Interpretation of clinical imagingexaminations by radiographers:a programme of research

Background Studies which have investigated the interpretation of plain skeletal examinations by radiographers have demonstrated encouraging findings, however, the studies have not extended beyond this area of practice and radiographers' diagnostic performance for other more complex investigations has not been established. Comparisons of performance between groups of healthcare practitioners to date, has also been limited. Aim This research programme aimed to investigate the interpretation of clinical imaging examinations by radiographers, and other healthcare practitioners, in the provision of initial interpretations and/or definitive reports of plain imaging ( skeletal and chest) and crosssectional (magnetic resonance imaging [MRI] – lumbar/thoracic spine, knees and internal auditory meati [IAM]) investigations. Methods The eight studies utilised a variety of methodological approaches and included quasiexperimental and observational studies. One quasi-experimental study compared the performance of radiographers, nurses and junior doctors in initial image interpretation and another similar study included a training intervention; both utilised alternate free-response receiver operating characteristic curve (AFROC) methodology. Three of the observational studies investigated the ability of radiographers to provide definitive reports on a wide range of clinical examinations, including chest and MRI investigations, in a controlled environment. One large multi-centre observational study investigated the performance of radiographers, in clinical practice (A/E: skeletal examinations) during the implementation of a radiographic reporting service. The agreement between consultant radiologists' MRI reports of lumbar/thoracic spine, knee and IAM examinations was investigated in another observational study. The final study compared the reports of trained radiographers and consultant radiologists, with those of an index radiologist, when reporting on MRI examinations of the knee and lumbar spine, as part of a prospective pre-implementation agreement study. Results The first AFROC study demonstrated statistically significant improvements after training, for radiographers (A1=0.55 - 0.72) and nurses (A1=0.65 - 0.63), although the radiographers maintained a better overall performance post training (p=0.004) in providing an initial image interpretation of trauma radiographs of the appendicular skeleton. Radiographers also achieved statistically higher (p<0.01) AUC values (A1=0.75) than nurses (A1=0.58) and junior doctors (A1=0.54) in the second AFROC study. Three studies, which examined 11155 reports, were conducted under controlled conditions in an academic setting and provided evidence of radiographers’ high levels of accuracy in reporting of skeletal A/E (93.9%); skeletal non A/E (92.5%); chest (89.0%); MRI lumbar/thoracic spine (87.2%), knees (86.3%) and IAM (98.4%) examinations. In the multi-centre clinical study, the mean accuracy, sensitivity and specificity rates of the radiographers reports (n=7179) of plain examinations of the skeletal system in the trauma setting was found to be 99%, 98% and 99%, respectively. The considerable range of values for agreement, between consultant radiologists reports of MRI examinations of the thoracic/lumbar spine (k=0 – 0.8), knee (k=0.3 – 0.8) and IAM (k=1.0) was similar to other studies and resulted in a reasonable estimation of the performance, in the UK, of an average non specialist consultant radiologist in MRI reporting. In the final study, radiographers reported in clinical practice conditions, on a prospective random sample of knee and lumbar spine MRI examinations, to a level of agreement comparable with non-musculoskeletal consultant radiologists (Mean difference in observer agreement <1%, p=0.86). Less than 10% of observers' reports (radiographers and consultant radiologists) were found to be sufficiently discordant to be clinically important. Conclusion The outcomes of this research programme demonstrate that radiographers can provide initial interpretations of radiographic examinations of the appendicular skeleton, in the trauma setting, to a higher level of accuracy than A/E practitioners. The findings also provide evidence that selected radiographers with appropriate education and training can provide definitive reports on plain clinical examinations (A/E and non A/E referral sources) of the skeletal system and the chest; and MRI examinations of the knee, lumbar/thoracic spine and IAM to a level of performance comparable to the average non specialist consultant radiologist. Wider implementation of radiographer reporting is therefore indicated and future multi-centre research, including economic evaluations, to further inform practice at a national level, is recommended

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

Content of Presentation: Reporting by radiographers is now widely adopted into the service delivery of English NHS trusts. CT Head reporting courses have been running since the early 2000’s, and has been running at Canterbury Christ Church University since 2007. Relevance: To analyse the objective structured examination (OSE) results of the last four cohorts of radiographers (n=24) who successfully completed the postgraduate training. Outcomes: Using OSE scores of Agreement, Sensitivity and Specificity and using Kappa agreement of scores for comparison to 3 groups of consultant radiologists who produced the initial OSE reports. The cases contained a prevalence of 50% abnormal cases and 50% normal cases. Discussion: At the end of this study of training, radiographers appear to achieve high standards of CT head reporting. The findings for this study suggest that the agreement rates for appropriately educated and trained radiographers is likely to be similar to consultant radiologists, although further work is on-going to investigate this, and confirm the clinical application of these initial encouraging findings that support the radiographers contribution to this aspect of the reporting service

Nebraska Urban Indian Health Coalition Alcohol, Tobacco And Other Drugs Prevention Program (Atod-Year 4) Evaluation Report: Final Report

