Diagnostic accuracy of radiographer reporting of computed tomography colonography examinations: A systematic review

Reporting radiographers in CT and MRI: A literature review with a systematic approach

OBJECTIVES

The aim of this literature review is to provide an overview and synthesize the evidence on the role of reporting radiographers in CT and MRI, with a focus on their diagnostic accuracy, the education and training required for this role, and the challenges and opportunities associated with their integration into clinical practice.

KEY FINDINGS

Radiographers in CT and MRI reporting roles often achieve diagnostic accuracy comparable to radiologists, particularly for straightforward pathologies and as first readers. However, discrepancies are more common in complex cases, such as extracolonic findings in CT colonography or smaller polyps in MR colonography. Structured training, including postgraduate certificates, tele-training, and technology-enhanced learning, enhances radiographers' diagnostic accuracy and confidence. However, regional variation in training availability and standardisation limits broader implementation. Challenges to integration include legal and regulatory constraints, geographical training disparities, and concerns about misdiagnosis. Regular audits and mentoring are crucial to ensuring quality and addressing these concerns.

CONCLUSION

Radiographers have demonstrated the ability to achieve diagnostic performance comparable to radiologists in specific contexts, particularly when supported by structured training and mentorship. However, challenges such as variability in training opportunities, legal and regulatory constraints, and the risk of misdiagnosis persist. While the evidence highlights the potential of radiographer-led reporting to enhance diagnostic workflows, reduce radiologist workloads, and improve patient care, further research is needed to address these challenges and evaluate long-term impacts on clinical outcomes.

IMPLICATIONS FOR PRACTICE

Healthcare organisations should implement standardised training pathways to prepare radiographers for reporting roles. Collaborative models, where radiographers support rather than replace radiologists, can improve efficiency while maintaining quality. Policymakers must provide clear guidelines and funding to expand these roles, particularly in radiologist-shortage areas. Technological tools, such as AI-assisted reporting, can help radiographers manage complex cases. Equitable training opportunities, including remote learning and mobile apps, should address geographical disparities. Robust quality assurance protocols are essential to sustain confidence in radiographer-led reporting and enhance patient care outcomes.

The scope of practice for diagnostic radiographers in Singapore: A preliminary survey

INTRODUCTION

There has been an increased demand for medical imaging procedures through the years. This demand requires the diagnostic radiographers in the workforce to be equipped with adequate training and understanding of their roles. The aims of this research are to distill and further describe the current scope of practice as established by the Allied Health Professional Council and map the diffusion of tasks, roles and responsibilities within Singapore's radiography imaging modalities.

METHODS

A structured questionnaire was distributed to all diagnostic radiographers in Singapore through emails sent out by the Singapore Society of Radiographers. Information collected included respondents' duties in their respective imaging modalities, the professional tracks they specialised in, and their demographical information. Quantitative data analysis was conducted using SPSS and Fisher's Exact test of independence was used to determine correlations between variables.

RESULTS

A total of 120 questionnaire responses were obtained and after exclusion, 99 responses were analysed. It was observed that there was a significant positive correlation in radiography experience and performing specialised Computed Tomography examinations (p = 0.005). Additionally, higher radiographer designation was shown to be correlated with the ability to perform more specialised Ultrasound examinations (p < 0.001). The study demonstrated a diverse range of tasks by radiographers which was determined by education, disparity in experience, institutional practice and training provided.

CONCLUSION

This preliminary study on Singapore diagnostic radiographers provided valuable insight and mapping of their activities in several imaging modalities, allowing for future development of a scope of practice document for Singapore.

IMPLICATION FOR PRACTICE

The tasks undertaken by the diagnostic radiographers were integral to imaging service delivery and play a significant role in the advancement of radiography to further enhance the quality of patient care.

Difficulties associated with access to training and clinical support for Reporting Radiographers - A narrative evidence synthesis

OBJECTIVES

This narrative synthesis of evidence identifies and explores issues that impact upon the expansion or effectiveness of Reporting Radiographers working in all diagnostic modalities within the United Kingdom (UK). The publication focuses on accessibility to training for prospective Reporting Radiographers as well as clinical support within and beyond training.

