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Lockwood P, Burton C, Woznitza N, Shaw T. Assessing the barriers and enablers to the implementation of the diagnostic radiographer musculoskeletal X-ray reporting service within the NHS in England: a systematic literature review. BMC Health Serv Res 2023; 23:1270. [PMID: 37974199 PMCID: PMC10655396 DOI: 10.1186/s12913-023-10161-y] [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: 05/05/2023] [Accepted: 10/16/2023] [Indexed: 11/19/2023] Open
Abstract
INTRODUCTION The United Kingdom (UK) government's healthcare policy in the early 1990s paved the way adoption of the skills mix development and implementation of diagnostic radiographers' X-ray reporting service. Current clinical practice within the public UK healthcare system reflects the same pressures of increased demand in patient imaging and limited capacity of the reporting workforce (radiographers and radiologists) as in the 1990s. This study aimed to identify, define and assess the longitudinal macro, meso, and micro barriers and enablers to the implementation of the diagnostic radiographer musculoskeletal X-ray reporting service in the National Healthcare System (NHS) in England. METHODS Multiple independent databases were searched, including PubMed, Ovid MEDLINE; Embase; CINAHL, and Google Scholar, as well as journal databases (Scopus, Wiley), healthcare databases (NHS Evidence Database; Cochrane Library) and grey literature databases (OpenGrey, GreyNet International, and the British Library EthOS depository) and recorded in a PRISMA flow chart. A combination of keywords, Boolean logic, truncation, parentheses and wildcards with inclusion/exclusion criteria and a time frame of 1995-2022 was applied. The literature was assessed against Joanna Briggs Institute's critical appraisal checklists. With meta-aggregation to synthesize each paper, and coded using NVivo, with context grouped into macro, meso, and micro-level sources and categorised into subgroups of enablers and barriers. RESULTS The wide and diverse range of data (n = 241 papers) identified barriers and enablers of implementation, which were categorised into measures of macro, meso, and micro levels, and thematic categories of context, culture, environment, and leadership. CONCLUSION The literature since 1995 has reframed the debates on implementation of the radiographer reporting role and has been instrumental in shaping clinical practice. There has been clear influence upon both meso (professional body) and macro-level (governmental/health service) policies and guidance, that have shaped change at micro-level NHS Trust organisations. There is evidence of a shift in culturally intrenched legacy perspectives within and between different meso-level professional bodies around skills mix acceptance and role boundaries. This has helped shape capacity building of the reporting workforce. All of which have contributed to conceptual understandings of the skills mix workforce within modern radiology services.
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Affiliation(s)
- P Lockwood
- Present address: School of Allied Health Professions, Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent, UK.
| | - C Burton
- Present address: School of Allied Health Professions, Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent, UK
| | - N Woznitza
- Present address: School of Allied Health Professions, Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent, UK
- Radiology Department, University College London Hospitals NHS Foundation Trust, 235 Euston Road, London, UK
| | - T Shaw
- Present address: School of Allied Health Professions, Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent, UK
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Murphy L, Nightingale J, Calder P. Difficulties associated with Reporting Radiographer working practices - A narrative evidence synthesis. Radiography (Lond) 2022; 28:1101-1109. [PMID: 36075163 DOI: 10.1016/j.radi.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/28/2022] [Accepted: 08/17/2022] [Indexed: 12/01/2022]
Abstract
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.
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Affiliation(s)
- L Murphy
- Radiology Department, Newcastle Upon Tyne NHS Foundation Trust, UK.
| | - J Nightingale
- Dept of Allied Health Professions, Sheffield Hallam University, UK
| | - P Calder
- Radiology Department, Newcastle Upon Tyne NHS Foundation Trust, UK
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Murphy L, Nightingale J, Calder P. Difficulties associated with access to training and clinical support for Reporting Radiographers - A narrative evidence synthesis. Radiography (Lond) 2022; 28:1071-1079. [PMID: 35998381 DOI: 10.1016/j.radi.2022.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 07/28/2022] [Accepted: 08/02/2022] [Indexed: 12/23/2022]
Abstract
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.
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Affiliation(s)
- L Murphy
- Radiology Department, Newcastle Upon Tyne NHS Foundation Trust, UK.
| | - J Nightingale
- Dept of Allied Health Professions, Sheffield Hallam University, UK
| | - P Calder
- Radiology Department, Newcastle Upon Tyne NHS Foundation Trust, UK
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Chevalier S, Colombat P, Lejeune J, Guglielmin B, Bouquet M, Aubouin-Bonnaventure J, Coillot H, Fouquereau E. Recognition of radiographers in the workplace: Why it matters. Radiography (Lond) 2022; 28:648-653. [DOI: 10.1016/j.radi.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/25/2022] [Accepted: 05/02/2022] [Indexed: 11/16/2022]
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Assessing clinical applicability of COVID-19 detection in chest radiography with deep learning. Sci Rep 2022; 12:6596. [PMID: 35449199 PMCID: PMC9022741 DOI: 10.1038/s41598-022-10568-3] [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: 04/20/2021] [Accepted: 04/07/2022] [Indexed: 11/08/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has impacted healthcare systems across the world. Chest radiography (CXR) can be used as a complementary method for diagnosing/following COVID-19 patients. However, experience level and workload of technicians and radiologists may affect the decision process. Recent studies suggest that deep learning can be used to assess CXRs, providing an important second opinion for radiologists and technicians in the decision process, and super-human performance in detection of COVID-19 has been reported in multiple studies. In this study, the clinical applicability of deep learning systems for COVID-19 screening was assessed by testing the performance of deep learning systems for the detection of COVID-19. Specifically, four datasets were used: (1) a collection of multiple public datasets (284.793 CXRs); (2) BIMCV dataset (16.631 CXRs); (3) COVIDGR (852 CXRs) and 4) a private dataset (6.361 CXRs). All datasets were collected retrospectively and consist of only frontal CXR views. A ResNet-18 was trained on each of the datasets for the detection of COVID-19. It is shown that a high dataset bias was present, leading to high performance in intradataset train-test scenarios (area under the curve 0.55–0.84 on the collection of public datasets). Significantly lower performances were obtained in interdataset train-test scenarios however (area under the curve > 0.98). A subset of the data was then assessed by radiologists for comparison to the automatic systems. Finetuning with radiologist annotations significantly increased performance across datasets (area under the curve 0.61–0.88) and improved the attention on clinical findings in positive COVID-19 CXRs. Nevertheless, tests on CXRs from different hospital services indicate that the screening performance of CXR and automatic systems is limited (area under the curve < 0.6 on emergency service CXRs). However, COVID-19 manifestations can be accurately detected when present, motivating the use of these tools for evaluating disease progression on mild to severe COVID-19 patients.
