Advanced radiographic practice in adult chest imaging

Increasing cost and activity pressures on health systems worldwide has led to advanced radiographer practice models developing internationally. In the United Kingdom, radiographer reporting has evolved from the reporting of trauma skeletal x-rays by trained radiographers to include the interpretation of adult chest x-rays, CT head, MRI knee and lumbar spine, mammography, ultrasound and gastrointestinal examinations. Advanced radiographer practice encompasses the entire spectrum of imaging, from justification of the referral, obtaining high quality images, initial image review and the provision of a definitive clinical report. The contribution that advanced practitioner radiographers make at patient, departmental and hospital levels will be highlighted. The positive influence on improved patient care and the service provided to referring clinicians will be illustrated through real case scenarios and departmental and hospital benefits explored though presentation of service review. The Royal College of Radiologists and the College of Radiographers are united in their position that all radiographers who expand their scope of practice must perform at a level comparable to a consultant radiologist. The growing body of evidence supporting adult chest x-ray interpretation by trained radiographers will be explored, including performance at the end of accredited postgraduate training, audit of clinical radiographer chest x-ray reporting in clinical practice and agreement between expert consultant chest radiologists and clinical reports; both radiologist and radiographer

Delivery of a preliminary clinical evaluation web based short course in Finland

Abnormality detection schemes in radiography have existed in the UK since the 1980s to aid patient triage. Following professional body guidance a PCE (preliminary clinical evaluation) scheme is now recommended where radiographers provide a brief description of imaging findings to the referrer when an immediate definitive report is unavailable. PCE teaching is undertaken in undergraduate radiography programmes in the UK but is limited outside of the UK. To improve PCE knowledge radiographers in Finland undertook a short course using blended learning from a UK university. Pre and post course test banks were used to assess performance

Radiographer reporting of neurological magnetic resonance imaging examinations of the head and cervical spine: findings of an accredited postgraduate programme

Introduction To analyse the objective structured examination (OSE) results of the first cohorts of radiographers (n = 13) who successfully completed an accredited postgraduate programme in clinical reporting of neurological magnetic resonance imaging (MRI) examinations of the head and cervical spine. Methods Forty MRI examinations were used in the OSE which included a range of abnormal cases (prevalence of abnormal examinations approximated 50%) and included: haemorrhage, infarction, demyelination disease, abscess, mass lesions (metastatic deposits, meningioma, glioma, astrocytoma); and disc disease, cord compression, stenosis, ligament rupture, syringomyelia appearances on patients referred from a range of referral sources. Normal variants and incidental findings were also included. True/false positive and negative fractions were used to mark the responses which were also scored for agreement with the previously agreed expected answers based on agreement between three consultant radiologists' reports. Results The mean sensitivity, specificity and agreement rates for all head and cervical spine investigations (n = 520) combined were 98.86%, 98.08% and 88.37%, respectively. The highest scoring cases were cases which included astrocytoma, disc protrusion with cord compression and glioma. The most common errors were related to syringomyelia, ligament rupture and vertebral fracture. Conclusions These OSE results suggest that in an academic setting, and following an accredited postgraduate education programme, this group of radiographers has the ability to correctly identify normal MRI examinations of the head/cervical spine and are able to provide a report on the abnormal appearances to a high standard. Further work is required to confirm the clinical application of these findings. Highlights •Following accredited training, radiographers can report MRI examinations of the head or cervical spine to a high standard. •The accuracy of the radiographers' reports is similar to rates in other MRI reporting studies of the lumbar spine or knee. •Radiographers in an academic setting, can report to a similar standard to non-specialised consultant radiologists

Radiographer reporting of magnetic resonance imaging breast examinations: findings of an accredited postgraduate programme

