Reporting radiographers within the European Federation of Radiographer Society (EFRS) member countries - motivation for becoming a reporting radiographer.

INTRODUCTION: Radiographer-led reporting originated in the United Kingdom as a strategy to reduce reporting backlog and time taken to report images. The effectiveness of reporting radiographers has been demonstrated, but their motivational factors have not been thoroughly explored. This survey aims to understand the incentives for radiographers to pursue postgraduate education in reporting radiography across Europe. METHODS: An online survey was conducted, collecting data across a range of topics such as demographic information, professional role, and job satisfaction. Questions assessing the influence of motivational factors on the decision to become a reporting radiographer are presented in this study. Descriptive statistics characterized the respondents' demographics. The motivational aspects were analysed quantitatively by regression analyses. Thematic analyses were performed for the free text responses on motivational aspects. RESULTS: 239 respondents from the UK, Denmark, Norway, Sweden, The Netherlands, Ireland, and Malta completed the survey's motivation section. Increased knowledge and new challenges were the most motivating factors for becoming a reporting radiographer, while less exposure to radiation and less patient contact were the least motivating factors. Job satisfaction was a significant motivator. Gender significantly correlated with the importance of social connections for female reporting radiographers. A cross-country comparison showed that title and position and job security were more important for reporting radiographers from the UK. CONCLUSION: Taking in consideration that a sample of 239 is not generalisable for the role, this survey does provides insights into the motivation behind being a reporting radiographer in Europe. Factors such as increased knowledge, new challenges, and job satisfaction play significant roles. Hindrances experienced by reporting radiographers included lack of time, support, and standards, while aspirations for further professional development were expressed. IMPLICATIONS FOR PRACTICE: A thorough understanding of the motivation behind pursuing postgraduate studies in reporting radiography is a valuable tool for managers, aiding in fostering a positive work environment and attracting/keeping qualified personnel. The findings of this study can be employed in the development of strategies to support and enhance the practice of reporting radiographers.

Reporting radiographers in Europe survey: Support, role satisfaction, and advanced clinical practice within the European federation of radiographer society (EFRS) member countries.

INTRODUCTION: Increasing number of radiographers are undertaking image reporting throughout Europe. However, there are variations in practice and experience in European countries. The study aim was to investigate reporting radiographer's perceptions in relation to support for their role and workload satisfaction and elements of advanced practice that may also be undertaken. METHODS: Following institutional ethical approval an online 34 item questionnaire survey was circulated via social media; Twitter, Facebook, and LinkedIn in a 12-week period in 2022 across Europe. The survey data were managed by the online secure database REDCap (Research Electronic Data Capture). Data was collected across a range of questions, of which those relating to support for, and barriers to radiographer reporting, role and job satisfaction, and other role elements are reported here. RESULTS: A response level of 345 individual reporting radiographers replied to the survey from 15 European countries; some questions were optional and therefore had a lower response rate. There was consensus about the need for support from radiologists and management, protected time, and funding to support the reporting role. The majority of respondents received additional pay for taking on this role and expressed satisfaction with their role and workload. In relation to elements of advanced practice, the majority of respondents were involved in educational and managerial activities, and there was interest, but limited involvement, in research. CONCLUSION: There was a consensus about the support needed, and perceived barriers to, radiographer reporting, between reporting radiographers from different countries. Whilst there is some commonality in relation to activities such as supervision and education, there was clearer variety in relation to opportunities for research between the respondents, perhaps reflecting the differences between reporting as a standalone role development and reporting as part of an advanced clinical practice role. IMPLICATIONS FOR PRACTICE: As there is increasingly an emphasis on advanced clinical practice, reporting radiographers are likely to require support to develop their skills so that they can actively participate in the broader activities associated with this role, including education, leadership, and research.

Assessing the barriers and enablers to the implementation of the diagnostic radiographer musculoskeletal X-ray reporting service within the NHS in England: a systematic literature review.