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Makanjee CR, Bergh AM, Xu D, Sarswat D. Creating person-al space for unspoken voices during diagnostic medical imaging examinations: a qualitative study. BMC Health Serv Res 2021; 21:954. [PMID: 34511105 PMCID: PMC8436476 DOI: 10.1186/s12913-021-06958-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 08/27/2021] [Indexed: 11/10/2022] Open
Abstract
Background There is emerging interest in person-centred care within a short-lived yet complex medical imaging encounter. This study explored this event from the viewpoint of patients referred for an imaging examination, with a focus on the person and their person-al space. Methods We used convenience sampling to conduct semi-structured interviews with 21 patients in a private medical imaging practice in Australia. The first phase of data analysis was conducted deductively, using the six elements of the person-centred, patient-journey framework of the Australian Commission on Safety and Quality in Healthcare: transition in; engagement; decisions; well-being; experience; and transition out. This was followed by inductive content analysis to identify overarching themes that span a patient’s journey into, through and out of an imaging encounter. Results The transition-in phase began with an appointment and the first point of contact with the imaging department at reception. Engagement focused on patient-radiographer interactions and explanations to the patient on what was going to happen. Decisions related primarily to radiographers’ decisions on how to conduct a particular examination and how to get patient cooperation. Participants’ well-being related to their appreciation of gentle treatment; they also referred to past negative experiences that had made a lasting impression. Transitioning out of the imaging encounter included the sending of the results to the referring medical practitioner. Person-al vulnerabilities emerged as a cross-cutting theme. Patients’ vulnerability, for which they needed reassurance, pertained to uncertainties about the investigation and the possible results. Healthcare professionals were vulnerable because of patient expectations of a certain demeanour and of pressure to perform optimal quality investigations. Lastly, patients’ personal lives, concerns and pressures – their person-al ‘baggage’ – shaped their experience of the imaging encounter. Conclusion To add value to the quality of the service they deliver, radiography practitioners should endeavour to create a person-al space for clients. Creating these spaces is complex as patients are not in a position to judge the procedures required by technical imaging protocols and the quality control of equipment. A reflective tool is proposed for radiographers to use in discussions with their team and its leaders on improving person-centred care and the quality of services in their practice.
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Affiliation(s)
- Chandra Rekha Makanjee
- Department of Medical Radiation Science, University of Canberra, University Drive, Bruce, ACT, 2617, Australia.
| | - Anne-Marie Bergh
- Research Centre for Maternal, Fetal, Newborn and Child Health Care Strategies, University of Pretoria, Private Bag X323, Gezina, 0083, South Africa
| | - Deon Xu
- Department of Medical Radiation Science, University of Canberra, University Drive, Bruce, ACT, 2617, Australia
| | - Drishti Sarswat
- Department of Medical Radiation Science, University of Canberra, University Drive, Bruce, ACT, 2617, Australia
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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.
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Affiliation(s)
- K Wood
- College of Health, Psychology and Social Care, University of Derby, UK.
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Pedersen MRV, Kraus B, Santos R, Harrison G. Radiographers' individual perspectives on sonography - A survey of European Federation of Radiographer Societies (EFRS). Radiography (Lond) 2021; 28:31-38. [PMID: 34391653 DOI: 10.1016/j.radi.2021.07.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Radiographers can elect to work within many different modalities, one being ultrasound. Within Europe there are differing opinions about how much of a role radiographers should take in relation to the ultrasound examination, particularly report writing. This paper provides findings exploring the radiographer's views on working within sonography. METHODS In 2019 an electronic survey was disseminated to radiographer members by European Federation of Radiographer Societies (EFRS) national radiographer societies, following a pilot study. A mix of closed questions, free text, and scale responses aimed to investigate radiographers' practice, legal responsibilities, report writing, educational level and experiences of support and mentoring. RESULTS Of 561 radiographers participating, most (92%) reported performing ultrasound scans. Challenges with legislation, medical protectionism and lack of high-quality education restricted other radiographers. On average, the respondents have practiced ultrasound for 13.5 years. A total of 60% had postgraduate education and carried out a wide range of examinations. A full interpretative report, including advice on further investigations is performed by 52%, whilst 22% provide a checklist or descriptive report. Over 55% of radiographers took legal responsibility for the examination and the majority had clear protocols, good mentoring and support in the workplace. Peer review of their work was less common. CONCLUSION The result shows that in 21 (n = 25) countries radiographers perform ultrasound, however not without challenges. Educational levels range from no formal education or short courses to an MSc in ultrasound. Report writing practice differs across the EFRS countries responding to the survey, as does peer review to enhance skills and clinical practice. IMPLICATIONS FOR PRACTICE National Radiographer societies could review findings to support campaigning for a change in legislation and improvements to educational offerings in ultrasound.
