Longitudinal changes in extended roles in radiography: A new perspective

PurposeThe purpose of this research was to update data on the scope of changes to radiographic practice since the principal author's last survey in 2000. The study also sought to identify any regional patterns in the adoption and diffusion of extended roles and to map the implementation of the 4-tier structure.MethodStructured questionnaires were sent to radiology managers at acute National Health Service (NHS) trusts across the United Kingdom. Information sought included region, teaching/non-teaching status, the nature of extended role tasks undertaken and the year in which these tasks were adopted, numbers of radiographers and radiologists in post. Information was also sought on the implementation of the ‘4-tier structure’.ResultsSome 177 questionnaires were returned from a total of 258 dispatched giving a 68.6% response rate. In 166 trusts, radiographers administered intravenous injections; they performed barium enemas in 147 trusts and barium meals in 19 trusts, while a red dot system was in operation in 143 trusts. Each category showed an increase from that reported in 2000. Likewise reporting by radiographers had increased since 2000. Responses indicated that at 146 trusts, radiographers were reporting in ultrasound; reporting of the appendicular skeleton was undertaken at 81 trusts and axial skeletal reporting at 70 trusts. Barium enemas were reported by radiographers in 78 trusts. Reporting was also undertaken by radiographers on barium meals, mammography, nuclear medicine, paediatric and chest radiography; and all showed an increase in frequency since 2000. Regional differences were again apparent in reporting, with a greater prevalence in the English regions, with the exception of London.In respect of the 4-tier structure, 59% of the sample employed assistant practitioners, 47% advanced practitioners and 3% employed consultants. The numbers reported in each category (excluding practitioners) were 158 assistants, 623 advanced practitioners and six consultants. There were a number of trusts that had plans to introduce assistants, advanced practitioners and/or consultants over the following two-year period.ConclusionThe study provided data that illustrated the extent to which NHS acute trusts are utilising the skills of radiographers and recognizing the extended scope of radiographic practice. Implementation of the 4-tier structure is underway with the greatest number of staff (excluding practitioners) categorized as advanced practitioners. This does provide some evidence of trusts responding to the 2000 NHS Plan in introducing new ways of working. The number of consultants, as could be expected at the time of the survey was low.     

An assessment of different healthcare professionals’ attitudes towards radiographers’ reporting A&E films

Purpose: To assess whether different professionals in a district hospital found acceptable the reporting of accident and emergency (A&E) plain films for selected body areas by two specifically trained radiographers.Methods: A self-answer questionnaire using the Likert scale was used to measure the attitude of different professionals at the hospital towards the introduction of radiographers reporting. An open-ended section investigated how this may have freed time for radiologists to perform other tasks, the effect on the radiographers’ workload and the possibility of extending their reporting role.Results: With the exception of one radiologist, who was uncertain, the different professionals agreed that radiographers reporting A&E films for selected body areas was acceptable and a success. However, reporting has reduced these radiographers’ involvement in conventional radiography and speciality areas like angiography or computed tomography. The consensus between radiologists was that it has done little to alleviate their reporting workload. Furthermore, in contrast with the two radiographers who agreed that their reporting role should be extended to include all A&E examinations, other professionals disagreed or were uncertain. It was also suggested that not reporting any A&E films could de-skill radiologists.Conclusions: The reporting of A&E films for selected body areas by specifically trained radiographers was found to be acceptable by all professional groups. However, extending the radiographers reporting role was considered more contentious as it could be at the expense of other skills. The radiologists reporting skills could also be diminished with little benefit to other areas of their work.     

Radiographers’ perception on task shifting to nurses and assistant nurses within the radiography profession