INTRODUCTION: The United Kingdom (UK) government's healthcare policy in the early 1990s paved the way adoption of the skills mix development and implementation of diagnostic radiographers' X-ray reporting service. Current clinical practice within the public UK healthcare system reflects the same pressures of increased demand in patient imaging and limited capacity of the reporting workforce (radiographers and radiologists) as in the 1990s. This study aimed to identify, define and assess the longitudinal macro, meso, and micro barriers and enablers to the implementation of the diagnostic radiographer musculoskeletal X-ray reporting service in the National Healthcare System (NHS) in England. METHODS: Multiple independent databases were searched, including PubMed, Ovid MEDLINE; Embase; CINAHL, and Google Scholar, as well as journal databases (Scopus, Wiley), healthcare databases (NHS Evidence Database; Cochrane Library) and grey literature databases (OpenGrey, GreyNet International, and the British Library EthOS depository) and recorded in a PRISMA flow chart. A combination of keywords, Boolean logic, truncation, parentheses and wildcards with inclusion/exclusion criteria and a time frame of 1995-2022 was applied. The literature was assessed against Joanna Briggs Institute's critical appraisal checklists. With meta-aggregation to synthesize each paper, and coded using NVivo, with context grouped into macro, meso, and micro-level sources and categorised into subgroups of enablers and barriers. RESULTS: The wide and diverse range of data (n = 241 papers) identified barriers and enablers of implementation, which were categorised into measures of macro, meso, and micro levels, and thematic categories of context, culture, environment, and leadership. CONCLUSION: The literature since 1995 has reframed the debates on implementation of the radiographer reporting role and has been instrumental in shaping clinical practice. There has been clear influence upon both meso (professional body) and macro-level (governmental/health service) policies and guidance, that have shaped change at micro-level NHS Trust organisations. There is evidence of a shift in culturally intrenched legacy perspectives within and between different meso-level professional bodies around skills mix acceptance and role boundaries. This has helped shape capacity building of the reporting workforce. All of which have contributed to conceptual understandings of the skills mix workforce within modern radiology services.

Reporting radiographers in Europe survey: An overview of the role within the European Federation of Radiographer Society (EFRS) member countries.

INTRODUCTION: Reporting radiographers undertake an important role in healthcare and for the radiographer profession in general. First introduced in the United Kingdom, reporting radiographers are now practicing in several other European countries. Our objective was to investigate the workforce of reporting radiographers across the European Federation of Radiographer Societies (EFRS) community. METHOD AND MATERIAL: A voluntary anonymous 34 item electronic survey was distributed online using social media accounts such as Twitter, Facebook and LinkedIn covering a wide range of topics relating to professional role, advanced practice, education, and seniority. The questionnaire was distributed during a 12-week period in 2022. RESULT: A total of 345 individual responses were received from 15 countries with majorities of respondent from United Kingdom (n = 245, 71%) and Denmark (n = 66, 19%). Mean age was 41.9 (S.D 9.8), similar for females, 42.5 (S.D 9.0) and men 40.9 years (S.D 9.7). Most reporting radiographers worked in public hospitals (90%). The vast majority of the respondents (n = 270, n = 94%) authored and signed their own clinical reports while a minority (n = 18, 6%) stated that their reports were checked by radiologists. CONCLUSION: The survey highlights the scope of practice of reporting radiographers working in Europe. Reporting is becoming a career path for an increasing number of radiographers across Europe and there is assess to academic education and clinical support. IMPLICATION FOR PRACTICE: Reporting radiographers fulfil an important role within the current demands of healthcare. This demand is likely to increase in the future, and therefore it is vital that there is some form of standardisation in the level of education that this group of healthcare professionals receive.

Concordance between a gastrointestinal consultant radiologist, a consultant radiologist and qualified reporting radiographers interpreting abdominal radiographs.

INTRODUCTION: Radiographers can accurately report musculoskeletal and chest radiographs, but there is paucity of research comparing the performance of reporting radiographers (RRs) with consultant radiologists when interpreting and reporting abdominal radiographs. This study assessed interobserver agreement in the clinical setting between reporting radiographers and a consultant radiologist compared to an expert gastrointestinal radiologist in a District General Hospital. Major discordant reports affecting patient management were also examined. METHODS: 126 abdominal radiographs reported by 3 RRs in clinical practice were randomly selected and reported by a consultant radiologist and index gastrointestinal radiologist. The reports of the RRs and consultant radiologist were compared against the reports made by the index radiologist for agreement by a colorectal consultant surgeon. All 126 reports were scored as being in either complete agreement, minor disagreement or major disagreement which would have resulted in a change to patient management. RESULTS: There was no significant difference in overall agreement between the consultant radiologist (CR) and RRs when compared to the index radiologist (CR: n = 90/126, 71.4% and RRs: n = 94/126, 74.6%. p = 0.57). Major disagreements were found, but there was no significant difference between both groups (CR: n = 23/126, 18.3% and RRs: n = 17/126, 13.5%. p = 0.30). CONCLUSION: RRs can report abdominal radiographs to a comparable level of agreement as a consultant radiologist in the clinical setting. There was no significant difference in reports deemed to affect patient management. IMPLICATIONS FOR PRACTICE: This study addresses the gap in assessing the performance of RRs reporting abdominal radiographs. This small scale study indicates that radiographers could provide additional support in the reporting of abdominal radiographs. This would help to reduce radiologist workload and enhance the role of the reporting radiographer. CLASSIFICATION: Agreement between reporting radiographers and radiologists interpreting and reporting abdominal radiographs.