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Affiliation(s)
- M R V Pedersen
- European Federation of Radiographer Societies, Churchilllaan 11, 3527 GV, Utrecht, the Netherlands; University Hospital Southern Denmark, Department of Radiology, Vejle, Beriderbakken 4, 7100, Vejle, Denmark; University of Southern Denmark, Department of Regional Health, Campusvej 55, Odense, Denmark.
| | - B Kraus
- European Federation of Radiographer Societies, Churchilllaan 11, 3527 GV, Utrecht, the Netherlands; Department of Health Sciences, Radiological Technology, University of Applied Sciences FH Campus Wien, Favoritenstrasse 226, A-1100, Vienna, Austria
| | - R Santos
- European Federation of Radiographer Societies, Churchilllaan 11, 3527 GV, Utrecht, the Netherlands; Polytechnic Institute of Coimbra, Coimbra Health School, Department of Clinical Physiology, Rua 5 de Outubro - SM Bispo, Apartado 7006, 3046-854, Coimbra, Portugal; Laboratory for Applied Health Research (LabinSaúde), Rua 5 de Outubro - SM Bispo, Apartado 7006, 3046-854, Coimbra, Portugal
| | - G Harrison
- European Federation of Radiographer Societies, Churchilllaan 11, 3527 GV, Utrecht, the Netherlands; Society and College of Radiographers, 207 Providence Square Mill Street, London, SE1 2EW, UK
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Abuzaid MM, Elshami W, McConnell J, Tekin HO. An extensive survey of radiographers from the Middle East and India on artificial intelligence integration in radiology practice. HEALTH AND TECHNOLOGY 2021; 11:1045-1050. [PMID: 34377625 PMCID: PMC8342654 DOI: 10.1007/s12553-021-00583-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 07/29/2021] [Indexed: 11/30/2022]
Abstract
Assessing the current Artificial intelligence (AI) situation is a crucial step towards its implementation into radiology practice. The study aimed to assess radiographer willingness to accept AI in radiology work practice and the impact of AI in work performance. An exploratory cross-sectional online survey conducted for radiographers working within the Middle East and India was conducted from May–August 2020. A previously validated survey used to obtain radiographer's demographics, knowledge, perceptions, organization readiness, and challenges of integrating AI into radiology. The survey was accessible for radiographers and distributed through the societies page. The survey was completed by 549 radiographers distributed as (77.6%, n = 426) from the Middle East while (22.4%, n = 123) from India. A majority (86%, n = 773) agreed that AI currently plays an important role in radiology and (88.0%, n = 483) expected that AI would play a role in radiology practice and image production. The challenges for AI implementation in practice were developing AI skills (42.8%, n = 235) and AI knowledge development (37.0%, n = 203). Participants showed high interest to integrate AI in under and postgraduate curriculum. There is excitement about what AI could offer, but education input is a requirement. Fears are expressed about job security and how radiology may work across all ages and educational backgrounds. Radiographers become aware of AI role and challenges, which can be improved by education and training.
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Affiliation(s)
- Mohamed M Abuzaid
- Medical Diagnostic Imaging Department, College of Health Sciences, University of Sharjah, Sharjah, UAE
| | - Wiam Elshami
- Medical Diagnostic Imaging Department, College of Health Sciences, University of Sharjah, Sharjah, UAE
| | - Jonathan McConnell
- Radiology Department, NHS Greater Glasgow and Clyde, Glasgow, Scotland UK
| | - H O Tekin
- Medical Diagnostic Imaging Department, College of Health Sciences, University of Sharjah, Sharjah, UAE
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Cartwright AK, Pain T, Heslop DJ. Substitution, delegation or addition? Implications of workforce skill mix on efficiency and interruptions in computed tomography. AUST HEALTH REV 2021; 45:382-388. [PMID: 33691082 DOI: 10.1071/ah20118] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/08/2020] [Indexed: 11/23/2022]
Abstract
Objectives This study evaluated multiple computed tomography (CT) workforce models to identify any implications on efficiency (length of stay, scan frequency and workforce cost) and scanning radiographer interruptions through substituting or supplementing with a trained CT assistant. Methods The study was conducted in a CT unit of a tertiary Queensland hospital and prospectively compared four workforce models, including usual practice: Model 1 used an administrative assistant (AA) and one radiographer; Model 2 substituted a medical imaging assistant (MIA) for the AA; Model 3 was usual practice, consisting of two radiographers; and Model 4 included two radiographers, with a supplemented MIA. Observational data were collected over 7 days per model and were cross-checked against electronic records. Data for interruption type and frequency, as well as scan type and duration, were collected. Annual workforce costs were calculated as measures of efficiency. Results Similar scan frequency and parameters (complexity) occurred across all models, averaging 164 scans (interquartile range 160-172 scans) each. The median times from patient arrival to examination completion in Models 1-4 were 47, 35, 46 and 33min respectively. There were between 34 and 104 interruptions per day across all models, with the 'assistant role' fielding the largest proportion. Model 4 demonstrated the highest workforce cost, and Model 2 the lowest. Conclusion This study demonstrated that assistant models offer similar patient throughput to usual practice at a reduced cost. Model 2 was the most efficient of all two-staff models (Models 1-3), offering the cheapest workforce, slightly higher throughput and faster examination times. Not surprisingly, the additional staff model (Model 4) offered greater overall examination times and throughput, with fewer interruptions, although workforce cost and possible role ambiguity were both limitations of this model. These findings may assist decision makers in selecting the optimal workforce design for their own individual contexts. What is known about the topic? Innovative solutions are required to address ongoing health workforce sustainability concerns. Workforce substitution models using trained assistants have demonstrated numerous benefits internationally, with translation to the Australian allied health setting showing promise. What does this paper add? Building on existing research, this study provides clinical workforce alternatives that maintain patient throughput while offering cost efficiencies. This study also quantified the many daily interruptions that occur within the CT setting, highlighting a potential clinical risk. To the best of our knowledge, this study is the first to empirically test the use of allied health assistants within CT. What are the implications for practitioners? Role substitution in CT may offer solutions to skills shortages, increasing expenditure and service demand. Incorporating appropriate assistant workforce models can maintain throughput while demonstrating implications for efficiency and interruptions, potentially affecting staff stress and burnout. In addition, the assistant's scope and accepted level of interruptions should be considerations when choosing the most appropriate model.