This final report documents the major findings of an evaluation of the Alcohol, Tobacco and Other Drug Prevention Program (ATOD-Year 4) conducted by the Consortium for Organizational Research and Evaluation (CORE) of the University of Nebraska at Omaha for the Nebraska Urban Indian Health Coalition (NUIHC). The purpose of the study is to provide an analysis of several key NUIHC substance-abuse prevention initiatives. The study consists of four parts: 1) an analysis and comparison of the results obtained from NUIHC’s administration of their risk/need and outreach/discussion form, 2) an update and analysis of the results obtained from a survey of community perceptions/needs at the Omaha Metro Powwow, 3) the results obtained from a pre- and post-test of participants in NUIHC’s Strengthening Families Program (SFP) program and 4) the results obtained from post-tests of participants in NUIHC’s Protecting You/Protecting Me (PY/PM) classes

An Attitude Survey of Residents of Omaha\u27s Neighborhood Housing Services Program Area

In the Omaha Neighborhood Housing Services (NHS) program, as in the planning and policy making stages of any revitalization project, a realistic and comprehensive understanding of the targeted area is an essential element and a logical starting point

A Grain Agriculture Fashioned in Nature’s Image: The Work of the Land Institute

Modern industrialized agriculture is based on monocultures of annual crops requiring massive levels of biocide, fertilizer, and fossil fuel inputs. This form of agriculture has led to soil erosion and chemical contamination of soil and ground water. The Land Institute is studying a new model for grain agriculture, based on the prairie ecosystem, involving diversified plantings of perennial seed crops. Species we have studied include eastern gamagrass, wildrye, Illinois bundle flower, wild senna, Maximilian sunflower, hybrid perennial sorghum, and hybrid perennial rye. The Land Institute s research program develops perennial polycultures based on basic questions concerning high seed yield, over yielding, nitrogen supply by a legume component, and biological management of weeds, insect pests, and plant diseases. Results to support the model are presented

Soaring Over Methamphetamine And Suicide (Soms) Program Evaluation (Year-6): Omaha, Nebraska With A Catalog Of Native-American Community Survey, Youth Risk/Need Assessment And Program Evaluation Instruments

This final report documents the major findings of the evaluation of the Methamphetamine and Suicide Prevention Initiative (MSPI Year-6), also referred to locally as the Soaring Over Methamphetamine and Suicide Program (SOMS), funded by the Indian Health Service (IHS), Division of Behavioral Health. The University of Nebraska at Omaha, Consortium for Organizational Research and Evaluation (CORE) contracted with the Nebraska Urban Indian Health Coalition (NUIHC) to provide technical assistance in completing this evaluation and the report. The evaluation study consists of information collected and analyzed from three sources: 1) a review and summary of program-implementation, process and outcome data that was collected and reported in semi-annual and annual grant reports to IHS, 2) in-person interviews with NUIHC administrators and staff to gather additional program-evaluation information and 3) an evaluation of the “Question, Persuade, Refer” (QPR) suicide-prevention training program undertaken by NUIHC to better understand and provide services for the client population

Native American Methamphetamine And Suicide Prevention Program Evaluation (Year-5): Omaha, Nebraska, Final Report

This final report documents the major findings of the evaluation of the Methamphetamine and Suicide Prevention Initiative (MSPI Year-6), also referred to locally as the Soaring Over Methamphetamine and Suicide Program (SOMS), funded by the Indian Health Service (IHS), Division of Behavioral Health. The University of Nebraska at Omaha, Consortium for Organizational Research and Evaluation (CORE) contracted with the Nebraska Urban Indian Health Coalition (NUIHC) to provide technical assistance in completing this evaluation and the report. The evaluation study consists of information collected and analyzed from three sources: 1) a review and summary of program-implementation, process and outcome data that was collected and reported in semi-annual and annual grant reports to IHS, 2) in-person interviews with NUIHC administrators and staff to gather additional program-evaluation information and 3) evaluations of program assessment initiatives undertaken by NUIHC to better understand and provide services for the client population. The study also includes recommendations to improve both NUIHC MSPI-program performance and evaluation efforts in future years

Native American Perceptions of Community and Social Problems Affecting Health and Well-being

In addition to significant unmet healthcare-coverage and services needs for Native Americans described in an earlier post,1 the 2010 UNO Consortium for Organizational Research and Evaluation (CORE) study results helped document widespread community and social problems facing low-income areas of Omaha and Lincoln

Re-Use of the Muse Theatre: A Study of Consumer Preferences

In February 1986, Park East, Inc., a nonprofit redevelopment agency, contracted with the Center for Applied Urban Research of the University of Nebraska at Omaha to conduct a marketing survey related to the redevelopment of the Muse Theater at 24th and Farnam Streets. Representatives of Park East, Inc., believe that two critical trends have converged to create an opportunity for redevelopment in this area--the ongoing and already successful redevelopment of downtown Omaha and adjacent areas and the recent increase in the population of young, well-educated, professionals living and working near downtown Omaha. Mutual of Omaha, the largest employer in Omaha, and the numerous medical complexes in the area (the University of Nebraska Medical Center, St. Joseph Hospital, Creighton University Hospital, Veterans\u27 Hospital, and Clarkson Hospital) employ many of these individuals

Kellom Heights Stage II: Trends and Conditions Impacting Commercial and Office Space Development

This report was prepared in response to a request for assistance from the Omaha Economic Development Corporation for the collection of information pertaining to the development of a neighborhood commercial and office center near 24th and Cuming Streets. The primary purpose of the report is to provide an accurate description of current conditions and significant trends in the immediate Kellom Heights area that would have an impact on the proposed development