Aim To present the objective structured examination (OSE) results of the initial cohorts of radiographers (n=6) who have completed a postgraduate education programme (accredited by the College of Radiographers) to report magnetic resonance imaging (MRI) investigations of the breast. Method Twenty-five MRI investigations (prevalence of abnormal cases approximately 50%) were used in the OSE which included the following appearances: malignancy (mass; multi-focal disease; nipple and/or lymph node involvement); benign cysts; implant rupture (intra and extra capsular); and normal breast (with and without implant). The radiographers indicated if the appearances were normal or abnormal and provided a description and interpretation of any abnormal appearances. Responses (n=150) were compared to the expected answers previously agreed with a consultant radiologist external examiner. Sensitivity and specificity rates were calculated on the normal/abnormal decision and the total percentage agreement rates were calculated using a pre-determined marking scheme. Results The mean % rates (and 95% Confidence Intervals) for sensitivity, specificity and agreement were 96.0% (82-98); 95% (85-98) and 89.8% (80-96), respectively. The most common false positive and false negative errors were lymph node involvement, fibroadenoma and implant rupture. Conclusion These results suggest that this group of radiographers can report MRI breast examinations to a satisfactory level of competence to be of benefit to clinical departments committed to achieving recent guidelines. Further work is required to confirm the clinical application of these findings

An unusual cause of respiratory distress

Background: Respiratory distress is a very common presenting complaint in children and neonates, and is one that will regularly face healthcare professionals. A thorough clinical assessment and sound appreciation of the broad range of differential diagnoses is key to enabling effective and subsequent targeted investigation and management of the condition. Bronchogenic cysts, while rare, are one of the most common mediastinal masses encountered in the neonate. The clinical presentation of bronchogenic cysts is variable, however in the neonate they often present with respiratory distress shortly after birth. Radiological appearances are rarely conclusive, with histology required for a definitive diagnosis. Case: Presented here is a case of a term infant who developed respiratory distress shortly after birth that required intubation and ventilation. Antenatal ultrasound demonstrated a persistent posterior mediastinal cystic structure. Investigations: Chest radiographs obtained shortly after birth revealed a smooth, well-defined homogenous mediastinal mass, with left lung hyperinflation. Subsequent computed tomography confirmed that the mass was closely related to the trachea anteriorly and oesophagus posteriorly, displacing both of these structures to the right. Differential diagnosis: Differential diagnosis was of an oesophageal duplication cyst or bronchogenic cyst. Treatment: After stabilisation on the neonatal intensive care unit, the infant was transferred to a tertiary centre for definitive management. Thoracotomy was performed, and histopathology of the mass confirmed the diagnosis of a bronchogenic cyst. Outcome and follow up: The infant made an uneventful recovery, and was discharged 17 days post-operatively. She has since been discharged from formal follow up and displays no respiratory complications. Discussion: This case serves as a reminder to the reader that, although uncommon, bronchogenic cysts should be considered in the differential diagnosis, particularly when assessing the newborn infant with respiratory distress. As such, it provides an important educative value. It also serves to highlight the importance of careful radiographic imaging and interpretation. While often not diagnostic, when used in conjunction with good clinical assessment, imaging can help to narrow the differential diagnosis and subsequently focus the investigation and management

Optimizing patient care in radiology through team-working: A case study

Objectives: To investigate how changes in service delivery within the radiology department of an acute district general hospital optimized imaging services for patients and referrers through a strong emphasis on team-working. Methods: Data related to service delivery was collected for three consecutive years and interrogated by imaging modality and reporting practitioner (radiologist, reporting radiographer, sonographer) to explore how workload had changed over the cycle. Results: Departmental activity demonstrated consistent increases, both overall (13.3%) and for most modalities (MRI 43.7%, CT 22.8%) for the study period (March 2010 – March 2013). Overall trend suggested significantly shorter waiting times (CT 0.7 weeks, MRI 1.3 weeks, non-obstetric ultrasound one week; all modalities p=0.001). Some modality variation in reporting times was apparent, with CT (p=0.06) and MRI (p=0.01) decreasing but there was an increase in x-ray reporting times (p=0.001). Reporting radiographers and sonographers reported the majority of x-ray and non-obstetric ultrasound interpretations (59% and 52%, respectively). A radiographer-led neonatal reporting service was implemented and the urology patient pathway redesigned. Effective team-working produced savings of three full-time consultant radiologist posts. Conclusion: Radiologists and radiographers, working together, can deliver an effective service. Innovation, staff development and redesign of patient pathways, have produced significant improvements