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Affiliation(s)
- Andrew K Cartwright
- Medical Imaging Department, Townsville University Hospital, Douglas, Qld 4814, Australia; and College of Medicine and Dentistry, James Cook University, Townsville, Qld 4810, Australia; and School of Population Health, Faculty of Medicine, UNSW Sydney, NSW 2052, Australia. ; and Present address: University of Notre Dame Fremantle, School of Medicine, Fremantle, WA 6160, Australia; and Corresponding author.
| | - Tilley Pain
- Townsville University Hospital, 100 Angus Smith Drive, Douglas, Qld 4814, Australia. ; and College of Public Health, Medical and Veterinary Sciences, James Cook University, 1 James Cook Drive, Douglas, Townsville, Qld 4811, Australia
| | - David J Heslop
- School of Population Health, Faculty of Medicine, UNSW Sydney, NSW 2052, Australia.
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Comparison of reporting radiographers' and medical doctors' performance in reporting radiographs of the appendicular skeleton, referred by the emergency department. Radiography (Lond) 2021; 27:1099-1104. [PMID: 34006443 DOI: 10.1016/j.radi.2021.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION There is an increasing trend towards deploying reporting radiographers in Danish hospitals who, among various professional groups, interpret and report skeletal radiographs from the emergency department (ED). This study aimed to compare the quality of the reports issued by reporting radiographers to three different groups of medical doctors (MDs) who interpret or report skeletal radiographs at the ED. METHODS Four professional groups (i.e. four reporting radiographers, two radiology trainees, two orthopaedic senior trainees, and two orthopaedic trainees) reported 100 radiographs of the appendicular skeleton. The Consequence of clinical Outcome score (CO-score), accuracy, sensitivity, and specificity of each group were compared. The relative risk of a false-negative, false-positive or wrong result, the risk of a serious error, as well as the odds ratio of a more severe CO-score for each of the three MD groups, were compared to the reporting radiographers. RESULTS There was a significant difference between the groups in reference to the CO-score (P ≤ 0.001), accuracy (P = .003), specificity (P = .022), and in the proportion of serious errors (P ≤ 0.001). Compared to the reporting radiographers, all three groups of MDs showed a significantly higher CO-score and a significantly increased risk of a wrong result. Moreover, two of the MD groups showed a significantly increased risk of a false-positive result and for severe errors. CONCLUSION Based on the CO-score, the relative risk of errors, which could potentially cause malpractice in treatment and patient recall, significantly decreased when the reports were completed by reporting radiographers. IMPLICATIONS FOR PRACTICE To explore the need for a 24-h radiographer reporting service to the EDs, an upscaled study, like the current, with more participants representing the professional groups is highly recommended.
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A longitudinal review of Scottish reporting radiographer output between 2015 and 2019. Radiography (Lond) 2021; 27:200-207. [DOI: 10.1016/j.radi.2020.07.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 11/24/2022]
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Woznitza N, Steele R, Hussain A, Gower S, Groombridge H, Togher D, Lofton L, Lainchbury J, Compton E, Rowe S, Robertson K. Reporting radiographer peer review systems: A cross-sectional survey of London NHS Trusts. Radiography (Lond) 2021; 27:173-177. [DOI: 10.1016/j.radi.2020.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/12/2020] [Accepted: 07/17/2020] [Indexed: 12/20/2022]
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MRI reporting radiographers - A survey assessment of number and areas of practice within the United Kingdom. Radiography (Lond) 2020; 27:568-573. [PMID: 33339747 DOI: 10.1016/j.radi.2020.11.017] [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: 09/29/2020] [Revised: 11/20/2020] [Accepted: 11/25/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The aim of this study was to determine a baseline assessment of the national picture of MRI reporting radiographers within the United Kingdom. METHOD A questionnaire was utilised using both open and closed questions, the twenty questions were based on four main themes of those in training, those trained, those no longer reporting and post qualification sign off and expectations. The questionnaire was sent out to multiple special interest and MRI specific groups. RESULTS Responses were received from 46 trusts (n = 46) between September 2019 and May 2020. The majority of respondents were from English Trusts (n = 40/46). 31 radiographers from 21 different trusts were training in MRI reporting with the majority of those training to report thoraco-lumbar spines and knees. 80 radiographers from 38 trusts had completed training with 77 of those being trained at one south of England University. 57 radiographers from 35 trusts were in practice with the majority of these reporting thoraco-lumbar spines and knees. CONCLUSION This survey provides an insight into the current status of MRI reporting radiographers in the UK. Although courses have been available since 2003, numbers are still low and there are significant geographical and working practice variations. Defined standards of practice and the implementation of a central register would benefit both those in practice and those looking to implement a MRI reporting radiographer service. IMPLICATIONS FOR PRACTICE This study gives some baseline evidence of the number and scope of practice of MRI reporting radiographers in the UK.
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Piper K, Mitchell M, Griffin K, Morgan T, Roy A, Thomas A, Pittock L, Woznitza N, Faruqui R, Sakel M. Concordance between a neuroradiologist, a consultant radiologist and trained reporting radiographers interpreting MRI head examinations: An empirical study. Radiography (Lond) 2020; 27:475-482. [PMID: 33218744 DOI: 10.1016/j.radi.2020.10.016] [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: 09/21/2020] [Revised: 10/23/2020] [Accepted: 10/27/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION This study assessed agreement between MRI reporting radiographers and a consultant radiologist compared with an index neuroradiologist when reporting MRI head (brain/internal auditory meati [IAMs]) examinations. The effect on patient management of any discordant reports was also examined. METHODS Two trained MRI reporting radiographers (RRs), a consultant radiologist (CR) and an index neuroradiologist (INR) reported on a random sample of 210 MRI examinations. The radiographers reported during clinical practice and the radiologists in clinical practice conditions. Two independent consultant physicians (neuro-rehabilitation and neuropsychiatry) compared these reports with the index neuroradiologist report for agreement and the clinical importance of discrepant reports. RESULTS Overall observer agreement between the RRs and CR was comparable in relation to agreement with the INR: RR; 93/210 (44.3%); and the CR; 83/210 (39.4%) for all head MRI examinations (p = 0.32). For brain examinations the difference was similar: RR; 64/180 (35.6%); and CR; 54/190 (30.0%), p = 0.26. Agreement rates for the IAMs examinations were identical, 29/30 (97.7%). For all head MRI examinations (n = 210) there was a very small observed difference of <0.5% in mean agreement between the reporting radiographers and the consultant radiologist (p = 0.92) for examinations where a major disagreement would have been likely to have led to a change in patient management. CONCLUSION MRI reporting radiographers reported during clinical practice on MRI head examinations to a level of agreement comparable with a consultant radiologist. IMPLICATIONS FOR PRACTICE This is an area in which radiographers could provide additional reporting roles to the reporting service to increase capacity. Wider potential benefits include cost-effectiveness and role development/retention of radiographers.
