Optimising diagnostics through imaging informatics: Costs and opportunities

YesIncreasing diagnostic capacity is a national priority to expedite the timeliness and appropriateness of patient treatment interventions. Imaging—encompassing a range of technologies including X-ray, CT, MRI, nuclear medicine and ultrasound—is a key diagnostic service and central to decision-making in most, if not all, disease pathways. However, imaging is an expensive discipline accounting for an estimated 3–5% of the annual NHS budget. As a result, it is imperative that we maximise service efficiency while optimising patient outcomes.The manuscript version differs from the published version

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

yesObjective: To update knowledge on individual radiographer contribution to plain-film reporting workloads; to assess whether there is scope to further increase radiographer reporting capacity within this area. Methods: Reporting radiographers were invited to complete an online survey. Invitations were posted to every acute National Health Service trust in the UK whilst snowball sampling was employed via a network of colleagues, ex-colleagues and acquaintances. Information was sought regarding the demographics, geographical location and anatomical and referral scope of practice. Results: A total of 259 responses were received. 15.1% and 7.7% of respondents are qualified to report chest and abdomen radiographs, respectively. The mean time spent reporting per week is 14.5 h (range 1–37.5). 23.6% of radiographers report only referrals from emergency departments whilst 50.6% of radiographers have limitations on their practice. Conclusion: The scope of practice of reporting radiographers has increased since previous studies; however, radiographer reporting of chest and abdomen radiographs has failed to progress in line with demand. There remain opportunities to increase radiographer capacity to assist the management of reporting backlogs. Advances in knowledge: This study is the first to examine demographic factors of reporting radiographers across the UK and is one of the largest in-depth studies of UK reporting radiographers, at individual level, to date

Ultrasound clinical progress monitoring: Who, where and how?

Prior to assessment of final ultrasound clinical competency it is important to monitor clinical progress, provide high quality feedback and encourage skills development. The role of the supervisor, mentor and assessor are fundamental to the on-going progress monitoring of ultrasound trainees. This article forms the second part of a larger project which was to elicit ultrasound practitioners’ opinions on how progress should be monitored, where and by whom. An on-line questionnaire was used to gain opinions from ultrasound practitioners. Totally, 116 responses were received from professionals with an interest in ultrasound assessment. Results suggested that experienced, qualified ultrasound practitioners should undertake the role of supervisor and assessor, having been prepared for that role by the training centre. Formative monitoring should take place both within the clinical department and possibly the training centre, using a range of methods. Following completion of the training, practitioners should have a preceptorship period to consolidate their knowledge and skills for 3 to 6 months or until further competencies have been demonstrated. Formative progress monitoring should be a recognised part of ultrasound training. Essentially, staff undertaking supervision and assessor roles should be supported and trained to ensure a high quality, consistent learning experience for ultrasound trainees. Additionally, they should provide appropriate feedback to the trainee and education centre

CT head reporting by radiographers: results of an accredited postgraduate programme

Aim: To evaluate the results of the summative objective structured examination (OSE) for the first four cohorts of radiographers (n ¼ 24) undertaking an accredited postgraduate course in reporting computer tomography (CT) head examinations. Method: The construction of a summative OSE contained twenty five CT head examinations that incorporated 1:1 normal to abnormal pathological examples. All cases were blind reported by three consultant radiologists to produce a valid reference standard report for comparison with the radiographer's interpretation. The radiographers (n ¼ 24) final reports (n ¼ 600) were analysed to determine the sensitivity, specificity and agreement values and concordance for the four cohorts. Results: The four cohorts (2007e2013) of postgraduate radiography students' collective OSE results established a mean sensitivity rate of 99%, specificity 95% and agreement concordance rates of 90%. The final grades indicate that within an academic environment, trained radiographers possess high levels of diagnostic performance accuracy in the interpretation of CT head examinations

Transvaginal ultrasound simulation and its effect on trainee confidence levels: A replacement for initial clinical training?

