Efficacy, utility, and validity in Computed Tomography head reporting by radiographers

Introduction: Demand for Computed Tomography (CT) head imaging has increased exponentially
within the National Health Service (NHS) coinciding with a limited consultant radiologist workforce,
resulting in time-critical CT reporting delays for patients. The safety and effectiveness of the NHS
improvement initiative increasing reporting capacity with radiographers is not yet established.

Aim: To establish the diagnostic accuracy (efficacy) of trained radiographers reporting CT head
examinations; their role in the patient pathway (clinical utility); beneficial outcomes of radiographers’
reports (validity); and an economic assessment of the role.

Methods: A literature review using validated critique frameworks assessing methodological quality
(QUADAS-2, CASP, CHEERS) and reporting (STARD, StaRI) of radiographers reporting CT head
examinations studies established the ‘knowledge gap’ in evidence and requirement for research
rigour. A further literature review identified an efficacy framework to structure the pragmatic mixedmethod
research strategy. Seven studies assessed diagnostic accuracy, radiographers’ roles within the
NHS, and economic evaluation, against the same frameworks to demonstrate research rigour.

Results: Radiographers trained to report CT head scans demonstrated an efficacy level (AUC 0.98)
equivalent to consultant radiologists. Radiographers communicated actionable reports and advice to
multidisciplinary teams aiding clinician’s decisions including medical interventions and surgical
referral evidencing clinical utility. Cross-sectional surveys demonstrated radiographers’ scope of
practice included all referral pathways of trauma, health screening, disease diagnosis, staging, and
monitoring treatment, and patient groups. The role was cost-effective (up to £328,865 per annum, per
radiographer) and contributed a cost-benefit, attesting to the validity of the role within the patient
pathway and healthcare system.

Conclusion: Novel findings evidence trained CT head reporting radiographers’ efficacy is equivalent
to radiologists, with beneficial impact for service design and delivery of expanding the workforce
safely to potentially reduce reporting delays. An emerging theme from the findings underscores the
need for robust study design to generate translational evidence for clinical practice.