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Affiliation(s)
- K Piper
- School of Allied and Public Health Professions, Canterbury Christ Church University, Canterbury, CT1 1QU, UK.
| | - M Mitchell
- School of Allied and Public Health Professions, Canterbury Christ Church University, Canterbury, CT1 1QU, UK; Imaging Department, Medway Maritime Hospital, Medway NHS Foundation Trust, Gillingham, ME7 5NY, UK.
| | - K Griffin
- Imaging Department, Medway Maritime Hospital, Medway NHS Foundation Trust, Gillingham, ME7 5NY, UK.
| | - T Morgan
- Radiology Department, Northampton General Hospital NHS Trust, Northampton, NN1 5BD, UK; Diagnostic/Medical Imaging Department, Hinchingbrooke Hospital, North West Anglia NHS Foundation Trust, Huntingdon, PE29 6NT, UK.
| | - A Roy
- Radiology Department, Guy's and St Thomas' NHS Foundation Trust, London, SE1 7EH, UK.
| | - A Thomas
- School of Allied and Public Health Professions, Canterbury Christ Church University, Canterbury, CT1 1QU, UK.
| | - L Pittock
- School of Allied and Public Health Professions, Canterbury Christ Church University, Canterbury, CT1 1QU, UK.
| | - N Woznitza
- School of Allied and Public Health Professions, Canterbury Christ Church University, Canterbury, CT1 1QU, UK; Radiology Department, University College London Hospitals, London, NW1 2PG, UK.
| | - R Faruqui
- Centre for Health Services Studies, University of Kent, Canterbury, CT2 7NH, UK.
| | - M Sakel
- NeuroRehabitation Service, East Kent University Hospitals NHS Foundation Trust, Canterbury, CT1 3NG, UK.
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Møller Christensen B, Pettersson T, Bjällmark A. Radiographers' perception on task shifting to nurses and assistant nurses within the radiography profession. Radiography (Lond) 2020; 27:310-315. [PMID: 32958399 DOI: 10.1016/j.radi.2020.09.002] [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: 07/08/2020] [Revised: 08/28/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The radiography profession is challenged by greater responsibilities and shortage of educated radiographers. Implementation of task shifting is one strategy to deal with the current situation in health care. The aim of this studiy was to evaluate radiographers' perception of assistant nurses and nurses carrying out tasks that traditionally were undertaken within the radiography profession in a Swedish context. METHODS An electronic questionnaire was distributed to radiographers at eleven hospitals in Sweden. The questionnaire included background questions and questions about radiographers' perception about task shifting to nurses and assistant nurses. The respondents rated their agreement level regarding task shifting on a five-point Likert scale. Data was statistically evaluated in SPSS using Mann Whitney U test. RESULTS Sixty-five radiographers participated in the study. Most radiographers responded negatively to task shifting to nurses (72%) or assistant nurses (65%). Most radiographers disagree that nurses should perform mammography screening or work within interventional radiography, while the attitude towards nurses calculating glomerular filtration rate was more positive. A majority disagree regarding assistant nurses performing conventional radiographs, informing the patient about contrast media administration or inserting peripheral intravenous catheters, while there was a positive attitude towards assistant nurses preparing patients for examinations. The attitude towards task shifting was not influenced by age, however radiographers with less working experience were more positive to task shifting in general. CONCLUSION A majority of the radiographers had a negative attitude towards task shifting to nurses and assistant nurses. The radiographers were more positive to hand over tasks related to patient care and administrative tasks than technical related tasks within the profession. IMPLICATIONS FOR PRACTICE Knowledge about radiographers' perception on task shifting within the profession is essential when planning and implementing strategies for task shifting in the clinical settings.
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Affiliation(s)
- B Møller Christensen
- Department of Natural Science and Biomedicine, School of Health and Welfare, Jönköping University, Gjuterigatan 5, Jönköping, SE-553 18, Sweden
| | - T Pettersson
- Department of Radiology, Södra Älvsborg Hospital, Brämhultsvägen 53, SE-501 82, Borås, Sweden
| | - A Bjällmark
- Department of Natural Science and Biomedicine, School of Health and Welfare, Jönköping University, Gjuterigatan 5, Jönköping, SE-553 18, Sweden.
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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.
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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
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Lockwood P, Pittock L. Multi-professional image interpretation: Performance in preliminary clinical evaluation of appendicular radiographs. Radiography (Lond) 2019; 25:e95-e107. [DOI: 10.1016/j.radi.2019.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/12/2019] [Accepted: 04/23/2019] [Indexed: 11/26/2022]
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Rowe S, O'Riordan P, Woznitza N. Greater than the sum of the parts: Impact of radiographer clinical image interpretation. J Med Radiat Sci 2019; 66:149-151. [PMID: 31449741 PMCID: PMC6745340 DOI: 10.1002/jmrs.342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 06/04/2019] [Indexed: 11/18/2022] Open
Abstract
Radiographer preliminary image evaluation, within strong governance and audit systems, can help reduce diagnostic errors in the emergency setting. Radiographers, clinicians and radiologists should work together as a team to improve patient care and outcomes.