IntroductionThe radiography profession is challenged by greater responsibilities and shortage of educated radiographers. Implementation of task shifting is one strategy to deal with the current situation in health care. The aim of this studiy was to evaluate radiographers’ perception of assistant nurses and nurses carrying out tasks that traditionally were undertaken within the radiography profession in a Swedish context.MethodsAn electronic questionnaire was distributed to radiographers at eleven hospitals in Sweden. The questionnaire included background questions and questions about radiographers’ perception about task shifting to nurses and assistant nurses. The respondents rated their agreement level regarding task shifting on a five-point Likert scale. Data was statistically evaluated in SPSS using Mann Whitney U test.ResultsSixty-five radiographers participated in the study. Most radiographers responded negatively to task shifting to nurses (72%) or assistant nurses (65%). Most radiographers disagree that nurses should perform mammography screening or work within interventional radiography, while the attitude towards nurses calculating glomerular filtration rate was more positive. A majority disagree regarding assistant nurses performing conventional radiographs, informing the patient about contrast media administration or inserting peripheral intravenous catheters, while there was a positive attitude towards assistant nurses preparing patients for examinations. The attitude towards task shifting was not influenced by age, however radiographers with less working experience were more positive to task shifting in general.ConclusionA majority of the radiographers had a negative attitude towards task shifting to nurses and assistant nurses. The radiographers were more positive to hand over tasks related to patient care and administrative tasks than technical related tasks within the profession.Implications for practiceKnowledge about radiographers’ perception on task shifting within the profession is essential when planning and implementing strategies for task shifting in the clinical settings.     

Reporting radiographers in Norway – A qualitative interview study

IntroductionA number of Norwegian radiographers have attended an advanced programme of education and training in musculoskeletal reporting, some in the UK and some in Norway. The aim of this study was to examine how reporting radiographers, radiologists and managers experienced the education, competence, and role of reporting radiographers in Norway. To our knowledge, the role and function of reporting radiographers in Norway has not yet been explored.MethodsThe study had a qualitative design and was based on eleven individual interviews of reporting radiographers, radiologists, and managers. The participants represented five different imaging departments from four hospital trusts in Norway. The interviews were analyzed using inductive content analysis.ResultsThe analysis identified two main categories: “Education and training”, and “The reporting radiographer”. The subcategories were: “Education”, “Training”, “Competence”, and “The new role”.The study found the program to be demanding, challenging, and time-consuming. However, the reporting radiographers described it as motivating because they gained new competence. The competence of reporting radiographers was regarded as adequate. The participants found that reporting radiographers had a unique competence in both image acquisition and reporting, and they were described as a missing link between radiographers and radiologists.ConclusionReporting radiographers are experienced as an asset for the department. Reporting radiographers not only contribute to musculoskeletal imaging reports but are also important for collaboration, training, and professional development in imaging, and in collaborating with orthopedics. This was seen to increase the quality of musculoskeletal imaging.Implications for practiceReporting radiographers are a valuable resource in image departments, especially in smaller hospitals where the shortage of radiologists is noticeable.     

A comparison of radiographer and radiologist reports on radiographer conducted barium enemas

Purpose: To compare radiographer and radiologist reports on radiographer conducted barium enemas. Method: Two specially trained, experienced radiographers performed barium enemas and prepared provisional reports without consulting radiologists. Later, formal radiologist reports were issued. The reports of each were compared and correlated with clinical findings derived from case note review.Results:Seven hundred and eighty eight patients had barium enemas. Males numbered 295 (37.5%) and females 493 (62.5%). Patients ages ranged from 17 to 95 years (mean 62). The radiologist reported 244 as normal, 432 as diverticular change, 70 with polyps (31 of which had co-existent diverticular disease), 31 with carcinomas and 12 with colitis (three of which had co-existent diverticular disease). Taking the radiologist reports as gold-standard radiographer reports were concordant in 753 (95.5%). There were 35 (4.5%) discordant radiographer reports of these 19 were false–positive diagnoses of polyps and six false positive diagnoses of diverticular change. There were seven false–negative diagnoses of polyps (only one of these was found to have a polyp at follow-up endoscopy). There was one false–negative diagnosis of colitis and two false–negative reports of diverticular change. On follow up there were no false negative diagnoses of carcinoma by either radiographer or radiologist. There was one concordant false–positive diagnosis of carcinoma. Conclusion:Radiographers with specialized training can report barium enemas to a high standard.     

