A comparison of radiographer and radiologist reports on radiographer conducted barium enemas

An investigation of radiographers' and radiologists' perceptions and attitudes in Kuwait towards extending radiographers' role in mammography

INTRODUCTION

Kuwait has a shortage of radiologists, especially in mammography, resulting in increased workload and longer waiting times for women receiving imaging investigations. This study looked at how radiographers and radiologists perceived radiographers' role extension (RE) in mammography, and whether this could reduce radiologist workload, thereby improving patient service and waiting times.

METHODS

A single case study design with 10 radiographers (mammographers) and 10 radiologists was undertaken across multiple sites: hospitals, screening clinics and specialist centres in Kuwait. Data included individual semi-structured interviews, documentary analysis and field notes. Perceptions were examined under a theoretical framework, Abbotts' System of Professions.

RESULTS

Two main themes were identified, firstly in examining the current role of radiographers in mammography and areas of interest for extending role, this highlighted insufficient knowledge of the concept. The second focused on in-depth understanding of drivers and barriers to RE in mammography, both groups opposed radiographers performing extended tasks without radiologist supervision.

CONCLUSION

Radiologists and radiographers' attitudes were influenced by concepts of professional identity and professional identity formation. Insufficient professional knowledge negatively affected the radiographers' readiness to undertake RE in mammography. Radiologists are reluctant to blur boundaries, enabling them to maintain and control jurisdiction of their own profession and that of radiographers, thereby, as discussed in Abbott's theory, limiting impact on workload or waiting times.

IMPLICATIONS FOR PRACTICE

Whilst RE is limited, to improve workload and patient waiting times, setting up an educational programme for radiographers specialising in mammography would be an important step to extending the radiographers' role. The study highlighted a need to educate radiographers to undertake breast ultrasound and amend policy to introduce training programmes for radiographers. Radiographer rotation across the various radiographic modalities negatively affected radiographers' performance, placing well-trained radiographers permanently within the mammography department should improve experience and overall skills.

Added value of double reading in diagnostic radiology,a systematic review

Objectives

Double reading in diagnostic radiology can find discrepancies in the original report, but a systematic program of double reading is resource consuming. There are conflicting opinions on the value of double reading. The purpose of the current study was to perform a systematic review on the value of double reading.

Methods

A systematic review was performed to find studies calculating the rate of misses and overcalls with the aim of establishing the added value of double reading by human observers.

Results

The literature search resulted in 1610 hits. After abstract and full-text reading, 46 articles were selected for analysis. The rate of discrepancy varied from 0.4 to 22% depending on study setting. Double reading by a sub-specialist, in general, led to high rates of changed reports.

Conclusions

The systematic review found rather low discrepancy rates. The benefit of double reading must be balanced by the considerable number of working hours a systematic double-reading scheme requires. A more profitable scheme might be to use systematic double reading for selected, high-risk examination types. A second conclusion is that there seems to be a value of sub-specialisation for increased report quality. A consequent implementation of this would have far-reaching organisational effects.

Key Points

• In double reading, two or more radiologists read the same images.

• A systematic literature review was performed.

• The discrepancy rates varied from 0.4 to 22% in various studies.

• Double reading by sub-specialists found high discrepancy rates.

Electronic supplementary material

The online version of this article (10.1007/s13244-018-0599-0) contains supplementary material, which is available to authorised users.

Does radiography advanced practice improve patient outcomes and health service quality? A systematic review

OBJECTIVE

To investigate the impact of radiographer advanced practice on patient outcomes and health service quality.

METHODS

Using the World Health Organization definition of quality, this review followed the Centre for Reviews and Dissemination guidance for undertaking reviews in healthcare. A range of databases were searched using a defined search strategy. Included studies were assessed for quality using a tool specifically developed for reviewing studies of diverse designs, and data were systematically extracted using electronic data extraction pro forma.