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Affiliation(s)
- Susan Rowe
- Radiology DepartmentHomerton University HospitalLondonUK
| | - Paul O'Riordan
- Radiology DepartmentHomerton University HospitalLondonUK
| | - Nick Woznitza
- Radiology DepartmentHomerton University HospitalLondonUK
- School of Allied and Public Health ProfessionsCanterbury Christ Church UniversityKentUK
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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]
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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]
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Lockwood P, Dolbear G. Nuclear medicine image interpretation by radiographers: Findings of an accredited postgraduate module. Radiography (Lond) 2019; 25:114-120. [PMID: 30955683 DOI: 10.1016/j.radi.2018.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/24/2018] [Accepted: 11/26/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The study aimed to analyse the results of radiographer's image interpretation of nuclear medicine (NM) examinations following a nine-month postgraduate module. METHODS Twenty participants completed 60 summative image commentaries each at the end of the module from prospective NM worklists in England. Each submitted a mixed selection of examinations in bone, lung, renal, and thyroid scans. Prevalence of abnormalities was 51% incorporating acute and chronic pathology, normal variants and incidental findings. Every commentary was marked against reference standard radiologist definitive reports. Statistical analysis included Kappa (k), intraclass correlation coefficient (ICC) and Spearman's rank correlation coefficient (RS). RESULTS Bone scan sensitivity and specificity was 93% (95% CI 91.3-95.6) and 88% (95% CI 84.3-90.9) respectively, accuracy at 91.5% (95% CI 88.6-93.7), with k = 0.82, ICC = 0.904, RS = 0.826. Lung scans demonstrated a sensitivity of 92.6% (95% CI 85.7-96.8), specificity was 92.1% (95% CI 88.7-94.1), accuracy 92.3% (95% CI 87.7-95.0), k = 0.83, ICC = 0.910, RS = 0.835. Renal scan sensitivity was 95% (95% CI 91.0-97.3), with 95.2% specificity (95% CI 91.8-97.3), accuracy were 95% (95% CI 91.4-97.3), k = 0.90, ICC = 0.948, RS = 0.907. Thyroid scans sensitivity was 88% (95% CI 83.1-91.4), with 93% specificity (95% CI 85.9-96.8), accuracy were 90.2% (95% CI 84.3-93.8), k = 0.80, ICC = 0.897, RS = 0.813. CONCLUSION In this small pilot study, the image interpretation ability in assessing prospective NM examinations in a clinical environment displayed encouraging results. Further work is recommended to evaluate a larger sample and case selection.
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Affiliation(s)
- P Lockwood
- Clinical and Medical Sciences Research Hub, School of Allied Health Professions, Canterbury Christ Church University, Kent, UK.
| | - G Dolbear
- Clinical and Medical Sciences Research Hub, School of Allied Health Professions, Canterbury Christ Church University, Kent, UK
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23
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Woznitza N, Piper K, Burke S, Bothamley G. Chest X-ray Interpretation by Radiographers Is Not Inferior to Radiologists: A Multireader, Multicase Comparison Using JAFROC (Jack-knife Alternative Free-response Receiver Operating Characteristics) Analysis. Acad Radiol 2018; 25:1556-1563. [PMID: 29724674 DOI: 10.1016/j.acra.2018.03.026] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 03/08/2018] [Accepted: 03/29/2018] [Indexed: 12/25/2022]
Abstract
RATIONALE AND OBJECTIVES Chest X-rays (CXR) are one of the most frequently requested imaging examinations and are fundamental to many patient pathways. The aim of this study was to investigate the diagnostic accuracy of CXR interpretation by reporting radiographers (technologists). METHODS A cohort of consultant radiologists (n = 10) and reporting radiographers (technologists; n = 11) interpreted a bank (n = 106) of adult CXRs that contained a range of pathologies. Jack-knife alternate free-response receiver operating characteristic (JAFROC) methodology was used to determine the performance of the observers (JAFROC v4.2). A noninferiority approach was used, with a predefined margin of clinical insignificance of 10% of average consultant radiologist diagnostic accuracy. RESULTS The diagnostic accuracy of the reporting radiographers (figure of merit = 0.828, 95% confidence interval 0.808-0.847) was noninferior to the consultant radiologists (figure of merit = 0.788, 95% confidence interval 0.766-0.811), P < .0001. CONCLUSIONS With appropriate postgraduate education, reporting radiographers are able to interpret CXRs at a level comparable to consultant radiologists.
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Affiliation(s)
- Nick Woznitza
- Radiology Department, Homerton University Hospital, Homerton Row, London E9 6SR, United Kingdom; School of Allied Health Professions, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent CT1 1QU, United Kingdom.
| | - Keith Piper
- School of Allied Health Professions, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent CT1 1QU, United Kingdom
| | - Stephen Burke
- Radiology Department, Homerton University Hospital, Homerton Row, London E9 6SR, United Kingdom
| | - Graham Bothamley
- Department of Respiratory Medicine, Homerton University Hospital, London, United Kingdom
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24
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Piper K, Pittock L, Woznitza N. Radiographer reporting of neurological magnetic resonance imaging examinations of the head and cervical spine: Findings of an accredited postgraduate programme. Radiography (Lond) 2018; 24:366-369. [DOI: 10.1016/j.radi.2018.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 04/25/2018] [Accepted: 05/19/2018] [Indexed: 11/25/2022]
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Lockwood P, Dolbear G. Image interpretation by radiographers in brain, spine and knee MRI examinations: Findings from an accredited postgraduate module. Radiography (Lond) 2018; 24:370-375. [PMID: 30292508 DOI: 10.1016/j.radi.2018.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/18/2018] [Accepted: 05/23/2018] [Indexed: 01/14/2023]
Abstract
INTRODUCTION The aim of the study was to evaluate the performance of radiographers in image interpretation of magnetic resonance imaging (MRI) brain, spine and knee examinations following a nine-month work based postgraduate MRI module. METHODS Twenty-seven participants each submitted 60 image commentaries taken from prospective clinical workloads. The image interpretations (n = 1620) comprised brain, spine, and knee MRI examinations. Prevalence of abnormal examinations approximated 53% (brain), 74% (spine), and 73% (knee), and included acute and chronic pathology, normal variants and incidental findings. Each image interpretation was graded against reference standard consultant radiologist definitive report. RESULTS The radiographer's performance on brain image interpretations demonstrated mean accuracy at 86.7% (95% CI 83.4-89.3) with sensitivity and specificity of 84% (95% CI 80.9-86.4) and 89.7% (95% CI 86.2-92.6) respectively. For spinal interpretations the mean accuracy was 86.4% (95% CI 83.4-89.0), sensitivity was 90.2% (95% CI 88.2-92), mean specificity was 75.3% (95% CI 69.4-80.4). The mean results for knee interpretation accuracy were 80.9% (95% CI 77.3-84.1), sensitivity was 83.3% (95% CI 80.8-85.5), with 74.3% specificity (95% CI 67.4-80.4). CONCLUSIONS The radiographer's demonstrated skills in brain, spine and knee MRI examination image interpretation. These skills are not to replace radiologist reporting but to meet regulating body standards of proficiency, and to assist decision making in communicating unexpected serious findings, and/or extend scan range and sequences. Further research is required to investigate the impact of these skills on adjusting scan protocols or flagging urgent findings in clinical practice.
