Image Interpretation by radiographers in brain, spine and knee MRI examinations: Findings from an accredited postgraduate module

Journal article


Lockwood, P. and Dolbear, G. 2018. Image Interpretation by radiographers in brain, spine and knee MRI examinations: Findings from an accredited postgraduate module. Radiography. https://doi.org/10.1016/j.radi.2018.05.009
AuthorsLockwood, P. and Dolbear, G.
Abstract

Introduction:
The aim of the study was to evaluate the performance of radiographers in image interpretation of magnetic resonance imaging (MRI) brain, spine and knee examinations following a nine-month work based postgraduate MRI module.

Methods:
Twenty-seven participants each submitted 60 image commentaries taken from prospective clinical workloads. The image interpretations (n=1,620) comprised brain, spine, and knee MRI examinations. Prevalence of abnormal examinations approximated 53% (brain), 74% (spine), and 73% (knee), and included acute and chronic pathology, normal variants and incidental findings. Each image interpretation was graded against reference standard consultant radiologist definitive report.

Results: The radiographer’s performance on brain image interpretations demonstrated mean accuracy at 86.7% (95% CI 83.4-89.3) with sensitivity and specificity of 84% (95% CI 80.9-86.4) and 89.7% (95% CI 86.2-92.6) respectively. For spinal interpretations the mean accuracy was 86.4% (95% CI 83.4-89.0), sensitivity was 90.2% (95% CI 88.2-92), mean specificity was 75.3% (95% CI 69.4-80.4). The mean results for knee interpretation accuracy were 80.9% (95% CI 77.3-84.1), sensitivity was 83.3% (95% CI 80.8-85.5), with 74.3% specificity (95% CI 67.4-80.4).
Conclusions: The radiographer’s demonstrated skills in brain, spine and knee MRI examination image interpretation. These skills are not to replace radiologist reporting but to meet regulating body standards of proficiency, and to assist decision making in communicating unexpected serious findings, and /or extend scan range and sequences. Further research is required to investigate the impact of these skills on adjusting scan protocols or flagging urgent findings in clinical practice.

KeywordsImage interpretation; magnetic resonance imaging; diagnostic radiographers
Year2018
JournalRadiography
PublisherElsevier
ISSN1078-8174
Digital Object Identifier (DOI)https://doi.org/10.1016/j.radi.2018.05.009
Publication dates
Online06 Jun 2018
Publication process dates
Deposited08 Jun 2018
Accepted23 May 2018
Accepted author manuscript
License
Output statusPublished
References

