Elsevier

Radiography

Volume 24, Issue 4, November 2018, Pages 366-369
Radiography

Radiographer reporting of neurological magnetic resonance imaging examinations of the head and cervical spine: Findings of an accredited postgraduate programme

https://doi.org/10.1016/j.radi.2018.05.006Get rights and content

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

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.

Introduction

Workload continues to rise in diagnostic imaging departments in the United Kingdom (UK), and in England the total number of plain imaging (X-ray), computed tomography (CT) and magnetic resonance imaging (MRI) investigations increased by 12% between 2012–13 and 2015–16, to over 30 million.1 In the same period the number of MRI scans increased by 31%,1 and as a result many departments face significant challenges to meet the escalating demands associated with the timely reporting of these examinations. Sustained increase in MRI examinations means additional reporting capacity is required and new models of care are required to meet the growing diagnostic capacity gap.

Radiographers, appropriately educated and trained, have been providing definitive clinical reports on a variety of imaging examinations since the 1990s; and the role of radiographer reporting, which is now well established within the UK,2 continues to have an increasing impact on service and cost-effectiveness for imaging services in the UK.3, 4

Studies which have investigated the interpretation of plain skeletal examinations by radiographers have demonstrated encouraging findings.5 More recent research, related to radiographers' diagnostic performance in the reporting of other more complex investigations, is also emerging. In particular, this includes research related to the reporting of chest examinations,6, 7, 8 and cross-sectional imaging studies; MRI examinations of the lumbar/thoracic spine and knee9, 10 and computed tomography (CT) examinations of the head.11, 12

Over 120 radiographers have completed the postgraduate certificate (PgC) Clinical Reporting (MRI- General Investigations) programme which aims to prepare radiographers to provide definitive clinical reports on lumbar/thoracic spine and knee investigations, and a growing number (>10%) of diagnostic imaging departments have confirmed that radiographers contribute to the delivery of MRI reporting services in this way.9, 13

As radiographers can report different MRI body areas and given the significant challenges in meeting the growing diagnostic imaging reporting demands, the progression to prepare radiographers to report other neurological examinations (cervical spine and head) seems a logical extension.

A small number of radiographers (n = 13) have also completed a separate PgC programme (accredited by the College of Radiographers) which prepares radiographers to report magnetic resonance imaging (MRI) neurological investigations of the head and cervical spine.14 The 12-month workplace based programme consists of short, two day, briefing blocks held at the university approximately every two months. Experienced MRI consultant radiologists are involved in the design, management, teaching and assessment aspects of the programme. The assessment schedule includes a case-study, an assignment which requires students to critically reflect on their developing competence in MRI reporting and 500 practice reports, 125 of which must be checked by a consultant radiologist mentor in the students' workplace. Consistent with other postgraduate programmes in clinical reporting at this university, one of the final summative assessments for the PgC is an Objective Structured Examination (OSE) which, for this pathway, consists of 40 MRI investigations.

Section snippets

Aim

To analyse the OSE results of the first cohorts of radiographers (n = 13) who successfully completed the PgC programme; and to determine radiographers competence to report magnetic resonance imaging (MRI) neurological investigations of the head and cervical spine.

Method

Compliance with the University's Research Ethics and Governance procedures was confirmed and all other relevant guidance followed.15

Obuchowski16 acknowledged the importance of the diversity of observers' interpretations and in particular recognised the need to consider the performance of an ‘average reader’ when measuring observer performance. Accordingly the OSE was constructed using cases (n = 40) where there was good agreement between 3 experienced consultant radiologists.

To ensure that an

Results

The mean performance rates (and 95% CIs) for all students (n = 13) and for each anatomical area (head and cervical spine), are shown in Table 1. 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 mean scores for each anatomical area (head: 4.49/5; cervical spine: 4.07/5) are shown in Table 2.

The highest and lowest mean scores for all cases are listed in Table 3 indicating the

Discussion

The unique nature of the work presented in this study is perhaps limited in that it was conducted in the OSE setting and the relatively small number of cases relates to a small, specialised cohort of radiographers. The mean sensitivity and specificity rates for the radiographers were all high (99.0% and 98%, respectively). The majority of radiographers (9/13) achieved sensitivity and specificity rates of 100% demonstrating they could correctly identify all the abnormal investigations included

Conclusion

The aim of this study was to determine radiographers' competence in the reporting of neurological MRI examinations of the head and cervical spine, and overall, the results presented suggest that this small group of radiographers, at the end of an accredited postgraduate programme, can report on the broad range of, with satisfactory accuracy under examination conditions. Although lessons are to be learned from these initial experiences, generally the types of errors made appear to be similar to

Recommendations

In the future it will be imperative to investigate the accuracy of MRI reporting by radiographers more extensively and particularly throughout implementation into clinical practice and in comparison with consultant radiologists.

Radiographers could continue to contribute to the reporting service as part of a sustainable strategy to meet growing demands and diagnostic capacity requirements.

Conflict of interest statement

None.

Acknowledgements

The authors are grateful to the radiologists and radiographers who reported the images referred to in this study. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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