KEY FINDINGS

Fifteen studies informed the themes of this article, they were published between 2014 and 2021. Reporting Radiographers often found it difficult find support during training and once qualified, this was usually due to the availability and workload of supervising staff. Although resistance and obstruction were experienced by many. Concerns relating to pay, promotion and interest were expressed by some respondents whilst access to courses and finance were highlighted as areas of variance across the UK.

CONCLUSION

Inadequate support of Reporting Radiographers is impairing expansion of the specialism, whilst impacting capability and morale. This increases risk of patient harm, delays to care and inefficiency, it also threatens the sustainability of services. Negative interactions between Reporting Radiographers and Radiologists or managers is disappointing considering development of the specialism; evidence of Reporting Radiographer effectiveness and current collaboration between Royal College of Radiologists and Society of Radiographers. Issues raised in relation to pay/promotion and litigation could be clarified with ease, this should be considered when guidance is updated. Access to finance and courses is a major barrier in some regions of the UK. Scope exists for further exploration of training. England has used grants to facilitate uptake, these may prove to be an important tool in other countries.

IMPLICATIONS FOR PRACTICE

Drivers to increase recruitment should be implemented alongside measures to facilitate accessibility to training and improvements to support infrastructure.

What is the impact of CT colonography interpretation by advanced practitioner radiographers on delivery of the 28 day colorectal cancer target?

INTRODUCTION

CT Colonography (CTC) is an indicated test to assess the colon and rectum for evidence of polyps and neoplasms. The advanced practitioner radiographer (APR) is increasingly involved with the entirety of the radiology pathway including procedural modification, preliminary clinical evaluation (PCE) and multi-disciplinary team (MDT) meeting notification of high risk colonic pathologies.

METHODS

A retrospective audit of the Radiology Information System (RIS) was undertaken at a large secondary care centre, 12 months of data of 119 consecutive patients who had undergone CTC with summary coded reports of high risk pathology were included for analysis. Analysis of accuracy of procedural modification, PCE and impact of hypothesised earlier full radiological staging data being available for MDT discussions were measured and evaluated.

RESULTS

For high risk C4b studies, just 16.67% of colonic pathology was observed during the CTC study, rising to 79% during radiographer PCE. For likely colonic neoplasm C5a studies 86% of colonic pathology was observed during the CTC study, rising to 93% during radiographer PCE. Where subsequent CT chest staging was deemed necessary following CTC by the referring team, patients had a median wait of 34 days for completion CT chest scan staging.

CONCLUSION

This study supports the integration of the advanced practitioner radiographer into the entire radiological processes of a CTC, with time advantages apparent for both diagnostics, but also the decision to treat.

IMPLICATIONS FOR PRACTICE

Appropriately trained radiographers are able to support CTC services to ensure delivery of an effective two-week wait diagnostic service with direct MDT liaison.

Written Observations as a Part of Computed Tomography Angiography Post Processing by Medical Radiation Technologists: A Pilot Project

BACKGROUND

A facility faced a local backlog of computed tomography angiography (CTA) results. During post processing, technologists review the CTA images and may consider pathology demonstrated. This is an excellent scenario for a clinical observation as part of an advanced practice role.

METHOD AND MATERIALS

Five hundred seventeen CTA examinations were performed during the project period. The medical radiation technologist post processed and included observations for 78 CTA examinations. The impact on the timely release of results was considered. The analysis compared the time frame from actual scan completion to results transcribed for both CTA examinations processed and reported by a radiologist only versus those post processed with written observations by the technologist. Evaluations against both a small pool of two radiologists as well as a larger pool of five radiologists are included. Radiologists involved with the project completed a stakeholder evaluation form.

RESULTS

The five radiologist groups' mean time to results (TTR) was 7.77 days. The CTAs with written observations had a mean TTR of 14.73 days. The two radiologist groups had a mean time to results of 19.69 days. Thus, the CTAs with the written observations provide some efficiency in timely results when compared with a smaller radiologist workforce.