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

Superior shoulder suspensory complex fracture dislocation case report

Background: Acromioclavicular joint dislocation can be more complex than it first appears. The presented case had an unusual combination of injuries to the superior shoulder suspensory complex, which yielded some interesting learning points. Case summary: The injuries were sustained after a fall from a push bike and included acromioclavicular dislocation with coracoid process, clavicle and acromion process fractures. These were identified on the initial X-ray examination, which was followed by computed tomography for surgical planning. The injuries were successfully treated by internal fixation. Conclusion: The unexpected complexity of the injuries could have led to subtle but important findings being overlooked. This case highlights the importance of a thorough search strategy, consideration of injury biomechanics and knowledge of associated injuries

Diagnostic radiographer advanced clinical practice in the United Kingdom – A national cross-sectional survey

Objectives: To survey the diagnostic radiography workforce in the United Kingdom (UK) at an organisational level to ascertain the scope of advanced practice and compliance with Health Education England standards for multiprofessional advanced clinical practice (ACP). Methods: 174 diagnostic imaging departments were invited to participate in a cross-sectional electronic survey focused upon advanced level practice and their educational and accreditation expectations (October–December 2019). Breast imaging, computed tomography, fluoroscopy, interventional radiology, lithotripsy, magnetic resonance imaging and projectional radiography were included. Results: A total of 97 responses were received, of which 79 were eligible for inclusion (45%). Respondents reported advanced-level practice roles across all imaging modalities, which included clinical reporting, procedural-based and combined roles. Radiograph and mammogram reporting were most prevalent (95 and 67% of Trusts), with fluoroscopy the most frequent procedure-only role (25%). Only 39% of trusts required adherence to the four pillars of ACP within job descriptions, and only 12% requiring a full Masters qualification. Conclusions: Diagnostic radiographer reporting and procedure-based roles in the NHS are varied and widespread. However, inconsistencies in fulfilment against the expected standards for advanced practice exist. Realignment of advanced-level roles to delineate enhanced and advanced clinical practice may ensure consistency between roles and professions. A requirement for accreditation as an advanced (clinical) practitioner with adherence to advanced practice requirements could therefore provide value to accreditation for both individual practitioners and Trusts. Advances in knowledge: Within the UK, diagnostic radiographer roles previously self-identified as advanced-level practice may be termed enhanced practice when not adhering to expected ACP standards

Intraorbital foreign body detection and localisation by radiographers: a preliminary JAFROC observer performance study

Introduction - The purpose of this study was to run a preliminary investigation to establish if a short course of learning would increase radiographers’ performance in intraorbital foreign body (IOFB) detection and localisation on pre-magnetic resonance imaging (MRI) orbital computed radiographs (CR). Method - A multi-reader multi-case (MRMC) human observer study was performed. Fifteen radiographers from 5 hospitals participated. Each radiographer reviewed a pre- and post-training image bank and was instructed to identify the presence or absence of IOFBs, indicating the lesion location on each case whilst scoring the detection using a confidence index on a 5-point scale, for 30 orbital radiographs. The results were analysed using a Jackknife free-response receiver operating characteristic (JAFROC2 equal weighted) methodology. Results -The performance of the radiographers demonstrated a statistically significant difference after a short period of training in the detection of IOFBs on orbital radiographs (F (1,14)= 12.99, df = 14.0, p = 0.0029). The JAFROC2 analysis averaged figure of merit (FOM) for the radiographers was 0.818 (95% CI 0.769, 0.867) pre-training and 0.920 (95% CI 0.891, 0.950) post-training. Conclusion - These results suggest that with a short programme of learning in image interpretation for IOFBs in orbital radiographs, radiographers should be able to achieve a high level of accuracy in the identification and localisation of IOFBs prior to MRI examination

Diagnostic radiographer advanced clinical practice in the United Kingdom - A national cross-sectional survey

