Impact of a digital training platform and tailored education on the chest image interpretation performance of healthcare professionals.

INTRODUCTION: With the use of expert consensus a digital training tool was developed which proved useful when teaching radiographers how to interpret chest images. The training tool included A) a search strategy and B) an educational video programme to communicate the search strategies using eye tracking technology. METHODS: A multi-reader multi-case study was undertaken to assess the effectiveness of a training tool and study day. The interventions were designed to cover a range of potential pathological presentations. Participants, physiotherapists and nurse practitioners working at a cardiothoracic Intensive Care Unit (ICU), were asked to interpret 20 chest images at the beginning of the study and following access to each intervention. Participants received access to the training tool at different times for a period of 4-6 weeks. A study day was then be provided to all participants and interpretations of a different dataset were completed by all. Each participant was asked to complete a questionnaire to gain perceptions of the training provided. RESULTS: Twenty-eight participants interpreted a total of 1680 chest radiographs. Improvements in specificity were noted across the participants. Sensitivity fell in both groups following both training interventions. CONCLUSION: Face to face learning and digital components are potentially useful in professional development and revision in chest x-ray interpretation for non-medical healthcare professionals working in an ICU setting. IMPLICATIONS FOR PRACTICE: The training tool and study day may be useful as image interpretation revision aids or to accompany formal methods of education.

A scoping review of educational programmes on artificial intelligence (AI) available to medical imaging staff.

INTRODUCTION: Medical imaging is arguably the most technologically advanced field in healthcare, encompassing a range of technologies which continually evolve as computing power and human knowledge expand. Artificial Intelligence (AI) is the next frontier which medical imaging is pioneering. The rapid development and implementation of AI has the potential to revolutionise healthcare, however, to do so, staff must be competent and confident in its application, hence AI readiness is an important precursor to AI adoption. Research to ascertain the best way to deliver this AI-enabled healthcare training is in its infancy. The aim of this scoping review is to compare existing studies which investigate and evaluate the efficacy of AI educational interventions for medical imaging staff. METHODS: Following the creation of a search strategy and keyword searches, screening was conducted to determine study eligibility. This consisted of a title and abstract scan, then subsequently a full-text review. Articles were included if they were empirical studies wherein an educational intervention on AI for medical imaging staff was created, delivered, and evaluated. RESULTS: Of the initial 1309 records returned, n = 5 (∼0.4 %) of studies met the eligibility criteria of the review. The curricula and delivery in each of the five studies shared similar aims and a 'flipped classroom' delivery was the most utilised method. However, the depth of content covered in the curricula of each varied and measured outcomes differed greatly. CONCLUSION: The findings of this review will provide insights into the evaluation of existing AI educational interventions, which will be valuable when planning AI education for healthcare staff. IMPLICATIONS FOR PRACTICE: This review highlights the need for standardised and comprehensive AI training programs for imaging staff.

The changing concept of radiographer's role in UAE: An analysis of radiologists' opinions and acceptance.

INTRODUCTION: The role of radiographers in the United Arab Emirates (UAE) is currently focused on image acquisition. However, many advances have been made in different countries in recent years whereby radiographers who receive appropriate education and training, can provide image interpretation/reports. When implemented, this role development has enabled a more cost effective and efficient service delivery whilst relieving the burden off radiologists, allowing them to concentrate on more complex imaging examinations. This role development is commonplace in many countries but not in the UAE. AIM: This study aims to investigate the radiologists' opinions, perceptions, and willingness to accept the advanced practice role of reporting radiographers in the UAE and determine their level of support for implementing these roles. METHODS: Data was collected utilizing a mixed-methods study design that included a survey and focus group discussions (FGD). Study participants included radiologists who currently work in UAE public and private health organizations. The survey link was emailed directly to the radiologists, together with a covering letter and participants' information sheet outlining the study's aim. Participants indicated on the survey if they wanted to participate in FGD. Two online FGD were conducted using Zoom software (Zoom Video Communications Inc., San Jose, California, United States) and aimed to explore possible reasons for participant's opinions. Ethical approval was obtained from the Ministry of Health, and all methods were performed as per study protocol. RESULTS: A total of 69 radiologists participated in the survey, 48 males and 21 females aged between 41 and 60 years and with between 11 and 16 years of experience. Most participants (n = 54, 78.2%) believe that radiographers should only perform advanced tasks in image interpretation after obtaining adequate training and under the supervision of a radiologist. According to 55% of radiologists, the development of the radiographer role could draw more UAE nationals to the field. Six participants were recruited to FGD and declared mixed opinions that emphasized the need to improve the radiographers knowledge and experience to enable role development. CONCLUSION: Radiologists' worries about radiographer engagement in image interpretation may be alleviated if they participate in education and training for new responsibilities. In addition, this could boost the confidence of radiologists and improve trust in radiographer competency and training. IMPLICATIONS FOR PRACTICE: Guidelines and work standards must be developed jointly by radiologists and radiographers to ensure the governance and acceptability of new radiographer reporting roles. Some radiologists perceive that radiographer reporting is possible in UAE when radiographers are trained to set guidelines and with supervision from radiologists. Change is taking place, and many radiologists express optimism for the future, though the rate of change will be determined by a willingness to change attitudes and perceptions.

