Implementing radiographic CT head reporting: The experiences of students and managers

Has the skills mix promise been broken? A scoping review of the deployment of the support and assistant workforce within diagnostic imaging in the UK

INTRODUCTION

In the UK the development of skill mix in radiography at the end of the 20th century formalised the assistant practitioner role, separating it from the support worker function. The key aim was to increase imaging capacity whilst enabling opportunities for career progression within both the support and radiography workforce. There has been limited examination of these support and assistive roles and this review aims to explore the current evidence.

METHODS

This scoping review used a systematic search strategy and interrogated MEDLINE, CINAHL, Scopus and Google Scholar. Primary research articles published in the English-language referring to studies conducted in the UK on assistant or support roles in radiography were sought. The sourced data was uploaded to a web-based review platform for screening.

RESULTS

The literature search identified only 11 articles which met the search criteria, of which only one referred to the support worker role. Adopting a primarily qualitative approach the quality of the articles varied. Thematic analysis was undertaken using a priori themes role purpose, outcomes, aspirations and capacity building.

CONCLUSION

There is limited research evidence of capacity generation with most presenting individual perspectives. Job satisfaction and career aspirations within the support and assistive workforce are evident but there is still confusion over scope of practice and supervision.

IMPLICATIONS FOR PRACTICE

The support and assistive workforce are a key part of the diagnostic imaging workforce but limited research evidence examining these roles has been published. Further research exploring the impact of skill mix changes across all levels and imaging professions is required.

Difficulties associated with Reporting Radiographer working practices - A narrative evidence synthesis

OBJECTIVES

This narrative synthesis of evidence identifies and explores issues that impact upon the expansion or effectiveness of Reporting Radiographers working in all diagnostic modalities within the United Kingdom (UK). The publication focuses on working practices affecting trainees and qualified Reporting Radiographers.

KEY FINDINGS

Fourteen studies informed the themes of this article, they were published between 2014 and 2021. Delays to commencement of reporting roles and variance in performance monitoring was common. Lack of formalisation, overly restrictive and out of date scopes of practice were also found. Whilst, staffing shortages contributed to underutilisation. Failure to utilise skills was most prevalent in cross sectional imaging modalities. Considerable variance in practice was also found between centres. Meanwhile, Reporting Radiographer involvement in professional development, education and research is far from universal and often dependant on individuals sacrificing their own time.

CONCLUSION

Governance in many centres would benefit from renewal and standardisation, particularly relating to scopes of practice and performance monitoring audits. Measures are also required to encourage compliance with guidance, address staffing issues and reduce variation between centres. Failure to address these issues has the potential to impair collaboration, delay patient care and increase economic inefficiencies whilst negatively impacting satisfaction for service users and staff. Lack of involvement in professional development, education and research suggests Reporting Radiographers are not accomplishing their full potential, educating the next generation of the reporting workforce and driving evidence-based change for further development of the specialism.

IMPLICATIONS FOR PRACTICE

Better use of the existing workforce is essential to increase productivity, value, and security of Reporting Radiographer services, which are essential to improve patient outcomes and efficiency.

Difficulties associated with access to training and clinical support for Reporting Radiographers - A narrative evidence synthesis

OBJECTIVES

This narrative synthesis of evidence identifies and explores issues that impact upon the expansion or effectiveness of Reporting Radiographers working in all diagnostic modalities within the United Kingdom (UK). The publication focuses on accessibility to training for prospective Reporting Radiographers as well as clinical support within and beyond training.

KEY FINDINGS

Fifteen studies informed the themes of this article, they were published between 2014 and 2021. Reporting Radiographers often found it difficult find support during training and once qualified, this was usually due to the availability and workload of supervising staff. Although resistance and obstruction were experienced by many. Concerns relating to pay, promotion and interest were expressed by some respondents whilst access to courses and finance were highlighted as areas of variance across the UK.

CONCLUSION

Inadequate support of Reporting Radiographers is impairing expansion of the specialism, whilst impacting capability and morale. This increases risk of patient harm, delays to care and inefficiency, it also threatens the sustainability of services. Negative interactions between Reporting Radiographers and Radiologists or managers is disappointing considering development of the specialism; evidence of Reporting Radiographer effectiveness and current collaboration between Royal College of Radiologists and Society of Radiographers. Issues raised in relation to pay/promotion and litigation could be clarified with ease, this should be considered when guidance is updated. Access to finance and courses is a major barrier in some regions of the UK. Scope exists for further exploration of training. England has used grants to facilitate uptake, these may prove to be an important tool in other countries.

IMPLICATIONS FOR PRACTICE

Drivers to increase recruitment should be implemented alongside measures to facilitate accessibility to training and improvements to support infrastructure.

How is the reporting radiographer role portrayed in published studies? A scoping review

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.

Radiographer role extension in Oman - Current practice and future opportunities

INTRODUCTION

Radiographers in Oman are believed to be engaged with varying levels of role extension however the nature and extent of this currently unknown. The aim of this study was to investigate role extension for radiographers in Oman, and to evaluate radiographers and the radiologists' opinions and attitudes toward role extension.

METHODS

A cross sectional study of radiographers and radiologists at 13 major hospitals in Oman was used. A total of 189 radiographers and 77 radiologists were invited to complete a questionnaire seeking information on current and possible future role extension activities.

