An exploratory study of radiographer's perceptions of radiographer commenting on musculo-skeletal trauma images in rural community based hospitals

AimThis study sought to explore the perceptions of community hospital based radiographers in North East Scotland regarding the practice of radiographer commenting on musculo-skeletal trauma images.MethodA purposive sample of radiographers (n = 8) were recruited from community hospitals throughout the North-east of Scotland. A qualitative, exploratory study was conducted employing semi-structured interviews consisting of one focus group and two individual interviews. The interviews were audio recorded and transcribed in full to allow thematic analysis of the data using a framework adapted from Pope and Mays (2006).Main findingsThis study revealed that the practice of radiographer commenting in the community provides a valuable front line opinion on musculo-skeletal trauma image appearances to enhance diagnostic outcomes for patients and streamline their care pathway. The appreciation shown from inter-professional colleagues for this practice induced feelings of professional pride and job satisfaction in the sample group. All participants expressed a desire to undertake additional training to allow progression from radiographer commenting to radiographer reporting of musculo-skeletal trauma images.Perceived barriers to the practice of radiographer commenting were time constraints and a lack of support with regards to continuing professional development (CPD) opportunities and mentorship from radiology colleagues.ConclusionThe practice of radiographer commenting in the community setting should be supported by ongoing training, and radiologist involvement in mentoring could provide radiographers with a valuable support mechanism. The voice of all radiographers regarding this extended role must be heard by professional leaders to ensure that the skills and education required for radiographer commenting are provided and subsequent patient care is not compromised.     

Accuracy of radiographer comment following a two-month experiential and blended learning in appendicular skeleton X-ray interpretation: The Singapore experience

IntroductionThe value of combined blended and experiential learning on radiographer diagnostic comment has not been explored. This study aims to examine the accuracy of image interpretation comment of radiographers who received a period of blended and experiential learning in Radiographer Abnormality Detection Systems (RADS).MethodsWe evaluated the diagnostic opinions of 13 radiographers who received a blended training and experiential learning (a process of self-learning and reflection) in RADS. Radiographers' opinions on 16,483 images were examined using the final radiologists’ report as a reference standard. For each radiographer, we recorded the number of true positive, true negative, false positive and false negative opinions and MedCal® was used to calculate diagnostic performance and error rates. A t-test was used to assess whether the number of images read was associated with performance and whether the radiographers retained performance over time.ResultsSensitivity ranged from 87.4 (84.0–90.2) to 98.9 (97.5–99.7) with a mean of 94.3 (93.6–94.8). Specificity varied from 96.4 (94.8–97.5) to 99.9 (99.41–100.0) with a mean of 98.2 (97.9–98.4). Diagnostic accuracy ranged from 93.1 (91.5–94.4) to 99.5 (98.9–99.8) with a mean of 96.9 (96.6–97.1). The mean false positive rate was 0.018 (range: 0.010–0.031) with a false negative rate of 0.057 (range: 0.026–0.11). There were no differences in performance between the first and latter nine months of providing opinions and the number of images reviewed was not associated with performance.ConclusionRadiographers who received blended and experiential learning in RADS provide accurate diagnostic comments on plain emergency appendicular skeleton radiographs.Implication for practiceA combined blended and experiential learning can equip radiographers to provide diagnostic opinion on plain appendicular skeleton radiographs.     

Accuracy of radiographer preliminary clinical evaluation of skeletal trauma radiographs,in clinical practice at a district general hospital