Guidelines and legal requirements which inform role expansion in radiography

Purpose: Role expansion in radiography is linked to ethico-legal responsibilities and accountability. This paper clarifies the legal requirements, outlines professional guidelines, and suggests that role developments require new rules and standards.Methods: A thorough review of the literature was used to collect information on role expansion and related topics, such as Continuous Professional Development (CPD) and skills mix. Emphasis was placed on case law and professional guidelines.Results: Radiographers who develop their roles must continue to provide a high quality service and demonstrate high level competencies, skills and knowledge. When deciding who should provide the service, the ultimate decision should be based on client benefit. Radiographers who expand their role will be gauged against specialists in that field, e.g. medical professionals, so radiographers must be confident in their own abilities and competent to perform such tasks. If a radiographer claims to be a specialist, the standard of care is that of the reasonable specialist and not that of the general radiographer. In legal terms, a patient is entitled to a greater standard of care from a specialist than from an ordinary practitioner and radiographers must meet that standard.Conclusions: Role expansion in radiography has associated legal responsibilities and radiographers are accountable for acts or omissions arising out of practice. Guidelines should be established which ensure that radiographers have skills and knowledge on a par with specialists in their area of practice so as to maintain the maximum benefit to the client.     

Occupational stress amongst radiographers: does working in private or public practice make a difference?

Purpose: Nothing is known about the effects of stress amongst radiographers in different clinical settings (hospital and private). We aimed to evaluate the magnitude and impact of this problem.Methods: We conducted a cross-sectional study of public hospital and private radiography departments/practices. A sample of 70 radiographers from hospitals and 75 from private radiography establishments in Sydney, Australia, were asked to complete a self-report questionnaire. Levels of stress, stressors, physical symptoms of stress, and blood pressure were all measured in health care workers with stress-related illness, and details of general socio-demography were collected.Results: The response rate was 71% (n=145). The age range of respondents was (20–66 years) with a mean age of 31, SD=9.68. There was no evidence of gender bias (54% female). Private practice radiographers were almost four times more likely to miss work due to a stress-related illness then those working in a public practice (OR=3.75, 95% CI: 1.51–9.20). Moreover, radiographers in private practice were three times more likely to drink alcohol as a way of relieving stress compared to radiographers in public practice (OR=3.09, 95% CI: 1.46–6.53).Conclusion: Occupational stress is a common occurrence amongst all radiographers. There are no differences in the levels of stress between private and public practices, but there is a difference in the type of stressor(s) in the two clinical settings.     

Radiographer role extension in Oman – Current practice and future opportunities

IntroductionRadiographers in Oman are believed to be engaged with varying levels of role extension however the nature and extent of this currently unknown. The aim of this study was to investigate role extension for radiographers in Oman, and to evaluate radiographers and the radiologists’ opinions and attitudes toward role extension.MethodsA cross sectional study of radiographers and radiologists at 13 major hospitals in Oman was used. A total of 189 radiographers and 77 radiologists were invited to complete a questionnaire seeking information on current and possible future role extension activities.ResultsThe overall response rate was 80.4% for radiographers and 63.6% for radiologists. Approximately half (53.3%) of the radiographer respondents reported they carry out examinations traditionally performed by radiologists (i.e. role extension); this was primarily in gastrointestinal and barium enema studies. Fewer (21%) reported being involved in image interpretation, most commonly in accident and emergency examinations. Forty percent of radiographers reported involvement in intravenous injections, most commonly for CT and intravenous urography procedures. Both radiographers and radiologists supported the involvement of radiographers in a range of examination types however responses vary within and between hospitals.ConclusionThis study concluded that radiography role extension activities are widely implemented at hospitals in Oman and that radiographers have sufficient skills and education for participating in these activities.Implications for practiceThe involvement of radiographers in role extension activities is believed to be cost and time effective, improve teamwork and has potential for significant service delivery benefits.     

Cost-effectiveness of barium enemas performed by radiographers

AIM: To assess the cost-effectiveness of barium enemas performed by radiographers compared to those performed by consultant radiologists. METHOD: Prospective study of 200 barium enemas carried out by a senior radiographer and a consultant radiologist. The sample was a consecutive sample of adult out-patients over a 3-month period, with no exclusion. The length of time of the enema and the numbers and grades of staff involved in the procedure were recorded. This was translated into staffing costs using the appropriate pay scales. RESULTS: The barium enemas performed by the superintendent radiographer were more cost-effective than those performed by the consultant radiologist (pound 1406 for 100 radiographer-performed barium enemas compared to pound 1787 for 100 carried out by the consultant radiologist). CONCLUSION: In terms of staffing costs, radiographers performing barium enemas not only liberates radiologist time, it is also a cost-effective method of providing an out-patient barium enema service.     