The Impact of COVID-19 on the Clinical Experience and Training of Undergraduate Student Radiographers internationally: The Clinical Tutors' perspective.

INTRODUCTION: The impact on the clinical training and education of healthcare students by COVID-19 has been documented. However, the thoughts and experiences of clinical tutors (CTs) about radiography students attending for clinical training and education during this now elongated period beyond first recognition of the virus has not been explored. This paper will discuss data collected from CTs in the UK Devolved Nations (UKDN) and the United Arab Emirates (UAE) who were compared because of their similarities in delivery based on individual 'rules of engagement' devised by their various health departments. AIM: The purpose of this study was to examine the clinical tutors' thoughts and experiences of supervising radiography students attending clinical placement during the COVID-19 pandemic. METHODS: The UK Devolved Nations (UKDN) and the United Arab Emirates (UAE) were selected for comparison on an international level as they are geographically distinct with a comparable population and education accredited/acknowledged by the Society and College of Radiographers (SCoR). Data was collected data from CTs across the UKDN and the UAE. The study used an online questionnaire (Google Forms) with closed questions in four themes including: students' experiences, impact on students' clinical placement, attitude of the clinical staff and the potential effects of COVID-19 on future graduates' skills and competencies. Further data was gathered on the experience of CTs mentoring students during the COVID-19 pandemic. RESULTS: Data were collected from 59 CTs (81%, n = 48) from UKDN and (19%, n = 11) UAE. Twenty-seven (46%) respondents reported that COVID-19 had a negative impact on clinical practical experience. However, 32 (54%) identified that COVID-19 had no impact on student supervision/feedback or on clinical achievements. Eleven (19%) respondents thought that students should not have been on clinical placement during the pandemic but a further 51% (n = 30) were happy with the students on placement and expressed willingness to delegate work to students. Interestingly, 58% (n = 34) of CTs suggested that future graduates may need a longer preceptorship after they graduate due to receiving decreased clinical experience during the pandemic. Overall, 78% (n = 46) of respondents thought that students improved their clinical confidence by working directly with COVID-19 positive patients. CONCLUSION: The current study has identified conflicting opinions across CTs in different clinical departments. Whilst some felt that students should not be in the hospital during the pandemic, others reported that working directly with COVID-19 patients had a positive impact on students as it improved their clinical confidence. Despite the challenges presented by COVID-19, CTs were able to provide direct clinical supervision and feedback to students on clinical placement throughout the pandemic. Nevertheless, future graduates may need a longer preceptorship period due to decreased clinical experience during the pandemic. IMPLICATIONS FOR PRACTICE: Clinical placements should continue during subsequent COVID-19 waves of infection or future pandemics to ensure development of skills in resilience and adaptability. Underdeveloped skills due to a decreased range of examinations can be rectified when any wave of the infection subsides by providing tailored training based on individual student's needs.

The radiography students' perspective of the impact of COVID-19 on education and training internationally: a across sectional survey of the UK Devolved Nations (UKDN) and the United Arab Emirates (UAE).