IntroductionError in interpretation of trauma radiographs by referrers is a problem which has detrimental effects on the patient and causes unnecessary repeat attendances. Radiographers can reduce errors by offering their opinion at the time of imaging. The Society and College of Radiographers have a longstanding recommendation that Red Dot (RD) schemes should be replaced by Preliminary Clinical Evaluation (PCE). The purpose of the study was to evaluate radiographer interpretation of skeletal trauma radiographs in clinical practice, determine if there was any difference in ability to interpret appendicular and axial studies, and evaluate appropriateness of PCE implementation.MethodsA convenience sample of 23 self-selecting radiographers provided RD and PCE on 762 examinations. Each case was compared against the verified report and assigned a true negative/positive or false negative/positive value. Accuracy, sensitivity and specificity were calculated and performance measures between RD versus PCE, and appendicular versus axial were compared using Two-sample Z-Tests. Error analysis was performed and inter-observer consistency determined.ResultsOverall RD and PCE accuracy, sensitivity and specificity for the study were 90%, 72% and 97% (RD), and 92%, 80% and 97% (PCE) respectively. Significant difference was demonstrated for sensitivity with PCE more sensitive than RD (p-value 0.03) and appendicular more sensitive than axial (RD p-value <0.02, PCE p-value <0.0001). Most errors were false negatives. Inter-observer consistency was evaluated by review of 128 cases and no difference between reviewers was established.ConclusionRadiographers without specific training were able to provide RD and PCE to a high standard. Radiographers interpreted positive findings more accurately using PCE than RD, and positive findings on appendicular cases were interpreted more accurately than those on axial cases.Implications for practiceThis study supports local PCE implementation, contributes to the wider evidence base to justify transition towards PCE and identifies the necessity for local axial image interpretation training.     

A pilot study to assess radiographer preliminary clinical evaluation (PCE) introduced for emergency department adult appendicular X-ray examinations: Comparison of trained and untrained radiographers

IntroductionRadiographers are transitioning from using “Red Dot” annotations to flag abnormal emergency X-ray images, to providing written preliminary clinical evaluation (PCE) diagnostic comments. This study explored the impact of local training on radiographers’ PCE participation and accuracy performance during a trial period.MethodsTen radiographers provided PCE comments for adult appendicular trauma X-ray examinations performed in the Emergency Department of an English public hospital over a 19 week trial period. Five senior radiographers who had received local PCE training and five more recently qualified radiographers, without this local training, participated in the trial. PCE participation rates were recorded and the PCE comments were scored for accuracy compared to the formal radiology report.ResultsThere were 796 eligible examinations, of which 528 (66%) had PCE comments. PCE participation was significantly higher (p < 0.001) for the radiographer group who received the training (80%, 253/316) compared to the untrained group (57%, 275/480). Similar levels of PCE accuracy (90% vs. 89%), sensitivity (86% vs. 82%) and specificity (91% vs. 93%) were found for the trained and untrained cohorts respectively, with no statistically significance difference between these scores.ConclusionLocal PCE training was associated with more frequent PCE participation but did not appear to influence PCE accuracy. The accuracy results suggest that radiographers are well equipped to provide PCE comments for adult appendicular X-ray examinations.Implications for practiceLocal PCE training is likely to be important for consistent PCE scheme participation. Both experienced and recently qualified radiographers appear well equipped to provide accurate PCE for adult appendicular trauma X-ray examinations.     

Initial single centre experiences of a radiographer advanced practitioner led nephrostomy exchange programme

IntroductionTo evaluate the technical success, radiation dose, complications and costs from the introduction of a radiographer-led nephrostomy exchange service.MethodsPost-graduate qualified interventional radiographers with several years' experience in performing other interventional procedures began performing nephrostomy exchanges. Training was provided by an interventional radiologist. Each radiographer performed ten procedures under direct supervision followed by independent practice with remote supervision. Each radiographer was then responsible for the radiological report, discharge, re-referral for further exchange and, where indicated, sending urine samples for culture and sensitivity. Data extraction included the time interval between exchanges, radiation dose/screening time and complications.ResultsThirty-eight long-term nephrostomy patients had their histories interrogated back to the time of the initial insertion. The mean (range) age at nephrostomy insertion was 67 (35–93) years and 65% were male. Indications for nephrostomy were prostatic or gynaecological malignancy, ureteric injury, bulky lymphoma and post-transplant ureteric stricture. A total of 170 nephrostomy exchanges were performed with no statistically significant differences in the radiation dose, fluoroscopy time nor complication rates between consultants and radiographers. There was, however, a statistically significant reduction in the time interval between nephrostomy exchanges for the radiographer group (P = 0.022).ConclusionInterventional radiographers can provide a safe, technically successful nephrostomy exchange program with radiation doses equivalent to radiologists. This is a cost-effective solution to the capacity issues faced in many departments, whilst providing career progression, job satisfaction and possibly improved care.Implications for practiceRadiographer-led interventional services should be considered by other institutions as a means of providing effective nephrostomy exchanges.     