1. The Health and Care Professions Council. Standards of Proficiency: Radiographers. London: The Health and Care Professions Council; 2013.
2. The Health and Care Professions Council. Standards of education and training. London: The Health and Care Professions Council; 2017.
3. Society and College of Radiographers. Approval and Accreditation Board Handbook. London: Society and College of Radiographers; 2009.
4. The Society and College of Radiographers. Education and Career Framework for the Radiography Workforce. London: SCoR; 2013.
5. Society and College of Radiographers. Preliminary Clinical Evaluation and Clinical Reporting by Radiographers: Policy and Practice Guidance. London: Society and College of Radiographers; 2013.
6. McConnell J, Devaney C, Gordon M, Goodwin M, Strahan R, Baird M. The impact of a pilot education programme on Queensland radiographer abnormality description of adult appendicular musculo-skeletal trauma. Radiography 2012; 31;18(3):184-90.
7. Hazell L, Motto J, Chipeya L. The influence of image interpretation training on the accuracy of abnormality detection and written comments on musculoskeletal radiographs by South African radiographers. J Med Imaging Radiat Sci 2015; 30;46(3):302-8.
8. Stevens BJ, Thompson JD. The impact of focused training on abnormality detection and provision of accurate preliminary clinical evaluation in newly qualified radiographers. Radiography 2018; 24(1):47-51.
9. Girling, S. Strudwick R. Seeing Red. Imaging and Therapy Practice 2015; June: 4-7.
10. Centre for Workforce Intelligence. Securing the future workforce supply: Clinical radiology stocktake. London: Centre for Workforce Intelligence; December; 2012.
11. The Royal College of Radiologists. Clinical radiology: UK workforce census 2016 report. The Royal College of Radiologists. October; 2017.
12. The Royal College of Radiologists. Unreported X-rays, computed tomography (CT) and magnetic resonance imaging (MRI) scans: Results of a snapshot survey of English National Health Service (NHS) trusts. The Royal College of Radiologists. March; 2015.
13. The Royal College of Radiologists. Diagnostic radiology: Our patients are still waiting……… London. The Royal College of Radiologists.2016.
14. The Care Quality Commission. The state of health care and adult social care in England 2016/17 (Presented to Parliament pursuant to section 83(4)(a) of the Health and Social Care Act 2008). Newcastle upon Tyne: House of Commons; 2017.
15. Department of Health. Improving outcomes: A Strategy for Cancer. London: HMSO; 2011.
16. The Royal College of Radiologists. Magnetic resonance imaging (MRO) equipment, operations and planning in the NHS: Report from the Clinical Imaging Board. The Royal College of Radiologists. 2017.
17. NHS England. Next steps on the NHS Five Year Forward View (Gateway number 06669). Leeds: NHS England; 2017.
18. Woznitza N, Piper K, Rowe S, West C. Optimizing patient care in radiology through team-working: a case study from the United Kingdom. Radiography 2014; 20(3):258-63.
19. Snaith B, Hardy M. Radiographer abnormality detection schemes in the trauma environment—An assessment of current practice. Radiography 2008; 14(4):277-81.
20. Snaith B, Hardy M, Lewis EF. Reducing image interpretation errors–Do communication strategies undermine this?. Radiography 2014; 20(3):230-4.
21. Brealey S. Measuring the effects of image interpretation: an evaluative framework. Clinical radiology. 2001 May 1;56(5):341-7.
22. Hardy M, Flintham K, Snaith B, Lewis EF. The impact of image test bank construction on radiographic interpretation outcomes: A comparison study. Radiography 2016;31;22(2):166-70.
23. Pinto A, Acampora C, Pinto F, Kourdioukova E, Romano L, Verstraete K. Learning from diagnostic errors: a good way to improve education in radiology. Eur J Radiol 2011; 30;78(3):372-6.
24. Leslie, A. Jones, AJ. Goddard, PR. The influence of clinical information on the reporting of CT by radiologists. Br J Radiol 2000; 73:1052-1055.
25. Berbaum KS, Franken JR EA, Anderson KL, Dorfman DD, Erkonen WE, Farrar GP, Geraghty JJ, Gleason TJ, Macnaughton ME, Phillips ME, Renfrew DL. The influence of clinical history on visual search with single and multiple abnormalities. Invest Radiol 1993; 1;28(3):191-201.