INTRODUCTION: The overnight change in hospital practice and service delivery during the COVID-19 pandemic raises the question whether undergraduate radiography students received an adequate clinical experience. Many students had their clinical placements cancelled, deferred or replaced with simulated learning. As a way of dealing with the pandemic some hospitals were dedicated to COVID-19 patients only resulting in many elective procedures being cancelled. Many patients also chose to stay away from the hospital out of fear of infection or the desire to reduce the burden on staff. This resulted in a limited range of examinations and clinical experience for those students who were able to complete their clinical placement. AIM: This study aims to investigate the impact of COVID-19 on the education and training of radiography students internationally in the United Kingdom Devolved Nations (UKDN) and the United Arab Emirates (UAE), to determine any possible impact on their future careers. METHOD: Ethical permission was sought and granted from the Research Ethics Committees (ID: 21-04-12-02 and ID:21/0032). An online survey was developed using Google Forms and link was shared with students via email. RESULTS: 262 students participated in the study [UAE (n = 60, 23%) and UKDN (n = 202, 77%)]. 72% stated that their clinical skills have improved and 82% were confident in the choice of radiography as a career. Participants from UAE displayed a higher tendency towards anxiety (p = 0.009). Students who were on clinical placements during the COVID-19 pandemic and worked with COVID-19 positive patients displayed less ongoing concern relating to COVID-19 (p = 0.004). 78% of the participants did not require wellbeing advice or request any type of wellbeing support from the higher education institutions (HEIs). Nevertheless, the study found that wellbeing of students was found to be negatively affected during the pandemic. CONCLUSION: Completing clinical placement during the COVID-19 pandemic allowed the continuation of education as students were allowed to improve their skills, confidence and resilience in coping with uncertainties and challenges. Undergraduate students should not be excluded from the clinical department during subsequent waves of COVID-19 or future pandemics to ensure continued workforce planning is possible. IMPLICATIONS FOR PRACTICE: HEIs should find solutions to compensate students for the loss of practical experience and skills due to the decreased number of patients in some areas of radiography practice. Providing academic and career counselling can assist students achieve their professional objectives and decrease the risk of attrition and problems upon qualification.

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.

Changing the model of radiography practice: Challenges of role advancement and future needs for radiographers working in the UAE.

INTRODUCTION: The radiographers' role in the United Arab Emirates (UAE) is focused on image acquisition with a willingness to accept advanced practice roles after appropriate education and training. Radiographers working in the UAE are highly motivated and ambitious to achieve those internationally identified levels of professional recognition and opportunities for role advancement. This study investigates the radiographers' perspectives, perceptions and hopes for role advancement in the UAE. METHODS: A qualitative research study design using Focus Group Discussions (FGD) was used to elicit the perceptions of radiographers. Participants were radiographers working in the hospitals and clinics supervised by the Ministry of Health and Prevention. Participants were asked about the recognized tasks defined as advancement roles, needs for roles clinically, challenges and requirements to prepare radiographers to participate in extended/developed roles. The discussions were audio recorded and later transcribed by an independent research assistant. Thematic analysis was used for data analysis RESULTS: 29 radiographers participated in the FGDs, and 83% (n = 24) were interested in role advancement. FGD revealed that their current practice showed some informal extended role that may promote career progression. The most significant challenges identified by participants was their knowledge level as provided by the current curriculum and the need for education and licensing body support to accommodate change. CONCLUSION: The study identified a need for education and licensing body support to enable change in roles by radiographers, through improving radiographer knowledge and experience for role advancement. IMPLICATIONS FOR PRACTICE: To sustain role advancement, formal intense training and education are necessary, normally above bachelor's degree level. Furthermore, establishing standards, licensing organizations/professional bodies should be part of the transformation of the profession to enable internationally recognized models to be followed.

Paediatric injuries around the knee: Soft tissue injuries.

We review the diagnosis, management and potential pitfalls of acute soft tissue injuries in the skeletally immature knee, including anterior cruciate ligament (ACL) injuries, meniscal injuries, patellar dislocation and patellofemoral instability (PFI). There has been an increasing incidence of such injuries in the paediatric population, and controversy remains regarding their treatment. We summarise evidence-based treatments for these injuries and discuss strategies to minimise complications as the child reaches skeletal maturity.