Accuracy of radiographer plain radiograph reporting in clinical practice: a meta-analysis

AIM: To determine the accuracy of radiographer plain radiograph reporting in clinical practice. MATERIALS AND METHODS: Studies were identified from electronic sources and by hand searching journals, personal communication and checking reference lists. Eligible studies assessed radiographers' plain radiograph reporting in clinical practice compared with a reference standard, and provided accuracy data to construct 2 x 2 contingency tables. Data were extracted on study eligibility and characteristics, quality and accuracy. Summary estimates of sensitivity and specificity and receiver operating characteristic curves were used to pool the accuracy data. RESULTS: Radiographers compared with a reference standard, report plain radiographs in clinical practice at 92.6% (95% CI: 92.0-93.2) and 97.7% (95% CI: 97.5-97.9) sensitivity and specificity, respectively. Studies that compared selectively trained radiographers and radiologists of varying seniority against a reference standard showed no evidence of a difference between radiographer and radiologist reporting accuracy of accident and emergency plain radiographs. Selectively trained radiographers were also found to report such radiographs as accurately as those not solely from accident and emergency, although some variation in reporting accuracy was found for different body areas. Training radiographers improved their accuracy when reporting normal radiographs. CONCLUSION: This study systematically synthesizes the literature to provide an evidence-base showing that radiographers can accurately report plain radiographs in clinical practice.     

Development of a clinical chart audit programme

Radiation oncology charts containing medical information and treatment details are the major methods of communication between the various personnel involved in delivering radiation therapy to the patient. It is paramount to good patient care for this communication to be clear, precise and accurate in detail. A regular chart audit should be a part of the quality assurance programme of every radiation oncology department. The primary aim of this study was to develop and assess an objective and quantitative programme for reviewing radiation oncology charts, thereby improving the quality of communication and hence patient management. A secondary aim was to compare the charts of radically treated patients with those treated palliatively. A pilot study using a new chart review tool, developed at the Perth Radiation Oncology Centre, was carried out over an 8-month period. A sample of charts, representing 25% of our treatment group, were assessed using the tool on a monthly basis. A total of 156 charts were reviewed during this time period. Fifty-six per cent were radical treatments and 44% were palliative. The overall mean chart scores significantly improved over the time of this study (P < 0.001). The individual radiation oncologists' scores were also seen to improve during the study period. The alpha coefficients for intra-rater and inter-rater reliability were 0.99 and 0.88, respectively. The chart review programme was found to be an easy-to-use and a reliable tool by both medical and non-medical reviewers. It appeared to have a positive influence on the standard of radiation oncology charts in our department.     

Improving radiographer highlighting of trauma films in the accident and emergency department with a short course of study--an evaluation

The case for radiographer abnormality highlighting in the Accident and Emergency (A&E) department is well documented. Following evaluative feedback, 280 questionnaires were sent nationally to A&E radiology departments (excluding Northern Ireland). The intent of the survey was to ascertain the viability of constructing a short course in trauma plain film pattern recognition in the axial and appendicular skeleton. Following a highly positive response a course was designed and operated on a workshop basis, being lead primarily by reporting radiographers. The course was evaluated for effectiveness using three identical assessments of 42 films, including 12 positive for trauma. A sample of 22 radiographers who attended the pilot course and subsequent courses throughout 1998/99 undertook the assessment. The assessments themselves were performed at the start and end of the course and 6-10 weeks after completion. Results appear to indicate that a significant improvement in the specificity (p = 0.002) and accuracy (p = 0.005) was achieved following the course. In the light of continuing professional development, the course appears to address the needs of the majority of clinical radiographers working in A&E.     

Radionuclide demonstration of a renopleural fistula following trauma

A renopleural fistula was detected on a Tc-99m DTPA renal study during evaluation for possible post-traumatic urinoma.     

Impact of a continuing education programme for teachers of dental radiology

Continuing professional education is recognized as an important mission of contemporary dental schools. Research has shown that innovative methods of course delivery result in increased impact of continuing education efforts as measured by change in behaviour of the participants in their own workplaces. A case study is reported which describes the Carolina Institute of Dental Radiology Education. This 2-week intensive course for dental radiology instructors is offered by the University of North Carolina School of Dentistry. A survey of participants indicated that significant improvements in the radiology programmes supervised by the participants occurred following their attendance at the Institute.     