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.

INTRODUCTION: Radiographers 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. METHODS: Ten 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. RESULTS: There 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. CONCLUSION: Local 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 PRACTICE: Local 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.

UK reporting radiographers' perceptions of AI in radiographic image interpretation - Current perspectives and future developments.

INTRODUCTION: Radiographer reporting is accepted practice in the UK. With a national shortage of radiographers and radiologists, artificial intelligence (AI) support in reporting may help minimise the backlog of unreported images. Modern AI is not well understood by human end-users. This may have ethical implications and impact human trust in these systems, due to over- and under-reliance. This study investigates the perceptions of reporting radiographers about AI, gathers information to explain how they may interact with AI in future and identifies features perceived as necessary for appropriate trust in these systems. METHODS: A Qualtrics® survey was designed and piloted by a team of UK AI expert radiographers. This paper reports the third part of the survey, open to reporting radiographers only. RESULTS: 86 responses were received. Respondents were confident in how an AI reached its decision (n = 53, 62%). Less than a third of respondents would be confident communicating the AI decision to stakeholders. Affirmation from AI would improve confidence (n = 49, 57%) and disagreement would make respondents seek a second opinion (n = 60, 70%). There is a moderate trust level in AI for image interpretation. System performance data and AI visual explanations would increase trust. CONCLUSIONS: Responses indicate that AI will have a strong impact on reporting radiographers' decision making in the future. Respondents are confident in how an AI makes decisions but less confident explaining this to others. Trust levels could be improved with explainable AI solutions. IMPLICATIONS FOR PRACTICE: This survey clarifies UK reporting radiographers' perceptions of AI, used for image interpretation, highlighting key issues with AI integration.

Online training resources to aid therapeutic radiographers in engaging in conversations about physical activity and diet: A mixed methods study.

INTRODUCTION: This study explored changes in therapeutic radiographers' (TRs) self-reported knowledge and skills to engage in conversations about physical activity and diet with people living with and beyond cancer following completion of publicly available online courses. METHODS: Participants were randomly assigned to two of five online courses that aim to support health professionals to engage in conversations about physical activity and diet in the oncology setting. Participants rated their agreement with 18 statements related to the COM-B (capability, opportunity and motivation-behaviour) model components following completion of an online course on healthy diet (n = 16) and physical activity (n = 21). Semi-structured telephone interviews (n = 21) were also conducted. Analysis of the interviews was guided by the Theoretical Domains Framework. RESULTS: Overall, the online courses were acceptable and the TRs in this study self-reported improved COM to deliver advice on physical activity and diet. The inclusion of the evidence and scientific rationale on the benefits of diet and physical activity, and also guidance on how to start conversations with patients were highlighted as important features of the courses. Suggestions for adaptations to the nutrition courses included the need for content that accounts for the side effects cancer patients experience while undergoing treatment. To support the implementation of training and the delivery of advice on these topics, multi-disciplinary working, organisational support and guidance around professional role boundaries were highlighted as important. CONCLUSION: Current publicly available online courses on physical activity and diet for oncology health professionals can reduce some barriers among TRs to providing advice to those living with and beyond cancer. IMPLICATIONS FOR PRACTICE: Existing online training courses could be used to support TRs to deliver physical activity and dietary advice in practice. Findings show that these courses can be disseminated within radiotherapy departments. The results also highlight a number of important considerations for the implementation of brief health behaviour advice and online training interventions on physical activity and diet within cancer care.