A retrospective 5-year study on the accuracy of the barium enema examination performed by radiographers

Barium enema examinations have been undertaken by radiographers at the Frenchay Hospital for more than 10 years. We have performed a retrospective study to assess the accuracy of this radiographer service by reviewing those patients who have been examined by both Barium enema and colonoscopy/flexible sigmoidoscopy to determine agreement, and reasons for disagreement. This paper does not attempt to compare the two techniques. In the 5 years between 1992 and 1996, 595 patients had both barium enema and colonoscopy or flexible sigmoidoscopy. In 488 (82%) of these patients the barium enema examination was performed by a radiographer. Comparisons with endoscopy indicate that 96% of polyps >1 cm, and 97% of carcinomas were detected radiologically. We conclude that radiographer performed barium enemas with double reporting produces a very high standard of examination with detection rates for significant lesions comparable with published data.     

How is the reporting radiographer role portrayed in published studies? A scoping review

ObjectivesRadiographers have been undertaking reporting tasks since the 1980's with a wealth of evidence published to support this practice. Radiographers have since developed skills in reporting all body systems, from all referral sources across a range of modalities. Radiographer reporting is now considered established and demand for radiographers in this role is rising to meet service demand. Reporting radiographers work as part of multi-professional image reporting teams, it is unclear how the radiographer role is perceived as part of this model. The aim was to review peer-reviewed literature to evaluate how the role of the reporting radiographer is portrayed and how the relationship between the two imaging professions has developed.Key findingsLanguage used to discuss the role of the reporting radiographer has changed over time. There is progress demonstrated from the practice of radiographer reporting being considered contentious or opposed to accepted and established. Recent publications focus on the importance utilising the skills of all multi-disciplinary team members in workforce structure. This features prominently when discussing future workforce design, such as with the Cancer workforce strategy and the development of the national standards for musculoskeletal reporting.ConclusionPublished literature has highlighted a move towards acceptance of the reporting radiographer role. Multi-disciplinary team working, utilising the skills of all imaging team members, is essential to the success and sustainability of the imaging workforce moving forwards.Implications for practiceReporting by radiographers is established and will be prominent in the reporting workforce as part of long-term workforce planning, considering skills mix to form effective and sustainable multidisciplinary reporting teams.     

Can skeletal image reporting be taught online: Perspectives of experienced reporting radiographers?

BackgroundImage interpretation relies upon expert clinical skill and comprehensive knowledge and understanding of the theories and concepts that underpin clinical practices. Traditionally, radiographer reporting education has been delivered using a blend of classroom based learning combined with workplace clinical practice. The direct and indirect costs of staff development and maintenance of the service has seen the incorporation of e-learning into courses in other health professions. Yet, despite its proven success, in the UK radiography has been resistant to progression into e-learning for reporting. This study aims to explore the perceptions of reporting radiographers to interactive online delivery of skeletal image reporting education.MethodInvitations to participate in the study were sent to 80 radiology departments in the UK. Reporting radiographers were asked to complete an online questionnaire to detail their reporting education experiences and to consider whether online delivery was a viable option.ResultsA total of 86 radiographers participated in the study. They could see potential benefits of online delivery but agreed it would only be suitable for delivery of theoretical subjects, and that development of practical/clinical skills required interaction with experts in the field to enhance learning.ConclusionImage reporting education is not suitable for entirely online delivery, and a blended learning solution, where online classroom based learning is combined with work based learning is more appropriate as it allows for interaction with experts in the field of reporting to facilitate the development of reporting skills enhance the overall learning experience.     

Undergraduate research: theory or practice?

