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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Skill mix in radiology: a personal tale

Chris Loughran BIR blogWhen Dr Chris Loughran published research into the benefits of trained radiographers reporting trauma radiology he was accused of committing professional suicide. But he was on a mission to spread the word.

 

 

Years ago I was appointed as Clinical Director of Radiology. I knew nothing about management and thought I had better go and learn something. I enrolled at Keele University for a diploma course in Management in Radiology. In the second year I had to write a dissertation. Scratching around for something I was inspired by Prof. Roger Dyson to consider what he termed “Clinical Radiography”, a concept that encouraged radiographers to move from the production of diagnostic images only to one where they also interpreted them.

Some research was essential and I was able to cajole three radiographers into contributing to the research effort. The aim was to determine if the diagnostic performance of the radiographers in trauma radiology could be enhanced with training, to such an extent that they could report such radiographs to a high standard. We showed that they could and the research findings were subsequently published in the BJR.1 We took the plunge even before the paper was published and with the backing of the East Cheshire NHS Trust those radiographers started to report directly to the accident department. I believe we were the first in the country to do this. The backing of the Trust Board was sought, and was essential, to ensure that in the event of error we were covered. It fulfilled my belief that radiographers could employ their talents to a greater extent—for the benefit of the department, the hospital in general and, of course, the patients.

I felt as though I was now on a mission—time to spread the word and encourage other departments to work in a similar fashion. To this end I decided to seek out further interest at a local regional radiologists meeting. Naively, I thought my proposals to expand our local in house training programme to a more established and regional exercise would be welcomed. Less time spent by radiologists on an element of the work that many were reluctant to undertake combined with better service delivery to patients seemed like an unbeatable combination. I should have known better! I had never been shouted down previously (nor since) but was that afternoon. “You’re committing professional suicide !” one colleague ferociously remarked, he’s probably forgotten, I never have. The idea clearly touched many raw nerves. So I slunk away, cowed, feeling battered and rejected. What I couldn’t really get my head round was the absolute rejection of the idea when I knew so many departments were struggling with their workloads and so many radiologists complained about it.

Despite this rejection the radiographers themselves picked up on the idea and I was asked by many organisations to speak about the research and the concept in general. I particularly remember one meeting in Nottingham where I spoke to a crowded lecture theatre. I was introduced by a radiologist, the talk went well and he very kindly remarked afterwards that I was so convincing he would buy a second hand car from me!

Later I was invited to help establish a course in radiographer reporting at Canterbury, Christ Church College. We agreed a schedule for the course and associated examination. I was privileged to be an external examiner and was mightily impressed by the very high standard that many candidates attained. Radiologists had (until then) never been examined in trauma plain film radiology to the extent these candidates were.

Of course, similar training soon followed elsewhere and it now is established practice in many departments. Indeed it has gone further with radiographers reporting other examinations including CT head scans, for example. Moreover, many adverts for radiologist positions now highlight this practice as an inducement for candidates to apply for their posts. Its moved a long way since that regional radiology meeting all those afternoons ago.

Its taught me that its not only the truth that matters but also the diligence with which it is pursued. If you believe in something keep going! As Edward Bulwer-Lytton put it, “Enthusiasm is the genius of sincerity and truth accomplishes no victories without it”.

  1. Loughran CF. Reporting of fracture radiographs by radiographers: the impact of a training programme. Br J Radiol 1994; 67: 945–50. doi: 1259/0007-1285-67-802-945

About Dr Chris Loughran

I qualified in Liverpool in 1976 and have been pursuing radiology since 1978. I trained in radiology in Liverpool. After a 2-year stint as Consultant at Broadgreen Hospital I went to the USA for a year where I was Assistant Professor in The Medical University of South Carolina, Charleston, USA. Returning to England I took up post in Macclesfield where I have been since 1986.

In my time I have been Clinical Director, Postgraduate Tutor, Associate Medical Director and Chairman of the Medical Staff Committee. I was Chairman of the Northern Branch of the BIR and BIR council member some years ago. Now I work as a clinical radiologist and am so lucky that I still enjoy the speciality as much as I did all those years ago.