Artificial Intelligence: Guidance for clinical imaging and therapeutic radiography professionals, a summary by the Society of Radiographers AI working group.

INTRODUCTION: Artificial intelligence (AI) has started to be increasingly adopted in medical imaging and radiotherapy clinical practice, however research, education and partnerships have not really caught up yet to facilitate a safe and effective transition. The aim of the document is to provide baseline guidance for radiographers working in the field of AI in education, research, clinical practice and stakeholder partnerships. The guideline is intended for use by the multi-professional clinical imaging and radiotherapy teams, including all staff, volunteers, students and learners. METHODS: The format mirrored similar publications from other SCoR working groups in the past. The recommendations have been subject to a rapid period of peer, professional and patient assessment and review. Feedback was sought from a range of SoR members and advisory groups, as well as from the SoR director of professional policy, as well as from external experts. Amendments were then made in line with feedback received and a final consensus was reached. RESULTS: AI is an innovative tool radiographers will need to engage with to ensure a safe and efficient clinical service in imaging and radiotherapy. Educational provisions will need to be proportionately adjusted by Higher Education Institutions (HEIs) to offer the necessary knowledge, skills and competences for diagnostic and therapeutic radiographers, to enable them to navigate a future where AI will be central to patient diagnosis and treatment pathways. Radiography-led research in AI should address key clinical challenges and enable radiographers co-design, implement and validate AI solutions. Partnerships are key in ensuring the contribution of radiographers is integrated into healthcare AI ecosystems for the benefit of the patients and service users. CONCLUSION: Radiography is starting to work towards a future with AI-enabled healthcare. This guidance offers some recommendations for different areas of radiography practice. There is a need to update our educational curricula, rethink our research priorities, forge new strong clinical-academic-industry partnerships to optimise clinical practice. Specific recommendations in relation to clinical practice, education, research and the forging of partnerships with key stakeholders are discussed, with potential impact on policy and practice in all these domains. These recommendations aim to serve as baseline guidance for UK radiographers. IMPLICATIONS FOR PRACTICE: This review offers the most up-to-date recommendations for clinical practitioners, researchers, academics and service users of clinical imaging and therapeutic radiography services. Radiography practice, education and research must gradually adjust to AI-enabled healthcare systems to ensure gains of AI technologies are maximised and challenges and risks are minimised. This guidance will need to be updated regularly given the fast-changing pace of AI development and innovation.

Artificial intelligence in radiography: Where are we now and what does the future hold?

OBJECTIVES: This paper will outline the status and basic principles of artificial intelligence (AI) in radiography along with some thoughts and suggestions on what the future might hold. While the authors are not always able to separate the current status from future developments in this field, given the speed of innovation in AI, every effort has been made to give a view to the present with projections to the future. KEY FINDINGS: AI is increasingly being integrated within radiography and radiographers will increasingly be working with AI based tools in the future. As new AI tools are developed it is essential that robust validation is undertaken in unseen data, supported by more prospective interdisciplinary research. A framework of stronger, more comprehensive approvals are recommended and the involvement of service users, including practitioners, patients and their carers in the design and implementation of AI tools is essential. Clearer accountability and medicolegal frameworks are required in cases of erroneous results from the use of AI-powered software and hardware. Clearer career pathways and role extension provision for healthcare practitioners, including radiographers, are required along with education in this field where AI will be central. CONCLUSION: With the current growth rate of AI tools it is expected that many of the applications in medical imaging will continue to develop to more accurate, less expensive and more readily available versions moving from the bench to the bedside. The hope is that, alongside efficiency and increased patient throughput, patient centred care and precision medicine will find their way in, so we will not only deliver a faster, safer, seamless clinical service but also one that will have the patients at its heart. IMPACT FOR PRACTICE: AI is already reaching clinical practice in many forms and its presence will continue to increase over the short and long-term future. Radiographers must learn to work with AI, embracing it and maximising the positive outcomes from this new technology.

Digital mammographic interpretation by UK radiographer mammographers: A JAFROC analysis of observer performance.

