Origins of the Reporting Radiographer

A talk on the ‘The Origins of the Reporting Radiographer’, looking at the changing roles and practice of the profession from the first x-ray technicians at the start of the 20th century, through two World Wars to the start of radiographer reporter training from 1994. Christ Church was the first institution worldwide to offer postgraduate opportunities in Clinical Reporting, starting with a pilot programme by Keith Piper (Principal Lecturer) in 1994 accredited to teach NHS Radiographers to report x-ray images. This sector leading programme helped to facilitate and implement extended practice and consultant roles for radiographers, a model that made the UK a world leader in radiography reporting and helped developed a national and international reputation for Christ Church in this area of research and work

CT Sinus and facial bones reporting by radiographers: findings of an accredited postgraduate programme

Objectives The aim of this study was to compare the observer performance of a cohort of radiographer’s in reporting Computed Tomography (CT) sinus and facial bones 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 anonymised DICOM 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 bones 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 (k), summary receiver operating characteristic curves with estimated area under the curve (AUC). Results The cohort of radiographer’s sensitivity was 97.5%, specificity 93.6%, accuracy 95%, with p < 0.000 and a k=0.9121 score of agreement. The mean radiographers AUC was 0.9822. The summary reported data of the alternative literature reference standard comparator was 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 to comparable high standards

An economic evaluation of introducing a skills mix approach to CT head reporting in clinical practice.

Background: Computed Tomography (CT) head examinations are a common diagnostic examination in National Health Service (NHS) acute hospital trusts. Current NHS England and Royal College of Radiologist (RCR) reports estimate the year on year increase of examinations to be 10%, with the designated workforce of radiologists disproportionate to the increase in demand of imaging reporting. Objective: To determine an economic evaluation of cost, risk and feasibility of introducing skills mix CT head reporting by radiographers. Design: Applying a PICO framework study to evaluate the patient workflow demand from retrospective audit data of CT head examination attendance (n=7,266) at an acute NHS district general hospital (DGH) to model an example workflow demand over 12 months. Reviewing potential outcome risk data (diagnostic thresholds), and feasibility (workforce capacity) of both interventions. The economic evaluation calculated hourly unit costs for comparison estimation of consultant radiologists and reporting radiographers using Netten et al’s Ready Reckoner. Report unit costs were calculated utilising the Gishen’s Ready Reckoner to estimate the uninterrupted time of reporting a non-complex CT report using RCR, Centre for Workforce Intelligence (CfWI) and Department of Health (DoH) estimates for both interventions. Conclusions: The economic evaluation of introducing a skills mix reporting service model to the benefit of service delivery with the NHS has shown a potential £299,359-£124,514 per annum cost saving using a generic acute DGH workload model. Research into recorded discrepancy/error audit data for potential detrimental risk to patient outcomes identified a paucity of evidence, and recommends further research is needed

Out of the comfort zone (Part 2)

When we are normally asked to report strange masses in heads, some of us take it as an interesting challenge away from the hum drum day to day long running contest of stroke or no stroke, but when we get presented with conditions that extend out of our normal range of competencies how do we deal with this

Efficacy, utility, and validity in Computed Tomography head reporting by radiographers

Introduction: Demand for Computed Tomography (CT) head imaging has increased exponentially within the National Health Service (NHS) coinciding with a limited consultant radiologist workforce, resulting in time-critical CT reporting delays for patients. The safety and effectiveness of the NHS improvement initiative increasing reporting capacity with radiographers is not yet established. Aim: To establish the diagnostic accuracy (efficacy) of trained radiographers reporting CT head examinations; their role in the patient pathway (clinical utility); beneficial outcomes of radiographers’ reports (validity); and an economic assessment of the role. Methods: A literature review using validated critique frameworks assessing methodological quality (QUADAS-2, CASP, CHEERS) and reporting (STARD, StaRI) of radiographers reporting CT head examinations studies established the ‘knowledge gap’ in evidence and requirement for research rigour. A further literature review identified an efficacy framework to structure the pragmatic mixedmethod research strategy. Seven studies assessed diagnostic accuracy, radiographers’ roles within the NHS, and economic evaluation, against the same frameworks to demonstrate research rigour. Results: Radiographers trained to report CT head scans demonstrated an efficacy level (AUC 0.98) equivalent to consultant radiologists. Radiographers communicated actionable reports and advice to multidisciplinary teams aiding clinician’s decisions including medical interventions and surgical referral evidencing clinical utility. Cross-sectional surveys demonstrated radiographers’ scope of practice included all referral pathways of trauma, health screening, disease diagnosis, staging, and monitoring treatment, and patient groups. The role was cost-effective (up to £328,865 per annum, per radiographer) and contributed a cost-benefit, attesting to the validity of the role within the patient pathway and healthcare system. Conclusion: Novel findings evidence trained CT head reporting radiographers’ efficacy is equivalent to radiologists, with beneficial impact for service design and delivery of expanding the workforce safely to potentially reduce reporting delays. An emerging theme from the findings underscores the need for robust study design to generate translational evidence for clinical practice