Evaluating the fundamental qualities of a nuclear medicine radiographer for the provision of an optimal clinical service

The developing nature of nuclear medicine practice highlights the need for an evaluation of the fundamental qualities of a Radiographer working within this discipline. Existing guidelines appear to be in place for clinical technologists working within nuclear medicine. However, limited guidance has been provided for Radiographers practicing within this discipline. This article aims to discuss the fundamental qualities that are considered essential for optimal service delivery, following consultation with various stakeholders. Areas such as technical expertise and knowledge, appropriate use of imaging equipment and current models of safe working practice will be discussed. Patient care and ethical considerations will also be evaluated, along with some core recommendations for future advanced practice.     

Traumatic left main coronary artery dissection in a young adult following blunt chest trauma – A case report

Blunt chest trauma may cause variable degrees of thoracic injuries. Most of the patients may remain asymptomatic after sustaining blunt chest trauma. But in rare instances, life-threatening conditions such as coronary artery dissection may occur. The authors present a 29-year-old male adult with persistent chest pain following blunt trauma with a rise in cardiac troponins and elevated ST segment in ECG. Coronary CT and conventional angiography demonstrated dissection of the left main coronary artery. It is deemed necessary to suspect cardiac injury in patients with a history of blunt chest trauma in appropriate clinical settings. Early recognition of coronary artery dissection is vital to reduce morbidity and mortality. ECG combined with cardiac enzymes can be essential tools helping the physicians raise the suspicion towards a cardiac injury followed by cross-sectional and conventional angiographies for confirmation.     

骨盆创伤全生命周期临床数据库构建初步探讨

目的 探讨骨盆创伤各流程的主要危险因素,构建适合临床需要的全生命周期数据库,为流行病学调查和制定损伤控制预案提供参考.方法 对既有医院信息系统的骨盆创伤数据进行分析,讨论临床流程各阶段的主要评估指标和数据类型,包括患者基本信息、创伤严重度指数、基础疾病、骨折分类、专科治疗、康复和随访信息等.结果 在创伤评分系统V3.0的基础上,开发骨盆创伤临床ACCESS数据库,收录2007年11月-2009年5月的588例骨盆创伤患者的临床资料并进行初步分析.结论 骨盆创伤临床数据库可作为通用型网络版创伤数据库系统的特定模块,大规模、多中心、标准化的骨盆创伤数据对于形成前瞻性的损伤控制预案具有重要意义.

Abstract：

Objective To construct the clinical database on pelvic trauma life cycle so as to provide reference for epidemiological investigations and development of pelvic damage control plan. Methods The existing pelvic trauma data of the hospital information system was analyzed to discuss the main evaluation indicators and data types at different stages, including basic data, injury severity index, underlying disease, fracture classification, specialist treatment, rehabilitation and follow-up information. Results Based on the V3.0 trauma scoring system, the clinical pelvic trauma ACCESS database was developed. The data of 588 patients with pelvic trauma were collected from November 2007 to May 2009 and preliminarily analyzed. Conclusions Clinical database of pelvic trauma can be used as the specific modules of general network trauma database system and a large-scale, multi-center and standard pelvic trauma database may play an important role in preparation of the prospective damage control plans.     

Comparison of the clinical performance of three digital mammography systems in a breast cancer screening programme

This study compares the clinical performance of three digital mammography system types in a breast cancer screening programme. 28 digital mammography systems from three different vendors were included in the study. The retrospective analysis included 238 182 screening examinations of females aged between 50 and 64 years over a 3-year period. All images were double read and assigned a result according to a 5-point rating scale to indicate the probability of cancer. Females with a positive result were recalled for further assessment imaging and biopsy if necessary. Clinical performance in terms of cancer detection rate was analysed and the results presented. No statistically significant difference was found between the three different mammography systems in a population-based screening programme, in terms of the overall cancer detection rate or in the detection of invasive cancer and ductal carcinoma in situ. This was shown in both prevalent and subsequent screening examination categories. The results demonstrate comparable cancer detection performance for the three imaging system types operational in the screening programme.     

Transection of the retrohepatic vena cava in a case of total situs inversus following blunt trauma

Total transection of the retrohepatic inferior vena cava from blunt trauma is a rare and usually fatal injury. Such an injury in a patient with total situs inversus and previous surgical correction of great vessel transposition is described. A possible mechanism for the injury is suggested.