Long-term outcome after surgical treatment of Scheuermann's Kyphosis (SK).

STUDY DESIGN: A retrospective observational cohort study with a minimum follow-up of 10 years of patients who underwent surgery for Scheurmann Kyphosis (SK). OBJECTIVE: Evaluate the long-term clinical and radiological outcome of patients with SK who either underwent combined anterior-posterior surgery or posterior instrumented fusion alone. There is paucity of literature for long-term outcome studies on SK. The current trend is towards only posterior (PSF) surgical correction for SK. The combined strategy of anterior release, fusion and posterior spinal fusion (AF/PSF) for kyphosis correction has become historic relic. Long-term outcome studies comparing the two procedures are lacking in literature. METHODS: 51 patients (30 M: 21F) who underwent surgery for SK at a single centre were reviewed. Nineteen had posterior instrumentation alone (PSF) (Group 1) and 32 underwent combined anterior release, fusion with posterior instrumentation (AF/PSF) (Group 2). The clinical data included age at surgery, gender, flexibility of spine, instrumented spinal levels, use of cages and morcellised rib grafts (in cases where anterior release was done), posterior osteotomies and instrumentation, complications and indications for revision surgery. Preoperative flexibility was determined by hyperextension radiographs. The radiological indices were evaluated in the pre-operative, 2-year post-operative and final follow-up [Thoracic Kyphosis (TK), Lumbar lordosis (LL), Voustinas index (VI), Sacral inclination (SI) and Sagittal vertical axis (SVA)]. The loss of correction and incidence of JK (Junctional Kyphosis) and its relation to fusion levels were assessed. Complications and difference in outcome between the two groups were analyzed. RESULTS: The mean age at surgery for 51 patients was 20.6 years who were followed up for a minimum of 10 years (mean: 14 years; range 10-16 years). The mean age was 18.5 ± 2.2 years and 21.9 ± 4.8 years in groups 1 and 2, respectively. The mean pre- and 2-year post-operative ODIs were 32.6 ± 12.8 and 8.4 ± 5.4, respectively, in group 1 (p < 0.0001) and 30.7 ± 11.7 and 6.4 ± 5.7, respectively, in group 2 (p < 0.0001). The final SRS-22 scores in group 1 and 2 were 4.1 ± 0.4 and 4.0 ± 0.35, respectively (p = 0.88). The preoperative flexibility index was 49.2 ± 4.2 and 43 ± 5.6 in groups 1 and 2, respectively (p < 0.0001). The mean TKs were 81.4° ± 3.8° and 86.1° ± 6.0° for groups 1 and 2, respectively, which corrected to 45.1° ± 2.6° and 47.3° ± 4.8°, respectively, at final follow-up (p < 0.0001). The mean pre-operative LL angle was 60.0° ± 5.0° and 62.4° ± 7.6° in groups 1 and 2, respectively, which at final follow-up was 45.1° ± 4.4° and 48.1° ± 4.8°, respectively (p < 0.0001). The mean pre-operative and final follow-up Voustinas index (VI) in group 1 were 22.9 ± 2.9 and 11.2 ± 1.2, respectively, and in group 2 was 25.9 ± 3.5 and 14.0 ± 2.3, respectively. The mean pre-operative and final follow-up SI angle were 43.6° ± 3.3° and 31.2° ± 2.5° in group 1, respectively, and 44.3° ± 3.5° and 32.1° ± 3.5° in group 2, respectively (p < 0.0001). The pre-operative and final follow-up SVA in group 1 were - 3.3 ± 1.0 cms and - 1.3 ± 0.5 cms, respectively, and in group 2 was - 4.0 ± 1.3cms and - 1.9 ± 1.1cms, respectively (p < 0.0001). Though the magnitude of curve correction in the groups 1 and 2 was significant 36° vs 39° (p = 0.05), there was no significant difference in correction between the two groups. Proximal JK was seen in seven and distal JK in five patients were observed in the whole cohort. CONCLUSION: The long-term clinical outcomes for both PSF and AF/PSF are comparable with reproducible results. No difference was noted in loss of correction and outcome scores between the two groups. The correction of thoracic kyphosis (TK) had a good correlation with ODI. AF/PSF had much higher complications than PSF group. The objective of correcting the sagittal profile and balancing the whole spinal segment on the pelvis can be achieved through single posterior approach with fewer complications.