INTRODUCTION: Radiologists utilise mammography test sets to bench mark their performance against recognised standards. Using a validated test set, this study compares the performance of radiographer readers against previous test results for radiologists. METHODS: Under similar test conditions radiographer readers were given an established test set of 60 mammograms and tasked to identify breast cancer, they were measured against their ability to identify, locate and give a confidence level for cancer being present on a standard set of mammographic images. The results were then compared to previously published results for radiologists for similar or the same test sets. RESULTS: The 10 radiographer readers demonstrated similar results to radiologists and for lesion sensitivity were the highest scoring group. The study group score a sensitivity of 83; a specificity of 69.3 and lesion sensitivity of 74.8 with ROC and JAFROC scores of 0.86 and 0.74 respectively. CONCLUSION: Under test conditions radiographers are able to identify and accurately locate breast cancer in a range of complex mammographic backgrounds. IMPLICATIONS FOR PRACTICE: The study was performed under experimental conditions with results comparable to breast radiologists under similar conditions, translation of these findings into clinical practice will help address access and capacity issues in the timely identification and diagnosis of breast cancer.

Concordance between a neuroradiologist, a consultant radiologist and trained reporting radiographers interpreting MRI head examinations: An empirical study.

INTRODUCTION: This study assessed agreement between MRI reporting radiographers and a consultant radiologist compared with an index neuroradiologist when reporting MRI head (brain/internal auditory meati [IAMs]) examinations. The effect on patient management of any discordant reports was also examined. METHODS: Two trained MRI reporting radiographers (RRs), a consultant radiologist (CR) and an index neuroradiologist (INR) reported on a random sample of 210 MRI examinations. The radiographers reported during clinical practice and the radiologists in clinical practice conditions. Two independent consultant physicians (neuro-rehabilitation and neuropsychiatry) compared these reports with the index neuroradiologist report for agreement and the clinical importance of discrepant reports. RESULTS: Overall observer agreement between the RRs and CR was comparable in relation to agreement with the INR: RR; 93/210 (44.3%); and the CR; 83/210 (39.4%) for all head MRI examinations (p = 0.32). For brain examinations the difference was similar: RR; 64/180 (35.6%); and CR; 54/190 (30.0%), p = 0.26. Agreement rates for the IAMs examinations were identical, 29/30 (97.7%). For all head MRI examinations (n = 210) there was a very small observed difference of <0.5% in mean agreement between the reporting radiographers and the consultant radiologist (p = 0.92) for examinations where a major disagreement would have been likely to have led to a change in patient management. CONCLUSION: MRI reporting radiographers reported during clinical practice on MRI head examinations to a level of agreement comparable with a consultant radiologist. IMPLICATIONS FOR PRACTICE: This is an area in which radiographers could provide additional reporting roles to the reporting service to increase capacity. Wider potential benefits include cost-effectiveness and role development/retention of radiographers.

An analysis of advanced and specialist posts in diagnostic radiography: Do job descriptions describe advanced practice?

INTRODUCTION: Underpinned by a multi professional advanced clinical practice (ACP) framework, role consistency in practice level and education has been advocated across allied health professions. However little research has evaluated ACP expectations in radiography. This study identified the capability requirements of advanced and specialist diagnostic radiographers and mapped these to home country advanced practice frameworks and the Society and College of Radiographers (SCoR) Education and Career Framework. METHODS: A consecutive sample of UK job advertisements was collected over six months and analysed for role focus, professional and clinical responsibilities, reporting or procedural expectations and knowledge and experience. Qualitative content analysis was used to scrutinise capabilities during role mapping. RESULTS: A total of 42 job descriptions were analysed across UK Trusts and Health Boards, with 31 roles (73.8%) containing the terms advanced or specialist. Half of the advertised roles expected proficiency in reporting (n = 21; 50%). Responsibilities mapped to the practice outcomes of the SCoR framework in 31 roles (n = 31/42; 73.8%). The English documents (n = 40/42; 95.2%) evaluated against the multi professional framework identified significantly (χ2 = 14.6; p < 0.01) fewer capabilities (n = 13/40; 32.5%). Clinical practice was reflected broadly in textual behavioural descriptors however, leadership, education and research responsibilities were internal and operational in nature. CONCLUSION: This analysis of diagnostic radiographer job descriptions has demonstrated that many posts advertised as 'advanced' differ from advanced practice roles defined by the multi professional ACP framework, although they meet professional body standards. IMPLICATIONS FOR PRACTICE: Utilisation of diagnostic radiographers as 'true' advanced clinical practitioners remains intermittent. Greater consistency in job descriptions is required to strengthen radiography advanced practice and support radiographer development.

