Radiographer reporting

Radiographers worldwide are integral to the diagnostic pathway and are optimally placed to provide expert comment on radiographs. By nature, the radiographer is the first health care professional to view each diagnostic image, which has been acquired by a focus on the patient. Radiographers are in a unique position to communicate their professional observations directly with the treating clinician in a timely manner and thereby have a significant influence on patient care. Currently, advanced practitioner roles, which incorporate radiographer reporting, are limited to the United Kingdom (UK). The changing nature of health care worldwide has seen several countries including Canada, Australia, Norway and Denmark develop models of advanced radiographer practice which includes definitive clinical reporting. Swinburne first raised the possibility of trained radiographers expanding their role to incorporate preliminary image interpretation, although the pioneering work of Berman et al. is seen as the origin of radiographer preliminary image interpretation. The proposed system of work required radiographers to highlight abnormal trauma skeletal radiographs by placing a ‘red dot’ on the image, which indicated to the casualty officer the possible presence of significant pathology. This method has been shown to reduce diagnostic errors in the Emergency Department. In 2006, the Society and College of Radiographers, while recognising the benefits of the ‘red dot’ system of preliminary radiograph interpretation, also identified several weaknesses, which includes the ambiguity of an absence of a ‘red dot’. Preliminary clinical evaluation (PCE) builds on abnormality detection by radiographers, as PCE requires a concise written statement which localises and describes the pertinent findings. The provision of a written interpretation directs the treating clinician to the area(s) of concern and removes many of the ambiguity of the ‘red dot’ system, such as cases with multiple abnormalities, incorrect interpretation of abnormalities on an abnormal image and communication of uncertainty in the radiographer decision. A survey undertaken of UK radiology departments in 2008 found a significant majority provide a system of radiographer abnormality detection for skeletal trauma imaging; most still use the ‘red dot’, while some provide a PCE or a hybrid system. In parallel to this expansion of radiographer practice, the role of the advanced practitioner has been developed in the United Kingdom which incorporates the provision of definitive clinical reports by appropriately trained radiographers. The performance of radiographers in interpreting skeletal radiographs at the end of an accredited postgraduate training program was promising with high levels of sensitivity (91.6–96.7%) and specificity (92.1–94.0%) reported. A large multi-centre clinical evaluation, consisting of 7179 cases conducted across four sites in the United Kingdom, demonstrated very high levels of accuracy, sensitivity and specificity, 99.1%, 97.6% and 99.3%, respectively, for skeletal trauma reports produced by trained reporting radiographers. A subsequent meta-analysis conducted by Brealey et al. examined the performance of radiographer reporting for 28,900 plain imaging examinations and provided the definitive evidence that trained reporting radiographers can provide clinical reports on skeletal radiographs at a level comparable to consultant radiologists. Trained radiographers now provide definitive clinical reports on skeletal radiographs throughout the U.K., with 59 (41%) of 143 departments providing this service in 2012. In response to evolving service needs, radiographer reporting has expanded in scope beyond skeletal trauma. There is a growing body of evidence that supports trained radiographers who can provide definitive clinical reports for chest radiographs, magnetic resonance imaging (MRI) lumbar spine and knee examinations, and mammograms. Multidisciplinary team working, which incorporates radiographer reporting, has been highlighted in recent a