26. Hawkins, CM. Anton CG. Bankes, WM. Leach, AD. Zeno, MJ. Pryor, RM. Larson, DB. Improving the Availability of Clinical History Accompanying Radiographic Examinations in a Large Pediatric Radiology Department. AJR 2014; 202:790-796.
27. Brealey S, Scally AJ. Methodological approaches to evaluating the practice of radiographers’ interpretation of images: a review. Radiography. 2008 Dec 1;14: e46-54.
28. Brealey S, Scally AJ, Thomas NB. Methodological standards in radiographer plain film reading performance studies. The British journal of radiology. 2002 Feb;75(890):107-13.
29. The Royal College of Radiologists. Standards for the reporting and interpretation of imaging investigations. London: The Royal College of Radiologists; 2006.
30. Brady A. Error and discrepancy in radiology: Inevitable or avoidable? Insights into Imaging 2017;8(1):171-182.
31. Brealey S, Piper K, King D, Bland, M, Caddick J, Campbell P, Gibbon A, Highland A, Jenkins N, Petty D, Warren D. Observer agreement in the reporting of knee and lumbar spine magnetic resonance (MR) imaging examinations: Selectively trained MR radiographers and consultant radiologists compared with an index radiologist. Eur J Radiol 2013;82.10: e597-e605.
32. Krampla W, Roesel M, Svoboda K, Nachbagauer A, Gschwantler M, Hruby W. MRI of the knee: how do field strength and radiologist’s experience influence diagnostic accuracy and interobserver correlation in assessing chondral and meniscal lesions and the integrity of the anterior cruciate ligament? Eur Radiol 2009;1;19(6):1519-28.
33. Royal College of Radiologists. Audit Live An audit of Radiology Report Quality. London: The Royal College of Radiologists; 2010.
34. Brealey S, King DG, Hahn S, Godfrey C, Crowe MT, Bloor K, Crane S, Longsworth D. The costs and effects of introducing selectively trained radiographers to an A&E reporting service: a retrospective controlled before and after study. The British journal of radiology. 2005 Jun;78(930):499-505.
35. Piper K, Buscall K, Thomas N. MRI reporting by radiographers: Findings of an accredited postgraduate programme. Radiography 2010;16.2: 136-142.
36. Scally AJ, Brealey S. Confidence intervals and sample size calculations for studies of film-reading performance. Clinical radiology. 2003 Mar 1;58(3):238-46.
37. Piper K, Buscall KL. MRI reporting by radiographers: The construction of an objective structured examination. Radiography 2008;14.2: 78-89.
38. Kim YW, Mansfield LT. Fool me twice: delayed diagnoses in radiology with emphasis on perpetuated errors. Am J Roentgenol. 2014 Mar;202(3):465-70.
39. Cosson P, Dash R. A taxonomy of anatomical and pathological entities to support commenting on radiographs (preliminary clinical evaluation). Radiography 2015; 28;21(1):47-53.
40. Berlin L. Radiologic errors, past, present and future. Diagnosis 2014; 1:79–84.
41. Lee CS, Nagy PG, Weaver SJ, Newman-Toker DE. Cognitive and system factors contributing to diagnostic errors in radiology. Am J Roentgenol 2013;201(3):611-7.
42. Kapeller P, Barber R, Vermeulen RJ, Ader H, Scheltens P, Freidl W, Almkvist O, Moretti M, Del Ser T, Vaghfeldt P, Enzinger C. Visual rating of age-related white matter changes on magnetic resonance imaging. Stroke 2003;1;34(2):441-5.
43. Wahlund LO, Barkhof F, Fazekas F, Bronge L, Augustin M, Sjögren M, Wallin A, Adèr H, Leys D, Pantoni L, Pasquier F. A new rating scale for age-related white matter changes applicable to MRI and CT. Stroke 2001;1;32(6):1318-22.
44. Van Rijn JC, Klemetso N, Reitsma JB, Bossuyt PM, Hulsmans FJ, Peul WC, Den Heeten GJ, Stam J, Majoie CB. Observer variation in the evaluation of lumbar herniated discs and root compression: spiral CT compared with MRI. Brit Journal Radiol 2006;79(941):372-7.
45. Lurie JD, Tosteson AN, Tosteson TD, Carragee E, Carrino J, Kaiser J, Sequeiros RT, Lecomte AR, Grove MR, Blood EA, Pearson LH. Reliability of readings of magnetic resonance imaging features of lumbar spinal stenosis. Spine 2008;15;33(14):1605.
46. Devitt BM, O’Sullivan R, Feller JA, Lash N, Porter TJ, Webster KE, Whitehead TS. MRI is not reliable in diagnosing of concomitant anterolateral ligament and anterior cruciate ligament injuries of the knee. Knee Surg Sports Tr A 2017;1;25(4):1345-51.
47. Link TM, Neumann J, Li X. Prestructural cartilage assessment using MRI. J Magn Reson 2017; 1;45(4):949-65.

