The study aimed to analyse the results of radiographer’s image interpretation of nuclear medicine (NM) examinations following a nine-month postgraduate module.
Twenty participants completed 60 summative image commentaries each at the end of the module from prospective NM worklists in England. Each submitted a mixed selection of examinations in bone, lung, renal, and thyroid scans. Prevalence of abnormalities was 51% incorporating acute and chronic pathology, normal variants and incidental findings. Every commentary was marked against reference standard radiologist definitive reports. Statistical analysis included Kappa (k), intraclass correlation coefficient (ICC) and Spearman’s rank correlation coefficient (RS).
Bone scan sensitivity and specificity was 93% (95% CI 91.3-95.6) and 88% (95% CI 84.3-90.9) respectively, accuracy at 91.5% (95% CI 88.6-93.7), with k=0.82, ICC= 0.904, RS=0.826. Lung scans demonstrated a sensitivity of 92.6% (95% CI 85.7-96.8), specificity was 92.1% (95% CI 88.7-94.1), accuracy 92.3% (95% CI 87.7-95.0), k=0.83, ICC=0.910, RS=0.835. Renal scan sensitivity was 95% (95% CI 91.0-97.3), with 95.2% specificity (95% CI 91.8-97.3), accuracy were 95% (95% CI 91.4-97.3), k=0.90, ICC=0.948, RS=0.907. Thyroid scans sensitivity was 88% (95% CI 83.1-91.4), with 93% specificity (95% CI 85.9-96.8), accuracy were 90.2% (95% CI 84.3-93.8), k=0.80, ICC=0.897, RS=0.813.
In this small pilot study, the image interpretation ability in assessing prospective NM examinations in a clinical environment displayed encouraging results. Further work is recommended to evaluate a larger sample and case selection.
1. The Royal College of Radiologists. Clinical radiology: UK workforce census 2017 report. The Royal College of Radiologists. September; 2018.
2. Centre for Workforce Intelligence. Securing the future workforce supply: Clinical radiology stocktake. London: Centre for Workforce Intelligence; December; 2012.
3. The Royal College of Radiologists. Clinical radiology: UK workforce census 2016 report. The Royal College of Radiologists. October; 2017.
4. The Royal College of Radiologists. Teleradiology and outsourcing census. The Royal College of Radiologists. May; 2010.
5. NHS Improvement. Quality, service improvement and redesign (QSIR) tools. [Accessed 16.09.2018] https://improvement.nhs.uk/resources/quality-service-improvement-and...
6. 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.
7. Department of Health. Improving outcomes: A Strategy for Cancer. London: HMSO; 2011.
8. NHS England. Diagnostic Imaging Dataset Statistical Release: Provisional monthly statistics, July 2016 to July 2017. November; 2017.
9. NHS England. Next steps on the NHS Five Year Forward View (Gateway number 06669). Leeds: NHS England; 2017.
10. The Kings Fund. Quality Monitoring Report November 2017: how is the NHS performing? The Kings Fund; 2017.
11. NHS Improvement. Quarter 2 2017/18 performance report: Performance of the NHS Provider Sector month ended 30 September 2017.
12. European Federation of Radiographer Societies. EFRS Definition of a radiographer. European Federation of Radiographer Societies; 2011.
13. Hogg P, Williams P, Norton S. Extended roles of radiographers working in nuclear medicine: a survey of current practice. Radiography 1997;3(3):179-90.
14. Hogg P, Holmes K. The interpretation of nuclear medicine data by non-medical health care professionals: developments in the United Kingdom. Journal of Diagnostic Radiography and Imaging. 2000;3(2).
15. The Health and Care Professions Council. Standards of Proficiency: Radiographers. London: The Health and Care Professions Council; 2013.
16. The Health and Care Professions Council. Standards of education and training. London: The Health and Care Professions Council; 2017.
17. Society and College of Radiographers. Approval and Accreditation Board Handbook. London: Society and College of Radiographers; 2009.
18. The Society and College of Radiographers. Education and Career Framework for the Radiography Workforce. London: SCoR; 2013.
19. Society and College of Radiographers. Preliminary Clinical Evaluation and Clinical Reporting by Radiographers: Policy and Practice Guidance. London: Society and College of Radiographers; 2013.
20. 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.
21. Welsh ME, Wakefield K, Holmes KG. The impact of radiographer reporting on the care and management of the patients in nuclear medicine. Nucl Med Commun 2005; 26(3):278.
22. Brealey S. Measuring the effects of image interpretation: an evaluative framework. Clinical radiology. 2001 May 1;56(5):341-7.
23. 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.
24. The Royal College of Radiologists. Audit Live Peer Review- Using Double Reporting as a Tool for Revalidation. London: The Royal College of Radiologists; 2010.
25. British Nuclear Medicine Society. Guidelines for the issue of reports by non-medical staff. BNMS; 2005.
26. 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.
27. 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.
28. Brealey S, Scally AJ. Methodological approaches to evaluating the practice of radiographers’ interpretation of images: a review. Radiography 2008:14; e46-54.
29. Brealey S, Scally AJ, Thomas NB. Methodological standards in radiographer plain film reading performance studies. Br J Radiol 2002;75(890):107-13.
30. van Ooijen PM, Jorritsma W. Medical Imaging Informatics in Nuclear Medicine. In Quality in Nuclear Medicine 2017:241-267.
31. xxxxxxxxxx (blinded for review)
32. Scally AJ, Brealey S. Confidence intervals and sample size calculations for studies of film-reading performance. Clinical Radiology 2003;58(3):238-46.
33. Department of Health. Notes for Guidance on the Clinical Administration of Radiopharmaceuticals and Use of Sealed Radioactive Sources: Administration of Radioactive Substances Advisory Committee. Public Health England. Gateway number 2016613. February 2017. Oxon. UK.
34. Custis K. A study to assess the feasibility of introducing radiographer reporting in a nuclear medicine department. Nucl Med Commun 2006: 27(3):290.
35. Svasti-Salee D, Flanigan JJ, Conry BG, Wetton CW, Akhurst S. The reliability of radiographer based interpretation in acute reporting of V/Q scans: a prospective assessment. Nucl Med Commun 2004;25(4):408.
36. Khonsari M, Sulkin T. Audit of radiographer reporting of perfusion lung scans. Nucl Med Commun 2004;25(3):315.
37. Elliot, L. Radiographer reporting in the NM department: a learning curve? Radiography 2003; 9(3): 247-251.
38. Mckillop JH, Williams ED, Harding LK. Consistency in nuclear medicine reporting — a pilot study using bone scans. Nucl Med Commun 1990:11(3):253-258.
39. Lensing AW, van Beek EJ, Demers C, Tiel-van Buul MM, Yakemchuk V, van Dongen A, Coates G, Ginsberg JS, Hirsh J, ten Cate JW, Büller HR. Ventilation-perfusion lung scanning and the diagnosis of pulmonary embolism: improvement of observer agreement by the use of a lung segment reference chart. Thrombosis and haemostasis 1992;68(03):245-9.
40. Patel K, Charron M, Hoberman A, Brown ML, Rogers KD. Intra-and interobserver variability in interpretation of DMSA scans using a set of standardized criteria. Pediatr Radiol 1993:1;23(7):506-9.
41. Zuckier LS, Freeman LM. Nonosseous, Nonurologic Uptake on Bone Scintigraphy: Atlas and Analysis. Semin Nucl Med 2010; 40:242-256.
42. The Royal College of Radiologists. Standards for interpretation and reporting of imaging investigations (second edition). The Royal College of Radiologists. March; 2018.