1. Radiographer Reporting Presented by Chan Tsz Chun 02373683d Ng Kwan Ho 02435819d Wong Kin Long, Gulliver 02710632d

2. Objective Reasons for radiographer reporting Reasons for radiographer reporting Purpose of the study Purpose of the study Methodology Methodology Justification of the study Justification of the study Result and suggestion for the current practice Result and suggestion for the current practice

3. Reasons for reporting All radiographic examinations accompanied by written report All radiographic examinations accompanied by written report Timely, accurate and appropriate Timely, accurate and appropriate Few radiology departments provide 24 hour reporting service Few radiology departments provide 24 hour reporting service Reports turn round quickly Reports turn round quickly Insufficiently fully trained clinical radiologists to undertake all procedures Insufficiently fully trained clinical radiologists to undertake all procedures

4. Purpose of the study Non medically trained staff (radiographers) undertake reporting Non medically trained staff (radiographers) undertake reporting Under supervision on selected groups of examinations (skeletal radiographs) Under supervision on selected groups of examinations (skeletal radiographs) Radiographers increasingly involved in image interpretation Radiographers increasingly involved in image interpretation Errors and variation in interpretation now represents weakest area of clinical imaging Errors and variation in interpretation now represents weakest area of clinical imaging Measure film reading performance of radiographers Measure film reading performance of radiographers

5. Methodology Two radiographers (work independently) incorporated into radiologist rota for film reporting sessions. Two radiographers (work independently) incorporated into radiologist rota for film reporting sessions. Access to radiologist reported model, pervious reports and radiographic records Access to radiologist reported model, pervious reports and radiographic records Full text description for significant abnormalities, normal variants & current attendance (degree & recent fracture) Full text description for significant abnormalities, normal variants & current attendance (degree & recent fracture)

6. Sample size 11322 examinations 11322 examinations Systematic sampling (A&E skeletal examination) preview by A&E staff Systematic sampling (A&E skeletal examination) preview by A&E staff Excluded injuries severe enough to require immediate admission to hospital (in-patient) Excluded injuries severe enough to require immediate admission to hospital (in-patient) Overt fractures treated in A&E with referral to next available fracture clinic for early follow up Overt fractures treated in A&E with referral to next available fracture clinic for early follow up Aim to detect abnormalities missed by initial A&E review (high normal findings) Aim to detect abnormalities missed by initial A&E review (high normal findings)

7. Outcome assessment Hypothesis- initial report missed bony injury to cause persistent symptoms. Hypothesis- initial report missed bony injury to cause persistent symptoms. Re-attend for further examination related to original injury (radiographic or other procedures) Re-attend for further examination related to original injury (radiographic or other procedures) Follow up period- 18months Follow up period- 18months Detect false negative of the index report Detect false negative of the index report Review discrepancy for subsequent report Review discrepancy for subsequent report

8. Limitation Exclusion of the sample Exclusion of the sample Study population composed of negative or equivocal finding or relatively minor injuries (more difficult subtle cases) Study population composed of negative or equivocal finding or relatively minor injuries (more difficult subtle cases) Not directly applied to unselected A&E cases Not directly applied to unselected A&E cases Missed false negative patients for not re- attending (heal spontaneously or chronic) Missed false negative patients for not re- attending (heal spontaneously or chronic) Large proportion re-attendant, elsewhere Large proportion re-attendant, elsewhere

9. Justification Measuring radiographers' performance in controlled conditions in comparison with a reference standard is an assessment of validity Measuring radiographers' performance in controlled conditions in comparison with a reference standard is an assessment of validity Radiologists as gold standard Radiologists as gold standard Receiver operating characteristic (ROC) curve analysis for the radiographers and consultant radiologists when reporting Receiver operating characteristic (ROC) curve analysis for the radiographers and consultant radiologists when reporting

10. Justification Magnitude of inter-observer variation between consultant radiologists Magnitude of inter-observer variation between consultant radiologists Single radiologist's report should not be classified as the reference standard Single radiologist's report should not be classified as the reference standard Unless consultant radiologist with extensive experience in specific Unless consultant radiologist with extensive experience in specific Radiographers have also attained levels of accuracy Radiographers have also attained levels of accuracy

11. Another approach Search behaviour techniques Search behaviour techniques Perceptual errors occur when an observer fails to identify an abnormality Perceptual errors occur when an observer fails to identify an abnormality Radiographers comparable patterns of search strategies to radiologists Radiographers comparable patterns of search strategies to radiologists Level of accuracy comparable to radiologists Level of accuracy comparable to radiologists Assessment on subsequent effect of these reports on clinicians diagnosis and treatment plans and patient outcome Assessment on subsequent effect of these reports on clinicians diagnosis and treatment plans and patient outcome

12. Result Just under one half of patients not re-attend Just under one half of patients not re-attend For re-attended population (other half) Majority (over 80%) underwent unrelated examinations at subsequent attendance Majority (over 80%) underwent unrelated examinations at subsequent attendance 10% re-attended for repeat radiographs of same area or related examinations 10% re-attended for repeat radiographs of same area or related examinations

13. Related examination population 97% of follow up examination 97% of follow up examination Second and subsequent reports concordant to index reports. Second and subsequent reports concordant to index reports. Whether positive or negative suggestion Whether positive or negative suggestion Only four cases patients re attended for examinations related to original injury Only four cases patients re attended for examinations related to original injury Consultant suggested discrepant interpretations for wording of index reports Consultant suggested discrepant interpretations for wording of index reports

14. Suggestion for current practice With appropriate training & supervision With appropriate training & supervision Radiographers interpretation with high level of accuracy Radiographers interpretation with high level of accuracy Selection of particular ability & motivation (may not be widely applied) Selection of particular ability & motivation (may not be widely applied) Unselected radiographs or more complex imaging studies are uncertain Unselected radiographs or more complex imaging studies are uncertain Red dot system as initiative approach Red dot system as initiative approach

15. Reference Brealey, S. (2003). Accident and Emergency and General Practitioner plain radiograph reporting by radiographers and radiologists: a quasi-randomized controlled trial. The British Journal of Radiology, 76, 57-61. Brealey, S. (2003). Accident and Emergency and General Practitioner plain radiograph reporting by radiographers and radiologists: a quasi-randomized controlled trial. The British Journal of Radiology, 76, 57-61. Brealey, S. (2002). Methodological standards in radiographer plain film reading performance studies. The British Journal of Radiology, 75, 107–113 Brealey, S. (2002). Methodological standards in radiographer plain film reading performance studies. The British Journal of Radiology, 75, 107–113 Brealey, Stephen. (2001). Measuring the Effects of Image Interpretation: An Evaluative Framework. Clinical Radiology 56: 341- 347. Brealey, Stephen. (2001). Measuring the Effects of Image Interpretation: An Evaluative Framework. Clinical Radiology 56: 341- 347. Robinson, PJA. (1999). Interpretation of selected accident and emergency radiographic examinations by radiographers: a review of 11000 cases. The British Journal of Radiology, 72, 546-551. Robinson, PJA. (1999). Interpretation of selected accident and emergency radiographic examinations by radiographers: a review of 11000 cases. The British Journal of Radiology, 72, 546-551.