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Affiliation(s)
- P Lockwood
- Clinical and Medical Sciences Research Hub, School of Allied Health Professions, Canterbury Christ Church University, Kent, UK.
| | - G Dolbear
- Clinical and Medical Sciences Research Hub, School of Allied Health Professions, Canterbury Christ Church University, Kent, UK
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26
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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.
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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
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Woznitza N, Piper K, Burke S, Ellis S, Bothamley G. Agreement between expert thoracic radiologists and the chest radiograph reports provided by consultant radiologists and reporting radiographers in clinical practice: Review of a single clinical site. Radiography (Lond) 2018; 24:234-239. [DOI: 10.1016/j.radi.2018.01.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 01/28/2018] [Accepted: 01/30/2018] [Indexed: 10/18/2022]
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Palmer D, Snaith B, Harris MA. Assistant radiographer practitioners: Creating capacity or challenging professional boundaries? Radiography (Lond) 2018; 24:247-251. [PMID: 29976338 DOI: 10.1016/j.radi.2018.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 02/24/2018] [Accepted: 03/01/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Over the last 2 decades the assistant radiographer practitioner (ARP) role has been introduced into NHS diagnostic imaging departments as a strategy to expand the workforce and create capacity. This skill mix initiative has not been implemented in a standardised way and there is limited knowledge of the current role scope within general radiography (X-Ray). METHOD An electronic survey of ARPs working within UK diagnostic imaging departments was conducted. Both open and closed questions sought information regarding basic demographic data (age category; gender; geographic region), scope of practice (patient groups; anatomical regions; imaging outside of the diagnostic imaging department), limitations placed on practice, supervision and additional roles. RESULTS A total of 108 responses, including 13 trainees, were received. Most sites employ three or less ARPs in general radiography (n = 43/66; 65.2%), although 11 sites have five (range 1-15). The majority undertake imaging of both adults and children (n = 85/108; 78.7%), although limitations on age were described. Their scope of practice covers a broad anatomical range and included some non-ambulant patients. The level of supervision varied with some sites empowering ARPs to check the referral prior to examination (n = 25) or images post acquisition (n = 32) (both n = 20/66; χ2 = 16.003; 1df; p = 0.000). CONCLUSION ARPs are helping to maintain capacity in imaging departments but we suggest there is further scope for expansion. The practice described by the post holders suggests that many are working beyond the scope envisaged by the radiography professional body.
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Affiliation(s)
- D Palmer
- Mid Yorkshire Hospitals NHS Trust, Aberford Road, Wakefield, WF1 4DG, UK
| | - B Snaith
- Mid Yorkshire Hospitals NHS Trust, Aberford Road, Wakefield, WF1 4DG, UK; University of Bradford, Richmond Road, Bradford, BD7 1DP, UK.
| | - M A Harris
- Mid Yorkshire Hospitals NHS Trust, Aberford Road, Wakefield, WF1 4DG, UK
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Woznitza N, Devaraj A, Janes SM, Duffy SW, Bhowmik A, Rowe S, Piper K, Maughn S, Baldwin DR. Impact of radiographer immediate reporting of chest X-rays from general practice on the lung cancer pathway (radioX): study protocol for a randomised control trial. Trials 2017; 18:521. [PMID: 29110698 PMCID: PMC5674683 DOI: 10.1186/s13063-017-2268-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 10/23/2017] [Indexed: 11/11/2022] Open
Abstract
Background Diagnostic capacity and suboptimal logistics are consistently identified as barriers to timely diagnosis of cancer, especially lung cancer. Immediate chest X-ray (CXR) reporting for patients referred from general practice is advocated in the National Optimal Lung Cancer Pathway to improve time to diagnosis of lung cancer and to reduce inappropriate urgent respiratory medicine referral for suspected cancer (2WW) referrals. The aim of radioX is to examine the impact of immediate reporting by radiographers of CXRs requested by general practice (GP) on lung cancer patient pathways. Methods A two-way comparative study that will compare the time to diagnosis of lung cancer for patients. Internal comparison will be made between those who receive an immediate radiographer report of a GP CXR compared to standard radiographer GP CXR reporting over a 12-month period. External comparison will be made with a similar, neighbouring hospital trust that does not have radiographer CXR reporting. Primary outcome is the effect on the speed of the lung cancer pathway (diagnosis of cancer or discharge). Secondary outcomes include the effect of the pathway on efficiency including the number of repeat CXRs performed in a timely fashion for suspected infection and the effect of immediate reporting of GP CXRs on patient satisfaction. Discussion The radioX trial will examine the hypothesis that immediate reporting of CXRs referred from GP reduces the time to diagnosis of lung cancer or discharge from the lung cancer pathway. Trial registration International Standard Randomised Controlled Trial Number ISRCTN21818068. Registered on 20 June 2017. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2268-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nick Woznitza
- Radiology Department, Homerton University Hospital, London, UK. .,School of Allied Health Professions, Canterbury Christ Church University, Canterbury, UK.
