Breaking the mould – how  radiographer reporting is better for the patient.

nigel-thomas

Professor Nigel Thomas from the University of Salford explains why allowing a radiographer to report X-rays  is not threat to the radiology profession.

 

 

 

I’ll nail my colours to the mast straight away, and state that I have been an active proponent of radiographer role extension in general, and radiographer reporting in particular, for over 20 years.

I first became involved in mid 1995 when the University of Salford (then University College Salford) asked for help in setting up a formal plain film reporting course for radiographers. The context for this was the unresolved tension between the large numbers of unreported films in most X-ray Departments and the realisation that radiographers as a group of professionals were often working below their full potential – a real untapped resource within our own departments. Becoming involved in the process seemed to me to be a very obvious thing to do, and I have never had any regrets about doing so. I don’t believe that I have contributed to the demise of my profession, and I certainly don’t feel like a “turkey voting for Christmas”.

Over the years since then, radiographers have increased the breadth of their involvement in reporting (to currently include some types of MR scanning and CT, as well as gastro-intestinal contrast studies amongst other things), as well as developing a career structure which encompasses working at Advanced Practitioner and Consultant Radiographer levels (the latter being a particular success in the world of breast imaging, where consultant radiographers can follow an entire patient journey by being able to perform and report mammograms, perform and report breast ultrasound and perform guided biopsies, as well as having counselling skills).

It was clear from the beginning that there would be opposition to the idea of radiographer reporting, both from the radiology establishment, and, to a much lesser extent, from within the radiography profession itself. In order to ensure that the process of creating reporting radiographers was as good as it could be, certain quality measures were put into place. No radiographer can report in the UK without a recognised qualification (at PgC or Pgd level) gained from a higher education institution. In the context of the workplace, reporting is done within an agreed scheme of work (signed off by the employing Trust Board), and regular audit is undertaken.

In 2017 between 15 and 20% of all plain film examinations in the UK are reported by radiographers, and there are now over 50 people in consultant radiographer grades around the country. Reporting radiographers have been “part of the furniture” in X-ray departments for over 20 years, and generations of junior doctors, nurses and physiotherapists have been familiar with using them as a port of call for advice on the interpretation of images.

And yet, despite all of the above, resistance to radiographer reporting persists. I find this particularly perplexing for several reasons:

  1. The reporting shortfall still persists, and patients are being put at risk by our failure to report their examinations in a timely and accurate way – would we rather leave them unreported?
  2. Radiologists have more than enough to do – there are too few of us, and our time is used to apply our unique skill set to report labour intensive complex examinations, undertake time-consuming interventional procedures, and provide a commitment to the support of MDTs.
  3. There is a substantial body of sound scientific evidence (published in the major UK peer-reviewed radiological journals) that radiographer reporting works, is safe, and is of a comparable standard to that provided by medical staff in many areas.
  4. Radiologists have been involved in this process from day 1 – advising on course content, giving lectures, acting as examiners and external examiners, and, most importantly, acting as mentors to radiographers in training at their places of work.

The final irony for me, as we progress into the 21st century is that, despite all the above, it is clear that some of my colleagues are much keener to gain help from computers than humans. Don’t get me wrong, I’m sure that Computer Aided Design (CAD) and Artificial Intelligence (AI)  will have a huge role to play in the routine provision of a radiology service in the near future, but reporting radiographers can help patients here and now.

References

Berman L, de Lacey G, Twomey E, Twomey B, Welch, T and Eban, R. ‘Reducing errors in the accident department: a simple method using radiographers’, British Medical Journal 1985; 290: 421-2

Loughran,C.F., Reporting of fracture radiographs by radiographers: the impact of a training programme. British Journal of Radiology, 67(802), 945 –950, 1994

Judith Kelly, Peter Hogg, Suzanne Henwood. The role of a consultant breast radiographer: A description and a reflection. Radiography, Volume 14, Supplement 1, e2-e10, 2008.

Brealey, S., Hewitt, C., Scally, A., Hahn, S., Godfrey, C., and Thomas, N.B. Bivariate meta-analysis of sensitivity and specificity of radiographers’ plain radiograph reporting in clinical practice. British Journal of Radiology, 82, (979), 600-604, 2009.

Piper, K., Buscall, K., Thomas, N.B., MRI reporting by radiographers: Findings of an accredited postgraduate programme. Radiography, Volume 16, Issue 2, 136-142, May 2010

  1. Piper, S. Cox, A. Paterson, A. Thomas, N.B. Thomas, N. Jeyagopal, N. Woznitza. Chest reporting by radiographers: Findings of an accredited postgraduate programme, Radiography, Volume 20, Issue 2, 94-99, February 2014
  1. Snaith, M. Hardy, E.F. Lewis Radiographer reporting in the UK: A longitudinal analysis

Radiography, Volume 21, Issue 2, 119-123, 2015

About Nigel Thomas

Born and raised in Cornwall, I qualified from St Bartholomew’s Hospital in London in 1981 having gained an intercalated B.Sc in Biochemistry in 1978.

My radiology training was undertaken on the North Western Training Scheme (based in Manchester), and I was appointed as Consultant Radiologist to North Manchester General Hospital in 1989.In 2005 I moved to a Consultant post at Trafford General Hospital and retired as a full-time NHS Consultant Radiologist in 2015.

I currently work as an independent Consultant Radiologist and, amongst other roles, am a mentor to Reporting Radiographers at two large Foundation Trusts in the Manchester conurbation.

I first became involved in the process of radiographer role development at the University of Salford in 1995, and was appointed as an Honorary Professor there in 2000. I have over 40 publications in scientific journals, and am a co-author of a standard textbook of Obstetric and Gynaecological Ultrasound scanning.

 

Image: Courtesy of Nottingham University Hospitals

 

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