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In the United Kingdom, radiographers with a qualification in image interpretation have interpreted mammograms since 1995. These radiographers work under the title of radiography advanced practitioners (RAP) or Consultant Radiographer. This study extends upon what has been very recently published by exploring further clinical, non-clinical and experiential factors that may impact the reporting performance of RAPs. Fifteen RAPs interpreted an image test set of 60 2D mammograms of known truth using the Detected-X software platform. Unknown to the reader, twenty cases contained a malignancy. Sensitivity, specificity, lesion sensitivity, receiver operating characteristic (ROC) and jack-knife free response operating characteristic (AFROC) values were established for each RAP. Specific features that had significant impact on accuracy were identified using Student's-T and Mann Whitney tests. RAPs with more than 10 years' experience in image interpretation, compared to those with less than 10 years' experience, demonstrated lower specificity (51.3% vs 84.8%, p = 0.0264), ROC (0.83 vs 0.91, p = 0.0264) and AFROC (0.75 vs 0.87, p = 0.0037) values. Further, higher sensitivity values of 90.7% were seen in those RAPs who had an eye test in the last year compared to those who had not, 82% (p = 0.021). Other changes are presented in the paper. These data reveal previously unidentified factors that impact the diagnostic efficacy of RAPs when interpreting mammographic images. Highlighting such findings will empower screening authorities to better examine ways of standardising performance and offer a baseline for performance benchmarks. This study for the first time performs an initial exploration of the factors that may be associated with RAP performance when interpreting screening mammograms. [ABSTRACT FROM AUTHOR]

Advanced practice is well established in the health professions with multiprofessional capabilities in place in England. To recognise achievement of these capabilities an ePortfolio (supported) route was initiated in 2022. This study aimed to review the demographics and experiences of radiographers applying for recognition in the first year of operation. The multi method evaluation consisted of quantitative data analysis of information regarding the first three cohorts of radiographers (n = 40) participating in the NHS England (NHSE) scheme. Interviews with 12 participants was undertaken with thematic analysis of the transcripts. Self-rated scores of expertise were significantly higher by therapeutic radiographers (n = 8) compared to their 32 diagnostic colleagues (t = 5.556; p < 0.01). Radiographers saw the ePortfolio as an opportunity to validate their experience and to evidence parity with other professions. Participants felt the process also enabled critical reflection and gave unseen insight into themselves and their roles. The support of experienced educational supervisors was felt to be vital in this process and for successful completion of portfolio. Several radiographers have now achieved the necessary standards to achieve NHSE recognition. The evaluation exposed that most radiographers did not have the relevant evidence to hand and the ongoing collection of evidence around capabilities and impact is critical to evidencing advanced practice capabilities. Radiographers are able to achieve the capabilities expected for multiprofessional practice. Cultural change is required to normalise recording of evidence within practice including case-based discussions, clinical supervision and feedback from colleagues and patients. The support of an experienced educational supervisor aided the critical reflection on practice level. [ABSTRACT FROM AUTHOR]

This paper presents motivational factors to engage, start a research project and pursue a research career. The study aimed to investigate radiographer's motivation for engaging in research. Eight radiographers from Denmark with experience in research were interviewed in a 2-h focus group interview in October 2023. This qualitative approach was selected to allow the participants to discuss their opinions and values. The discussions were audio recorded and transcribed before the thematic analysis was performed. The analysis revealed six main themes: the importance of radiographic research, the importance of radiographers' participation in research, research radiographers' motivation, funding and participation in research projects, demotivation and difficulties, and facilitating radiographic research in the future. The participants were motivated by different factors. The participants found both research in radiography and radiographers' participation in research-related activities important, although they found lack of support from managers, funding, and time to be demotivational factors. This study contributes to the limited literature on motivational factors for becoming a researcher within radiography. [ABSTRACT FROM AUTHOR]

Non-medical professionals in the United Kingdom (UK) have been granted prescribing rights to improve patient care quality and cost-effectiveness. There is limited evidence on how therapeutic radiographer prescribers have impacted medicine management or patient services. An online survey was conducted amongst non-medical prescribing therapeutic radiographers in the UK between 2019 and 2022. The study teams initially analysed the individual data sets, subsequently combined, and secondary analysis was performed to provide a UK perspective, to understand the services provided and identify areas for improvement. Data was analysed using descriptive statistics from Microsoft Excel® and SPSS®. 74 non-medical prescribing therapeutic radiographers who were predominantly over 40 years old and in full-time work participated. The main job categories were consultant radiographers (n = 23, 31.1%) and advanced practice practitioners (n = 18, 24.3%). Many use their prescribing qualifications (87.5%, n = 62), issuing a mean of 15 independent and seven items by supplementary and prescribing per week. Most received assessment and diagnostic skills training before prescribing courses (91.6%, n = 67). Respondents prescribed from a median of six areas, with the highest being in GI (82%), skin (68%), infections (58%), urinary tract disorders (55%) and ear, nose, and oropharynx conditions (54%). This study presents the first report on therapeutic radiographers prescribing in the UK, offering insights into current practices and highlighting the success of non-medical prescribing. Therapeutic radiographers' roles continue to expand into advanced practice and medicine-prescribing responsibilities, contributing to holistic and patient-centred care. The results are relevant for nations grappling with oncology workforce shortages and contemplating similar roles for therapeutic radiographers. The study can be a valuable resource for policymakers and healthcare organisations worldwide. [ABSTRACT FROM AUTHOR]

Adapting radiotherapy services with workforce innovation using skills-mix or task-shifting optimises resources, supporting current and future demands. Advanced practitioners (APs) work at a different level of practice (beyond initial registration) across four pillars: clinical practice, leadership and management, education, and research. There is limited cross-country research on the advanced therapeutic radiographers/radiation therapists (TR/RTTs), particularly in Europe. This study aimed to investigate European radiotherapy stakeholders' perceptions regarding current and future advanced practice (AP). From June to September 2022, one-to-one online semi-structured interviews were conducted in English, and audio and video were recorded. Full verbatim audio files were independently transcribed and checked by interviewer and interviewees. Braun and Clarke's seven steps guided the thematic analysis (using NVivo). Thirty-three interviewees working or studying in 16 European countries represented practitioners (n=14), managers (n=6), educators (n=4), professional bodies (n=4), students (n=3), and regulators (n=2). Four overarching themes emerged: "AP drivers and outcomes", "AP challenges vs enablers", "Current vs future AP", "Becoming and being advanced practitioner". Participants identified research as the neglected AP pillar due to a lack of protected time, limited staff skills, no research culture, no funding, workload, and clinical priorities. Interviewees highlighted the importance of consistency in job titles, harmonisation of education models and curricula, definition of AP requirements, and support for all AP pillars through job plans and workforce planning. Neither the profession nor education of TR/RTTs are harmonised across Europe, which is highly reflected in advanced-level practice. Advanced TR/RTTs should work across all pillars, including research, and these should be embedded in master's programmes, including leadership. This study highlights a policy gap in the education and practice of APs in radiotherapy. [ABSTRACT FROM AUTHOR]

The practice of sonography in the United Arab Emirates is evolving rapidly. This study explores the professional landscape and challenges of sonography practice in the United Arab Emirates, focusing on identifying areas for improvement in education, practice scope, and professional development. Employing qualitative methodologies, using focus group discussions and thematic analysis, this research gathers insights from practicing sonographers across various healthcare settings in the UAE to assess current practices, educational needs, and workplace challenges. Findings reveal a consensus among sonographers on the need for a structured professional framework, standardized education pathways, and clear career progression routes. Additionally, the study highlights a desire among sonographers for an expanded scope of practice, particularly in specialized areas, amidst challenges such as workload and equipment quality. The study concludes that enhancing the sonography profession in the UAE requires a comprehensive approach that includes developing a regulatory framework, improving access to specialized training, and recognizing sonographers' advanced practice roles. Recommendations include establishing accredited educational programs, developing a formal competency framework, and advocating for role expansion and professional recognition. These steps are essential for meeting the evolving needs of the healthcare system and improving patient care outcomes. [ABSTRACT FROM AUTHOR]