Reporting radiographer peer review systems: A cross-sectional survey of London NHS Trusts.

INTRODUCTION: Peer review is frequently incorporated within radiographer reporting services. The aim of this study is to establish peer review systems used for radiograph reports provided by reporting radiographers in London. METHODS: An online cross-sectional survey of NHS diagnostic imaging departments was performed. Reporting radiographer demographics (number, frequency of reporting, scope of practice) and systems used to provide peer review of radiograph reports (review frequency, case selection, volume, outcome measure, practitioner performing the review) were collected. RESULTS: Thirteen eligible responses were received (61.9% response rate). Variability was found between Trusts in the number of reporting radiographers, frequency of reporting sessions and scope of practice. Most Trusts (9 of 13, 69.2%) have active peer review systems for radiographer reporting. All peer review systems use random case selection, most often performed on a monthly basis. Both a fixed number or a percentage of cases reported were used, with true positive, true negative, false positive, false negative the most frequent outcome measure. Of the 12 Trusts that have or are planning a peer system, all currently or plan to use reporting radiographers to conduct the review, with five (41.2%) also using consultant radiologists. CONCLUSION: Peer review of radiographer reporting is common in London NHS Trusts although there is variation in the methods used. IMPLICATIONS FOR PRACTICE: Radiographer reports frequently undergo peer review. Standardisation of reporting radiographer peer review systems should be considered, and a standardised systematic peer review system has been proposed.

Clinical reporting of radiographs by radiographers: Policy and practice guidance for regional imaging networks.

OBJECTIVES: Radiographer reporting is an essential component of imaging across the United Kingdom. Since the previous policy and practice guidance in 2004 the role and contribution of reporting radiographers has changed significantly. The move to imaging networks further reinforces the need for consistency in scope of practice and clinical governance for radiographer reporting. KEY FINDINGS: This guidance provides a consistent, evidence-based template for planning a reporting service, resourcing, clinical governance, preceptorship, volume and frequency of reporting, a peer learning framework and expected standards. CONCLUSION: Developed for North Central and East London, this framework and standards will help reduce unwarranted variation. IMPLICATIONS FOR PRACTICE: Consistency in practice could help maximise the contribution of radiographer reporting.

COVID-19 in the radiology department: What radiographers need to know.

OBJECTIVES: The aim is to review current literature related to the diagnosis, management, and follow-up of suspected and confirmed Covid-19 cases. KEY FINDINGS: Medical Imaging plays an important auxiliary role in the diagnosis of Covid-19 patients, mainly those most seriously affected. Practice differs widely among different countries, mainly due to the variability of access to resources (viral testing and imaging equipment, specialised staff, protective equipment). It has been now well-documented that chest radiographs should be the first-line imaging tool and chest CT should only be reserved for critically ill patients, or when chest radiograph and clinical presentation may be inconclusive. CONCLUSION: As radiographers work on the frontline, they should be aware of the potential risks associated with Covid-19 and engage in optimal strategies to reduce these. Their role in vetting, conducting and often reporting the imaging examinations is vital, as well as their contribution in patient safety and care. Medical Imaging should be limited to critically ill patients, and where it may have an impact on the patient management plan. IMPLICATIONS FOR PRACTICE: At the time of publication, this review offers the most up-to-date recommendations for clinical practitioners in radiology departments, including radiographers. Radiography practice has to significantly adjust to these new requirements to support optimal and safe imaging practices for the diagnosis of Covid-19. The adoption of low dose CT, rigorous infection control protocols and optimal use of personal protective equipment may reduce the potential risks of radiation exposure and infection, respectively, within Radiology departments.

Targeted active screening for tuberculosis in Zimbabwe: are field digital chest X-ray ratings reliable?

