Image interpretation – digital learning


to support traditional training Nick Woznitza, Dorothy Keane


Radiology services have seen an unprecedented rise in workload across the United Kingdom, with exponential growth over the last decade1


. T


his increase in activity has been driven by an ageing population, the expansion of high technology imaging and renewed focus on the early diagnosis and treatment of cancer2


. Furthermore, ultrasound


as part of radiology services has seen sustained and increasing demand in traditional areas such as abdominal and paediatric examinations as well as growth in the range of applications performed outside the radiology department, such as in emergency, respiratory, intensive care, and sports medicine3,4


. Emerging


technologies that cross the boundaries of traditional modalities, such as positron emission tomography combined with computed tomography (CT) and magnetic resonance imaging (MRI), have also contributed to increases in imaging examinations; and have also challenged the traditional teaching and mentoring structure of higher education and the NHS5


. These sustained, indeed escalating, pressures are occurring


during times of increased public and political focus on the delivery of safe, effective and patient focused radiology services in the wake of the Francis Report6


.


Radiographers are pivotal members of the healthcare team and are usually the first practitioners to see the diagnostic image7


momentum through the patient journey. The current pressures facing the NHS, rising emergency activity and delayed patient discharge, magnify bottlenecks and barriers to efficient service delivery8


effective and efficient delivery of care that minimises ‘double-handling’ of patients and seeks to always continue patients through their care pathway is paramount. With the move to seven-day working and the extended provision of specialist imaging modalities9,10


and clinical reporting, support efficient and patient focused radiology and remove barriers to delayed diagnosis.


-36- . Radiographers are aware of the pressures of rising demand and the need to maintain . The need for , the ability of radiographers to interpret the images


that they acquire will only increase, to optimise patient care and to instigate appropriate referral pathways, when serious or unexpected findings are encountered11


. Radiographer preliminary clinical evaluation (PCE)


Background Interpretation of radiographs and other imaging procedures by radiographers is not a new concept. The pioneering work of Berman et al12


demonstrated that when radiographers, operating as part of an emergency


department team, flagged possible abnormalities on skeletal radiographs, there was enhanced fracture detection and improved patient care. The review conducted by Brealey and colleagues, found that radiographers without postgraduate qualifications in clinical reporting had high levels of accuracy when detecting abnormalities on trauma radiographs; sensitivity 87% and 92% specificity13


.


The ‘red dot’ or abnormality detection system, where radiographers highlight a suspected abnormality on a radiograph by using a red sticker, has become embedded in many imaging departments14 patient care. However, a simple image flag is ambiguous11


and has improved and may not have sufficient impact on patient


management. In response to these shortcomings, the College of Radiographers has emphasised the need to move from the red dot system into PCE, in which radiographers provide concise written summaries of their imaging findings on plain radiographs11


. Replacing the 'red dot' with a written interpretation overcomes many


of the shortfalls of the red dot system, however PCE has shown relatively slow uptake across the UK (only 20 of 137 departments)14


. There are a number of logistical issues to be overcome, but there are also other barriers to


the implementation of radiographer PCE, particularly ensuring that radiographers are educated for, competent and confident in undertaking PCEs. Several studies have examined the confidence of radiographers when providing initial image interpretation and have found lower radiographer confidence when participating in PCE rather than abnormality detection15,16


. However, when compared to junior medical staff and emergency nurse


practitioners, radiographers were the only group whose confidence reasonably correlated with their interpretation performance17


. This is important as it demonstrates that some professionals who are expected to act on their


findings may, in fact, be acting on erroneous evaluation of the imaging investigation. These professionals clearly need educational support to improve their performance and the Society and College of Radiographers and the e-Learning for Healthcare Image Interpretation project offers this. Plain imaging is not the only modality where radiographers have a positive impact on patient care through image interpretation and clinical reporting. Sonographers, most of whom are radiographers in the UK, provide a significant contribution to the delivery of an effective ultrasound service, and have been providing independent


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