Research has been performed by sonographers (also known as ultrasound reporting radiographers) for many years for improving diagnosis of disease, developing new imaging approaches, and enhancing patient outcomes. Despite this, sonographers' perspectives on research have not been well studied. To understand the views of sonographers is essential, as they have an important role in the successful implementation of research outcomes during their daily work. The study aimed to explore sonographers' perspectives on research. This cross-sectional online questionnaire was developed, and pilot tested, before distribution on social media platforms by the research group to sonographers or reporting radiographers in ultrasound worldwide. The questionnaire included 21-items. The link was open for 8 weeks in the spring of 2023. A mix of closed, open and scale questions were used. Informed consent was mandatory, and information about the study and anonymity was presented. A total of 165 sonographers participated in the questionnaire of which 66.1 % were from Europe (n = 109), 6.1 % from North America (n = 10), 0.6 % from South America (n = 1), 2.4 % from Asia (n = 4), 13.3 % from Africa (n = 22) and 11.5 % from Oceania (n = 19). A total of 32 % of the participants had performed research. Also, 68.5 % would like to become more involved in research. Most sonographers work in large hospitals, and half of them have obtained academic level 7 education. A limited number of sonographers have published peer reviewed papers. Many sonographers expressed an interest in research. This suggests a potential for future development of the sonographers' role in research. The findings for this study provide insight that could be used to improve research practice for sonographers. [ABSTRACT FROM AUTHOR]

Increasing number of radiographers are undertaking image reporting throughout Europe. However, there are variations in practice and experience in European countries. The study aim was to investigate reporting radiographer's perceptions in relation to support for their role and workload satisfaction and elements of advanced practice that may also be undertaken. Following institutional ethical approval an online 34 item questionnaire survey was circulated via social media; Twitter, Facebook, and LinkedIn in a 12-week period in 2022 across Europe. The survey data were managed by the online secure database REDCap (Research Electronic Data Capture). Data was collected across a range of questions, of which those relating to support for, and barriers to radiographer reporting, role and job satisfaction, and other role elements are reported here. A response level of 345 individual reporting radiographers replied to the survey from 15 European countries; some questions were optional and therefore had a lower response rate. There was consensus about the need for support from radiologists and management, protected time, and funding to support the reporting role. The majority of respondents received additional pay for taking on this role and expressed satisfaction with their role and workload. In relation to elements of advanced practice, the majority of respondents were involved in educational and managerial activities, and there was interest, but limited involvement, in research. There was a consensus about the support needed, and perceived barriers to, radiographer reporting, between reporting radiographers from different countries. Whilst there is some commonality in relation to activities such as supervision and education, there was clearer variety in relation to opportunities for research between the respondents, perhaps reflecting the differences between reporting as a standalone role development and reporting as part of an advanced clinical practice role. As there is increasingly an emphasis on advanced clinical practice, reporting radiographers are likely to require support to develop their skills so that they can actively participate in the broader activities associated with this role, including education, leadership, and research. [ABSTRACT FROM AUTHOR]

Prior studies have demonstrated inconsistent development and utilisation of radiographers in the reporting of radiographs, and there is ongoing consideration of the level at which such radiographers should be educated to and operating at. This study aimed to explore and evaluate expectation and utilisation of radiographers currently, or training in, reporting in projection radiography across one integrated care system (ICS). A multi-method approach was utilised, with document analysis of projection radiography reporting role job descriptions and person specifications and an online survey of managers and clinical leads. A single ICS in the north of England formed the setting for the study. This study demonstrated variation in implementation and utilisation of the role across trusts within the ICS. Inconsistencies in scope, expected underpinning education and role activity were identified. Radiographers autonomously reporting in projection radiography were titled advanced practitioners, however are not expected to achieve national educational standards for such roles and are not empowered to work at this level of practice by their employers. It was acknowledged that staffing pressures hinder appropriate role utilisation and reporting capacity. Inconsistent development and utilisation of radiographers in such roles may hamper collaboration and service delivery across a network. Identifying variation and working towards role standardisation could promote cross-organisational working and improve career progression opportunities. Scoping the reporting radiographer workforce may assist and guide future imaging service and workforce planning. [ABSTRACT FROM AUTHOR]

There is a growing understanding of the potency of bowel ultrasound leading to an increasing application of ultrasound in examining different bowel conditions. However, sonographers' involvement in bowel ultrasound is under-researched. This study investigated the factors influencing sonographers' experience in adult bowel ultrasound. A convenience sampling method was used to promote the study in April 2021. A mixed methods online questionnaire was utilised to explore the participants' views. Quantitative data were analysed using descriptive analysis on Excel, while qualitative data were analysed using inductive thematic analysis. Almost half of the participants (53%; n = 16) indicated low confidence in using ultrasound to examine the bowel for abnormalities. While 63% of the participants reported having high confidence in examining the bowel for suspected appendicitis, 70% (n = 21) reported low confidence in carrying out ultrasound in examining Inflammatory bowel disease. Furthermore, 23 participants (77%) indicated a high interest in bowel ultrasound training. Qualitative findings revealed mixed opinions on bowel ultrasound practice. Factors influencing sonographers' experience are the need for more training opportunities, preference for other imaging modalities, management challenges, radiologists' influence, sonographers' perspectives, and positive perspectives. Several factors influence sonographers' confidence in using ultrasound for bowel abnormalities. However, the findings emphasise the need for more research into the future design and implementation of sonographers' bowel ultrasound training. This study brings new insight to an under-researched area on the scope of sonography practice, highlighting some sonographers' experience, opinions, and involvement in bowel ultrasound. It further strengthens the argument for more training to be made available to sonographers on bowel ultrasound. [ABSTRACT FROM AUTHOR]

This narrative review aims to identify what factors are linked to diagnostic performance variation for those who interpret mammograms. Identification of influential factors has potential to contribute to the optimisation of breast cancer diagnosis. PubMed, ScienceDirect and Google Scholar databases were searched using the following terms: 'Radiology', 'Radiologist', 'Radiographer', 'Radiography', 'Mammography', 'Interpret', 'read', 'observe' 'report', 'screen', 'image', 'performance' and 'characteristics.' Exclusion criteria included articles published prior to 2000 as digital mammography was introduced at this time. Non-English articles language were also excluded. 38 of 2542 studies identified were analysed. Influencing factors included, new technology, volume of reads, experience and training, availability of prior images, social networking, fatigue and time-of-day of interpretation. Advancements in breast imaging such as digital breast tomosynthesis and volume of mammograms are primary factors that affect performance as well as tiredness, time-of-day when images are interpreted, stages of training and years of experience. Recent studies emphasised the importance of social networking and knowledge sharing if breast cancer diagnosis is to be optimised. It was demonstrated that data on radiologist performance variability is widely available but there is a paucity of data on radiographers who interpret mammographic images. This scarcity of research needs to be addressed in order to optimise radiography-led reporting and set baseline values for diagnostic efficacy. [ABSTRACT FROM AUTHOR]

