1. Radiographer role extension: a paradigm shift in practice.
S Mathers*+, G McKenzie*,
+The Health Services Research Group, The Robert Gordon University, *NHS Grampian
Aberdeen, Scotland, UK.

2. Factors leading to radiographer role extension
Political
NHS organisations are accountable for continuously improving the quality of the service
New roles are encouraged to demonstrate innovations and (hopefully) improve quality
A First-class Service, Quality in the NHS, 1998

3. Staff ‘The traditional demarcations between staff have held services
back ...the provision of health services should depend on the
ability of the staff, not their job title.’
A Health Service for All Talents – Developing the NHS Workforce, Dept of Health, 2000

4. Radiology serious shortage of radiologists
increasing waiting lists for procedures
year on year increase of examinations performed
- additional demands on radiologist’s time

5. Guidance on delegation of tasks
Medical practitioners may delegate medical care to non-medical
health care staff – but the MP must be sure that the staff are
competent ... to carry out that task.
Such health care workers must be accountable to a statutory
body, i.e. state registered.
GMC, Good Medical Practice, 1995

7. Main areas of role extension
In the areas of
- GI, e.g. radiographer performed barium enemas
- Ultrasound, e.g. general diagnostic US, O&G
Intravenous injections of contrast media
- IVU, CT, nuclear medicine
Reporting of images
- skeletal, US, GI, nuclear medicine, mammography,
Angiography, e.g. peripheral angiograms

8. Training Initially hospital based Courses now University led
e.g. St James’ Leeds Barium Enema Course
Courses now University led
e.g. Salford University
You must have a supportive and enthusiastic radiologist

9. Requirements between Dept and Hospital Management
Letter of agreement of radiographer role extension
- task(s) delegated
- to whom delegated
- who is responsible
- name(s) of radiographer(s) involved and training
- name(s) of supervising radiologist(s)
Signed by clinical manager and Hospital Manager
Radiographer must be insured
- Trust Indemnity Insurance AND
- Personally (usually through SoR)

10. Radiographers experience of performing barium enemas
The main aims were to:
determine characteristics of radiographers who performed BE
establish current practices
- ascertain benefits and drawbacks of performing BE

11. Study design
Sample
- convenience sample of 68 radiographers (GIRSIG members)
Postal questionnaires
- total of 20 questions (17 closed)
- in 3 sections
performing BE
other duties
personal information

12. Results
71% response rate (n=48/68)

13. Characteristics mean age 43 years (range 25-56 years)
76% (n=34) female
24% (n=11) male

14. Motivation

15. % of total BE performed by radiographers in their department
more than 80%
50% - 80%
less than 50%

16. Reporting
16% (n= 7) reported own enemas without input from radiologists

17. Performing other fluoroscopy procedures

18. Main benefits of performing barium enemas
Increased job satisfaction
Providing better service for patients
Increased contact with other staff
Raised profile of profession
Increased knowledge and expertise

19. Main drawbacks of performing barium enemas
Radiologist attitude
Lack of recognition of responsibilities
Lack of radiography staff
Lack of time for reporting
Limitation of further CPD

20. Conclusions expectations have been fulfilled concerns do exist
implications for the expansion of the service

21. BUT there are obstacles
reluctance of radiologists to delegate tasks
increasing shortage of radiographers
reluctance of radiographers to embrace the use of assistant practitioners

22. - since 2003 training courses for technologists to
Experience outside UK
USA
- since 2003 training courses for technologists to
perform BE, intravenous injections etc
- they will be known as radiologist assistants
- do not want to report
New Zealand
- radiographers performing BE

23. Conclusions radiographers role extension becoming the norm in UK
number of specialty area increasing
increasing job satisfaction
new career pathways for radiographers
Assistant practitioner
Practitioner
Advanced practitioner
Consultant

24. Paradigm shift?
Radiographers should provide the utmost service for radiologists
Furby, Radiography, 1944
Radiographers can distinguish between normal and abnormal
Swinburne, Lancet, 1971
Radiographers can report fracture radiographs
Loughran, BJR, 1994
Radiographer performed BE provide an excellent quality examination
with results comparing favourably with published data (for radiologists)
Law et al, Clin Rad, 2002