L-Dopa release from mesoporous silica nanoparticles engineered through the concept of drug-structure-directing agents for Parkinson's disease.

Parkinson's disease (PD) is a progressive neurodegenerative disease, the 2nd most common after Alzheimer's disease, the main effect of which is the loss of dopaminergic neurons. Levodopa or l-Dopa is an amino acid used in the treatment of PD that acts as the immediate precursor to dopamine. However, over time the efficacy of the medication gradually decreases requiring modified delivery methods. One of the major challenges for the medication to work is to achieve a gradual continuous supply of l-Dopa to the brain to minimise symptoms. Herein, mesoporous silica nanoparticles (MSNs) were engineered through the concept of drug-structure-directing agents (DSDAs) with inherent therapeutic activity. The DSDA used was l-Dopa drug modified by amidation with fatty acids to build anionic surfactants that were able to form micelles as templates for the assembly of inorganic precursors to form the silica framework. This templating route produced MSNs with tunable sizes ranging from 100 nm to 1 µm and with different shapes: spherical, with either solid structures with radial mesopores and porous shells, or hollow-shells with inside large void cavities; and elongated, characterized by long hollows covered by mesoporous shells. The concept of using DSDAs to synthesize drug nanocarriers can be used to avoid the surfactant removal and subsequent drug loading steps involved in the synthesis of conventional MSNs. We hypothesized that the l-Dopa released from MSN materials is mediated by the size and solubility of the DSDAs, and the surface chemical interactions between the DSDAs and MSN hosts. Different pHs (acidic and neutral) simulating gastrointestinal tract conditions were tested, and the results showed hardly any release for gastric conditions at pH 1.2, avoiding the premature release in the stomach typical of conventional MSNs, while for intestinal conditions of pH 7.4, the release of l-Dopa occurred in a continuous and sustained manner, which is well suited to the drug's application and delivery route, and matches well with achieving a sustained l-Dopa delivery to relief symptoms. This could open up new uses for MSNs synthesized by this approach to treat PD.

The effect of a digital training tool to aid chest image interpretation: Hybridising eye tracking technology and a decision support tool.

INTRODUCTION: Eye tracking technology, checklists and search strategies have been demonstrated as useful aids in image interpretation. A training tool was developed, by the research team, which included these features. This study aimed to evaluate the effect of the training tool on participant image interpretation performance. METHODS: The study was carried out with reporting radiographers who had either commenced training in chest image interpretation (n = 12) or were trained in musculoskeletal image interpretation (n = 23) (total n = 35). Participants were allocated to a control or intervention group. Participants completed an initial assessment at recruitment and re-attended nine months later for a follow-up assessment. The intervention group were given unlimited access to a digital training tool. During assessments participants interpreted 20 chest images whilst using eye tracking technology (total of 1400 images were interpreted). A confidence level was obtained from participants on their diagnosis and a questionnaire, to obtain demographic data, was completed following the assessment. RESULTS: Improvements were seen in the confidence of intervention group participants (p < 0.05). False Positive (FP) scores decreased for both the control and intervention group (p < 0.05), this decrease was from 4.20 to 3.20 for the control group and from 5.87 to 3.27 for the intervention group. True Negative (TN) scores increased, from 5.13 to 6.73 for the intervention group (p < 0.05). Mean decision time decreased for both the control and intervention group. CONCLUSION: The tool led to positive effects on participant performance and could be a useful aid in chest image interpretation learning. IMPLICATIONS FOR PRACTICE: Improvements in performance were observed with a digital tool. The tool could improve image interpretation methods and training.

Changing the model of radiography practice in the UAE: A snapshot of a profession in transition.