The role of radiographers in the United Arab Emirates (UAE) is currently focused on image acquisition. However, many advances have been made in different countries in recent years whereby radiographers who receive appropriate education and training, can provide image interpretation/reports. When implemented, this role development has enabled a more cost effective and efficient service delivery whilst relieving the burden off radiologists, allowing them to concentrate on more complex imaging examinations. This role development is commonplace in many countries but not in the UAE. This study aims to investigate the radiologists' opinions, perceptions, and willingness to accept the advanced practice role of reporting radiographers in the UAE and determine their level of support for implementing these roles. Data was collected utilizing a mixed-methods study design that included a survey and focus group discussions (FGD). Study participants included radiologists who currently work in UAE public and private health organizations. The survey link was emailed directly to the radiologists, together with a covering letter and participants' information sheet outlining the study's aim. Participants indicated on the survey if they wanted to participate in FGD. Two online FGD were conducted using Zoom software (Zoom Video Communications Inc., San Jose, California, United States) and aimed to explore possible reasons for participant's opinions. Ethical approval was obtained from the Ministry of Health, and all methods were performed as per study protocol. A total of 69 radiologists participated in the survey, 48 males and 21 females aged between 41 and 60 years and with between 11 and 16 years of experience. Most participants (n = 54, 78.2%) believe that radiographers should only perform advanced tasks in image interpretation after obtaining adequate training and under the supervision of a radiologist. According to 55% of radiologists, the development of the radiographer role could draw more UAE nationals to the field. Six participants were recruited to FGD and declared mixed opinions that emphasized the need to improve the radiographers knowledge and experience to enable role development. Radiologists' worries about radiographer engagement in image interpretation may be alleviated if they participate in education and training for new responsibilities. In addition, this could boost the confidence of radiologists and improve trust in radiographer competency and training. Guidelines and work standards must be developed jointly by radiologists and radiographers to ensure the governance and acceptability of new radiographer reporting roles. Some radiologists perceive that radiographer reporting is possible in UAE when radiographers are trained to set guidelines and with supervision from radiologists. Change is taking place, and many radiologists express optimism for the future, though the rate of change will be determined by a willingness to change attitudes and perceptions. [ABSTRACT FROM AUTHOR]

Many articles and guidelines have been published proposing suggestions for the optimal radiology report style; it is likely that different referrers will prefer different styles owing to a number of clinical variables. The aim of this study is to assess the x-ray report style preferences of referrers at a district general hospital. This electronic survey study used convenience sampling. An email invitation was sent to all referrers who had requested imaging examinations in the six months prior to the study start date. Participants were asked their opinions on the inclusion of recommendations and advice and to indicate their preferences of mock reports with combinations of the following; short/long, in-depth/brief and paragraph/bullet points. Manual analysis was undertaken in Excel. There were 114 participants from the identified population of 356, giving a response rate of 32%. Nearly all participants find the inclusion of recommendations and advice to be useful (n = 109, 96%). Seventy-nine participants (69.3%) request skeletal x-ray examinations, and 100 (87.7%) request chest x-ray examinations. More than half of skeletal referrers (n = 42, 53.2%) and the majority of chest referrers (n = 45, 45%) prefer reports with short sentences, brief, bullet point format. The most preferred report style for skeletal and chest x-ray reports is short sentences, brief with bullet-point format. These findings add to the current knowledge base and provide different report style options. Tailoring report styles could optimise service users' experience depending on clinical variables and might improve reporting workflow. Potential differences in style preferences may exist between community and hospital referrers. Consequently, focussed research regarding the report style preferences of GPs is recommended as an area for further research. [ABSTRACT FROM AUTHOR]

Whilst United Kingdom (UK) student ambitions for role development have been surveyed previously, no literature has explored their specialisation preferences. This study aimed to explore these ambitions and preferences in final year diagnostic radiography undergraduates at a Higher-Education Institute (HEI) in the North-West of England. University ethical approval was granted for a survey-based study. A questionnaire consisting of 4 closed questions and 6 open questions was distributed in paper format after a taught session. Responses were collated and summarised in Excel (descriptive statistics), and transferred into SPSS (inferential statistics). The response rate was 75.6% (n = 34/45). Respondents were predominantly female (73.5%), had A-level as their highest qualification (79.4%) and were of 'school-leaver' age (76.5%) at the start of the degree. By overall total, preferences were for reporting (n = 24/101; 23.8%), computed tomography (CT) (n = 20/101; 19.8%) and MRI/ultrasound (both 12/101; 12.5%). CT had more first choices (n = 8) than reporting (n = 7). 73.5% anticipated specialising in less than 2 years, and 100% within 4 years. Other than a larger percentage having A-level as their highest qualification, the participant demographics were similar to the UK radiography workforce. Reporting, CT, MRI and ultrasound are the specialisation preferences of final year undergraduate diagnostic radiography students. Expectations for the timeline of role development were slightly more ambitious than previously found. Identification of reporting as the preferred area of specialisation is a novel finding in the context of UK HEIs. Harnessing this ambition will help meet the goals of successive government policy. Ensuring the ambitions of graduate diagnostic radiographers can be satisfied has clear implications for staff retention within the NHS. [ABSTRACT FROM AUTHOR]

Variability in non-medical ultrasound practice across Europe has been highlighted in studies. Meanwhile, advanced practice in radiography has undergone rapid development in the United Kingdom (UK). This survey aimed to review results relating to extended role and advanced practice skills, motivation and job satisfaction from a wider survey of radiographers undertaking ultrasound examinations across the European Federation of Radiographer Societies' (EFRS) community. Following a pilot study, a SurveyMonkey™ on-line questionnaire was disseminated to EFRS member societies to share with their members, and via social media platforms. Quantitative questions for this article related to extended and advanced practice skills, communication of results, job satisfaction, motivation and career development. Theme analysis was used to assess qualitative feedback concerning priorities for future developments within the ultrasound role. There were 561 responses, mainly from the UK, Ireland and Spain (81%). The majority (83.4%) of UK sonographers communicate findings to patients, compared with 27.1% in other EFRS countries. More engage with teaching (UK = 90.1%, non-UK 72.9%) compared with activities in the other advanced practice domains. The lowest involvement was the research domain, with only 33% actively involved in research. Radiographers were motivated to undertake ultrasound to develop their knowledge and skills and assume more responsibility. Wide variations in ultrasound practice were seen across respondent countries. Generally, radiographers are happy with their ultrasound roles, although priorities include legislation for the sonographer role, remuneration, respect or support from medical colleagues, high quality education and role progression opportunities. The findings provide a better understanding of radiographer views which can assist radiographer societies and local teams to develop strategies to enhance advanced practice skills development and career prospects in ultrasound. [ABSTRACT FROM AUTHOR]

Online MRI guided adaptive radiotherapy (MRIgRT) is resource intensive. To maintain and increase uptake traditional roles and responsibilities may need refining. This novel study aims to provide an in-depth understanding and subsequent impact of the roles required to deliver on-line adaptive MRIgRT by exploring the current skills and knowledge of radiographers. A purposive sampling approach was used to invite radiographers, clinicians and physicists from centres with experience of MRIgRT to participate. Focus Group Interviews were conducted with two facilitators using a semi-structure interview guide (Appendix 1). Four researchers independently familiarised themselves and coded the data using framework analysis. A consensus thematic framework of ptive Radiotherapy codes and categories was agreed and systematically applied. Thirty participants took part (Radiographers: N = 18, Physicists: N = 9 and Clinicians: N = 3). Three key themes were identified: 'Current MRIgRT', 'Training' and 'Future Practice'. Current MRIgRT identified a variation in radiographers' roles and responsibilities with pathways ranging from radiographer-led, clinician-light-led and MDT-led. The consensus was to move towards radiographer-led with the need to have a robust on-call service heavily emphasised. Training highlighted the breadth of knowledge required by radiographers including MRI, contouring, planning and dosimetry, and treatment experience. Debate was presented over timing and length of training required. Future Practice identified the need to have radiographers solely deliver MRIgRT, to reduce staff present which was seen as a main driver, and time and resources to train radiographers seen as the main barriers. Radiographer-led MRIgRT is an exciting development because of the potential radiographer role development. A national training framework created collaboratively with all stakeholders and professions involved would ensure consistency in skills and knowledge. Role development and changes in education for therapeutic radiographers. [ABSTRACT FROM AUTHOR]

To explore relevant literature and policy around the role of the radiographer working within osteoporosis services. Discussion will examine the value of radiographers in these services, as well as current limitations and future opportunities for advancing practice in these domains. Osteoporosis and fracture prevention are a public health issue that must be addressed to improve patient outcomes following fractures. DXA radiographers currently fulfill an important role in the diagnosis of osteoporosis and collaborative working between radiology and osteoporosis services is to be encouraged. Radiographers are able to extend their role into advanced practice within osteoporosis services such as fracture liaison and rheumatology, they have expert knowledge and experience to bring to these roles and post graduate education can further increase radiographer's expertise in this field. The inability of diagnostic radiographers to become independent prescribers is a current limitation for radiographers working within osteoporosis services. The role of the radiographer working within DXA and osteoporosis services is evolving and is an exciting area of advanced practice. Promoting this specialty within radiography may help to improve job satisfaction as well as recruitment and retention rates. As radiographers scope of practice in osteoporosis changes and evolves, it is hoped that current legislation may change to allow independent prescribing for diagnostic radiographers, which can in turn streamline patient pathways and reduce the burden on primary and secondary care. [ABSTRACT FROM AUTHOR]