Exploring variation and trends in adherence to national occupational standards for reporting radiographers

Purpose: The primary aim of this study was to observe variations and trends in the implementation and conformity to guidelines and standards in the advanced practice role of radiographer reporting within United Kingdom (UK) National Health Service (NHS) trusts. Method: A questionnaire using a 5-point Likert categorical response scale, and free text open questions was applied. The engagement process used on-line survey was sent out between July and August 2015 to NHS reporting radiographers. The inclusion criteria covered a cross section of imaging modalities including plain film, computed tomography (CT), magnetic resonance imaging (MRI), nuclear medicine (NM), fluoroscopy, and mammography. Results: A total of 261 radiographers completed and returned the survey. Commenting on a selection of questions based on four key themes of scope of practice (a clearly defined job description (74.3%; n=168/226). Education and training support (55%; n=125/227 had no mentor allocated), resources and equipment (48%; n=102/212 did not have access to dedicated equipment); and outcome measures of performance (36%; n=77/216 regularly audited their workload). Conclusion: The results of the data collected, identified specific trends in the sample group on defined scope of practice, and the level of organisational support. It was implicitly implied from the varied responses on equipment and resources provided to fulfil the role, that best practice guidance on resources used to fulfil the role should have a clearly defined area in future frameworks and policy to support safe working practices. The variances of responses suggest adherence to recommended best principles in reporting were not consistent within this sample group; and acknowledged factors on the parity of support, equipment, scheduled sessions, audit mechanisms and cross-cover of service provision

CT skull base & calvarium normal variant pitfalls

Intended learning outcomes - To recognise the varied neurological appearances of skull based normal variants with the brain. Highlighting the importance of differentiation of normal and variant anatomy from the pitfalls of misdiagnosing a pathological condition Content of Presentation -Pictorial review of 12 common examples of neuroradiological normal variant conditions of skull base and calvarium anatomical areas of the brain, including sutures, asymmetry of bones, benign growths, thickenng, dilation of diploic channels and sinuses Relevance -There are an increase of radiographers taking up CT Head Reporting courses throughout the country due to the increased workload of CT departments and NHS funding of stroke units in district general hospitals Oucomes - To increase reporting radiographers and CT radiographers knowledge and CPD learning of cerebral anatomy and variants Discussion - The differentiation of a normal anatomical variant tends to come from experienced recognition of established patterns of variation from either empirical visual assessment or evidence based reesearch material that allow the reduction of false-positive findings and reduce unnecessary additional diagnostic imagin

Assessing the barriers and enablers to the diagnostic radiographer X-ray reporting service within the NHS in England: A systematic literature review

What are the barriers and enablers of the diagnostic radiographer X-ray reporting service within the National Healthcare Service in England

Out of the comfort zone (Part 1)

When we are normally asked to report strange masses in heads, some of us take it as an interesting challenge away from the hum drum day to day long running contest of stroke or no stroke, but when we get presented with conditions that extend out of our normal range of competencies how do we deal with this

The Right to Know: Disclosure of Information for Collective Bargaining and Joint Consultation

The legal obligation on employers to provide information to employees has grown since the early 1970s. At that time, the emphasis was on disclosure for collective bargaining. In the 1980s and 1990s, the emphasis shifted more to disclosure for joint consultation. In the context of new legislation, the possibility of further interventions from Europe, and a greater commitment to openness in other areas of company and public life, disclosure of information for collective bargaining and joint consultation at work is again on the agenda. This article focuses on disclosure for both of these processes. Disclosure for collective bargaining is the most developed and potentially significant area of the law from an industrial relations perspective. Disclosure for joint consultation, however, has been the most dynamic area in recent years. Voluntary information provision by firms has also been a significant part of developing human resource management practice. The paper therefore provides a broad examination of the law on disclosure. The UK provisions are conceptualised as constituting an agenda-driven disclosure model; i.e. the trigger for their use lies within the bargaining agenda. By contrast, the provisions stemming from European initiatives are event-driven; i.e. they are triggered by specific employer initiated events that affect employment contracts in other ways irrespective of the representative context. In the final sections, we attempt a broader evaluation of the intent and impact of the legislation and assess the pros and cons of the different approaches.Disclosure of information, collective bargaining, joint consultation