Comparison between radiographers with sonography education working in remote Australia and radiologists' interpretation of ultrasound examinations.

INTRODUCTION: Radiographers working in remote Far North Queensland (FNQ), Australia, need to possess unique skills sets in order to provide culturally safe practice to predominantly Indigenous communities. Due to the lack of onsite radiologists in FNQ, radiographers need to provide preliminary findings to referring practitioners including sonographic findings. The accuracy of such findings has not been evaluated to date. The objective of this study was to compare the level of agreement and recommendations for further investigations of FNQ radiographers to teleradiologists' reports. As radiographic findings are not recorded or stored as part of routine practice, only sonographic findings were included in the study. METHODS: Consecutive de-identified ultrasound cases were extracted between January and March 2019 inclusively by an independent investigator. The researcher scored the ultrasound cases between 1 and 4 according to levels of agreement between sonographic findings and teleradiologists' reports, and recommendations between radiographers and teleradiologists were also compared using frequency analysis. RESULTS: Five-hundred and thirty-two ultrasound cases were included for this study. Of those, 517 (97.2%) were in complete agreement and 15 (2.8%) reported minor discrepancies. There were no moderate or major discrepancies suggesting an overall accuracy rate of 100% as the radiographer/sonographer findings were in close agreement with the teleradiologists' reports. There was complete agreement regarding further clinical recommendations in 453 (85%) cases. The discrepancy in the remaining 15% of cases did not lead to any adverse or changed patient management. CONCLUSIONS: This study supports existing evidence about the accuracy and timely communication of sonographic findings to radiologists and other health care professionals, in keeping with the Medical Radiation Practice Board of Australia expectations. It is likely that radiographer comments on plain radiographic images are equally as reliable, but this remains to be explored.

Improvement of radiographer commenting accuracy of the appendicular skeleton following a short course in plain radiography image interpretation: A pilot study.

INTRODUCTION: Radiographers are at times required to provide preliminary information on plain radiography when significant findings are identified. The aim of the study was to evaluate the effectiveness of two short training modules to improve the accuracy of image interpretation of the appendicular skeleton amongst a group of radiographers. METHODS: Eight radiographers volunteered to participate in the study. All undertook a pre-test and, following delivery of course materials, an immediate post-test for two consecutive modules. A retention test was undertaken 6 months later. Sensitivity (Sn), specificity (Sp) and accuracy (Acc) scores were evaluated against the "Gold Standard" radiologists' reports. Paired-samples t-tests were carried out to compare image interpretation scores between the start of module one to the end of module two, and between the end of module 2 and 6 months later. Summary receiver operating characteristics (SROC) scores on each of the participants' module two post-test study results were undertaken. RESULTS: Significant improvements in scores were achieved between the mean (SD) scores of module 1 pre-test (77.5 (±3.9)) and the module 2 post-test (83.6 (±3.2) (P =0.022)). Sn, Sp and Acc scores increased from the start of module 1 pre-test to the end of module 2 post-test (Sn: 82.28-86.25%; Sp: 75.29-84.66%; Acc: 81.68-85.97%). The retention test revealed a non-significant reduction in mean scores (80.0 (±5.1)) when compared to post-test module 2 (83.6 (±3.2) (P =0.184)). SROC revealed an area under the curve of 0.90. CONCLUSION: Participants achieved significant improvements in commenting accuracy on plain radiography of the appendicular skeleton after completion of the two modules. However, continuous application and ongoing professional development is essential in order to maintain and develop the skills acquired.

Justification of radiographic examinations: What are the key issues?

Justification of radiographic examinations is the practice of evaluating requested radiological examinations to assess for clinical merit and appropriateness based on clinical notes and patient information. This implies that justification in radiography requires the evaluation of requested examinations, the justification of exposures being applied and determining whether patients fit the recommended criteria for the procedure. Medico-legal requirements by the professional registration body, the Medical Radiation Practice Board of Australia (MRPBA), identify justification as an advocated and obligatory practice for radiographers. Yet, justification remains an inconsistent practice implemented amongst Australian radiographers. This review aims to identify associated barriers inhibiting the consistent practice of justification and the hesitance by radiographers in practicing justification responsibilities. It also recommends a change in workplace culture which encourages radiographers to accept a more autonomous role that cultivates critical thinking, reflection and research-informed decision making as justification will ultimately benefit patients.