Interpretation of clinical imaging examinations by radiographers: a programme of research

Piper, K. (2014) Interpretation of clinical imaging examinations by radiographers: a programme of research. Ph.D. thesis, Canterbury Christ Church University.


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Studies which have investigated the interpretation of plain skeletal examinations by
radiographers have demonstrated encouraging findings, however, the studies have not
extended beyond this area of practice and radiographers' diagnostic performance for other
more complex investigations has not been established. Comparisons of performance
between groups of healthcare practitioners to date, has also been limited.

This research programme aimed to investigate the interpretation of clinical imaging
examinations by radiographers, and other healthcare practitioners, in the provision of initial
interpretations and/or definitive reports of plain imaging ( skeletal and chest) and crosssectional
( magnetic resonance imaging [MRI] – lumbar/thoracic spine, knees and internal
auditory meati [IAM]) investigations.

The eight studies utilised a variety of methodological approaches and included quasiexperimental
and observational studies. One quasi-experimental study compared the
performance of radiographers, nurses and junior doctors in initial image interpretation and
another similar study included a training intervention; both utilised alternate free-response
receiver operating characteristic curve (AFROC) methodology. Three of the observational
studies investigated the ability of radiographers to provide definitive reports on a wide range
of clinical examinations, including chest and MRI investigations, in a controlled environment.
One large multi-centre observational study investigated the performance of radiographers, in
clinical practice (A/E: skeletal examinations) during the implementation of a radiographic
reporting service. The agreement between consultant radiologists' MRI reports of
lumbar/thoracic spine, knee and IAM examinations was investigated in another observational
study. The final study compared the reports of trained radiographers and consultant
radiologists, with those of an index radiologist, when reporting on MRI examinations of the
knee and lumbar spine, as part of a prospective pre-implementation agreement study.

The first AFROC study demonstrated statistically significant improvements after training, for
radiographers (A1=0.55 - 0.72) and nurses (A1=0.65 - 0.63), although the radiographers
maintained a better overall performance post training (p=0.004) in providing an initial image
interpretation of trauma radiographs of the appendicular skeleton. Radiographers also
achieved statistically higher (p<0.01) AUC values (A1=0.75) than nurses (A1=0.58) and
junior doctors (A1=0.54) in the second AFROC study.
Three studies, which examined 11155 reports, were conducted under controlled conditions
in an academic setting and provided evidence of radiographers’ high levels of accuracy in
reporting of skeletal A/E (93.9%); skeletal non A/E (92.5%); chest (89.0%); MRI
lumbar/thoracic spine (87.2%), knees (86.3%) and IAM (98.4%) examinations.
In the multi-centre clinical study, the mean accuracy, sensitivity and specificity rates of the
radiographers reports (n=7179) of plain examinations of the skeletal system in the trauma
setting was found to be 99%, 98% and 99%, respectively.
The considerable range of values for agreement, between consultant radiologists reports of
MRI examinations of the thoracic/lumbar spine (k=0 – 0.8), knee (k=0.3 – 0.8) and IAM
(k=1.0) was similar to other studies and resulted in a reasonable estimation of the
performance, in the UK, of an average non specialist consultant radiologist in MRI reporting.
In the final study, radiographers reported in clinical practice conditions, on a prospective
random sample of knee and lumbar spine MRI examinations, to a level of agreement
comparable with non-musculoskeletal consultant radiologists (Mean difference in observer
agreement <1%, p=0.86). Less than 10% of observers' reports (radiographers and
consultant radiologists) were found to be sufficiently discordant to be clinically important.

The outcomes of this research programme demonstrate that radiographers can provide initial
interpretations of radiographic examinations of the appendicular skeleton, in the trauma
setting, to a higher level of accuracy than A/E practitioners. The findings also provide
evidence that selected radiographers with appropriate education and training can provide
definitive reports on plain clinical examinations (A/E and non A/E referral sources) of the
skeletal system and the chest; and MRI examinations of the knee, lumbar/thoracic spine and
IAM to a level of performance comparable to the average non specialist consultant
radiologist. Wider implementation of radiographer reporting is therefore indicated and
future multi-centre research, including economic evaluations, to further inform practice at a
national level, is recommended.

Item Type: Thesis (Doctoral)
Subjects: R Medicine > RC Internal medicine > RC0071 Examination. Diagnosis including radiography
Divisions: Faculty of Health and Wellbeing > School of Allied Health Professions
Depositing User: Mr Andrew Hudson
Date Deposited: 28 Apr 2015 12:24
Last Modified: 21 Sep 2016 09:46

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Last edited: 29/06/2016 12:23:00