RESULTS

The overall response rate was 80.4% for radiographers and 63.6% for radiologists. Approximately half (53.3%) of the radiographer respondents reported they carry out examinations traditionally performed by radiologists (i.e. role extension); this was primarily in gastrointestinal and barium enema studies. Fewer (21%) reported being involved in image interpretation, most commonly in accident and emergency examinations. Forty percent of radiographers reported involvement in intravenous injections, most commonly for CT and intravenous urography procedures. Both radiographers and radiologists supported the involvement of radiographers in a range of examination types however responses vary within and between hospitals.

CONCLUSION

This study concluded that radiography role extension activities are widely implemented at hospitals in Oman and that radiographers have sufficient skills and education for participating in these activities.

IMPLICATIONS FOR PRACTICE

The involvement of radiographers in role extension activities is believed to be cost and time effective, improve teamwork and has potential for significant service delivery benefits.

An evaluation of CT head reporting radiographers' scope of practice within the United Kingdom

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.

The journey to advanced practice: An Interpretative Phenomenological Analysis of reaching destination and beyond for reporting radiographers in Scotland

INTRODUCTION

Optimising radiographer and radiologist skill-mix is essential to increase efficiency and ensure quality patient care and safety in radiology services. Radiographer reporting, well established within the UK, has been legally and legitimately identified within the scope of radiographer practice for many years. Little research however has focused on perceptions and experiences of practitioners as they journey towards advanced practice in skeletal trauma reporting.

METHODS

A two-phase qualitative approach, utilising Interpretative Phenomenological Analysis (IPA), included a homogenous group of radiographer practitioners (n = 12). Phase 1 thematically analysed personal reflective diaries. Phase 2 included one-one, semi-structured interviews which were recorded, transcribed verbatim and reviewed using the IPA six stage thematic analysis.

RESULTS

Three super-ordinate themes emerged. This paper reflects the IPA generated from Super-ordinate Theme 3; Review upon and action for the role. Participants had reached destination and beyond with a focus on development of role, self and others. As reporting became firmly embedded, there was increased acceptance, educational development and positive impact on service. Reflections indicated motivation, drive, commitment, increased confidence and self-esteem CONCLUSION: This study provides an insight in to the participant journey towards advanced practice and skeletal trauma reporting in Scotland as participants reached destination and beyond.

IMPLICATIONS FOR PRACTICE

Developments within the NHS continue to rapidly evolve and diagnostic imaging, with advancing technology, practice and changing policies, continues to remain in a constant state of change. Continued support and investment for role development, framed within a culture of effective teamworking, positive engagement and professional respect is essential.

Observer Performance in Computed Tomography Head Reporting

AIM

To audit the reporting results of a cohort of radiographers (n = 6) completing an accredited academic program in clinical reporting of computed tomography (CT) head examinations.

METHODS

An audit of retrospective academic image case banks and prospective random clinical workload case banks. Both the academic test banks and clinical workload banks included a wide range of normal and abnormal cases of different levels of difficulty and pathology. Abnormalities included hemorrhage, fractures, lesions, infarctions, degeneration, and normal variants from a variety of referral sources. True positive and negative, as well as false positive and negative fractions were used to mark the reports, which were analyzed for accuracy against a reference standard. Furthermore, interobserver variability was assessed using Cohen's kappa, one-way analysis of variance, and Tukey for multiple comparisons and significance testing at 95% confidence intervals (CI).

RESULTS

The mean accuracy score for all radiographers (n = 6) and reports (n = 3,008) was 90.7% (95% CI, 88.3%-93.0%). Mean sensitivity and specificity rates were 86.9% (95% CI, 85.8%-88.2%) and 94% (95% CI, 89.6%-98.3%), respectively. The most common errors were associated with herniation, lacunar infarctions, and subtle fractures (false negatives) and involutional changes, subtle infarctions, and ventricular dilation (false positives).

CONCLUSIONS

The results suggest appropriately trained radiographers can successfully undertake to report computed tomography head examinations to a high standard. The adoption of both academic and clinical workload image banks that reflect disease examples and the prevalence that may logically be encountered in practice offers the potential for an accurate measure of performance of radiographer's abilities.

Radiographer reporting in the UK: is the current scope of practice limiting plain-film reporting capacity?

OBJECTIVE

To update knowledge on individual radiographer contribution to plain-film reporting workloads; to assess whether there is scope to further increase radiographer reporting capacity within this area.

METHODS

Reporting radiographers were invited to complete an online survey. Invitations were posted to every acute National Health Service trust in the UK whilst snowball sampling was employed via a network of colleagues, ex-colleagues and acquaintances. Information was sought regarding the demographics, geographical location and anatomical and referral scope of practice.

RESULTS

A total of 259 responses were received. 15.1% and 7.7% of respondents are qualified to report chest and abdomen radiographs, respectively. The mean time spent reporting per week is 14.5 h (range 1-37.5). 23.6% of radiographers report only referrals from emergency departments whilst 50.6% of radiographers have limitations on their practice.

CONCLUSION

The scope of practice of reporting radiographers has increased since previous studies; however, radiographer reporting of chest and abdomen radiographs has failed to progress in line with demand. There remain opportunities to increase radiographer capacity to assist the management of reporting backlogs.

ADVANCES IN KNOWLEDGE

This study is the first to examine demographic factors of reporting radiographers across the UK and is one of the largest in-depth studies of UK reporting radiographers, at individual level, to date.