Purpose: The purpose of this study was to determine what the research needs of the radiography profession are and to discover how radiography education centres are equipping graduates to meet those needs.Methods: A comprehensive literature search provided information for a self-response postal questionnaire, which was distributed to all 25 radiography education centres in the United Kingdom. A response rate of 68% was obtained.Results: All radiography education centres taught a variety of research methods at undergraduate level. All but three of the centres taught their students how to use a computer statistical package, with the amount of statistical analysis the student could perform varying between centres. The degree to which the students shared the course with other disciplines varied across the education centres, although the delivery was often multi-professional.Primary research was undertaken by students at all the education centres since it was seen to encourage clinical staff to evaluate their own practice, encouraging an evidence-based approach. It was acknowledged that not all radiographers would perform research once they had graduated, but if the skills were acquired at undergraduate level, then radiographers would be more confident in their ability to undertake research and more likely to be seen as credible research colleagues by other practitioners.Conclusions: Research skills were thought to be necessary for reflection and Continuing Professional Development (CPD) activity and vital to the future of the profession. Primary research needs to be encouraged at undergraduate level, but because of the political and ethical sensitivity surrounding it, it may not be appropriate for all students. Newly qualified radiographers should be encouraged to undertake research once they enter the clinical setting and they should publish their findings.     

Reducing dose at barium enema: radiographers do it digitally

It has been previously shown that, whilst radiographers in our hospital can undertake barium enema examinations with the same degree of diagnostic accuracy as consultant radiologists, there was a dose penalty to the patient arising from the use of a restrictive protocol requiring radiographers to take a series of plain radiographs for reporting purposes. For the past 3 years radiographers at this hospital have worked to a new protocol that replaces all routine radiographs with digital spot films. In the present study, dose-area product (DAP) measurements for 801 barium enema examinations performed by consultant radiologists and radiographers, using the revised protocol, were analysed and compared to ascertain whether there were still significant differences in radiation dose to the patient depending on the category of staff performing the examination. All examinations were reported by a consultant radiologist. The radiologists' reports were analysed against the known outcomes to compare the diagnostic accuracy of the examination when carried out by the two categories of staff. This study shows that using a modified protocol, in which digital spot films replace the series of overcouch radiographs for reporting, our radiographers are able to perform barium enemas without dose penalty to the patient, and without compromizing diagnostic accuracy. Means with 95% confidence intervals for DAP in the two groups were 9.8 Gycm(2) (9.4-10.3 Gycm(2)) and 10.7 Gycm(2) (10.2-11.1 Gycm(2)) for radiographers and radiologists, respectively.     

Career intentions,their influences and motivational factors in diagnostic radiography: A survey of undergraduate students

IntroductionThe choice of career and speciality can be a complex process. It is unclear what influences career decisions within undergraduate radiographers and whether the curriculum provides sufficient support.MethodsAn online cross-sectional survey was undertaken. All undergraduate diagnostic radiography students within one UK higher education institution were invited to participate. Questions were related to anticipated career choice, motivational factors and influences.ResultsThe response rate was 67.6% (90/133). The most popular specialist area for career preference was general radiography. The top three motivational factors were work life balance, career development and job satisfaction. The most influential factors on career choice were clinical placements, radiographers on placements and formal teaching. Career guidance was predominantly sourced from the personal academic tutor and was informed by role models.ConclusionRadiography academic teams and clinical placement providers must work together to ensure that students have access to high quality placements across specialities. The experiences received during undergraduate training are important in specialty choice.Implications for practiceCareer guidance is essential and should begin as early as possible. Clinical and academic radiographers need to appreciate the influence they have on students future career plans.     

Opportunities for radiographer reporting in Ghana and the potential for improved patient care

ObjectiveTo explore factors that influence the introduction of role extension in radiography and to discuss its potential for improved healthcare in Ghana.Key findingsKey findings of this review are the lack of literature on role extension in radiography in Ghana. The factors that have influenced the introduction of role extension in radiography globally include a shortage of radiologists, increased demand for radiology services, government policy and radiographer's desire for professional development.ConclusionsEvidence indicates that radiographers can report radiographs as accurately as radiologists and appropriate education improves their performance. Radiographer-led reporting is the professional practise most likely to deliver local patient benefit. Developments in professional perceptions, training, education and regulation of reporting are required to establish confidence in radiography-led reporting.Implications for practiceRadiographer reporting has the potential to improve patient outcomes, reduce waiting times, increase job satisfaction for radiographers and result in financial savings.