Permalink -

https://repository.canterbury.ac.uk/item/88v35/image-interpretation-by-radiographers-in-brain-spine-and-knee-mri-examinations-findings-from-an-accredited-postgraduate-module

Download files


Accepted author manuscript
  • 208
    total views
  • 212
    total downloads
  • 3
    views this month
  • 3
    downloads this month

Export as

Related outputs

A survey of the NHS reporting radiographer workforce in England
Lockwood, P., Burton, C., Shaw, T. and Woznitza, N. 2024. A survey of the NHS reporting radiographer workforce in England. Radiography Open. 10 (1), pp. 1-18. https://doi.org/10.7577/radopen.5635
Comparing the standard knee X-ray exposure factor, 10 kV rule, and modified 10 kV rule techniques in digital radiography to reduce patient radiation dose without loss of image quality
Lockwood, P. and Wenman, A. 2024. Comparing the standard knee X-ray exposure factor, 10 kV rule, and modified 10 kV rule techniques in digital radiography to reduce patient radiation dose without loss of image quality. Radiography. 30 (2), pp. 574-581. https://doi.org/10.1016/j.radi.2024.01.013
Obesity bias in diagnostic radiography students: A survey of attitudes, perceptions and technical confidence
Tamburrini, N. and Lockwood, P. 2023. Obesity bias in diagnostic radiography students: A survey of attitudes, perceptions and technical confidence. Radiography. 30 (1), pp. 202-208. https://doi.org/10.1016/j.radi.2023.11.006
Care of transgender patients by diagnostic radiographers: What can be learnt from the literature
Hammond, C and Lockwood, P. 2023. Care of transgender patients by diagnostic radiographers: What can be learnt from the literature. Radiography. 30 (1), pp. 145-150. https://doi.org/10.1016/j.radi.2023.10.020
Assessing the barriers and enablers to the implementation of the diagnostic radiographer musculoskeletal X‑ray reporting service within the NHS in England: a systematic literature review
Lockwood, P., Burton, C., Woznitza, N. and Shaw, T. 2023. Assessing the barriers and enablers to the implementation of the diagnostic radiographer musculoskeletal X‑ray reporting service within the NHS in England: a systematic literature review. BMC Health Services Research. 23 (1270), pp. 1-41. https://doi.org/10.1186/s12913-023-10161-y
Impostor phenomenon traits in radiography students: findings from a UK pilot survey
Gibson, C. and Lockwood, P. 2023. Impostor phenomenon traits in radiography students: findings from a UK pilot survey . Radiography. 30 (1), pp. 61-65. https://doi.org/10.1016/j.radi.2023.10.005
Investigating the adjacent patient radiation dose received during a simulated ward chest X-ray examination
Langfield, H and Lockwood, P. 2023. Investigating the adjacent patient radiation dose received during a simulated ward chest X-ray examination. Radiography Open. 9 (1), pp. 1-14. https://doi.org/10.7577/radopen.5354
Research ethics applications: Back to basics: What you ought to know about research ethics applications
Lockwood, P. 2023. Research ethics applications: Back to basics: What you ought to know about research ethics applications. Insights into Imaging. Spring (7), pp. 39-45.
An investigation into the clinical scope of practice of MRI reporting radiographers within the United Kingdom
Mitchell, M. and Lockwood, P. 2023. An investigation into the clinical scope of practice of MRI reporting radiographers within the United Kingdom. Radiography. 29 (3), pp. 489-495. https://doi.org/10.1016/j.radi.2023.02.015
Assessing the barriers and enablers to the diagnostic radiographer X-ray reporting service within the NHS in England: A systematic literature review
Lockwood, P. 2022. Assessing the barriers and enablers to the diagnostic radiographer X-ray reporting service within the NHS in England: A systematic literature review. York University.
Lead-rubber shielding effect on radiation dose to the gonads from a bilateral hand X-ray examination
Welborn, D. and Lockwood, P. 2022. Lead-rubber shielding effect on radiation dose to the gonads from a bilateral hand X-ray examination. Radiography. 28 (2), pp. 360-365. https://doi.org/10.1016/j.radi.2021.12.013
Could posterior-anterior projection cervical spine radiographs improve image quality and dose reduction
Faulkner, R. and Lockwood, P. 2022. Could posterior-anterior projection cervical spine radiographs improve image quality and dose reduction . Radiography Open. 8 (1). https://doi.org/10.7577/radopen.5004
Diagnostic radiography students' perceptions towards communication with service users who are deaf or hearing impaired.
Nolan-Bryant, A. and Lockwood, P. 2022. Diagnostic radiography students' perceptions towards communication with service users who are deaf or hearing impaired. Radiography. 29 (1), pp. 207-214. https://doi.org/10.1016/j.radi.2022.11.008
A cross-sectional student survey of the impact of the Covid-19 lockdowns on clinical placement in England
Hinds, Z. and Lockwood, P. 2022. A cross-sectional student survey of the impact of the Covid-19 lockdowns on clinical placement in England. Radiography. 29 (1), pp. 190-199. https://doi.org/10.1016/j.radi.2022.11.006
Pre-registration UK diagnostic radiography student ability and confidence in interpretation of chest X-rays
Lockwood, P. and Khan, A. 2021. Pre-registration UK diagnostic radiography student ability and confidence in interpretation of chest X-rays. Radiography Open. 7 (1), pp. 1-13. https://doi.org/10.7577/radopen.4529
Efficacy, utility, and validity in Computed Tomography head reporting by radiographers