This review seeks to explore the perceived impact, challenges and barriers of advanced and consultant radiographer roles on staff, patients and healthcare. A systematic approach was used to search for and identify suitable literature for review. All appropriate literature was critically appraised and analysed qualitatively by thematic analysis. The results were integrated to give an overall evaluation of the impact of advanced and consultant practice within Therapeutic Radiography. The literature found eleven studies that met the inclusion criteria and after critical appraisal, all were included in the analysis. Five key themes emerged from the analysis which is in keeping with the literature: education, quality of working life, patient care, benefit to healthcare and implementation obstacles. Most advanced and consultant radiographers felt unprepared for these roles and the education requirements were varied and misunderstood. It was well documented that the advanced and consultant radiographer found great satisfaction from these roles and felt that it benefitted the patients as well as themselves and their career. Advanced and consultant roles benefitted patients by streamlining pathways and increasing satisfaction and there was a clear benefit to healthcare due to time and cost savings. The implementation obstacles focused around a lack of understanding and support from colleagues. There is a positive impact from advanced and consultant roles in therapeutic radiography to patients, staff and the healthcare system. There are challenges with respect to educational requirements, implementation obstacles and understanding of these roles which need to be addressed. There needs to be more education about the benefits of these roles so that they are encouraged and the staff are supported [ABSTRACT FROM AUTHOR]

Underpinned by a multi professional advanced clinical practice (ACP) framework, role consistency in practice level and education has been advocated across allied health professions. However little research has evaluated ACP expectations in radiography. This study identified the capability requirements of advanced and specialist diagnostic radiographers and mapped these to home country advanced practice frameworks and the Society and College of Radiographers (SCoR) Education and Career Framework. A consecutive sample of UK job advertisements was collected over six months and analysed for role focus, professional and clinical responsibilities, reporting or procedural expectations and knowledge and experience. Qualitative content analysis was used to scrutinise capabilities during role mapping. A total of 42 job descriptions were analysed across UK Trusts and Health Boards, with 31 roles (73.8%) containing the terms advanced or specialist. Half of the advertised roles expected proficiency in reporting (n = 21; 50%). Responsibilities mapped to the practice outcomes of the SCoR framework in 31 roles (n = 31/42; 73.8%). The English documents (n = 40/42; 95.2%) evaluated against the multi professional framework identified significantly (χ2 = 14.6; p < 0.01) fewer capabilities (n = 13/40; 32.5%). Clinical practice was reflected broadly in textual behavioural descriptors however, leadership, education and research responsibilities were internal and operational in nature. This analysis of diagnostic radiographer job descriptions has demonstrated that many posts advertised as 'advanced' differ from advanced practice roles defined by the multi professional ACP framework, although they meet professional body standards. Utilisation of diagnostic radiographers as 'true' advanced clinical practitioners remains intermittent. Greater consistency in job descriptions is required to strengthen radiography advanced practice and support radiographer development. [ABSTRACT FROM AUTHOR]

Increasing prevalence in breast cancers, workforce shortages and technological advancements have increased the need to further develop advanced practice in breast diagnosis. The Advanced Clinical Practitioner training programme has been introduced to support this need. The aim of this work was to systematically review studies that explore advanced practice in mammography to assess the potential impact of the introduction of a specific Advanced Clinical Practitioner training programme in breast diagnosis within the UK. A systematic PRISMA review of the literature published between 1999 and January 2020 was carried out. A total of 17 studies were included in the review. Four themes were identified in the literature in relation to advanced practice in breast imaging: multidisciplinary practice; roles and responsibilities associated with advanced practice; development and progression; embedding and sustaining advanced practice. It was evident across all themes that advanced practice is vital in supporting better care for patients attending breast imaging in light of workforce shortages. Although advanced practice and its benefits are well established in breast imaging, persistent barriers were acknowledged such as role ambiguity, recruitment issues, lack of support from some radiologists and poor funding. Findings suggest that introducing a more formalised pathway to advanced practice into breast imaging through the implementation of a specific Advanced Clinical Practitioner apprenticeship training programme may overcome many of the challenges evidenced in this review. The findings of this review will help inform the development of the Advanced Clinical Practitioner apprenticeship programme specific to breast diagnosis. [ABSTRACT FROM AUTHOR]

To evaluate General Practitioner (GP) satisfaction with a radiographer-led general radiography reporting service in a single district general hospital in order to identify areas for improvement. A mixed method online survey was created and distributed to all GP surgeries in the catchment area of the hospital with a 6 week response period. Although the majority of GPs are satisfied with the service they receive, there were areas for improvement. Key areas included methods of contacting radiology department with queries, report content/terminology and recommendations for follow-up. Although the majority of GPs are happy for radiographers to report imaging examinations some resistance was encountered, particularly with regards to chest reporting. Recommendations are made for improvements designed to address these issues. This article is one of the first in the UK to assess GP satisfaction with general X-ray reporting services. As the majority of GP reporting in the UK is now completed by radiographers, the results will allow reporting teams to tailor their service, in order to improve outcomes for both commissioners and patients. [ABSTRACT FROM AUTHOR]

The United Kingdom (UK) has experienced one of the worst initial waves of the COVID-19 pandemic. Clinical signs help guide initial diagnosis, though definitive diagnosis is made using the laboratory technique reverse transcription polymerase chain reaction (RT-PCR). The chest x-ray (CXR) is used as the primary imaging investigation in the United Kingdom (UK) for patients with suspected COVID-19. In some hospitals these CXRs may be reported by a radiographer. Retrospective review of CXR reports by radiographers for suspected COVID-19 patients attending the Emergency Department (ED) of a hospital in the UK. Interpretation and use of the British Society of Thoracic Imaging (BSTI) coding system was assessed. Report description and code use were cross-checked. Report and code usage were checked against the RT-PCR result to determine accuracy. Report availability was checked against the availability of the RT-PCR result. A confusion matrix was utilised to determine performance. The data were analysed manually using Excel. Sample size was 320 patients; 54.1% male patients (n = 173), 45.9% female patients (n = 147). The correct code matched report descriptions in 316 of the 320 cases (98.8%). In 299 of the 320 cases (93.4%), the reports were available before the RT-PCR swab result. CXR sensitivity for detecting COVID-19 was 85% compared to 93% for the initial RT-PCR. Reporting radiographers can adequately utilise and apply the BSTI classification system when reporting COVID-19 CXRs. They can recognise the classic CXR appearances of COVID-19 and those with normal appearances. Future best practice includes checking laboratory results when reporting CXRs with ambiguous appearances. Utilisation of reporting radiographers to report CXRs in any future respiratory pandemic should be considered a service-enabling development. [ABSTRACT FROM AUTHOR]

Optimising radiographer and radiologist skill-mix is essential to increase efficiency and ensure quality patient care and safety in radiology services. Radiographer reporting, well established within the UK, has been legally and legitimately identified within the scope of radiographer practice for many years. Little research however has focused on perceptions and experiences of practitioners as they journey towards advanced practice in skeletal trauma reporting. A two-phase qualitative approach, utilising Interpretative Phenomenological Analysis (IPA), included a homogenous group of radiographer practitioners (n = 12). Phase 1 thematically analysed personal reflective diaries. Phase 2 included one–one, semi-structured interviews which were recorded, transcribed verbatim and reviewed using the IPA six stage thematic analysis. Three super-ordinate themes emerged. This paper reflects the IPA generated from Super-ordinate Theme 3; Review upon and action for the role. Participants had reached destination and beyond with a focus on development of role, self and others. As reporting became firmly embedded, there was increased acceptance, educational development and positive impact on service. Reflections indicated motivation, drive, commitment, increased confidence and self-esteem This study provides an insight in to the participant journey towards advanced practice and skeletal trauma reporting in Scotland as participants reached destination and beyond. Developments within the NHS continue to rapidly evolve and diagnostic imaging, with advancing technology, practice and changing policies, continues to remain in a constant state of change. Continued support and investment for role development, framed within a culture of effective teamworking, positive engagement and professional respect is essential. [ABSTRACT FROM AUTHOR]