INTRODUCTION: This study forms part of a needs assessment in relation to the challenges United Arab Emirates (UAE) radiographers face as they move beyond the role of a technician, and their learning needs to facilitate role advancement. It presents a snapshot of the workforce in terms of qualifications, clinical experience, and responsibilities, as it transitions towards an Emirati, led profession. The results will aid the radiography workforce to embrace a broader role within medical imaging and radiographic practice in the UAE. METHODS: An electronically distributed cross-sectional study was conducted among radiographers in the UAE. The questionnaire captured radiographer demographics, qualifications, professional experience, postgraduate training, professional development plans, and their interest in future role developments. RESULTS: 272 radiographers were invited to participate with a response rate of 68% (n = 185). Thirty-four (18%) radiographers were UAE nationals with the remainder educated overseas. BSc qualifications were held by 153 (82.7%) and had 6-20 years of experience. There were 12 masters' qualified and two with doctoral qualifications. Modality vendors were significant providers of professional development. Improved job satisfaction and the development of an Emirati led radiography profession were identified as the main gains for role advancement by 171 (92.4%) respondents. CONCLUSION: Currently, UAE radiographers work within traditional professional boundaries focussing on image acquisition under direct radiologist supervision. At the same time, many respondents revealed they had embraced advanced practice roles after appropriate education and training. IMPLICATIONS FOR PRACTICE: The findings suggest an Emirati led profession requires the creation of a distinct professional body to represent the interests of radiographers, more investment in postgraduate education, and the creation of a career structure that encompasses positive role development.

Radiography doctorates in Arabia: Current position and opportunities to transform research practice in the Middle East.

INTRODUCTION: Despite the existence of opportunities for postgraduate studies in radiography, the number of radiographers involved in postgraduate education is low and their research production is also considered low compared to other professions. The main aim of this study was to understand the profile of radiography Doctorate holders across the Arab countries, document their current role and identify barriers that may influence research and professional publication activity. METHODS: There is no formal database of doctoral radiographers in Arab countries, therefore a snowball sampling technique was used to recruit participants beyond those identified through organizational websites. An online survey was distributed to the participants with implied consent being applied through completion of the survey. RESULTS: From 53 responses, 78% were male and 98% were diagnostic radiographers. Fifty-one percent completed their PhD in non-Arab countries and 55% self-funded (paid for themselves) their PhD study. An increase in doctoral students was observed over time, where 36% (n = 19) of participants will graduate in 2020 and afterward. Barriers reported as preventing radiographers pursuing research/publication were support, employing institutions, lack of research focussed leadership and lack of collaboration. CONCLUSION: Government support and direction from national professional bodies is needed. To enable research growth, there must be a foundational component within pre-registration/licensing education. IMPLICATIONS FOR PRACTICE: Focussing on government or professional body supported projects that are divided into smaller linked investigations can provide foundational work for PhD development. It is through these opportunities that practitioner research enhancement and capability is improved. Potential Arabian regional and wider international collaborations should be pursued in future as a developmental approach.

A longitudinal review of Scottish reporting radiographer output between 2015 and 2019.

INTRODUCTION: Scottish radiographer reporting has been slow in its initiation compared with the wider UK. However, healthcare delivery imperatives require improvement in meeting seamless imaging acquisition and reporting. Initiatives supporting radiographer reporting could be extended to meet gaps in radiology and wider health service provision. METHODS: Development drivers leading to a national reporting radiographer (RR) framework initiated this RR service analysis. All 14 Scottish health boards (and the waiting time centre) provided RR performance details, staffing make up and practice scopes between 2015 and 2019, with gap analyses performed via surveys to radiology managers in 2017 and 2019. Further expenditure data was provided by the National Procurement Directorate. RESULTS: A reporting radiographer census revealed details of changing levels of practice and areas of working within musculo-skeletal projection radiograph reporting. Gap analyses two years apart showed little wider service change and growing external reporting costs. Managers identified areas where RRs could reduce costs, shorten reporting timeframes and broaden service development potential across all staff. CONCLUSION: Scottish RRs have a growing cost effective role. To extend this, the radiographic workforce should embrace the various employment tiers and how this contributes to ideal patient pathway outcomes. Technical development and service transformation will drive future workforce change and has the potential to refocus radiographer roles with others to deliver seamless diagnostic and public health oriented services. IMPLICATIONS FOR PRACTICE: Current service demand is supported by RRs identifying themselves as advanced practitioners. To meet deficiencies in service delivery, broadened practice scopes are required spanning the different grades of the profession, supported by education approaches to meet national geographic and staffing issues.