RESUMO
INTRODUCTION: Radiographer commenting is a written account of suspected abnormalities identified on medical imaging examinations by the radiographer at the time of image acquisition. Radiographer comments were originally implemented to support emergency clinicians; however, they may also have the potential to support radiologists in reducing missed findings. Therefore, the aim of this study was to investigate if a newly implemented radiographer comment system could reduce the number of errors made in radiology reports for general X-rays. Incidental findings from multisite collaborative research led to the hypothesis that in some cases radiographer comments could accurately detect abnormal X-ray appearances that were not otherwise documented in the radiologist report, thereby enabling results to be revised and errors collaboratively reduced [1]. METHODS: This study was conducted at an 800-bed hospital, where 92% of general radiographers self-selected to participate. Radiographer comments were provided to referring physicians through the electronic medical record and could be made for any emergency or inpatient general X-ray examinations. All comments made over a 12-month period were audited against the corresponding radiologist report. Radiologists were blinded to radiographer comments at the time of reporting. Where discrepancies between the radiographer comment and radiologist report arose, additional radiologist review or subsequent imaging reports were used to determine the accurate interpretation. The number of discrepant radiographer comments that were deemed true positive (TP) and provided new and correct diagnostic information compared to the radiologist report were identified. These were converted to a percentage of total radiographer comments that were therefore able to positively influence radiologist report accuracy. The number of discrepant cases where radiographer comments were deemed false positive (FP) was also measured and converted to a percentage of the total comments. Confidence intervals for both TP and FP binomial proportions were calculated using the Wilson Score Interval. RESULTS: Over 12 months, 282 radiographer comments were made to alert clinically significant radiographic appearances on general X-ray. Of these, 32 radiographer comments were discrepant with the report. Of these 32 comments, 24 were deemed TP meaning they correctly identified a pathological imaging appearance that was not otherwise documented in the radiology report. Therefore, 8.5% of all radiographer comments added value by correctly identifying a pathology that was not otherwise documented, 95% CI (5.8% - 12.4%). This enabled results to be promptly amended and reporting errors collaboratively reduced. Conversely, eight (2.8%) radiographer comments were discrepant with the report but deemed FP and did not add value to the investigation, 95% CI (1.4% - 5.5%). The remaining 250 non-discrepant comments did not contribute to error reduction but provided real-time abnormality detection that benefitted managing teams. CONCLUSION: These findings are consistent with previous literature proposing radiographer comments may provide a safety net for radiologists due to factors such as direct patient contact, ability to expand on clinical history, and difference in accumulated expertise. This study demonstrates that radiographer comments may be effectively used as a multidisciplinary error-reduction tool to assist radiologists in their important role and improve clinical outcomes.
RESUMO
The Medical Radiation Practice Board of Australia (MRPBA) minimum competency framework requires all Australian radiographers to identify significant pathology in radiological images and take appropriate action to alert these urgent findings and ensure patient safety. Despite professional bodies endorsing the provision of preliminary image evaluations (PIE) in written format, radiographer image interpretation often remains inconsistent, informal, or undocumented. The purpose of this narrative review was to assess the literature to determine if PIE in the form of written radiographer comments is of value to the Australian healthcare system. A structured search was completed using four health research databases: CINAHL, Medline, Scopus and Web of Science. Studies have suggested that there is a contextual need for commenting due to increased imaging service pressures, radiologist shortages and subsequent reporting delays. Radiographers appear well placed and willing to provide accurate initial input with evidence that this would be valued and appreciated within the multidisciplinary team. Radiographer commenting has also been shown to reduce diagnostic and communicative errors with the potential to improve patient management. Finally, it was shown that participation in image interpretation practices can enhance recruitment, retention and job satisfaction among radiographers. Therefore, the current literature supports implementation of radiographer commenting within the Australian healthcare system.