To evaluate the technical success, radiation dose, complications and costs from the introduction of a radiographer-led nephrostomy exchange service. Post-graduate qualified interventional radiographers with several years' experience in performing other interventional procedures began performing nephrostomy exchanges. Training was provided by an interventional radiologist. Each radiographer performed ten procedures under direct supervision followed by independent practice with remote supervision. Each radiographer was then responsible for the radiological report, discharge, re-referral for further exchange and, where indicated, sending urine samples for culture and sensitivity. Data extraction included the time interval between exchanges, radiation dose/screening time and complications. Thirty-eight long-term nephrostomy patients had their histories interrogated back to the time of the initial insertion. The mean (range) age at nephrostomy insertion was 67 (35–93) years and 65% were male. Indications for nephrostomy were prostatic or gynaecological malignancy, ureteric injury, bulky lymphoma and post-transplant ureteric stricture. A total of 170 nephrostomy exchanges were performed with no statistically significant differences in the radiation dose, fluoroscopy time nor complication rates between consultants and radiographers. There was, however, a statistically significant reduction in the time interval between nephrostomy exchanges for the radiographer group (P = 0.022). Interventional radiographers can provide a safe, technically successful nephrostomy exchange program with radiation doses equivalent to radiologists. This is a cost-effective solution to the capacity issues faced in many departments, whilst providing career progression, job satisfaction and possibly improved care. Radiographer-led interventional services should be considered by other institutions as a means of providing effective nephrostomy exchanges. [ABSTRACT FROM AUTHOR]

This study investigated the scope of practice of CT head reporting radiographers in the UK, and to compare adherence to professional body standards. An online questionnaire was utilized applying both multiple-choice and response (closed questions), and qualitative open question free-text responses. The 30 questions covered four key areas of demographics, the scope of practice, referrals, and ongoing competence, as described in professional body national guidance standards. The questionnaire was disseminated (convenience sampling) via Twitter and email to the National CT Head Reporting Special Interest Group. Responses were transcribed and coded; the results applied descriptive statistics to summarise observations of the study sample. The sample of participant response data analysed was n = 54. Most respondents were from England, with a postgraduate certificate award in clinical reporting, and a mean length of 8.3 years of reporting experience. The accepted referral pathway included a wide range of medical and surgical specialities, including both in and outpatients and acute and chronic pathways. Furthermore, 96.2% of the sample had a scope of practice that authorised referral recommendations to a broad and inclusive group of medical and surgical teams, and if required further or repeat diagnostic imaging. To maintain quality and evidence of ongoing competency, all radiographers were involved in audit cycles. The data collected confirmed the reporting practice within this sample group aligns to national recommended guidance. The data provided key information on the range and variation of individuals scope of practice within age restrictions of patients, examination types, referral teams, and ongoing competency practices. This paper details the scope of practice of CT head reporting by radiographers and the contribution made to the healthcare sector. [ABSTRACT FROM AUTHOR]

Increased demand for diagnostic imaging and professional body directives have resulted in radiographer reporting which requires postgraduate education due to the associated high degree of autonomy and complex decision making. Little research has focused on the transition from practitioner to the skeletal trauma reporting role. Two-phase, qualitative research using Interpretative Phenomenological Analysis (IPA) explored perceptions and experiences. Phase 2, one–one, semi-structured interviews (n = 6) were recorded, transcribed verbatim and reviewed using the IPA six stage thematic analysis, generating three super-ordinate themes. Researcher reflexivity, ethics and quality assessment were considered. This paper reflects the IPA generated from Super-ordinate Theme 2; Exposure to the reporting role. Participant reflections indicated positive opinion with agreement that combining the reporting role with the diagnostic radiographer role enhanced practice and increased job satisfaction. Potential for stress associated with increased responsibility and accountability was described but there was recognition that skeletal trauma reporting was what they had chosen and been educated to do. The interpretative approach and IPA for Super-ordinate Theme 2, fills a gap in existing knowledge, providing a unique and valuable insight into perceptions and experiences of practitioners as they became exposed to the skeletal reporting role. Participants were on their journey to advanced practice with plans to further develop their role. Excellent clinical practice had been demonstrated as well as facilitating learning with others. If there is expectation to achieve all domains associated with advanced practitioner status then time, commitment and support is essential from employers and management. [ABSTRACT FROM AUTHOR]

The paper, derived from a professional doctorate thesis explored the perceptions and experiences of diagnostic radiographers who had acquired a post graduate qualification affording them the opportunity to report skeletal trauma images. A qualitative approach was deemed appropriate to answer the research question and Interpretative Phenomenological Analysis (IPA) was selected as the research methodology. The two-phase qualitative research study included a homogenous group of radiographer practitioners (n = 12). Phase 1 thematically analysed personal reflective diaries completed during final year of study. Phase 2 included one-one, semi-structured interviews which were recorded, transcribed verbatim and reviewed using the IPA six stage thematic analysis. Researcher reflexivity was employed as were issues of ethics, permission and quality assessment. Reflective diary themes informed focus for one-one, semi-structured interviews. IPA of interview transcripts identified three superordinate themes: Preparation for the role; Exposure to the role; Review upon and action for the role. Subsumed within the three superordinate themes were twelve subthemes. The Results section for this paper reflects the IPA generated from Super-ordinate Theme 1. This study provides an insight in to the radiographer educational journey towards advanced practice and skeletal trauma reporting in Scotland. IPA identified a range of emotions, personal and professional commitment. Degrees of positivity were reported but perception and experience also identified stress and challenge. Mixed attitudes and a culture of resistance impacted on the lived experience of preparation for the role. This created potential to adversely affect practitioner development and requires ongoing attention from key stakeholders. • Advanced practitioner skeletal reporting perceptions and experiences. • Stakeholder impact on the practitioner educational journeys. • The need for ongoing government and professional body commitment for radiographer role development initiatives. • The use of Interpretative Phenomenological Analysis for Radiography research. [ABSTRACT FROM AUTHOR]

Radiographers have been providing reporting solutions for a number of years. Given the persistent radiologist vacancies and the increased demand on imaging services, the utilisation of reporting radiographers is widespread across England. Capacity and demand issues may lead to reporting boundaries being extended. The aim was to generate an updated appraisal of participants' scopes of practice in the West Midlands of region of England. Reporting radiographers at 11 healthcare institutions across the West Midlands region were invited to participate in an online survey. Topics covered included reporting scope of practice, onward referrals and suggestion of treatments. Descriptive statistics were generated in Microsoft Excel and free responses were analysed manually. Response rate was 47% (40/86). The majority (n = 34, 85%) report Emergency Department skeletal examinations, only 12 (30%) report adult chests and only three (8%) report paediatric chests. Of those permitted to refer to other modalities, 85% (n = 23/27) actively do so. Of those permitted to refer to specialist teams, 97% (n = 31/32) actively do so. Only 23% of all participants (n = 9/40) suggest treatments in their reports. An increased number of participants report chest and abdominal examinations than previously identified. Restrictions in paediatric scopes of practice and adult GP chest examinations are also evident. Participants stated they do include recommendations in their reports by referring to other modalities and for specialist opinions. Suggesting treatment is not common practice and is considered an area for further advancement. • Majority of participants report ED appendicular and axial examinations. • Limitations on reporting paediatric exams and adult GP chest exams are evident. • The number of chest and abdomen reporters is increasing. • The majority refer to other modalities and for specialist opinions. • Few reporters suggest treatment options, mainly for infective chest appearances. [ABSTRACT FROM AUTHOR]