SETTING: Fifteen purposively selected districts in Zimbabwe in which targeted active screening for tuberculosis (Tas4TB) was conducted among TB high-risk groups (HRGs). There were 230 patients started on TB treatment on the basis of chest X-ray (CXR) results without corresponding bacteriological confirmation. OBJECTIVES: To determine 1) the percentage of agreements in digital CXR ratings by medical officers against final ratings by radiologist(s), 2) inter-rater agreement in CXR ratings between medical officers and radiologists, and 3) number (and proportion) of patients belonging to HRGs who were over-treated during Tas4TB. DESIGN: This was a cross-sectional study using programme data. RESULTS: A total of 168 patients had their CXRs rated by two independent radiologists. Discordances among the radiologists were resolved by a third index radiologist, who provided the final rating. κ scores were 0.01 (field ratings vs. Radiologist A); 0.02 (field ratings vs. Radiologist B); 0.74 (Radiologists A vs. B). The percentage agreement for field and final radiologist rating was 70% (95%CI 64-78). Around 29% (95%CI 23-36) of the patients were potentially over-treated during Tas4TB. CONCLUSION: Over a quarter of patients with presumptive TB are potentially over-treated during Tas4TB. Over-treatment is highest among those with previous contact with TB patients. Trainings of radiographers and medical officers may improve CXR ratings.

Radiographer reporting of neurological magnetic resonance imaging examinations of the head and cervical spine: Findings of an accredited postgraduate programme.

INTRODUCTION: To analyse the objective structured examination (OSE) results of the first cohorts of radiographers (n = 13) who successfully completed an accredited postgraduate programme in clinical reporting of neurological magnetic resonance imaging (MRI) examinations of the head and cervical spine. METHODS: Forty MRI examinations were used in the OSE which included a range of abnormal cases (prevalence of abnormal examinations approximated 50%) and included: haemorrhage, infarction, demyelination disease, abscess, mass lesions (metastatic deposits, meningioma, glioma, astrocytoma); and disc disease, cord compression, stenosis, ligament rupture, syringomyelia appearances on patients referred from a range of referral sources. Normal variants and incidental findings were also included. True/false positive and negative fractions were used to mark the responses which were also scored for agreement with the previously agreed expected answers based on agreement between three consultant radiologists' reports. RESULTS: The mean sensitivity, specificity and agreement rates for all head and cervical spine investigations (n = 520) combined were 98.86%, 98.08% and 88.37%, respectively. The highest scoring cases were cases which included astrocytoma, disc protrusion with cord compression and glioma. The most common errors were related to syringomyelia, ligament rupture and vertebral fracture. CONCLUSIONS: These OSE results suggest that in an academic setting, and following an accredited postgraduate education programme, this group of radiographers has the ability to correctly identify normal MRI examinations of the head/cervical spine and are able to provide a report on the abnormal appearances to a high standard. Further work is required to confirm the clinical application of these findings.

Agreement between expert thoracic radiologists and the chest radiograph reports provided by consultant radiologists and reporting radiographers in clinical practice: Review of a single clinical site.

INTRODUCTION: To compare the clinical chest radiograph (CXR) reports provided by consultant radiologists and reporting radiographers with expert thoracic radiologists. METHODS: Adult CXRs (n = 193) from a single site were included; 83% randomly selected from CXRs performed over one year, and 17% selected from the discrepancy meeting. Chest radiographs were independently interpreted by two expert thoracic radiologists (CTR1/2).Clinical history, previous and follow-up imaging was available, but not the original clinical report. Two arbiters compared expert and clinical reports independently. Kappa (Ƙ), Chi Square (χ2) and McNemar tests were performed to determine inter-observer agreement. RESULTS: CTR1 interpreted 187 (97%) and CTR2 186 (96%) CXRs, with 180 CXRs interpreted by both experts. Radiologists and radiographers provided 93 and 87 of the original clinical reports respectively. Consensus between both expert thoracic radiologists and the radiographer clinical report was 70 (CTR1; Ƙ = 0.59) and 70 (CTR2; Ƙ = 0.62), and comparable to agreement between expert thoracic radiologists and the radiologist clinical report (CTR1 = 76, Ƙ = 0.60; CTR2 = 75, Ƙ = 0.62). Expert thoracic radiologists agreed in 131 cases (Ƙ = 0.48). There was no difference in agreement between either expert thoracic radiologist, when the clinical report was provided by radiographers or radiologists (CTR1 χ = 0.056, p = 0.813; CTR2 χ = 0.014, p = 0.906), or when stratified by inter-expert agreement; radiographer McNemar p = 0.629 and radiologist p = 0.701. CONCLUSION: Even when weighted with chest radiographs reviewed at discrepancy meetings, content of CXR reports from trained radiographers were indistinguishable from content of reports issued by radiologists and expert thoracic radiologists.