RESULTS

407 articles were identified and reviewed against the inclusion/exclusion criteria. Nine studies were included in the final review, the majority (n = 7) focusing on advanced radiography practice within the UK. Advanced practice activities considered were radiographer reporting, leading patient review clinics and barium enema examinations. The articles were generally considered to be of low-to-moderate quality, with most evaluating advanced practice within a single centre. With respect to specific quality dimensions, the included studies considered cost reduction, patient morbidity, time to treatment and patient satisfaction. No articles reported data relating to time to diagnosis, time to recovery or patient mortality.

CONCLUSION

Radiographer advanced practice is an established activity both in the UK and internationally. However, evidence of the impact of advanced practice in terms of patient outcomes and service quality is limited.

ADVANCES IN KNOWLEDGE

This systematic review is the first to examine the evidence base surrounding advanced radiography practice and its impact on patient outcomes and health service quality.

Accuracy of radiographers red dot or triage of accident and emergency radiographs in clinical practice: a systematic review

AIM

To determine the accuracy of radiographers red dot or triage of accident and emergency (A&E) radiographs in clinical practice.

MATERIALS AND METHODS

Eligible studies assessed radiographers red dot or triage of A&E radiographs in clinical practice compared with a reference standard and provided accuracy data to construct 2 x 2 tables. Data were extracted on study eligibility and characteristics, quality, and accuracy. Pooled sensitivities and specificities and chi-square tests of heterogeneity were calculated.

RESULT

Three red dot and five triage studies were eligible for inclusion. Radiographers' red dot of A&E radiographs in clinical practice compared with a reference standard is 0.87 [95% confidence interval (CI) 0.85-0.89] and 0.92 (0.91-0.93) sensitivity and specificity, respectively. Radiographers' triage of A&E radiographs of the skeleton is 0.90 (0.89-0.92) and 0.94 (0.93-0.94) sensitivity and specificity, respectively; and for chest and abdomen is 0.78 (0.74-0.82) and 0.91 (0.88-0.93). Radiographers' red dot of skeletal A&E radiographs without training is 0.71 (0.62-0.79) and 0.96 (0.93-0.97) sensitivity and specificity, respectively; and with training is 0.81 (0.72-0.87) and 0.95 (0.93-0.97). Pooled sensitivity and specificity for radiographers without training for the triage of skeletal A&E radiographs is 0.89 (0.88-0.91) and 0.93 (0.92-0.94); and with training is 0.91 (0.88-0.94) and 0.95 (0.93-0.96).

CONCLUSION

Radiographers red dot or triage of A&E radiographs in clinical practice is affected by body area, but not by training.

MRI diagnosis of fracture of the scaphoid bone: impact of a new practice where the images are read by radiographers

RATIONALE AND OBJECTIVES

To investigate whether magnetic resonance imaging (MRI) radiographers are able to evaluate MRI examinations with regard to scaphoid fractures to save patients unnecessary immobilization and clinical and radiographic examinations, and to reduce the costs for the hospital as well as society in general.

MATERIALS AND METHODS

Over a 1-year period 224 consecutive patients with a suspected clinical scaphoid fracture but negative radiography were referred for MRI and examined within 11 hours. The MR images were primarily evaluated by the MRI radiographer on duty. Other fractures and bone edema were not reported because these were not part of the work-up protocol agreed upon by the radiology and the orthopedic departments. The following weekday a final report was provided by a radiologist. For the economical analysis the official price-list for Danish hospital service was used.

RESULTS

The MRI radiographers reported 43 scaphoid fractures, whereas the radiologist ultimately diagnosed only 36 scaphoid fractures (16.1% of patients) (sensitivity, 100%; specificity, 96.3%). Six of the seven false-positive fractures occurred in patients with edema of the scaphoid. The seventh false-positive was a fracture of the capitate. The hospital saved at least 20,000 and the social care system 70.000.

CONCLUSION

It is possible to provide an acute MRI service to patients with clinically suspected fracture of the scaphoid and a normal plain radiograph. The MR images can be primarily read by sufficiently trained MR radiographers. This new work-up protocol reduces the cost for society.