This study assesses the feasibility of a new role for radiation therapists in Ontario, Canada, called the Advanced Practice Radiation Therapist (APRT), which would address health service pressures and improve patients' access to care. A literature search and expert consensus were used to define advanced practice. A standardized template was used to record each APRTs activities/competencies, along with the requisite knowledge, skills and judgment required to perform these competencies. A thematic analysis of the lists was undertaken to develop a single competency profile. Seven APRTs were deployed at four cancer centres to gather contextual information on the development and integration of the new role. The definition of AP consists of seven key traits and includes a framework identifying stages of practice from entry-level practitioner through expert to advanced practitioner. The competency profile consists of clinical, technical and professional domains which further define the scope of practice and shepherd the role through stages of implementation. Role testing showed support for the role and demonstrated that APRTs can deliver specialized services, perform delegated tasks and their work can lead to program efficiencies and new services. The new role may also lead to improved radiation therapist recruitment rates and work satisfaction. This feasibility assessment served as the foundation for the future long-term implementation of the Clinical Specialist Radiation Therapist (CSRT) Project. As of 2018, there were 24 CSRTs in Ontario. The APRT role is a natural progression for a readying profession which can play a transformative role in addressing health human resource shortages. Image 1 • An Advanced Practice Radiation Therapist (APRT) is a new role in Ontario, Canada. • Definition consisting of seven key traits and a framework, was developed for APRTs. • Task-shifting results in program efficiencies and new services. • APRT's can have a positive impact on the experiences of their stakeholders. [ABSTRACT FROM AUTHOR]

Abstract Introduction Many organisations struggle to clearly differentiate the radiographer consultant role from advanced or specialist practice, with newly appointed consultant practitioners often ill-prepared for working at this level. This article discusses the design, implementation and validation of an outcomes framework for benchmarking competencies for trainee or new-in-post consultant radiographers. Methods Five experienced radiographers from different clinical specialisms were seconded to a twelve month consultant trainee post, guided by a locally-devised outcomes framework. A longitudinal qualitative study explored, from the radiographers' perspective, the impact of the outcomes framework on the transition to consultant practice and beyond. Data collection included semi-structured interviews (months 1, 6 and 12), validation via a focus group (month 18) and a group interview (5 years). Results Early interactions with framework objectives were mechanistic, but as participants better understood the role more creative approaches emerged. Despite diverse clinical expertise, the framework facilitated parity between participants, promoting transparency and credibility which was important in how the consultant role was perceived. All participants achieved all framework outcomes and were subsequently appointed to substantive consultant radiographer positions. Conclusion This outcomes framework facilitates experienced radiographers to successfully transition into consultant radiographers, enabling them to meet multiple non-clinical targets while continuing to work effectively within a changing clinical environment. It is the first validated benchmarking tool designed to support the transition to radiographer consultant practice. Adoption of the tool will provide a standardised measure of consultant radiographer outcomes that will promote inter-organisational transferability hitherto unseen in the UK. Highlights • First validated tool to support the transition to radiographer consultant practice. • Supports acquisition of the skills, knowledge and behaviours for consultant practice. • May be adapted for use across radiography specialist practice, nursing and AHP roles. • Facilitates transparency, equity and standardisation in consultant role expectations. [ABSTRACT FROM AUTHOR]

Abstract Introduction The literature suggests that there is variation in various features of the written radiology report for a range of body areas and imaging modalities. The retrospective study presented here aims to determine if similar variation is demonstrated in a group of 5 reporting radiographers in a UK NHS Trust. Methods Full reports for 1530 knee radiographic examinations performed from accident and emergency referrals were extracted for a 12-month period from a Radiology Information System (RIS) into Excel. Copied into Word, the word count function was used for each report and the number of words and characters (without spaces) was returned into Excel. Average word count and word length per report, by radiographer, were calculated for the following sections of the report: report title, main body and signature. SPSS was used to perform inferential statistical analysis. Results A wide range in the maximum and minimum average report lengths (60.88 v 17.83 words) was demonstrated. Statistically significant differences (p < 0.05) were seen between all but one pair-wise comparison (Rad 2 v Rad 4; p = 0.98) for the overall report length; for the length of the findings section, four pair-wise comparisons did not reach significance. Average word length demonstrated less variation. 4 out of 5 radiographers always included a report title; 3 out of 5 never included a report signature. There was a strong negative correlation between experience and report length. Conclusion Variation in report structure and length, as well as word length, was seen, comparable to studies of radiologist reports. Further research is required to investigate the drivers of this variation, and determine if there is any clinical significance. Highlights • Radiographer reports of knee radiographs demonstrate significant variation. • The variation manifests as differences in both length and structure. • The variation is comparable to that established for radiologist reports. [ABSTRACT FROM AUTHOR]

Abstract Introduction To analyse the objective structured examination (OSE) results of the first cohorts of radiographers (n = 13) who successfully completed an accredited postgraduate programme in clinical reporting of neurological magnetic resonance imaging (MRI) examinations of the head and cervical spine. Methods Forty MRI examinations were used in the OSE which included a range of abnormal cases (prevalence of abnormal examinations approximated 50%) and included: haemorrhage, infarction, demyelination disease, abscess, mass lesions (metastatic deposits, meningioma, glioma, astrocytoma); and disc disease, cord compression, stenosis, ligament rupture, syringomyelia appearances on patients referred from a range of referral sources. Normal variants and incidental findings were also included. True/false positive and negative fractions were used to mark the responses which were also scored for agreement with the previously agreed expected answers based on agreement between three consultant radiologists' reports. Results The mean sensitivity, specificity and agreement rates for all head and cervical spine investigations (n = 520) combined were 98.86%, 98.08% and 88.37%, respectively. The highest scoring cases were cases which included astrocytoma, disc protrusion with cord compression and glioma. The most common errors were related to syringomyelia, ligament rupture and vertebral fracture. Conclusions These OSE results suggest that in an academic setting, and following an accredited postgraduate education programme, this group of radiographers has the ability to correctly identify normal MRI examinations of the head/cervical spine and are able to provide a report on the abnormal appearances to a high standard. Further work is required to confirm the clinical application of these findings. Highlights • Following accredited training, radiographers can report MRI examinations of the head or cervical spine to a high standard. • The accuracy of the radiographers' reports is similar to rates in other MRI reporting studies of the lumbar spine or knee. • Radiographers in an academic setting, can report to a similar standard to non-specialised consultant radiologists. [ABSTRACT FROM AUTHOR]

Objective With ever-increasing demands on the National Health Service (NHS), members of staff are blurring their professional boundaries in the attempt to benefit the healthcare system. This review aims to establish whether advancing practice within radiography does benefit the healthcare system by examining published literature. Key findings Key words were input into databases such as: CINAHL, Science Direct and PubMed. Various filters were applied to narrow down the articles. Key themes were identified within the literature: cost, job satisfaction, patient benefits, restrictions and workload. Having advanced practitioners undertake some of the radiologists' workload was potentially cost effective whilst continuing/increasing the standard of quality. Patients benefitted from the quality of their examinations, the high accuracy of their reports and the speed those reports were attained. Conclusion Evidence within the literature emphasises that advanced practice does benefit the healthcare system by means of: cost reduction, job satisfaction, patient benefits and workload. [ABSTRACT FROM AUTHOR]