Lockwood, P. 2021. Efficacy, utility, and validity in Computed Tomography head reporting by radiographers. PhD Thesis Canterbury Christ Church University School of Allied and Public Health Professions
COVID-19: A literature review of the impact on diagnostic radiography students
Astirbadi, D. and Lockwood, P. 2021. COVID-19: A literature review of the impact on diagnostic radiography students. Radiography. https://doi.org/10.1016/j.radi.2021.09.009
Multi-professional image interpretation: performance in preliminary clinical evaluation of appendicular radiographs
Lockwood, P. and Pittock, L. 2019. Multi-professional image interpretation: performance in preliminary clinical evaluation of appendicular radiographs. Radiography. https://doi.org/10.1016/j.radi.2019.04.013
Computed tomography head and facial bones review of a 2,700 year old Egyptian mummy
Lockwood, P., Elliott, J., Nelson, A. and Harris, S. 2019. Computed tomography head and facial bones review of a 2,700 year old Egyptian mummy . BJR Case Reports. https://doi.org/10.1259/bjrcr.20190076
Visual function assessment of diagnostic radiography students
Lockwood, P. and Blackman, A. 2019. Visual function assessment of diagnostic radiography students. Radiography. https://doi.org/10.1016/j.radi.2019.10.012
An evaluation of CT head reporting radiographers' scope of practice within the United Kingdom
Lockwood, P. 2019. An evaluation of CT head reporting radiographers' scope of practice within the United Kingdom. Radiography. 26 (2), pp. 102-109. https://doi.org/10.1016/j.radi.2019.09.001
Evaluation of an equilibrium phase free-breathing dynamic contrast-enhanced MRI prototype sequence compared to traditional breath-held MRI acquisition in liver oncology patients
Hopkinson, G., Lockwood, P. and Dolbear, G. 2018. Evaluation of an equilibrium phase free-breathing dynamic contrast-enhanced MRI prototype sequence compared to traditional breath-held MRI acquisition in liver oncology patients. Radiography. https://doi.org/10.1016/j.radi.2018.01.001
Nuclear medicine image interpretation by radiographers: findings of an accredited postgraduate module
Lockwood, P. and Dolbear, G. 2018. Nuclear medicine image interpretation by radiographers: findings of an accredited postgraduate module. Radiography. https://doi.org/10.1016/j.radi.2018.11.007
CT Sinus and facial bones reporting by radiographers: findings of an accredited postgraduate programme
Lockwood, P. 2017. CT Sinus and facial bones reporting by radiographers: findings of an accredited postgraduate programme. Dentomaxillofacial Radiology. 46 (4). https://doi.org/10.1259/dmfr.20160440
Exploring variation and trends in adherence to national occupational standards for reporting radiographers
Lockwood, P. 2017. Exploring variation and trends in adherence to national occupational standards for reporting radiographers. Journal of Social Science & Allied Health Professions. 1 (1), pp. 20-27.
Observer performance in Computed Tomography head reporting
Lockwood, P. 2017. Observer performance in Computed Tomography head reporting. Journal of Medical Imaging and Radiation Sciences. 48 (1), pp. 22-29. https://doi.org/10.1016/j.jmir.2016.08.001
Exploring the benefits of magnetic resonance imaging reporting by radiographers: A UK perspective
Lockwood, P. 2016. Exploring the benefits of magnetic resonance imaging reporting by radiographers: A UK perspective. Journal of Medical Imaging and Radiation Sciences. 47 (2). https://doi.org/10.1016/j.jmir.2015.12.083
An economic evaluation of introducing a skills mix approach to CT head reporting in clinical practice.
Lockwood, P. 2016. An economic evaluation of introducing a skills mix approach to CT head reporting in clinical practice. Radiography. https://doi.org/10.1016/j.radi.2015.09.004
Intraorbital foreign body detection and localisation by radiographers: a preliminary JAFROC observer performance study
Lockwood, P., Pittock, L., Lockwood, C., Jeffery, C. and Piper, K. 2015. Intraorbital foreign body detection and localisation by radiographers: a preliminary JAFROC observer performance study. Radiography. 2015, pp. 1-5. https://doi.org/10.1016/j.radi.2015.06.005
Out of the comfort zone (Part 2)
Lockwood, P. 2013. Out of the comfort zone (Part 2).
AFROC analysis of reporting radiographer’s performance in CT head interpretation
Lockwood, P. and Piper, K. 2015. AFROC analysis of reporting radiographer’s performance in CT head interpretation. Radiography. 21 (3), pp. e90-e95. https://doi.org/10.1016/j.radi.2015.04.001
Out of the comfort zone (Part 1)
Lockwood, P. 2013. Out of the comfort zone (Part 1).
Origins of the Reporting Radiographer
Lockwood, P. 2013. Origins of the Reporting Radiographer.
Patient safety and quality improvement: Iatrogenic venous air embolism in diagnostic imaging
Lockwood, P. and Breen, W. 2013. Patient safety and quality improvement: Iatrogenic venous air embolism in diagnostic imaging.
CT head reporting by radiographers: Findings of an accredited postgraduate programme
Lockwood, P. and Piper, K. 2013. CT head reporting by radiographers: Findings of an accredited postgraduate programme.
CT skull base & calvarium normal variant pitfalls
Lockwood, P. 2013. CT skull base & calvarium normal variant pitfalls.
CT head reporting by radiographers: results of an accredited postgraduate programme
Lockwood, P., Piper, K. and Pittock, L. 2015. CT head reporting by radiographers: results of an accredited postgraduate programme. Radiography. 21 (3), pp. e85-e89. https://doi.org/10.1016/j.radi.2014.12.001