YesTo survey the diagnostic radiography workforce in the United Kingdom (UK) at an organisational level to ascertain the scope of advanced practice and compliance with Health Education England standards for multiprofessional advanced clinical practice (ACP). 174 diagnostic imaging departments were invited to participate in a cross-sectional electronic survey focused upon advanced level practice and their educational and accreditation expectations (October-December 2019). Breast imaging, computed tomography, fluoroscopy, interventional radiology, lithotripsy, magnetic resonance imaging and projectional radiography were included. A total of 97 responses were received, of which 79 were eligible for inclusion (45%). Respondents reported advanced-level practice roles across all imaging modalities, which included clinical reporting, procedural-based and combined roles. Radiograph and mammogram reporting were most prevalent (95 and 67% of Trusts), with fluoroscopy the most frequent procedure-only role (25%). Only 39% of trusts required adherence to the four pillars of ACP within job descriptions, and only 12% requiring a full Masters qualification. Diagnostic radiographer reporting and procedure-based roles in the NHS are varied and widespread. However, inconsistencies in fulfilment against the expected standards for advanced practice exist. Realignment of advanced-level roles to delineate enhanced and advanced clinical practice may ensure consistency between roles and professions. A requirement for accreditation as an advanced (clinical) practitioner with adherence to advanced practice requirements could therefore provide value to accreditation for both individual practitioners and Trusts. Within the UK, diagnostic radiographer roles previously self-identified as advanced-level practice may be termed enhanced practice when not adhering to expected ACP standards

Concordance between a neuroradiologist, a consultant radiologist and trained reporting radiographers interpreting MRI head examinations: An empirical study

Introduction: This study assessed agreement between MRI reporting radiographers and a consultant radiologist compared with an index neuroradiologist when reporting MRI head (brain/internal auditory meati [IAMs]) examinations. The effect on patient management of any discordant reports was also examined. Methods: Two trained MRI reporting radiographers (RRs), a consultant radiologist (CR) and an index neuroradiologist (INR) reported on a random sample of 210 MRI examinations. The radiographers reported during clinical practice and the radiologists in clinical practice conditions. Two independent consultant physicians (neuro-rehabilitation and neuropsychiatry) compared these reports with the index neuroradiologist report for agreement and the clinical importance of discrepant reports. Results: Overall observer agreement between the RRs and CR was comparable in relation to agreement with the INR: RR; 93/210 (44.3%); and the CR; 83/210 (39.4%) for all head MRI examinations (p = 0.32). For brain examinations the difference was similar: RR; 64/180 (35.6%); and CR; 54/190 (30.0%), p = 0.26. Agreement rates for the IAMs examinations were identical, 29/30 (97.7%). For all head MRI examinations (n = 210) there was a very small observed difference of <0.5% in mean agreement between the reporting radiographers and the consultant radiologist (p = 0.92) for examinations where a major disagreement would have been likely to have led to a change in patient management. Conclusion: MRI reporting radiographers reported during clinical practice on MRI head examinations to a level of agreement comparable with a consultant radiologist. Implications for practice: This is an area in which radiographers could provide additional reporting roles to the reporting service to increase capacity. Wider potential benefits include cost-effectiveness and role development/retention of radiographers

Observations of sea level, wind and atmospheric pressure at Newport, Oregon, 1967-1980

Coastal sea level, atmospheric pressure and wind speed and direction are measured routinely at Newport, Oregon. The tide gage is situated just inside Yaquina Bay and has been operating continuously since February 1967. Atmospheric pressure is measured at the Oregon State University Marine Science Center, very near the tide gage; pressure has been recorded since November 1970. The anemometer, in operation on the south jetty since March 1969, has good exposure in all directions except perhaps northeast and southeast, Each variable is digitized at hourly intervals. The wind data are used to calculate wind stress, and sea level and atmospheric pressure are combined to yield adjusted sea level. The hourly data of all five variables are filtered numerically to provide low-passed data and very-low-frequency data, which suppress fluctuations shorter than 46 hours and 51 days, respectively. For each variable, the data are summarized in tables of monthly and annual means, tables of annual standard deviations, and time series plots of the hourly data and each form of the filtered data. In addition, the wind data are displayed in the form of progressive vector diagrams, scatter diagrams of the vector components, and time series of cumulative Ekman transport