Introduction The development of diagnostic imaging services manifests features specific to the Scottish environment, in particular development of the radiographic workforce through implementing skills mix and role developments to enhance outcomes for patients. A component of a College of Radiographers Industry Partnership Scheme (CoRIPS) supported study, this research investigates perspectives of strategic service managers with Health Board responsibility for service delivery. Method A questionnaire survey was administered to strategic service managers across Scotland ( N = 14), followed up with telephone interviews. There was a return rate of 57% ( n = 8) for the questionnaires and n = 4 agreed to be interviewed. Data collected related to radiographer roles across their Board area; awareness and understanding of service development issues and features as well as perspective on opportunities and barriers in the context of Scottish Government policy, workforce logistics, attitudes and inter-professional relationships. Results The results indicate evidence of financial, logistical and political barriers to service evolution, offset by a sense of optimism that scope for beneficial change may be approaching. There are a range of significant initiatives in place and an appetite exists to pursue the development of radiographer roles and skill mix for the benefit of service users more generally. Conclusion The difficulties in achieving change are well understood and there are basic issues related to finance and industrial relations. There are also however, cultural elements to contend with in the form of attitudes demonstrated by some radiographers and significantly, the radiological community whose influence on the practice of independently regulated radiographers seems incongruent. [ABSTRACT FROM AUTHOR]

Background Advanced practice roles are emerging in all disciplines at a rapid pace and reporting radiographers are ideally placed to work at such level. Advanced practitioners should demonstrate expert practice and show progression into three other areas of higher level practice. Most existing literature has focussed on the image interpretation aspect of the role, however there is little evidence that plain film reporting radiographers are undertaking activities beyond image interpretation and fulfilling the role of advanced practitioner. Method Letters were posted to every acute NHS trust in the UK, inviting reporting radiographers to complete an online survey. Both quantitative and qualitative information was sought regarding demographics and roles supplementary to reporting. Results A total of 205 responses were analysed; 83.3% of reporting radiographers describe themselves as advanced practitioner, however significantly less are showing progression into the four core functions of higher level practice. A total of 97.0% undertake expert practice, 54.7% have a leadership role, 19.8% provide expert lectures and 71.1% have roles encompassing service development or research, though most of these fall into the service development category. 34.5% felt that they were aware of the differences between extended and advanced practice though much less (9.3%) could correctly articulate the difference. Conclusion Few individuals are aware of the difference between extended and advanced practice. Though the majority of plain film reporting radiographers identify themselves as advanced practitioners, significantly less evidence all four core functions of higher level practice. The number of individuals undertaking research and providing expert-level education is low. [ABSTRACT FROM AUTHOR]

Cardiac computed tomography (CT) is a rapidly evolving technique for assessing cardiovascular disease which usually requires direct, time-consuming supervision by a radiologist or cardiologist for the whole examination. The cardiac radiologists at our institution decided to train CT radiographers to perform CT Coronary Angiography (CTCA) examinations independently. The aim of the initiative was to enable appropriately trained radiographers to perform the CTCA examination autonomously and to a high standard. Following the programme of training and development, participating radiographers have been shown to undertake CTCA examinations to the required standard, providing a safe, effective and patient focused experience, with no detriment to patient care or radiation dose received. Evidence of service enhancement which allows radiologists to undertake other work, has also been established. This paper describes the steps in the design of this new service and how advanced practice role development has been established and assessed at our institute. [ABSTRACT FROM AUTHOR]

Purpose The impact of changing roles, skill mix and a shortage of consultant radiologists on the profession of diagnostic radiography is not clearly understood in Scotland although the anecdotal perspective suggests the situation in many areas does not equate to that of England. Method A questionnaire survey was administered to ‘lead diagnostic radiographers’ across all Health Boards in Scotland and this was supplemented with telephone interviews. Results The implementation of skill mix initiatives and particularly advanced/extended scope practice was found to be geographically variable with limited evidence of change in some areas. Lack of effective funding and backfill for training was found to be a major barrier to change, although it was also acknowledged that opposition from some professional groups could be a major factor. Conclusion Although there is some optimism and evidence of accelerating change, development of the radiographic workforce in Scotland does not in general compare favourably to the findings of Price et al., in 2007. The reasons are multi-factorial including fiscal, professional and geographical elements. [ABSTRACT FROM AUTHOR]

Aim To examine the adult chest radiograph (CXR) reporting performance of a reporting radiographer in clinical practice using different audit systems; single radiologist and two radiologists, with clinical review of discordant cases. Materials and methods 100 chest radiographs (CXRs) were drawn randomly from a consecutive series of 4800 CXRs which had been reported during a nine month period at a district general hospital by a radiographer after two years of training. Diagnostic outcomes were normal or abnormal, and agreement with the reporting radiographer or not. There was 50% duplication of CXRs reported between three radiologists. Concordance rates were determined for the radiographer-radiologist and inter-radiologist interpretations. Independent clinical review of discordant cases was performed to establish the final diagnosis. Results Ninety-nine cases were reviewed, with 40 cases deemed abnormal by at least one radiologist. Consensus was found with the radiographers report in 59 normal and 33 abnormal CXRs reviewed by two radiologists (96.7% and 86.8% respectively). Seven CXR reports were discrepant with clinical review: mediastinal lymphadenopathy was missed by both radiologist and radiographer; linear atelectasis was reported by two radiologists but not the radiographer. Three cases were over-interpreted and on two occasions at least one radiologist agreed with the radiographer. There was very high concordance between the radiographer and each radiologist, 96%, 96% and 92% respectively. Conclusions This study suggested that regular audit, which incorporates case note review and discrepant reporting within a multidisciplinary setting, should contribute to safe practice. [ABSTRACT FROM AUTHOR]

Objectives To investigate how changes in service delivery within the radiology department of an acute district general hospital optimized imaging services for patients and referrers through a strong emphasis on team-working. Methods Data related to service delivery was collected for three consecutive years and interrogated by imaging modality and reporting practitioner (radiologist, reporting radiographer, sonographer) to explore how workload had changed over the cycle. Results Departmental activity demonstrated consistent increases, both overall (13.3%) and for most modalities (MRI 43.7%, CT 22.8%) for the study period (March 2010–March 2013). Overall trend suggested significantly shorter waiting times (CT 0.7 weeks, MRI 1.3 weeks, non-obstetric ultrasound one week; all modalities p = 0.001). Some modality variation in reporting times was apparent, with CT ( p = 0.06) and MRI ( p = 0.01) decreasing but there was an increase in X-ray reporting times ( p = 0.001). Reporting radiographers and sonographers reported the majority of X-ray and non-obstetric ultrasound interpretations (59% and 52%, respectively). A radiographer-led neonatal reporting service was implemented and the urology patient pathway redesigned. Effective team-working produced savings of three full-time consultant radiologist posts. Conclusion Radiologists and radiographers, working together, can deliver an effective service. Innovation, staff development and redesign of patient pathways, have produced significant improvements. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: In the face of growing demand in radiology, skill mix initiatives have sought to improve and expand service provision. Within the UK radiographer reporting is now widespread, although the growth in computerised tomography (CT) head reporting has not been as rapid as anticipated. The literature in this area is limited, but case studies have highlighted the successful implementation of this training through new radiographer roles in practice. Method: A cross-sectional survey was developed to elicit information from radiographers and managers on their experiences before, during and after post-graduate training in CT head reporting. Results: Seventy one responses were received comprising 48 past students (n = 48/111; 43.2%) and 23 service managers (n = 23/67; 34.3%). Key factors for the development were personal continual professional development for students and departmental need for managers. Challenges during training included a lack of study time due to staff shortages and access to radiologist mentors. Only 48.8% of students responding have gone on to use the new skills in practice cited reasons include staff shortages, resistance from radiologists and increase in radiological staffing. Conclusions: This qualitative study has demonstrated that those trusts who have implemented CT head reporting have evidenced perceptible benefits for both the department and individuals. Those radiographers who are successfully reporting have shown themselves to be highly motivated and persistent in their development. [Copyright &y& Elsevier]