Introduction: The ScanTrainer transvaginal ultrasound simulator has been developed to facilitate initial training of transvaginal ultrasound skills without patient contact. Due to the intimate nature of the examination and in some cases, limited training opportunities, the need for simulation-based education in ultrasound has gained momentum. Currently, research into the effectiveness of the ScanTrainer is limited. Methods: A mixed method study was conducted in a single institution between October 2011 and January 2012. Participants were recruited using convenience sampling and allocated to the control (clinical training) or experimental (simulation training) group following a pre-test. After 10 hours of their allocated transvaginal ultrasound training method a post-test assessment was conducted and the results statistically analysed. Participants then experienced the alternative method of training and completed questionnaires. The results were used to inform semi-structured interviews for each group. Interview transcripts were interpreted using theme analysis. Results: A small number of doctors completed the study, nine (82%) out of the 11 recruited. The majority of participants (89%) felt that practice on the ScanTrainer can increase confidence prior to attempting a real transvaginal ultrasound scan. Average scores showed that the simulation training group outperformed the clinical training group on overall score and each of the five post-test components. No statistically significant differences were demonstrated for overall score (U = 13, P = 0.556) or the five components (P = 0.190–1). Conclusions: Transvaginal ultrasound training on the ScanTrainer has the potential to replace initial clinical training; however, further larger trials are required to evaluate. Clinically significant outcomes exist if the ScanTrainer training is proven to be more effective than initial clinical training. The ScanTrainer prepares a trainee and builds confidence to progress to clinical scanning, which has the potential to improve the patient experience

AFROC analysis of reporting radiographer’s performance in CT head interpretation

Aim: A preliminary small scale study to assess the diagnostic performance of a limited group of reporting radiographers and consultant radiologists in clinical practice undertaking computer tomography (CT) head interpretation . Method: A multiple reader multiple case (MRMC) alternative free response receiver operating characteristic (AFROC) methodology was applied. Utilising an image bank of 30 CT head examinations, with a 1:1 ratio of normal to abnormal cases. A reference standard was established by double reporting the original reports using two additional independent consultant radiologists with arbitration of discordance by the researcher. Twelve observers from six southern National Health Service (NHS) trusts were invited to participate. The results were compared for accuracy, agreement, sensitivity, specificity. Data analysis used AFROC and area under the curve (AUC) with standard error. Results: The reporting radiographers results demonstrated a mean sensitivity rate of 88.7% (95% CI 82.3 to 95.1%), specificity 95.6% (96% CI 90.1 to 100%) and accuracy of 92.2% (95% CI 89.3 to 95%). The consultant radiologists mean sensitivity rate was 83.35% (95% CI 80 to 86.7%), specificity 90% (95% CI 86.7 to 93.3%) and accuracy of 86.65% (95% CI 83.3 to 90%). Observer performance between the two groups was compared with AFROC, AUC, and standard error analysis (p=0.94, SE 0.202). Conclusion: The findings of this research indicate that within a limited study, a small group of reporting radiographers demonstrated high levels of diagnostic accuracy in the interpretation of CT head examinations that was equivalent to a small selection of consultant radiologists

Audit of the job satisfaction levels of the UK radiography and physics workforce in UK radiotherapy centres 2012

Conclusion: Radiotherapy professionals are prone to the effects of compassion fatigue and burnout. Attention must be paid to workload and its impact on practitioners' job satisfaction. Professional development that is supported and informed by a performance development review is a simple and effective means of enhancing satisfaction. Individuals have a responsibility to themselves and their colleagues as their behaviours and attitudes influence job satisfaction. Advances in knowledge: This work identifies areas for future research to enhance the professional resilience of practitioners, in order to provide high-quality treatments. Objective: Workforce planning reports identify a staff shortfall that jeopardizes the ability of UK radiotherapy centres to meet future demands. Obtaining an understanding of the work experiences of radiotherapy professionals will support the development of strategies to increase job satisfaction, productivity and effectiveness. Methods: A quantitative survey assessed job satisfaction, attitudes to incident reporting, stress and burnout, opportunities for professional development, workload, retention and turnover. Clinical oncologists were not included, as the Royal College of Radiologists, London, UK, had recently assessed their members' satisfaction. All questions were taken from validated instruments or adapted from the "UK National Health Service Staff Survey". Results: The survey yielded 658 completed responses (approximately 16% response rate), from public and private sectors. Over a third (36%) of respondents were classified as satisfied for job satisfaction with 11% dissatisfied and the remaining 53% ambivalent. A significant proportion of clinical staff (37.5%) report high emotional exhaustion. Presenteeism was an issue with 42.4% attending work despite feeling unable to fulfil their role.</p

A systematic review of methods to immobilise breast tissue during adjuvant breast irradiation