| | - Anand Devaraj
- Radiology Department, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Samuel M Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | | | - Angshu Bhowmik
- Department of Respiratory Medicine, Homerton University Hospital, London, UK
| | - Susan Rowe
- Radiology Department, Homerton University Hospital, London, UK
| | - Keith Piper
- School of Allied Health Professions, Canterbury Christ Church University, Canterbury, UK
| | - Sue Maughn
- City and Hackney Clinical Commissioning Group, London, UK
| | - David R Baldwin
- Department of Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
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Andersson B, Lundgren S, Lundén M. Trends that have influenced the Swedish radiography profession over the last four decades. Radiography (Lond) 2017; 23:292-297. [DOI: 10.1016/j.radi.2017.07.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 07/25/2017] [Accepted: 07/26/2017] [Indexed: 10/19/2022]
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Expanding the role of radiographers in reporting suspected lung cancer: A cost-effectiveness analysis using a decision tree model. Radiography (Lond) 2017; 23:273-278. [DOI: 10.1016/j.radi.2017.07.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 07/20/2017] [Accepted: 07/22/2017] [Indexed: 11/24/2022]
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Hardy M, McIntosh B. Optimizing diagnostic imaging through skills mix: costs and opportunities. Br J Hosp Med (Lond) 2017; 78:306-307. [DOI: 10.12968/hmed.2017.78.6.306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Maryann Hardy
- Professor of Radiography and Imaging Practice Research, Faculty of Health Studies, University of Bradford, Bradford
| | - Bryan McIntosh
- Reader in Health Management and Organisational Behaviour, Faculty of Health Studies, University of Bradford, Bradford BD7 1DP
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Lockwood P. CT sinus and facial bones reporting by radiographers: findings of an accredited postgraduate programme. Dentomaxillofac Radiol 2017; 46:20160440. [PMID: 28267931 DOI: 10.1259/dmfr.20160440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVES The aim of this study was to compare the observer performance of a cohort of radiographers in reporting CT sinus and facial bone investigations against a reference standard and alternative comparator of summary data from peer-reviewed literature. METHODS The participants (n = 6) completed a 9-month part-time distance learning training programme prior to reporting an examination bank (n = 25 cases) from a retrospectively collected and anonymized digital imaging and communications in medicine archive of CT examinations with referral histories and clinical reports. A literature search was performed to identify an additional alternative comparison reference standard from studies reporting observer performance data in CT sinus and facial bone investigations of both trauma and sinus pathology (target conditions). The data analyses used to measure observer performance and determine differences between the cohort and the reference standards used statistical assessment models including accuracy, sensitivity, specificity, kappa (κ) and summary receiver-operating characteristic curves with estimated area under the curve (AUC). RESULTS The cohort of radiographer sensitivity was 97.5%, specificity 93.6% and accuracy 95%, with p < 0.000, and a κ = 0.9121 score of agreement. The mean radiographer AUC was 0.9822. The summary reported data of the alternative literature reference standard comparator were AUC 0.9533 for sinus and 0.9374 for trauma. CONCLUSIONS The results suggest that this cohort of radiographers at the end of a period training in CT sinus and facial bones are able to clinically report comparably high standards.
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Affiliation(s)
- Paul Lockwood
- Allied Health Department, Canterbury Christ Church University, Chatham, UK
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Snaith B, Milner R, Harris M. Beyond image interpretation: Capturing the impact of radiographer advanced practice through activity diaries. Radiography (Lond) 2016. [DOI: 10.1016/j.radi.2016.07.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Exploring the Benefits of Magnetic Resonance Imaging Reporting by Radiographers: A UK Perspective. J Med Imaging Radiat Sci 2016; 47:194-203. [DOI: 10.1016/j.jmir.2015.12.083] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 12/19/2015] [Accepted: 12/21/2015] [Indexed: 11/20/2022]
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Lockwood P. An economic evaluation of introducing a skills mix approach to CT head reporting in clinical practice. Radiography (Lond) 2016. [DOI: 10.1016/j.radi.2015.09.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Innes S, Maybury M, Hall A, Lumsden G. Ultrasound guided musculoskeletal interventions: professional opportunities, challenges and the future of injection therapy. SONOGRAPHY 2015. [DOI: 10.1002/sono.12039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Mark Maybury
- Good Hope Hospital, Heart of England; Birmingham UK
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Smith T, Harris J, Woznitza N, Maresse S, Sale C. Conceptualisation of the characteristics of advanced practitioners in the medical radiation professions. J Med Radiat Sci 2015; 62:204-11. [PMID: 26451243 PMCID: PMC4592675 DOI: 10.1002/jmrs.115] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 04/02/2015] [Accepted: 05/08/2015] [Indexed: 11/08/2022] Open
Abstract
Professions grapple with defining advanced practice and the characteristics of advanced practitioners. In nursing and allied health, advanced practice has been defined as ‘a state of professional maturity in which the individual demonstrates a level of integrated knowledge, skill and competence that challenges the accepted boundaries of practice and pioneers new developments in health care’. Evolution of advanced practice in Australia has been slower than in the United Kingdom, mainly due to differences in demography, the health system and industrial relations. This article describes a conceptual model of advanced practitioner characteristics in the medical radiation professions, taking into account experiences in other countries and professions. Using the CanMEDS framework, the model includes foundation characteristics of communication, collaboration and professionalism, which are fundamental to advanced clinical practice. Gateway characteristics are: clinical expertise, with high level competency in a particular area of clinical practice; scholarship and teaching, including a masters qualification and knowledge dissemination through educating others; and evidence-based practice, with judgements made on the basis of research findings, including research by the advanced practitioner. The pinnacle of advanced practice is clinical leadership, where the practitioner has a central role in the health care team, with the capacity to influence decision making and advocate for others, including patients. The proposed conceptual model is robust yet adaptable in defining generic characteristics of advanced practitioners, no matter their clinical specialty. The advanced practice roles that evolve to meet future health service demand must focus on the needs of patients, local populations and communities.
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Affiliation(s)
- Tony Smith
- University of Newcastle Department of Rural Health Taree, New South Wales, Australia
| | - Jillian Harris
- Crown Princess Mary Cancer Centre Westmead, Sydney, New South Wales, Australia
| | - Nick Woznitza
- Homerton University Hospital and School of Allied Health Professions, Canterbury Christ Church University Canterbury
| | - Sharon Maresse
- Department of Imaging and Applied Physics, Curtin University Perth, Western Australia, Australia
| | - Charlotte Sale
- School of Medical Science, RMIT University Melbourne, Victoria, Australia
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