Abstract: Advanced practice in screening mammography has become widespread in the United Kingdom over the last 20 years, and Australian radiographers working in BreastScreen programs have shown interest in similar developments. Radiographers working in BreastScreen Australia were surveyed in order to capture their thoughts and perceptions on role extension. Questionnaires were circulated to radiographers working in BreastScreen Australia programs. Thematic analysis was used to analyze the open response questions to explore the advantages and disadvantages identified by the participants with respect to role expansion in screening mammography as well as any changes to their duties over the last decade. There were 253 responses to the survey and of those responses, 70% of radiographers shared their thoughts on role extension and 49% provided comments on changes in the workplace. The majority (61%) radiographers responding to the role extension question were concerned about potential problems associated with role extension; the biggest issues were that role extension should not be mandatory and that selection criteria for advanced practitioners should be stringent, with adequate time made available for training and study. The major change in the role of the radiographer has been the increased time dedicated to quality assurance tasks and administrative duties as well as more training required due to technological changes from film-screen to digital mammography. There is high interest in role extension by radiographers working in BreastScreen programs, provided that it is voluntary. The role of the radiographer within breast imaging in Australia is still evolving. [Copyright &y& Elsevier]

Abstract: Quality Issue: Although costly and time consuming, videofluoroscopic swallowing (VFS) examinations are the gold standard for imaging of oro-pharyngeal dysphagia, and demand is likely to increase with an ageing population. Traditional radiologist-led VFS services in the UK are gradually being replaced by practitioner-led clinics undertaken jointly by speech and language therapists and radiographers. This article explores the impact on patient access of a practitioner-led VFS clinic at a large teaching hospital. Initial Assessment: Specific information pertaining to VFS patient waiting times and service quality was collected for a twelve month period both pre- and post-clinic formation. Choice of Solution: Additional capacity was achieved with the introduction of the practitioner-led clinic, with overall patient access improving by 111%. Mean waiting times for in-patients reduced by 75%, many of whom had the procedure on the same day as referral, with out-patients waiting times reducing by 62.5%. Evaluation: The data demonstrates that patient access and report turnaround times are significantly improved, with no adverse effects as measured by inadequate studies, incorrect reports, complaints and documented radiation dose levels. Lessons Learnt: Practitioner-led VFS services can be recommended as a safe and efficient method of improving service provision. [Copyright &y& Elsevier]

Abstract: Purpose: The success of skill development amongst radiographers in the UK over the last 30 years has stimulated discussion about similar developments in Australia. The introduction of flexible roles and responsibilities may well improve the recruitment and retention issues facing radiographers in mammography by increasing the level of job satisfaction and professional confidence. The main purpose of this study was to investigate the attitudes of BreastScreen Australia radiographers toward mammography screen reading and to determine other areas of interest in role extension. Methods and materials: Questionnaires were sent to radiographers working within Australian BreastScreening programs. The emphasis for this study was on image interpretation, although different areas of role expansion were discussed. The radiographers were asked whether there were any barriers preventing them from becoming screen readers and the levels of supervision and training they thought appropriate for different tasks.They were asked to discuss possible benefits and disadvantages of additional responsibilities. The involvement of radiographers with routine screening was explored as well as the possibility of further training leading to more diversity in their careers. Results: The results highlight the interest that radiographers working in Australia have for role extension in mammography. The radiographers indicated they would feel reasonably confident to undertake image interpretation, but two areas gave them cause for concern – a lack of prior images, and the prospect of no radiologist reading with them. The majority (79%) of radiographers were prepared to undertake extra training and demonstrated that the importance of increased pay for these extra responsibilities (39%) lagged behind the importance of increased professional equity (47%) and increased enjoyment and interest in mammography (66%). The possibility of role expansion being a cause of division in the workforce (pressure to comply) was seen as a problem by only 15% of respondents. Conclusion: This study reports on the thoughts and perceptions of Australian radiographers on many aspects of role expansion within BreastScreen Australia and shows their support for advanced practice. [Copyright &y& Elsevier]

Abstract: Purpose: This paper provides data on the continued success of radiographers in reviewing mammograms with similar accuracy to screen readers. Method: The participants consisted of 7 radiographers and 2 current official screen readers. Two hundred and fifty sets of mammograms from 2003 were used in this study. Each participant reviewed each set of mammograms as a Rescreen or Recall. Patient outcomes were assessed by following up the results of any histology or pathology tests in 2003 or the 2005/2006 screening results. Results: The screen reader’s sensitivities ranged from 79% to 93% and the specificities ranged from 82% to 84%. The radiographer values ranged from 57% to 97% and 63% to 80% respectively. Conclusion: The sensitivity and specificity values attained by some radiographers were equivalent to those of both the screen readers. Accuracy rates of the radiographers suggest that screen reading by selected and appropriately trained radiographers should be achievable in Australia. [Copyright &y& Elsevier]

Abstract: Aim: To explore the experience of the first consultant practitioners appointed; including the appointment process, nature of the role, their perceptions of success and challenges. Method: This was a whole population study of the known consultant radiographers appointed up to March 2005. It consisted of 3 phases. The first compared appointees job descriptions with the Department of Health guidance, the second collected contextual information using a questionnaire, and the third explored postholders experiences using telephone interviews. Results: Ten of the possible twelve appointees participated. All posts were established according to the guidelines, with largely similar job descriptions allowing for the different clinical specialist areas. All were very positive in their perceptions of their role, and faced similar challenges. They were strongest in their expert clinical practice working but had strong training and leadership roles. The number working at strategic level was low with limited research and few published papers, although there were notable exceptions. Conclusions: The first appointees demonstrated notable successes, strongest in the expert clinical practice element of roles, with evidence of team leadership, and involvement in training and education. Strategic engagement was disappointing, with little research being undertaken. Their experience was that the nature of consultancy was poorly understood by peers and medical colleagues. [Copyright &y& Elsevier]

Abstract: The purpose of this research was to assess (i) how confident Radiation Therapists (RTs) are in developing a series of plans that have increasing levels of difficulty, and (ii) the level of responsibility that they are willing to accept in relation to these treatments being implemented without the Radiation Oncologist (RO) reviewing or countersigning the plan. A self-administered questionnaire was designed around a set of six clinical planning scenarios demonstrating increasing levels of difficulty. Two hundred and three Radiation Therapists returned a completed questionnaire. All RTs indicated that they were confident to complete all the plans regardless of difficulty (p <0.0001) except for newly qualified RTs in their first year of practice who indicated a lack of confidence with the most difficult case only. Contrary to the high levels of confidence, RTs overall were only willing to accept responsibility for implementing treatment for the two basic level scenarios (p <0.0001). To gauge the clinical usefulness of this finding a clinical centre audit was conducted that indicated that basic level procedures account for around 30–40% of a department''s workload. RTs indicated a number of issues as barriers to accepting responsibility for more advanced work. [Copyright &y& Elsevier]

Abstract: Purpose: This study investigates the role of plain film reporting radiographers and the methods they employ to evaluate the quality of their performance. Method: The survey was conducted in 2003. Questionnaires were sent, via the universities, to radiographers who had registered on a post-graduate musculoskeletal image interpretation course at a University in England since their introduction (9years earlier). Results: The response rate was 37% (n =112). Sixty-four percent of the trained reporting radiographers surveyed are creating independent reports on musculoskeletal images and an additional 15% contribute to a double reporting system. Twenty-one percent of the reporting radiographers in this study are not undertaking audit of their practice. Of the 79% who are participating in audit programmes the variety of methods being used are widespread. In order to protect against litigation, 19% of reporting radiographers have a portfolio of evidence supporting their competency; 71% have a specific job description for their advanced role; 73% of reporting radiographers are members of a trade union; and 82% of reporting radiographers work to a departmental protocol. Conclusion: The majority of reporting radiographers are participating in some form of audit. However, it is imperative that the sizeable minority who are not should initiate this process promptly. It is important that national standards are set so that these audit processes become embedded into practice for the protection of both the patient and radiographer. The inconsistency shown with regard to audit processes and protection against litigation suggests that further clarification is required from the professional bodies. [Copyright &y& Elsevier]

Abstract: Radiographer''s roles have evolved with their scope broadening over the last 20years culminating in the development of advanced and consultant posts. Yet one development has not been embraced, despite being inherent in medicine and a common extension of nurse and other allied health professionals’ roles, is that of clinical assessment. This article explores the evolving role of the radiographer and discusses whether this should include skills in clinical history taking and physical examination. Issues for education and development will be addressed together with examples of current and potential roles. [Copyright &y& Elsevier]