery. METHODS An efficient and effective centralised model of workplace training support was designed for a cohort of trainee chest X-ray (CXR) reporting radiographers. A comprehensive schedule of tutorials was planned and aligned with the curriculum of a post-graduate certificate in CXR reporting. Trainees were supported via a hub and spoke model (centralised training model), with the majority of education provided by a core group of experienced CXR reporting radiographers. Trainee and departmental feedback on the model was obtained using an online survey. RESULTS Fourteen trainees were recruited from eight National Health Service Trusts across London. Significant efficiencies of scale were possible with centralised support (48 h) compared to traditional workplace support (348 h). Trainee and manager feedback overall was positive. Trainees and managers both reported good trainee support, translation of learning to practice and increased confidence. Logistics, including trainee travel and release, were identified as areas for improvement. CONCLUSION Centralised workplace training support is an effective and efficient method to create sustainable diagnostic capacity and support improvements in the lung cancer pathway.
Collapse
Affiliation(s)
- Nick Woznitza
- Radiology DepartmentHomerton University HospitalLondonUK
- School of Allied Health ProfessionsCanterbury Christ Church UniversityCanterburyUK
| | - Rebecca Steele
- Radiology DepartmentUniversity College London HospitalLondonUK
| | - Keith Piper
- School of Allied Health ProfessionsCanterbury Christ Church UniversityCanterburyUK
| | - Stephen Burke
- Radiology DepartmentHomerton University HospitalLondonUK
| | - Susan Rowe
- Radiology DepartmentHomerton University HospitalLondonUK
| | - Angshu Bhowmik
- Department of Respiratory MedicineHomerton University HospitalLondonUK
| | - Sue Maughn
- City and Hackney Clinical Commissioning GroupLondonUK
| | - Kate Springett
- School of Allied Health ProfessionsCanterbury Christ Church UniversityCanterburyUK
| |
Collapse
|