Greater use of 3D conformal, Intensity Modulated Radiotherapy (IMRT) and external beam partial breast irradiation following local excision (LE) for breast cancer has necessitated a review of the effectiveness of immobilisation methods to stabilise breast tissue. To identify the suitability of currently available breast (rather than thorax) immobilisation techniques an appraisal of the literature was undertaken. The aim was to identify and evaluate the benefit of additional or novel immobilisation approaches (beyond the standard supine, single arm abducted and angled breast board technique adopted in most radiotherapy departments). A database search was supplemented with an individual search of key radiotherapy peer-reviewed journals, author searching, and searching of the grey literature. A total of 27 articles met the inclusion criteria. The review identified good reproducibility of the thorax using the standard supine arm-pole technique. Reproducibility with the prone technique appears inferior to supine methods (based on data from existing randomised controlled trials). Assessing the effectiveness of additional breast support devices (such as rings or thermoplastic material) is hampered by small sample sizes and a lack of randomised data for comparison. Attention to breast immobilisation is recommended, as well as agreement on how breast stability should be measured using volumetric imaging. Keywords: Breast, immobilisation, positioning, reproducibility, review.</p

Musculoskeletal ultrasound imaging - An exploration of physiotherapists' interests and use in practice

Background Musculoskeletal ultrasound imaging (MSKUSI) has gained popularity; several professions have expressed an interest in this application but the clinical use by physiotherapists has not been fully researched. Objectives To explore physiotherapists’ interests and use of MSKUSI in practice. Design Sequential mixed-methods; questionnaire followed by semi-structured interviews. Method A questionnaire was developed and distributed to gain initial information, (75 responses). Analysis informed topic-guide development and enabled a purposive-sampling strategy for semi-structured interviews that explored physiotherapists’ interests, education and clinical use of MSKUSI (n = 11). Interview data were analysed thematically. Results Five themes were identified: 1. Professional skill set – physiotherapists’ suitability for MSKUSI. 2. Factors that have impacted physiotherapists’ ability to use MSKUSI. 3. Physiotherapists’ motivation to use ultrasound - improving patient focused care. 4. Quality assurance strategies. 5. Application of biopsychosocial model. Themes revealed links between physiotherapists’ core skills, knowledge and professional experiences that align with MSKUSI requirements. Some participants reported support accessing education but many described challenges finding appropriate mentorship. Participants observed education did not always reflect practice typical of physiotherapists. Application of clinical reasoning processes utilised by physiotherapists was regarded as integral to patient-focused scanning. Conclusions Physiotherapists’ professional training and musculoskeletal practice are seen as a foundation for education in MSKUSI. Accessing education can be challenging, in particular mentorship that fully incorporates the biopsychosocial model. Proposed roles for MSKUSI for physiotherapists include verification of clinical assessment findings for diagnosis and facilitation of patient education. The potential to streamline patient pathways and optimise resource management warrants investigation

The role of radiographers in ultrasound: A survey of the national societies within the European Federation of Radiographer Societies (EFRS)

INTRODUCTION: Ultrasound is one of many areas of specialism for radiographers to develop their skills in. As part of a wider suite of surveys, the European Federation of Radiographer Societies (EFRS) wanted to investigate the extent and scope of practice for radiographers practising ultrasound across Europe. This report details the results of the initial survey, exploring the views of the EFRS countries' National Radiographer Societies. METHODS: An electronic survey was sent to representatives of the 43 national radiographer societies who were members of the EFRS. Questions asked about radiographer practice in ultrasound within individual countries, scope of the role, particularly report writing, in addition to investigating current ultrasound education, barriers and opinions on priorities for radiographer ultrasound practice. RESULTS: Forty individual responses were received, from a total of 27 countries, covering 62.8% of the EFRS member societies invited to participate. Radiologists or specialised medical practitioners performed ultrasound in the majority of countries. Radiographers practise ultrasound in 48% of countries and 11% have some limited involvement in ultrasound. Countries without radiographer engagement in ultrasound reported legislative issues or lack of acceptance from the medical professions (52%) and/or limited specific ultrasound education (39%) as predominant factors. In most countries where radiographers practise ultrasound, clinical reporting is a descriptive report or checklist approved by a medical doctor/radiologist. CONCLUSION: The results highlight the scope of practice and barriers faced in some EFRS countries to enabling radiographers to develop their skills and competencies in ultrasound. IMPLICATIONS FOR PRACTICE: Priorities for radiographer societies to assist in the development of ultrasound as a pathway for radiographer progression in countries, where it is not yet available, include education programmes, acceptance by medical professionals and changes to legislation